Quantitative Coronary Angiography on the Cardiovascular Measurement System. QCA-CMS Version 5.2 for Windows-NT, 2000 and XP

Transcription

1 Quantitative Coronary Angiography on the Cardiovascular Measurement System QCA-CMS Version 5.2 for Windows-NT, 2000 and XP Conformance Statement September 1, 2002 MEDIS medical imaging systems Date: September 1,

2 Introduction Exchange of digital information of cardiological studies is regulated through an extension of the DICOM (Digital Imaging and Communications in Medicine) standard. As this standard grants certain flexibility in additional data, it is necessary for each vendor to describe the specific characteristics of his system in a conformance statement. In this document, the DICOM conformance of the MEDIS QCA-CMS, Quantitative Coronary Angiography software package is described, according to NEMA part PS 3.2. Since QCA-CMS is an extension to MEDIS CMS -View, the DICOM conformance of the QCA-CMS 5.2 consists of the DICOM conformance statement of CMS -View 5.2 and CMS -Store 5.2 (Sections 1 through 7) extended with the DICOM conformance part for QCA, as described in Sections 8 and 9. Intended audience The QCA-CMS is a quantitative coronary analysis package for the quantification of stenoses in the coronary arteries, visualized by X-ray angiography. It is assumed that the reader is familiar with the fundamentals of DICOM and QCA, and the basics of computer terminology. The intended audience is: Potential customers; System integrators of medical equipment; Marketing staff interested in technical system specifications; Software engineers implementing DICOM interfaces and QCA reporting tools. Used definitions, terms and abbreviations The following typographical conventions are used in this document: NEMA PS 3.x refers to a part of the DICOM standard, x from (1); MEDIS refers to MEDIS medical imaging systems. CMS is a registered trademark of MEDIS. References 1. The Digital Imaging and Communications in Medicine (DICOM) Standard, Parts 3.1 to 3.13 and Supplements, NEMA Publication Sales; Rosslyn VA. Date: September 1,

3 Table of Contents 1. Implementation Model Application Data Flow Diagram Functional Definitions of AE's Sequences of Real World Activities File Meta Information AE Specifications Media Storage Specification File Meta Information for the Application Entity Real World Activities for this Application Entity Applied modules and DICOMDIR keys Network Specification for CMS -View AE Association Establishment Policies Network Specification for CMS -Store AE Association Establishment Policies Communication Profiles Supported Communication Stacks (Parts 8,9) TCP/IP Stack API Physical media support Point-to-Point Stack Extensions Extended SOPs Private Transfer Syntaxes Configuration AE Title and Presentation Address Mapping Configurable remote AE Titles and Presentation Addresses Configurable Parameters Configurable Parameters of CMS -View Configurable Parameters of CMS -Store Support of Extended Character Sets Specification of Applied IODs Applied Modules in the XA Image IOD Applied Modules in the Ultrasound Multi-Frame Image IOD Applied Modules in the Basic Directory IOD Extensions to Part PS 3.3 for QCA Calibration...23 Date: September 1,

4 8.2. Caliper Line Measurement Caliper Line Measurement Sequence Caliper Angle Measurement Caliper Angle Measurement Sequence Caliper Contour Measurement Caliper Contour Measurement Sequence QCA Analysis QCA Analyzed Frames Sequence QCA Segment Sequence QCA Obstructions Sequence Subsegment parameters Brachy Analysis Brachy Analyzed Frames Sequence Brachy Segment Sequence Brachy Segment Parts I Sequence Brachy Segment Parts II Sequence QLV Analysis QLV Analyzed Frames Sequence Ejection Fraction Parameters Slager Wall Motion Parameters Centerline Wall Motion Parameters Stanford Wall Motion Parameters Extensions to Part PS 3.6 for QCA Calibration Measurement Sequence QCA Analysis QCA Analyzed Frames Sequence QCA Segment Sequence QCA Obstructions Sequence Subsegment parameters Brachy Analysis Brachy Analyzed Frames Sequence Brachy Segment Sequence Brachy Segment Parts I Sequence Brachy Segment Parts II Sequence QLV Analysis QLV Analyzed Frames Sequence Ejection Fraction Parameters Slager Wall Motion Parameters Centerline Wall Motion Parameters Stanford Wall Motion Parameters Date: September 1,

