nuclear medicine pacs and dicom application
TRANSCRIPT
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DICOM Korea Workshop 2015
Yonsei University, Gangwon, Korea
August 27, 2015
Nuclear Medicine PACS
and DICOM Application
Kim, Tae-Sung, MD National Cancer Center, South Korea
Department of Nuclear Medicine
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A Nuclear Medicine Study
Kim - Nuclear Medicine PACS
Radiopharmaceuticals
Cyclotron - Generator
Tagging
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A Nuclear Medicine Study
Radiopharmaceuticals
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A Nuclear Medicine Study
Kim - Nuclear Medicine PACS
Report:
LVEF (Left Ventricular
Ejection Fraction) is 63%.
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Scanner for Nuclear Medicine
Kim - Nuclear Medicine PACS
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Nuclear Medicine Images
Kim - Nuclear Medicine PACS
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Nuclear Medicine Images
Kim - Nuclear Medicine PACS
Nuclear Medicine Radiology
Function Anatomy
Activity Morphology
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Image flow: before PACS
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Image flow: PACS era
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Primary images vs Screen Capture
Kim - Nuclear Medicine PACS
Primary images of cardiac blood pool Screen Capture of Workstation
+
Only?
1)
2)
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Primary Image vs. Screen Capture
Kim - Nuclear Medicine PACS
Hold information for quantification No information for quantification
+
Only?
1)
2)
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Primary images vs Screen Capture
Kim - Nuclear Medicine PACS
Stack of primary images Screen Capture of MIP
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Old storage for NM images
Kim - Nuclear Medicine PACS
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Interfile
A file format for NM image
1982 COST-B2 project of European community
Need to design quality assurance programs
Define a file format for data sharing
Contains information about study and images
Kim - Nuclear Medicine PACS
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Interfile: file format for NM image
Limitations of `Interfile`
Lacks many information fields such as image position, orientation, …
Only for images from nuclear medicine
A file format specification, not a transfer protocol
Kim - Nuclear Medicine PACS
CeraSPECT
Old scanner’s workstation produce
‘nice’ interfile but
‘awful’ DICOM formatted file.
Old scanner’s workstation
can export/import interfile,
can export DICOM-file,
canNOT import DICOM-file.
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Old scanner’s images
at New workstation
Incompatible DICOM header
DICOM elements to calculate SUV, 3D positioning/orientation
Problems manipulating old PET machines images
(Gemini, Advances, …) at workstations from other vendor
Kim - Nuclear Medicine PACS
Philips Gemini PET image on GE Centricity Viewer
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Quantitation using PET scanner
Kim - Nuclear Medicine PACS
SUV = 26 g/ml
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Quantitation using PET scanner
Kim - Nuclear Medicine PACS
Standardize activity
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Application of SUV
Kim - Nuclear Medicine PACS
SUV=15g/ml
Metastasis from Colon cancer
SUV=3g/ml
Nodular hyperplasia
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Application of SUV
Kim - Nuclear Medicine PACS
Complete Metabolic Response:
MaxSUV 11.6background
Partial Metabolic Response:
Decrease in MaxSUV > 25% (20.99.5)
Treatment response evaluation (Chemotherapy+Radiotherapy)
Before therapy
Before therapy After therapy
After therapy
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Quantifying metabolism
using DICOM formatted PET image
Kim - Nuclear Medicine PACS
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Kim - Nuclear Medicine PACS
22147 Bq/ml
Quantifying metabolism
using DICOM formatted PET image
Injected dose 459589504 Bq
Time 10:20:48 - 9:23:00 = 3420 sec
Half life of F-18 = 6588 sec
Decay corrected injected dose = 320.7MBq
