DICOM WG-02

Advances in X-Ray Angiography

Projection Imaging and 3D

SPIE Medical Imaging

2009, Orlando

Authors:
Tim Becker European Society of Cardiology
Heinz Blendinger Siemens Healthcare
Bas Revet Philips Healthcare
Francisco Sureda GE Healthcare (Speaker)
Rainer Thieme Siemens Medical Solutions (Chair DICOM WG-02)

1
Presentation Outline
Introduction
Present and future of X-Ray Angiography in DICOM

2D Projection Images & Presentation

Application Cases of the Enhanced XA SOP Class
XA 2D Grayscale Softcopy Presentation State

3D Reconstruction from Projections & Presentation

X-Ray 3D SOP Class
N-Dimensional Grayscale Softcopy Presentation State

Conclusion

2
Overview of X-Ray Angiography in DICOM
Approved in the Work in
Standard Progress
X-Ray Acquisition Follow-up of PAS by
Supp 94: IEC MT38 – 62B
Radiation Dose
Reporting Follow-up of IHE REM
Profile

2D Projection Images Supp 139-PC:

Supp 83: Enhanced XA Informative
Enhanced Annex
XA/XRF Supp 140-PC:
Presentation State

3D Reconstruction
Supp 116:
Multi-Dimensional
X-Ray 3D
Presentation State
Storage

3
Workflow 2D X-Ray Angiography
SOP
CLASS
X-Ray X-Ray 2D
Acquisition Projection
Procedure SOP Class
SOP
CLASS
2D Presentation
State SOP Class

Presentation
Procedure

Visualization Visualization

X-Ray Acquisition 2D Visualization

System System

4
Enhanced XA: 2D projection images
Supplement 83 – Standard 2004
– New SOP Class for Multi-frame X-Ray Projection Angiography
– Re-use of encoding mechanisms of Enhanced CT and MR
– Enhanced with new attributes to support new applications

What can be done with this new SOP Class?

– Supplement 139 (Part 17 – Informative) – Public Comments passed
• Describes use cases where the Enhanced XA provides better
solutions
• Provides encoding guidelines for implementors, both creators
and users of the Enhanced XA SOP Class

5
Enhanced XA: Supplement 139
X-Ray 2D
Projection
Enhanced XA
X-Ray Acquisition SOP CLASS
Modality Applications

– General Definitions:
• Time relationships, Acquisition Geometry, Pixel Size calibration
– Application Use Cases
• Acquisition: Waveform synch, Mechanical Movement, X-Ray controls…
• Image Registration: 3D structures projected on 2D images
• Display: Standard pipeline, multi-mask subtraction, per-frame pixel shift
• Review: Variable review settings per group of frames
• Processing: Projection pixel calibration

6
Enhanced XA – Time Relationships
Frame “1” Frame “i” Frame “N”
Content Date Acquisition Acquisition Acquisition
(0008,0023) Datetime Datetime Datetime
Content Time (0018,9074)
(0008,0033)
Acquisition Frame “1” Frame “i” Frame “N”
Datetime Reference Reference Reference
(0008,002A) Datetime Datetime Datetime
(0018,9151)

… …
time
FRAME 1 FRAME i FRAME N

Frame “1” Frame “N”

Acquisition Acquisition
Duration Duration
(0018,9220)

Acquisition Duration (calculated)

If Acquisition is synchronized with

external time reference then Exposure Time (0018,9328) = SUMi( Frame “i” Acquisition Duration )
Acquisition Time Synchronized Average Pulse Width (0018,1154) = SUMi(Frame “i” Acquisition Duration) / N
(0018,1800) = YES
7
Enhanced XA – Time Relationships (one frame) Frame
Frame
Acquisition Reference
Datetime Datetime
(0018,9074) (0018,9151)

X-ray FRAME “i”