5 1. Implementation Model The CMS -View application provides a multi-modality DICOM Review Station. In combination with additional software modules, the system can perform quantification analysis. The CMS -Store application provides functionality to store incoming DICOM messages from remote DICOM applications on hard disk. The stored messages can be read by the CMS -View. In brief, the objectives of the CMS applications CMS -View and CMS -Store are: to read and display (real-time) image runs from DICOM files from disk and DICOM formatted CDROM; to write DICOM formatted files and filesets containing image information, not necessarily from original DICOM datasets; to perform queries on remote DICOM applications and retrieve selected DICOM images and accompanying image information; to store DICOM images on remote DICOM applications. In DICOM terms, CMS -View is an implementation of a DICOM Media Storage Service as File Set Updater (FSU), File Set Reader (FSR) and File Set Creator (FSC). It supports the 120 mm CDROM medium as described in PS 3.12-Annex F. CMS -View is also an implementation of a DICOM Query and Retrieve Service Class User (SCU) as well as a DICOM Storage Service Class User. As such, it can send DICOM queries (C-FIND) and move (C-MOVE) requests to a DICOM Query and Retrieve Service Class Provider as well as send store (C-STORE) requests to a DICOM Storage Service Class Provider. CMS -Store is an implementation of a DICOM Storage Service Class Provider (SCP), which can receive Store requests from a DICOM Storage Service Class User (SCU). CMS -Store is also an implementation of a DICOM Media Storage Service as File Set Updater (FSU). Date: September 1,

6 1.1. Application Data Flow Diagram Local Remote File Read File Save images Review and quantification of images Query and retrieve images Store images DICOM storage medium (hard disc / CDROM) FSU / FSC FSR CMS-View AE Storage SCU QR SCU Remote QR SCP Storage SCP Storage SCU FSU CMS-Store AE Storage SCP DICOM Standard Interface Store images on hard disk DICOM Standard Interface Figure 1. CMS application data flow diagram Functional Definitions of AE's The CMS -View AE can perform the following functions (real world activities): It can read an existing DICOM File-set from media. This includes DICOM Filesets from CD-ROM and hard disk. The (multi-frame) images that have been read will be displayed in a thumbnail overview and can be reviewed in one or more windows. More than one image can be reviewed at the same time. It can update a piece of media, writing additional SOP instances to an already existing DICOM File-set. It can create a new DICOM File-set on media. The image and accompanying information that is saved on media does not necessarily have to be an original DICOM dataset. Date: September 1,

7 It can send a request of the Verification SOP Class as a Service Class User (SCU). It can establish an association with a remote DICOM Query/Retrieve Service Class Provider (SCP). A Find request can be send with user defined query fields. Afterwards CMS-View will wait for Find responses. A Move request for selected studies, studies or images can be send. Afterwards CMS-View will wait for Move responses. It can establish an association with a remote DICOM Storage Service Class Provider (SCP). A request to store images can be send to the remote DICOM application. The images that are sent in the request must be located on the local hard disk as a DICOM compliant File-set. The CMS -Store AE can perform the following functions: It can respond to requests of the Verification SOP Class as a Service Class Provider (SCP). It can wait for incoming association requests from a Storage Service Class User (SCU). When an association request is received, the AE will respond with a list of SOP Class UIDs that it will accept. It then waits for a Store request. If a Store request is received, all incoming images that are conformant to the association are written to a DICOM File on hard disk Sequences of Real World Activities Before images can be reviewed, they should be loaded into the CMS -View application system. To accomplish that, the user should do one of the following: Load (one or more) File-sets from media; Perform a query and retrieve on a remote DICOM application from CMS -View. The remote DICOM application will send the requested image data to CMS - Store, which will store the message on media. Afterwards, CMS -View will load the File-set(s). After the images have been reviewed and/or analyzed, the following action can be performed: Storage of DICOM images on a remote DICOM application from CMS -View. The image to be stored must be located on local media File Meta Information Both CMS -View and CMS -Store will provide a single Implementation Class UID which is , where is the MEDIS organization root and 5.2 is the version number of the current implementation. Date: September 1,

