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Medical Visualization in Radiology
Radiology
technician
Relevant images
Reporting
Bernhard Preim
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Outline
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Radiology Departments
Storage of Medical Image Data
Conventional Film-Based Diagnosis
Soft-Copy Reading
• Digital Hanging Protocols
• 3D Visualizations in Radiology
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Radiology Departments
• Large variety of imaging devices (CT, MR, Computed X-Ray, …)
• Large variety of output devices (printer, CRT-monitors with
different spatial and grey-value resolution)
• Archival of image data in PACS-systems
• Huge amounts of data
• Imaging devices, output devices, workstations and PACS are
interconnected.
• Performance problems due to the large amounts of data are
frequent and annoying. → Spatial resolution is often reduced to
avoid performance problems.
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Radiology Departments
Radiology technician
Relevant images
Reporting
• General radiological workflow
Image Courtesy Jens Breitenborn,
MeVis Diagnostics
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Radiology Departments
Resulting requirements?
• Interoperability of devices from different manufacturers.
• Standardized format and description of image data.
• Data protection, security and reliable identification of patient and
body part, e.g. left leg
• „Correct“ or optimal display at different output devices
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Storage of Medical Image Data
• DICOM (Digital Imaging and Communications in Medicine)
• Established by NEMA (National Electronics Manufacturer‘s
Association) in 1993
• Enables digital communication between imaging devices,
information systems and referring physicians (other dept.s of the
hospital or external)
• Enables exchange of data between devices from different
manufacturers
• Conformance to the DICOM standard is formally certified.
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Storage of Medical Image Data
Scope of DICOM
• 20 parts, some 2200 pages
• 26 working groups discuss extensions
• Working group 24: Surgical DICOM
• Questions, such as: How to represent 3D meshes in DICOM
including different representations of an object, application of
textures, etc?
• Working group 26: Extensions for Digital Pathology
• Other working groups: Extensions for representing implant
geometries, radiation treatment planning, …
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Storage of Medical Image Data
CT and MRI Data in DICOM
• A series of individual DICOM files, each representing a slice.
• DICOM files belonging to one dataset are characterized by the
same patient-id.
• Important tags are included in the legend of a viewer (examples are MeVisLab
2D Viewers).
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Storage of Medical Image Data
Mandatory and optional tags summarized to groups
• Patient data:
Name, birth date, sex, optional: weight
• Image data:
study-id, series number, image group
• Image presentation: slice distance, pixel spacing, default
presentation (window width, window height)
• Acquisition parameters: sequence name, special description,
reconstruction filter, position and orientation of the patient
• Special parameters for a certain modality: e.g. in MR field
strength, used coils, echo and repetition time
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Conventional Film-based Diagnosis
Cooperation between radiologist and radiology technician:
• Radiologist decides which modality and scanning
parameters are used
• Radiology technician performs the
procedure, operates the device
and
arranges and prepares the
image data for
the diagnosis
Image Courtesy Sebastian Meyer, MeVis
Diagnostics
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Conventional Film-based Diagnosis
Result:
• Written report, e.g. using voice recorder
• Complex cases: Demonstration for the referring physician and/or
interdisciplinary discussion, e.g. tumor board
Digital solutions should support these processes!
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Written report
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Conventional Film-based Diagnosis
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Magnifying glasses are used intensively.
Simultaneous reading of „old“ and „new“ images
Careful and efficient arrangement of image data
Plenty of space for viewing
Films: High spatial and gray level resolution
Drawbacks:
• Quantitative analysis is heavily restricted.
• Diagnostic processes are rather subjective.
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Conventional Film-based Diagnosis
Why is it important?
• Radiologists are accustomed to this proces. Digital processes
should be somehow „similar“.
• Radiologists are extremely efficient in film-based diagnosis. Digital
processes must be at least that efficient.
• Radiologists cooperate with radiology technicians and focus on the
high-level tasks. Thus, the perspective of the radiology technicians
is also essential for adopting digital solutions.
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Soft Copy Reading
LCD and CRT monitors:
High requirements for CT and MRI viewing, w.r.t.
• Display size,
• Spatial resolution,
• Maximum contrast,
• Light intensity,
• Quality (very low geometric distortion, very few defect
pixels)
Careful regular tests including recalibration
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Soft Copy Reading
Special monitors with high spatial
resolution (2000x2500 pixels)
and high gray value resolution
(10 bit) are used for reading Xray images.
• Layout corresponds to the
habits in conventional filmbased diagnosis
• Enables easy comparison
between 1-year old and current
data.
Image Courtesy, MeVis BreastCare, 2002
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Soft Copy Reading
Image Courtesy, MeVis BreastCare, 2012
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Soft Copy Reading
Quantitative analysis of gray values in a ROI for assessing the
severity of diseases, such as emphysema and fibrotic disease and
bone mineral density (osteoporosis)
Analysis of cross-sectional areas (severity of a stenosis)
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Soft Copy Reading
• Digital Lightbox (BrainLab)
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3D Visualizations
3D Visualizations in radiology
• Are rarely used at all, since radiologists are trained to infer
spatial relations from cross-sectional images.
• Support an overview, not an in-depth analyis
• Primarily in case of rare anatomic variants, complex fractures.
• The radiologist „only“ describes the data.
• Are used whenever the referring physician requires it.
Preferred viewing modes:
• Maximum-intensity projection (often as Movie)
• Oblique Multi-planar reformations
• Slab rendering (trade-off between 2D and 3D)
• Direct volume rendering with predefined TFs
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3D Visualizations
Image Courtesy
B. Terwey, Bremen
MIP renderings of cerebral MR angiography data. Diagnostic task:
search for vascular malformations, e.g. aneurysms
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3D Visualizations
Oblique MPRs and slices
Image Courtesy Tobias Boskamp, MeVis
Research
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3D Visualization
Orientation cube (size and placement is adjustable). Also sticky
figures may be used.
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3D Visualization
Radiation treatment planning (Brainlab)
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3D Visualization
Radiation treatment planning (Brainlab)
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3D Visualizations
Image Courtesy Volker Dicken, MeVis
Research
Thin Slab-Rendering of CT thorax data. Diagnostic task: search
for lung nodules (suspicious of being malignant)
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3D Visualizations
Image Courtesy, SIEMENS Medical
Solutions
Volume rendering with pre-defined transfer functions (gallery
concept) based on high-resolution image data.
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3D Visualizations
Synchronized combinations of
2D and 3D visualizations are
useful for treatment planning.
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3D Visualizations
In dentistry, Digital Volume Tomography is employed. Images are
also presented in the layout with 4 views.
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Fused Multimodal Visualizations
Clipping planes and lenses in CT data provide a window to
underlying MRI data. Also radiation doses are overlaid.
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Interventional Radiology
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Summary
• The introduction of new techniques in radiology requires careful
integration in the infrastructure of radiological departments.
• DICOM is essential, also for communicating results.
• Analysis of conventional film-based diagnosis is inspiring.
• Try to improve on the drawbacks, but also to maintain the
positive aspects.
• Talk to users, analyze their needs and distinguish between
radiologists, radiology technicians and referring physicians.
Outlook:
• Similar changes occur currently in pathology with much larger
microscopy data.
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Links
• Integrating the health care enterprise
http://www.ihe.net/
• DICOM http://medical.nema.org/
• DICOMscope - DICOM-Viewer
http://dicom.offis.de/dscope.php.de
• David Clunie's dicom3tools
http://www.dclunie.com/dicom3tools.html
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