PRE-FRAME Frame Acquisition Number (0020,9156) = “i”
X-ray

time
Detector Activation
Offset from Exposure Frame Acquisition Duration (0018,9220)
(0018,7016)
R
Detector Active Time (0018,7014)

Cardiac Trigger Delay Time (0020,9153)

Last R-peak prior to the X-ray

FRAME “i”
T
Q
S NOTE: Positioner angle values, table position values etc… are measured at
the Frame Reference Datetime

8
Enhanced XA – Acquisition Techniques
Values per frame are in the Per-frame Functional Groups Seq. (200,9230):

In the Frame Content Sequence (0020,9111):

– Frame Acquisition Duration (0018,9220) in ms of frame « i » = ti

In the Frame Acquisition Sequence (0018,9417):

– KVP (0018,0060) of frame « i = kVpi
– X-Ray Tube Current in mA (0018,9330) of frame « i » = mAi

current
mA1 mA2
mA3
mA5
Average
mA4
mA

Frame Frame Frame Frame Frame

#1 #2 #3 #4 #5

time
t1 (ms) t2 (ms) t3 (ms) t4 (ms) t5 (ms)
9
Enhanced XA – Acquisition Geometry
System set up Image Transformation
X-Ray Pixel Data
Acquisition Storage
PATIENT FOV
position TABLE POSITIONER Detector Rotation
on the movement movement Binning & Horiz
Table Flip

Patient X-Ray X-Ray Detector FOV

Position Table Positioner Description Description
Description Description Description

 X-Ray Isocenter Reference System Macro  X-Ray Field of View Macro

 X-Ray Geometry Macro  XA/XRF Acquisition Module
 X-Ray Detector Module
 Image Pixel Module 10
Enhanced XA – 3D/2D Registration
Acquisition #1 Acquisition #2

+Z +X
O
+Y

+Z +X
O
+Y

Table Positioner SID, ISO, FOV

Movement Movement change
+Z +X
O +Z +X +Zp
O
+Y +Xp
+Y +Yp
+Z +X
O
+Y

P1 (x,y,z) P1t (xt,yt,zt) P2 (x,y,z) P2p (xp,yp,zp) P2(i,j)

fa(P1, Table1) fb(P1t, Table2) fc(P2, Positioner2) fd(P2, SID, ISO, FOV)

11
Enhanced XA – Standard Display Pipeline
Shape = “IDENTITY” if (0028,0004) = MONOCHROME2
Shape = “INVERSE” if (0028,0004) = MONOCHROME1

Stored
Values
XModality
LUT
VOI LUT P LUT

Pixel values transformed for

Display

specific application
Pixel Intensity (if TO_LINEAR, then pixel values Application
Relationship LUT proportional to the X-ray beam
intensity)
1 to N Pixel Intensity Relationship
LUT Sequence (0028,9422) “TO_LINEAR” is required if Pixel Intensity
Relationship (0028,1040) = LOG

Pixel Intensity Pixel values transformed for Application

Relationship LUT specific application

Pixel Intensity Relationship

LUT Sequence (0028,9422)
12
Enhanced XA – Variable Review Settings
FRAME ACQUISITION:

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

Acq. Frame rate: 4.0 Acq. Frame rate: 15.0 Acq. Frame rate: 8.0
Purpose: X-Ray control Purpose: Contrast Media Purpose: Contrast Media

Frame Display Sequence (0018,7022)

Item 1
>Start Trim (0008,2142) =1
>Stop Trim (0008,2143) =5
>Skip Frame Range Flag (0008,9460) = SKIP
DICOM ENCODING: >Recom. Display Frame Rate (0008,9459) = 4.0

XA/XRF Multi-frame Item 2

>Start Trim (0008,2142) =6
Presentation >Stop Trim (0008,2143) = 13
Module >Skip Frame Range Flag (0008,9460) = DISPLAY
> Recom. Display Frame Rate (0008,9459) = 15.0
Item 3
>Start Trim (0008,2142) = 14
>Stop Trim (0008,2143) = 19
>Skip Frame Range Flag (0008,9460) = DISPLAY
> Recom. Display Frame Rate (0008,9459) = 8.0 13
Enhanced XA – Pixel Shift per frame
FRAME ACQUISITION DICOM ENCODING:
and PROCESSING: Mask Module