8 2. AE Specifications 2.1. Media Storage Specification Both the CMS -View AE and the CMS -Store AE provide standard conformance to the DICOM Interchange Option of the Media Storage Service Class. The Application Profiles and roles are listed in Table 2.1. The conformance is non-standard in the sense that individual DICOM files can also be written without an accompanying Fileset description in a DICOMDIR. Files as well as File-sets can only be stored on hard disc, not directly onto CD-ROM. Application Profile Identifier Real-world Activity Basic cardiac XA studies on CD-ROM media Basic cardiac XA studies on hard disk STD-XABC-CD STD-XABC-HD Role SC Option File Read FSR Interchange Image Display of Multi Frame Ultrasound on CD-ROM Image Display of Multi Frame Ultrasound on hard disk STD-US-ID-MF-CD STD-US-ID-MF-HD Basic cardiac XA studies on hard disk STD-XABC-HD File Save Store Image Table 2.1: Supported Application Profiles and roles for CMS -View AE and CMS -Store AE File Meta Information for the Application Entity FSC FSU Interchange The AE title for media storage is set by the CMS -View or CMS -Store application and cannot be configured by the user Real World Activities for this Application Entity Application profiles for the RWA: File Read The CMS -View AE acts as an FSR using the Interchange option when requested to read DICOM files from hard disk or CD-ROM Application profiles for the RWA: File Save The CMS -View AE acts as an FSC using the Interchange options when requested to save image data as a new DICOM File-set. The CMS -View AE acts as an FSU using the Interchange options when requested to save changes to an existing DICOM File-Set. The saved DICOM File-sets, either created or updated, correspond to the Application Profiles in Table 2.2. The CMS -View AE can only save DICOM File-sets on hard disk. Date: September 1,

9 Application profiles for the RWA: Store images The CMS -Store AE acts as an FSU using the Interchange options when requested to store received image data. The data is saved on hard disk Applied modules and DICOMDIR keys The Modules supported by the CMS applications are specified in Section Network Specification for CMS -View AE The CMS -View AE provides standard conformance to the following DICOM SOP Classes as a Verification SCU. SOP Class Name SOP Class UID Verification SOP Class Table 2.2 Supported Verification SOP class for CMS -View AE as an SCU. The CMS -View AE provides standard conformance to the following DICOM SOP Classes as a Query Retrieve SCU. SOP Class Name SOP Class UID Ultrasound Multi-Frame Image Storage X-ray Angiographic Image Storage Study Root Query/Retrieve Information Model Find Study Root Query/Retrieve Information Model Move Table 2.3: Supported Query Retrieve SOP classes for CMS -View AE as an SCU. The CMS -View AE provides standard conformance to the following DICOM SOP Classes as a Storage SCU. SOP Class Name SOP Class UID Ultrasound Multi-Frame Image Storage X-ray Angiographic Image Storage Table 2.4: Supported Storage SOP classes for CMS -View AE as an SCU Association Establishment Policies General CMS -View will attempt to establish an association with a Storage SCP or a Query Retrieve SCP. The maximum PDU size for the CMS-View AE is Number of Associations The CMS -View AE uses a single association to connect to a Storage SCP or a Query Retrieve SCP. Date: September 1,

