Digital Data Reading (as per RACS DDI Options)

1. Image Data Format

2. Image Data Distribution

3. Image Data Reading

4. Image Data Display

5. Image Data Manipulation

6. Image Data Storage

Unless using digitally printed film, software or an application is needed to view diagnostic digital images.

Stage 3     Image Data Viewing	Optimum	Acceptable (qualified)
	1.       DICOM reading software with simple intuitive interface and certified by local regulatory authority as suitable for clinical use and compliant with IHE BRI for image display.  ** Ideally each user should have resident software  to support familiarity of use.	1.     DICOM reading software on export or transfer media. ** Should have simple intuitive interface and require no set-up or installation on viewing computer. Designed for occasional or emergency use. 2.       Direct observation of high quality hard copy film on a suitable light box. Note: there can be significant problems with large volume cross-sectional studies (e.g. isotropic CT)due to the number of images to be read)

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1.       Hard-copy film

No software requirements
Light box of adequate luminance (at least 2 000 Cd/m²) in viewing area, with adequate control of ambient light.

2.       Electronic (Network or portable digital media) distribution

    - WebPACS (Diagnostic Images viewed over the web) viewing software

If using WebPACS, then either a web browser (e.g. Internet Explorer, Firefox or Safari)  or local application (client) provided by the radiology service associated with each WebPACS will be needed. Note that each WebPACS product has its own user interface, which can create training issues.

   - Portable media viewing software

The DICOM content files can only be accessed using a DICOM reader application.  There are three ways of gaining access to a DICOM reader:

1.       Download a freeware reader

2.       Purchase and download a commercial DICOM viewer.

3.       Use a viewer provided on the image disc along with the images.

The viewer should be certified as able to display images for diagnostic and direct patient care purposes, and be compliant with the requirements of the local statutory regulatory authority.

It is recommended that any viewer to be used for diagnostic purposes be consistent with profiles under development by IHE:

IHE Basic Image Review (BIR) - Public Comment document  

and the  American Medical Association:

AMA Background and Initial Requirements for Simple DICOM Viewer with Universal Icons

It is appropriate that the interface has the following denotation:

“Suitable for diagnostic purposes if displayed on suitable monitor” (or similar)

Summary of functionality required – all with standard “pictorial” icons:

• Thumbnails of available studies
• Load
• Clear indicator of active window
• Tile
• Window – including automated preset “Window levels”
• Pan
• Measure – linear, angle, density
• Zoom
• Scroll
• Save image
• Print image
• Relevant DICOM header details
• Close
• Simple Help menu
• Abort - allow operator to terminate current action, and return to previous function
• Refresh - return viewer (i.e. windowing and zoom) to default settings
• Cross-sectional images - scout image display

    Scout image display: 

Minimum requirement – At least one representative scout image in at least one orthogonal plane, with clearly identifiable landmarks, that relates to a selected image set, is available to display on the same screen as the image set.

Preferred – All image sets are related to all other image sets in orthogonal planes such that the position of one image can be displayed in all other image sets in an orthogonal plane. At least one image set must have a clearly identifiable anatomical landmark.

o     Where scout images contain multiple lines to represent sections in an orthogonal plane, the density of the lines must not obscure the underlying anatomical detail.

o     Where scout images contain multiple lines with numeric labels that reference a slice number in an orthogonal plane, the density of the numeric labels lines must be such that the labels remain legible.

o     The image number on an individual image that corresponds to a scout image line must be clearly indicated and not obscured by other numerical information.

o     All images must have an associated scout image.

o     If more than one window is open, there should be an option allowing images obtained in the same plane to be synchronised to the same section position. If images in separate windows are orthogonal then scout image lines should be visible with a simple show scout image line command.  (Some have requested mini scouts in the same frame - perhaps this could be a separate icon that can be toggled on/off.)

      Ability to display and play DICOM compliant animations – MPG2

• Must have capacity for “screen capture” of animation.
• Must have standard animation controls of play, pause, reverse, fast forward and stop.

      Minimum on screen display to include:

• Demographic details – name, date of birth, study number
• Study details – basic details of study, region and type of study
• CR/DR,   LOSSY/LOSSLESS & Magnification

      Indication of relative radiation dose used – (to be confirmed)

This scale is a general measure of the radiation dose of the examination.

o       Does not directly measure actual patient absorbed dose.

o       Provides an overview of total radiation exposure.

     Ability to hide or unhide “on screen” details

All of the above Icons/ Designs should be implemented such that all “simple” viewers look and work in a similar fashion.  The advanced viewer can then be formatted in any manner deemed desirable by individual manufacturers. The simple menu option will be the default viewer and an expanded menu option can be accessed.

Computer Specification:

The hardware requirements for the computer will vary with the software system installed, and depends on the manipulation capabilities, and image data caching requirements desired.  The video card must be suitable for the display characteristics, however other specifications relate to the particular recommendation of the software supplier. Diagnostic image data should ideally be partitioned, backed up and secured separate from the primary practice management system.