Frames Right Left

Leg Leg

Sub ID Sub ID Mask Subtraction Sequence (0028,6100)

#1 101 100
Item 1
>Mask Operation (0028,6101) = AVG_SUB
>Subtraction Item ID (0028,9416) = 100
>Applicable Frame Range (0028,6102) = 2\3
>Mask Frame Numbers (0028,6110) =1
#2
>Mask Operation Expl. (0028,6190) = Left leg
Item 2
>Mask Operation (0028,6101) = AVG_SUB
>Subtraction Item ID (0028,9416) = 101
>Applicable Frame Range (0028,6102) = 2\3
#3 >Mask Frame Numbers (0028,6110) =1
>Mask Operation Expl. (0028,6190) = Right leg

14
Enhanced XA – Pixel Shift per frame
FRAME ACQUISITION DICOM ENCODING:
and PROCESSING: Frame Pixel Shift per frame

Frames Item 2 Frame #2

>Frame Pixel Shift Seq (0028,9415)
#1

#2

Item 3 Frame #3
>Frame Pixel Shift Seq (0028,9415)

#3

15
Enhanced XA – Pixel Shift per frame
FRAME ACQUISITION DICOM ENCODING:
and PROCESSING: Frame Pixel Shift per frame

Frames Left
Leg Item 2 Frame #2
>Frame Pixel Shift Seq (0028,9415)
#1 Item 1
mask
>>Subtraction Item ID (0028,9416) = 100
>>Mask Sub-pix Shift (0028,6114) = 0.0\8.0

Pixel Shift
#2 0.0 \ 8.0

Item 3 Frame #3
>Frame Pixel Shift Seq (0028,9415)
Item 1
Pixel Shift
#3 2.0 \ 10.0 >>Subtraction Item ID (0028,9416) = 100
>>Mask Sub-pix Shift (0028,6114) = 2.0\10.0

16
Enhanced XA – Pixel Shift per frame
FRAME ACQUISITION DICOM ENCODING:
and PROCESSING: Frame Pixel Shift per frame

Frames Right Left

Leg Leg Item 2 Frame #2
>Frame Pixel Shift Seq (0028,9415)
#1 Item 1
mask mask
>>Subtraction Item ID (0028,9416) = 100
>>Mask Sub-pix Shift (0028,6114) = 0.0\8.0
Item 2
Pixel Shift Pixel Shift >>Subtraction Item ID (0028,9416) = 101
#2 0.0 \ 0.0 0.0 \ 8.0 >>Mask Sub-pix Shift (0028,6114) = 0.0\0.0

Item 3 Frame #3
>Frame Pixel Shift Seq (0028,9415)
Item 1
Pixel Shift Pixel Shift
#3 0.0 \ -7.0 2.0 \ 10.0 >>Subtraction Item ID (0028,9416) = 100
>>Mask Sub-pix Shift (0028,6114) = 2.0\10.0
Item 2
>>Subtraction Item ID (0028,9416) = 101
>>Mask Sub-pix Shift (0028,6114) = 0.0\-7.0 17
Enhanced XA- Projection Pixel Size Calibration
How to convert from “image pixels” to “object mm in patient”
#Px = Object size in “image” pixels
D = Object size in mm

#Px TH = T
able Height (0018,1130)
TO = Dist. T
able to Object (0018,9403)
Isocenter BeamAngle (0018,9449)
Beam SID = Dist. Source-Detector (0018,110)
Angle
ISO = Dist. Source-ISO (0018,9402)
SID
Px = Imager Pixel Spacing (0018,1164)
D ISO