10 Asynchronous Nature The CMS -View AE does not support asynchronous operation (multiple outstanding transactions over a single association) Implementation Identifying Information The implementation is identified by an Implementation Class UID of , where is the MEDIS organization root and 5.2 the version number of the current implementation. The implementation version name is: CMS Real world activity: User Query and Retrieve Associated Real World Activity When the Query and Retrieve is initiated from the CMS -View, a dialog is presented where the user can select a DICOM messaging configuration and can provide query keys. After selecting the Query button, the CMS -View AE will send an association request to the selected DICOM remote network node. When an association has been established, a Find request is send with the provided query keys, and the CMS -View AE will wait for Find responses. The results of the Find request are presented to the user in the dialog. The user can make selections in the Find responses. After pressing the Retrieve button, the CMS -View AE will send a Move request for the selected images and will wait for Move responses. After a successful Move response, the CMS-View application will try to open the retrieved images Association Initiation Policy The CMS -View AE will initiate an association with the source DICOM node that has been selected from the DICOM messaging configuration drop-down box in the DICOM messaging dialog in CMS -View. Date: September 1,

11 Proposed Presentation Contexts Presentation Context Table Abstract Syntax Transfer Syntax Role Extended Negotiation Name UID Name List UID List Verification Service Class See Table 2.2 Implicit Little Endian Ultrasound Multi-frame Image See Table 2.3 Explicit Little Endian Explicit Big Endian Implicit Little Endian Explicit Little Endian Explicit Big Endian RLE Lossy JPEG Lossless JPEG , XA Image See Table 2.3 Lossless JPEG SCU None Study Root Query/Retrieve Information Model Find Study Root Query/Retrieve Information Model - Move See Table 2.3 See Table 2.3 Implicit Little Endian Explicit Little Endian Explicit Big Endian Implicit Little Endian Explicit Little Endian Explicit Big Endian Table 2.4 Presentation Context Table SCU SCU SCU SCU None None None None Real world activity: User Image storage Associated Real World Activity When the Image Storage is initiated from CMS -View, a dialog is presented where the user can select a DICOM messaging configuration and can provide query keys. After selecting the Query button, the CMS -View AE will present the contents of a local hard disc folder, as specified by the user in the CMS -View options (the File Save folder ). The user can make selections in the displayed file sets. When the user selects the Store selected images button, an association request is send to the selected remote DICOM network node. When an association has been established, a Store request is send with the first selected image, and the CMS -View AE will wait for Store responses. The CMS -View AE will send Store requests for all selected images Association Initiation Policy The CMS -View AE will initiate an association with the source DICOM node that has been selected from the DICOM messaging configuration drop-down box in the DICOM messaging dialog in CMS -View. Date: September 1,

12 Proposed Presentation Contexts Presentation Context Table Abstract Syntax Transfer Syntax Role Extended Negotiation Name UID Name List UID List Verification Service Class See Table 2.2 Implicit Little Endian Ultrasound Multi-frame Image See Table 2.4 Explicit Little Endian Explicit Big Endian Implicit Little Endian Explicit Little Endian Explicit Big Endian RLE Lossy JPEG Lossless JPEG , XA Image See Table 2.4 Lossless JPEG SCU None Table 2.4 Presentation Context Table. SCU SCU None None 2.3. Network Specification for CMS -Store AE The CMS -Store AE provides standard conformance to the following DICOM Service Object Pair (SOP) Classes as a Verification Service Class Provider (SCP). SOP Class Name SOP Class UID Verification SOP Class Table 2.5 Supported Verification SOP class for CMS-Store AE as an SCP. The CMS -Store AE provides standard conformance to the following DICOM Service Object Pair (SOP) Classes as a Storage Service Class Provider (SCP). SOP Class Name SOP Class UID Ultrasound Multi-frame Image Storage X-ray Angiographic Image Storage Table 2.6 Supported Storage SOP classes for CMS-Store AE as an SCP Association Establishment Policies General CMS -Store will accept association requests from a Storage SCU. The maximum PDU size for the CMS -Store AE is Date: September 1,