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Quantifying metabolism
using DICOM formatted PET image
Kim - Nuclear Medicine PACS
c(t) = 0.022147 MBq/ml
corrected injected activity(t) = 320.7MBq
body weight = 62 kg = 62000 g
SUV(t) = 4.28 g/ml
Required data elements for calculating SUV
(0054,1001) Units
(0010,1030) Patient’s Weight
(0054,0016)
> (0018,1072) Radiopharmaceutical Start Time
> (0018,1074) Radionuclide Total Dose
> (0018,1075) Radionuclide Half Life
(0008,0031) Series Time
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Problems in Calculating SUVs
Kim - Nuclear Medicine PACS
(0008,0021) DA '20131204' # Series Date
(0008,0031) TM '083220' # Series Time
(0018,1072) TM '120000.00' # Radiopharmaceutical Start Time
(0018,1074) DS '2996089088' # Radionuclide Total Dose
(0018,1075) DS '230400' # Radionuclide Half Life
Y-90 Half-life ~ 2.67 days
(0018,1078) DT '20131203120000.00' # Radiopharmaceutical Start Datetime
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Problems in Calculating SUVs
Kim - Nuclear Medicine PACS
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Problems in Quantification
Kim - Nuclear Medicine PACS
Max 1971
Max 255
Max 255
Max 6026
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Image Compression
Lossy image compression
Kim - Nuclear Medicine PACS
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Image Compression
Lossy image compression vs. Lossless compression
Kim - Nuclear Medicine PACS
I wanted to compare a study with an older study. Just after opening the case, I found that images of old study were spoiled.
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Image Compression
Lossy compression in NM image
- NM images have more noise than X-ray or CT or MR
- Severely degraded even in a low compression ratio
- Quantification using lossy compressed image alter study result.
Kim - Nuclear Medicine PACS
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Image Compression
Kim - Nuclear Medicine PACS
Lossy
Irreversible
Lossless
Reversible
Uncompressed
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Loss of Data elements
Kim - Nuclear Medicine PACS
Private Tags for calculating SUV
(image from Philips® PET scanner)
Private Tags is missing!
SUV cannot be calculated.
A DICOM file in long term storage
A DICOM file of PET image
I fetched an old study from PACS into my PET workstation. However, PET workstation didn’t show SUV number!
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VR with UN (Unknown VR)?
Kim - Nuclear Medicine PACS
(0054,0414) SQ (Sequence with explicit length #=1) # 54, 1 PatientGantryRelationship
(fffe,e000) na (Item with explicit length #=3) # 46, 1 Item
(0008,0100) SH [G-5191] # 6, 1 CodeValue
(0008,0102) SH [99SDM] # 6, 1 CodingSchemeDesignator
(0008,0104) LO [Feet-first] # 10, 1 CodeMeaning
(fffe,e00d) na (ItemDelimitationItem for re-encoding) # 0, 0 ItemDelimitationItem
(fffe,e0dd) na (SequenceDelimitationItem for re-encod.) # 0, 0 SequenceDelimitationItem
(0055,0010) LO [SIEMENS MED NM] # 14, 1 PrivateCreator
(0055,107e) UN 00\00\c8\41 # 4, 1 Unknown Tag & Data
(0055,10c0) UN 2f\00\11\00\d1\03\ef\00 # 8, 1 Unknown Tag & Data
VR is missing somewhere
Private data elements became unreadable
I opened a study of out-hospital patient and I felt something wrong…
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Risk of NM images in PACS
Saving storage by
performing lossy-compression,
removing data elements with private tag,
storing in “Implicit VR Little Endian”
Kim - Nuclear Medicine PACS
Image is displayed well anyway.
But, Information for quantification is gone!
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Please…
Quantification is crucial in Nuclear Medicine.
Do store “primary” nuclear medicine images if possible
Don’t lossy-compress
“Nuclear Medicine Image” and
“Positron Emission Tomography Image”
(“CT Image” and “Secondary Capture” are okay)
Don’t discard “private” data elements
Kim - Nuclear Medicine PACS
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Author Contacts
Kim, Tae-Sung • [email protected]
• 111 Jungbalsan-ro, Ilsandong-gu,
Goyang-si, Gyeonggi-do, 10408 Republic of Korea
Kim - Nuclear Medicine PACS
Thank you for your attention!