TH

TO
Table

D = # Px *  Px * SOD / SID

SOD = ISO - (TH- TO) / cos°(Beam Angle)

X-Ray 18
Source
XA/XRF Projection
Presentation State

19
Supplement 140: new XAGSPS IOD (for 2D)
Information that may be used to present angiographic projection
images

It includes capabilities from the Grayscale Softcopy Presentation

IOD for specifying:
a. the output grayscale space in P-V
alues
b. grayscale contrast transformations including VOI LUT
c. selection of the area of the image to display , rotate, flip
d. image and display relative annotations, graphics, text and overlays

20
Supplement 140: new XAGSPS IOD (for 2D)
Specific capabilities are provided for the presentation of
angiographic projection images:
a. shutter specifications on a frame-by-frame base,
b. mask subtraction including regional pixel shift
c. presentation of sets of frames
Similar to the XA/XRF Multi-Frame Presentation Module
of the Enhanced XA/XRF

21
XAGrayscale Softcopy Presentation State
Grayscale Contrast Transformations
The sequence of transformations from stored pixel values into P-V
alues is
explicitly defined in a conceptual model

Shutter per frame

The shutter coordinates per-frame may be modified in post-review

Frame #1
Frame #2
Frame #3
Frame #4
Frame #5 22
XAGrayscale Softcopy Presentation State
 mask subtraction & regional pixel shift
If Pixel Intensity
Relationship is not LOG « TO_LOG »
LUT

Else
SUB VOI LUT …
Contrast Frame(s)

Pixel Shift
&
Else Anatomic Background
Visibility

« TO_LOG »
If Pixel Intensity LUT
Relationship is not LOG

Mask Frame(s)
23
XAGrayscale Softcopy Presentation State
 Regional pixel shift

Applicable pixel shift in case of multiple pixel shift regions 24

Sup 140 – Example of Regional Pixel Shift

Mask frame: non-injected structures (bones, 25

soft-tissues…)
Sup 140 – Example of Regional Pixel Shift

Contrast frame: injected vessels – background 26

structures moved since the mask acquisition
Sup 140 – Example of Regional Pixel Shift

Subtraction without pixel shift: background 27

structures are visible
Sup 140 – Example of Regional Pixel Shift

Regional Pixel Shift: Select region 1 28

Sup 140 – Example of Regional Pixel Shift

Mask Pixel
Shift (Column)

Mask Pixel
Shift (Row)

Regional Pixel Shift: Apply shift to mask on region 1 29

Sup 140 – Example of Regional Pixel Shift

Mask Pixel
Shift (Column)

Mask Pixel
Shift (Row)

30
Sup 140 – Example of Regional Pixel Shift

Mask Pixel
Shift (Column)

Mask Pixel
Shift (Row)

31
Sup 140 – Example of Regional Pixel Shift

Mask Pixel
Shift (Column)

Mask Pixel
Shift (Row)

… until background structures are not visible anymore

32
Sup 140 – Example of Regional Pixel Shift

Regional Pixel Shift: Select region 2 33

Sup 140 – Example of Regional Pixel Shift

Mask Pixel
Shift (Column)

Regional Pixel Shift: Apply shift to mask on region 2 34

Sup 140 – Example of Regional Pixel Shift

Regional Pixel Shift: Select region 3 35

Sup 140 – Example of Regional Pixel Shift

Mask Pixel
Shift (Column)

Regional Pixel Shift: Apply shift to mask on region 3 36

Sup 140 – Example of Regional Pixel Shift

Subtraction with regional pixel shift: background 37

structures are not visible anymore
3D X-RayAngiography

38
Workflow 3D X-RayAngiography
SOP SOP
CLASS CLASS
X-Ray X-Ray 2D Reconstruction 3D Storage
Acquisition Projection Procedure SOP Class
Procedure SOP Class
In progress
3D Presentation
State SOP Class

Presentation
Procedure
X-Ray
Calibration
Calibration
Data
Procedure
Proprietary
Visualization Visualization

X-Ray Acquisition 3D Reconstruction 3D Visualization

System System System
39
X-Ray 3DAngiography
Supplement 116 – In standard 2007
– New SOP Class for Multi-frame X-Ray 3D from projections
– Re-use of encoding mechanisms of Enhanced CT and MR
– Re-use volumic descriptions of Enhanced CT and MR
– Additional information of the reconstruction from projections

What can be done with this new SOP Class?