13 Number of Associations The CMS -Store AE will accept not more than a single association at a time from a Storage SCU Asynchronous Nature The CMS -Store AE does not support asynchronous operations (multiple outstanding transactions over a single association) Implementation Identifying Information The implementation is identified by an Implementation Class UID of , where is the MEDIS organization root and 5.2 the version number of the current implementation. The implementation version name is: CMS Real world activity: Store Image Associated Real World Activity The CMS -Store AE is listening to a user defined port for incoming association requests. After an association request has been received, the CMS -Store AE will wait for Store requests. All images that will be received will be stored on disk in DICOM compliant File-sets. After the images have been stored, the CMS -Store AE will send a Store response to the remote DICOM node signaling the Store request was handled successfully. If the images could not be stored for any kind of reason, the CMS -Store AE will send a Store response with an error status Association Acceptance Policy The CMS -Store AE will only accept association requests from remote AE titles that have been registered with the application. Date: September 1,

14 Proposed Presentation Contexts Presentation Context Table Abstract Syntax Transfer Syntax Role Name UID Name List UID List Verification Service Class See Table 2.5 Implicit Little Endian Ultrasound Multi-frame Image See Table 2.6 Explicit Little Endian Explicit Big Endian Implicit Little Endian Explicit Little Endian Explicit Big Endian RLE Lossy JPEG Lossless JPEG SCP Extended Negotiation XA Image See Table 2.6 Lossless JPEG SCP None Table 2.7 Presentation Context Table. SCP None None Date: September 1,

15 3. Communication Profiles This section describes the communication profiles for CMS -View and CMS -Store Supported Communication Stacks (Parts 8,9) The CMS -View and CMS -Store applications provide DICOM V3.0 TCP/IP Network Communication Support as defined in Part 8 of the DICOM standard TCP/IP Stack The CMS -View and CMS -Store applications will inherit the TCP/IP stack from the Microsoft Windows-NT V4.0 system upon which they execute API Not applicable Physical media support The CMS -View and CMS -Store applications are indifferent to the physical medium over which TCP/IP executes Point-to-Point Stack Not applicable. Date: September 1,

16 4. Extensions This section describes the extended SOPs and private syntaxes used by the CMS - View and CMS -Store applications, according to PS Extended SOPs None Private Transfer Syntaxes None. Date: September 1,

17 5. Configuration This section describes the configuration parameters for the CMS -View and CMS - Store applications AE Title and Presentation Address Mapping Configurable remote AE Titles and Presentation Addresses Within the CMS -View application, DICOM Messaging Configuration sets must be defined. A DICOM Messaging Configuration set consists of the parameters for the source and destination locations that are used during a Query and Retrieve session as well as a Storage session. The DICOM role of the CMS -View application must be specified here; either Query Retrieve Service Class User or Storage Service Class User. CMS -Store owns a list of registered DICOM nodes, which is used as a look up list. The CMS -Store AE will only accept association requests from DICOM nodes that have been added to the DICOM node list. The DICOM nodes may be running on the local machine or anywhere in the network environment. Both the DICOM Messaging Configurations and the registered DICOM nodes can be dynamically added and removed from the system in the Options dialog of the application (users with administrator rights only). The settings are stored in the Windows-NT registry and are loaded at the start of the program and stored just before exiting Configurable Parameters Configurable Parameters of CMS -View The following parameters may be configured for CMS -View: Application Entity title Timeout value (default value CMS-AETITLE) (default 60 seconds) The values of the parameters can be changed from the Messaging pane of the Options dialog. The values are stored in the Windows-NT registry and are loaded at the start of the program and stored just before exiting Configurable Parameters of CMS -Store The following parameters may be configured for CMS -Store: Application Entity title Port number (default 104) Timeout value (default value CMS-AETITLE) (default 60 seconds) Date: September 1,

18 The values of the parameters can be changed from the Options dialog in both applications. The values are stored in the Windows-NT registry and are loaded at the start of the program and stored just before exiting. Date: September 1,

19 6. Support of Extended Character Sets CMS -View and CMS -Store support extended character set ISO_IR 100 which is the Latin alphabet No 1, supplementary set. Date: September 1,

20 7. Specification of Applied IODs The modules of the supported IODs CMS -View and CMS -Store are described here. For all supported modules, the attributes are defined in the DICOM standard PS Applied Modules in the XA Image IOD The applied modules in the XA Image IOD module are given in Table 7.1. Information Entity Module Reference to P3.3 Usage Patient Patient C M Study General Study C M Patient Study C U Series General Series C M Equipment General Equipment C M Image General Image C M Image Pixel C M Contrast/Bolus C C Required if contrast media was used in this image Cine C C Required if pixel data is Multi-Frame Cine data Multi-Frame C C Required if pixel data is Multi-Frame Cine data Frame Pointers C U Mask C C Required if the Image may be subtracted Device C U Therapy C U XA Image C M X-ray Acquisition C M XA Positioner C M Curve C.10.2 U Modality LUT C.11.1 C Required if Pixel Intensity Relationship is LOG U Options if Pixel Intensity Relationship is DISP VOI LUT C.11.2 U Table 7.1. Applied Modules in the XA Image IOD. Date: September 1,

21 CMS-View 7.2. Applied Modules in the Ultrasound Multi-Frame Image IOD The applied modules in the Ultrasound Multi-Frame Image IOD module are given in Table 7.2. Information Entity Module Reference to PS 3.3 Usage Patient Patient C M Study General Study C M Patient Study C U Series General Series C M Frame of Reference Frame of Reference C U US Frame of Reference C C Required if images are spatially related Equipment General Equipment C M Image Curve General Image C M Image Pixel C M Contrast/Bolus C C Required if contrast media was used in this image Cine C M Multi-Frame C M Palette Color Lookup Table US Region Calibration C.7.9 C C Required if Photometric Interpretation has a value of PALETTE COLOR US Image C M VOI LUT C.11.2 U SOP Common C.12.1 M Curve Identification C.10.1 M Curve C.10.2 M Audio C.10.3 U SOP Common C.12.1 M Table 7.2. Applied Modules of the US Multi-Frame Image IOD. U Date: September 1,

22 CMS-View 7.3. Applied Modules in the Basic Directory IOD The applied modules in the Basic Directory IOD are given in Table 7.3. Information Entity Module Reference to PS 3.3 Usage DICOMDIR File-Set Identification Directory Information F F Table 7.3. Applied Modules of the Basic Directory IOD. M U Date: September 1,

23 8. Extensions to Part PS 3.3 for QCA 8.1. Calibration The frames within an image run can be calibrated by applying a calibration method to one of the frames. The attributes used for the identification of the calibration method are described in Table 8.1 Calibration (7111,0010) 3 Calibration tag describing that a calibration method has been applied. Calibration Version Number (7111,1011) 1C The version number of the calibration module used. Required if Calibration (7111,0010) is present. Table 8.1 Calibration Sequence The used calibration method and the calibration factor are described in Table 8.2. Calibration Real Calibration True Calibration Method Calibration Factor (7111,1021) 3 The real (measured) diameter (in pixels) of the calibration object. (7111,1022) 3 The true (given) diameter (in mm) of the calibration object. (7111,1023) 1C The method of calibration is described. The following methods are supported: CATHETER, GRID, ISOCENTER, MANUAL, SPHERE, MARKERCATHETER. Required if Calibration (7111,0010) is present. (7111,1024) 1C The calibration factor (in mm / pixel), determined by dividing True by Real. Required if Calibration (7111,0010) is present. Table 8.2 Calibration Attributes Date: September 1,

24 The frame selection attributes are described in Table 8.3. Calibration Frame Number Calibration Frame Selection Date Calibration Frame Selection Time Calibration Frame Analyst Name Calibration Frame Description Calibration Original Frame Number (7111,1031) 1C The frame number for the calibration. Required if Calibration (7111,0010) is present. (7111,1032) 1C The date of the frame selection. Required if Calibration (7111,0010) is present. (7111,1033) 1C The time of the frame selection. Required if Calibration (7111,0010) is present. (7111,1034) 3 The name of the analyst who did the frame selection for the calibration. (7111,1035) 3 The description of the calibration frame, added by the analyst. (7111,1036) 3 The frame number selected for the calibration, as defined in the original source of the image data. (see description) Table 8.3 Calibration Frame Selection Parameters. When the catheter calibration method was used, additional information is stored, as described in Table 8.4. Mean (7111,1041) 3 Mean diameter (in mm) of the measured catheter. Pathline Proximal Point Pathline Distal Point Pathline Support Point (7111,1042) 3 The proximal point of the pathline analysis. (7111,1043) 3 The distal point of the pathline analysis. (7111,1044) 3 The support point of the pathline analysis. Pathline Contour (7111,1045) 3 The detected pathline through the catheter. Date: September 1,