– Basic 3D visualization (slices)
– References to 2D projections
– Description of the reconstruction application
– Relationship to the Equipment Coordinate System
– ...

40
X-Ray 3DAngiography – RotationalAcquisition

Frame #5:
X-ray settings 5
Geometry settings 5

Frame #4:
X-ray settings 4
Geometry settings 4

Frame #3: Optimized 3D

X-ray settings 3
Geometry settings 3
Reconstruction

Frame #2:
X-ray settings 2
Geometry settings 2

Frame #1:
X-ray settings 1
Geometry settings 1

41
X-Ray 3DAngiography – Reference to 2D
2D Projection SOP Instance «A» Contributing Sources
Sequence (0018,9506)
Mask Contrast Source #1: Contrib. SOP Inst = SOP Inst “A”
SOP Instance description
M1... ...M2 C1... ...C2
X-Ray 3DAcquisition
Sequence (0018,9507)
Acq #1: Source Img Seq = A: M1 to M2
Reconstruction Reconstruction Acq #2: Source Img Seq = A: C1 to C2
1 2
Acquisition description

X-Ray 3D Reconstruction
Sequence (0018,9530)
Recon #1:Acquisition Index =1
Mask SUB
Recon #2:Acquisition Index = 1\2
Reconstruction description

Per-Frame Func Groups

Sequence (5200,9230)
1... ...N N+1... ...N+k Frames #1 to #N: Recon Index =1
X-Ray 3D SOP Instance Frames #N+1 to #N+k: Recon Index =2
Frame description 42
X-Ray 3DAngiography - Relationship to Equipment
Image to Equipment Matrix (0028,9520)
 A x   M 11 M 12 M 13 Tx   B x 
A    
 y    M 21 M 22 M 23 Ty   B y 
 A z   M 31 M 32 M 33 Tz   B z 
     
 1   0 0 0 1   1 

Patient Oriented Equipment Coordinate

Coordinate System of System of the 2D
the 3D slices projections
P (Bx, B,yBz) P (Ax,A,yAz)

R +Z +X
O
+Y
L

Enhanced XA:
Isocenter Reference System
43
X-Ray 3DAngiography
Presentation State

44
X-Ray 3DAngiography – Presentation State
Needs for 3D Angiography Presentation
– Presentation features common to all 3D
– Speficic presentation of X-Ray 3DAngiography:
•Acquisition 3D shutter for collimation
• Volume Subtraction and voxel shift
• Stabilized point in all volumes (e.g. cardiac wall motion, stent stabilized)
• Catheter tracking trajectory in one volume
• 2D-3D blending presentation (3D conic projection on 2D fluoroscopy)

N-Dimensional Presentation State

• Work Item 2008-04-C.Addresses needs of multi-modalities
• Led by Working Group 1, participation of Web3D and other working groups
• Supplement in progress...

45
Conclusion
Supplement 139 – Enhanced XAapplication cases
In Public Comments. Informative (DICOM Part 17)
Will facilitate the adoption of the Enhanced XA(Sup 83)
Supplement 140 – XA/XRF Presentation State
In Public Comments. Enables:
shutter on a frame-by-frame base,
mask subtraction including regional pixel shift
presentation of set of frames

X-Ray 3D Angiography
New IOD approved in Standard 2007 (Sup 16)
3D Presentation State on-going...
Contact WG-02 chairman:
francisco.sureda@med.ge.com 46