25 Left Reference Contour Right Reference Contour (7111,1046) 3 Left reference contour description. (7111,1047) 3 Right reference contour description. Table 8.4 Catheter Attributes. When the grid calibration method was used, additional information is stored, as described in Table 8.5. Number of Grid Lines (7111,1051) 3 The number of lines drawn on the grid. Grid Lines Mean (7111,1052) 3 Mean line length (in mm). Grid Lines Error (7111,1053) 3 The error, indicating the differences between the line lengths. Grid Lines (7111,1054) 3 The coordinates of the lines drawn on the grid. Minimal Grid Lines Length Maximal Grid Lines Length (7111,1055) 3 Smallest line length (in mm). (7111,1056) 3 Largest line length (in mm). Table 8.5 Grid Attributes. When the sphere calibration method was used, additional information is stored, as described in Table 8.6. Sphere (7111,1061) 3 The sphere diameter. Sphere Center (7111,1062) 3 The coordinates of the sphere center. Sphere Radius (7111,1063) 3 The sphere radius. Table 8.6 Sphere Attributes Caliper Line Measurement Line measurements can be applied to each of the frames within an image run. The line measurement results are described in Table 8.7. Date: September 1,

26 Line Measurement Measurement Version Number (7113,0010) 3 Measurement result tag describing that caliper line measurements are stored. (7113,1011) 1C Version number of the measurement module used. Required if Line Measurement (7113,0010) is present. Table 8.7 Line Measurement Sequence Line measurements can be made on each frame within an image run. The frames on which is measured are described in Table 8.8. Measurement Frames Sequence (7113,1099) 3 Measurement sequence describing the frames onto which was measured. Table 8.8 Line Measurement Frames Sequence 8.3. Caliper Line Measurement Sequence Line measurements can be applied to each of the frames within an image run. Each individual frame is started with the Line Measurement Frame delimiter, described in Table 8.9. Each frame is further uniquely identified by the Measurement UID. Measurement Frame Measurement UID (7113,0010) 3 Measurement frame describing an individual frame that was measured. (7113,1010) 1C UID for the identification of the line measurement. Required if Measurement Frame (7113,0010) is present. Table 8.9 Line Measurement Frame. The frame selection attributes are described in Table Measurement Frame Number Measurement Frame Selection Date Measurement Frame Selection (7113,1021) 1C The selected frame number for the line measurement. Required if Measurement Frame (7113,0010) is present. (7113,1022) 1C The date of the frame selection. Required if Measurement Frame (7113,0010) is present. (7113,1023) 1C The time of the frame selection. Required if Measurement Frame Date: September 1,

27 Time Measurement Analyst Name Measurement Description Measurement Original Frame Number (7113,0010) is present. (7113,1024) 3 The name of the analyst who did the frame selection for the line measurement. (7113,1025) 3 The description of the line measurement frame, added by the analyst. (7113,1026) 3 The frame number selected for the line measurement, as defined in the original source of the image data. (see description) Table 8.10 Line Measurement Frame Selection Parameters. The results of a caliper line measurement are described in Table 8.11, storage of these results is optional. Measurement Name (7113,1031) 3 The (user defined) name of the line measurement. Number of Lines (7113,1032) 3 The number of lines that are used for the line measurement. Minimal Length (7113,1033) 3 Smallest line length. Maximal Length (7113,1034) 3 Largest line length. Mean Length (7113,1035) 3 Mean line length. Standard Deviation Length Measurement Lines (7113,1036) 3 Standard deviation of all measured line lengths. (7113,1037) 3 The coordinates of the lines used for the measurement. Table 8.11 Line Measurement Result Parameters Caliper Angle Measurement Angle measurements can be applied to each of the frames within an image run. The line measurement results are described in Table 8.7. Angle Measurement (7115,0010) 3 Measurement result tag describing that caliper angle measurements are stored. Date: September 1,

28 Measurement Version Number (7115,1011) 1C Version number of the measurement module used. Required if Angle Measurement (7115,0010) is present. Table 8.12 Angle Measurement Sequence Angle measurements can be made on each frame within an image run. The frames on which is measured are described in Table 8.8. Measurement Frames Sequence (7115,1099) 3 Measurement sequence describing the frames onto which was measured. Table 8.13 Angle Measurement Frames Sequence 8.5. Caliper Angle Measurement Sequence Angle measurements can be applied to each of the frames within an image run. Each individual frame is started with the Angle Measurement Frame delimiter, described in Table 8.9. Each frame is further uniquely identified by the Measurement UID. Measurement Frame Measurement UID (7115,0010) 3 Measurement frame describing an individual frame that was measured. (7115,1010) 1C UID for the identification of the angle measurement. Required if Measurement Frame (7115,0010) is present. Table 8.14 Angle Measurement Frame. The frame selection attributes are described in Table Measurement Frame Number Measurement Frame Selection Date Measurement Frame Selection Time (7115,1021) 1C The selected frame number for the measurement. Required if Measurement Frame (7115,0010) is present. (7115,1022) 1C The date of the frame selection. Required if Measurement Frame (7115,0010) is present. (7115,1023) 1C The time of the frame selection. Required if Measurement Frame (7115,0010) is present. Date: September 1,

29 Measurement Analyst Name Measurement Description Measurement Original Frame Number (7115,1024) 3 The name of the analyst who did the frame selection for the angle measurement. (7115,1025) 3 The description of the angle measurement frame, added by the analyst. (7115,1026) 3 The frame number selected for the angle measurement, as defined in the original source of the image data. (see description) Table 8.15 Angle Measurement Frame Selection Parameters. The results of a caliper angle measurement are described in Table 8.11, storage of these results is optional. Measurement Name (7115,1031) 3 The (user defined) name of the angle measurement. Angle (7113,1032) 3 Measured angle. Measurement Angle (7113,1033) 3 The coordinates of the points used for the angle. Table 8.16 Angle Measurement Result Parameters Caliper Contour Measurement Contour measurements can be applied to each of the frames within an image run. The contour measurement results are described in Table 8.7. Contour Measurement Measurement Version Number (7117,0010) 3 Measurement result tag describing that caliper contour measurements are stored. (7117,1011) 1C Version number of the measurement module used. Required if Contour Measurement (7117,0010) is present. Table 8.17 Contour Measurement Sequence Contour measurements can be made on each frame within an image run. The frames on which is measured are described in Table 8.8. Date: September 1,

30 Measurement Frames Sequence (7117,1099) 3 Measurement sequence describing the frames onto which was measured. Table 8.18 Contour Measurement Frames Sequence 8.7. Caliper Contour Measurement Sequence Contour measurements can be applied to each of the frames within an image run. Each individual frame is started with the Contour Measurement Frame delimiter, described in Table 8.9. Each frame is further uniquely identified by the Measurement UID. Measurement Frame Measurement UID (7117,0010) 3 Measurement frame describing an individual frame that was measured. (7117,1010) 1C UID for the identification of the contour measurement. Required if Measurement Frame (7117,0010) is present. Table 8.19 Contour Measurement Frame. The frame selection attributes are described in Table Measurement Frame Number Measurement Frame Selection Date Measurement Frame Selection Time Measurement Analyst Name Measurement Description Measurement Original Frame Number (7117,1021) 1C The selected frame number for the measurement. Required if Measurement Frame (7117,0010) is present. (7117,1022) 1C The date of the frame selection. Required if Measurement Frame (7117,0010) is present. (7117,1023) 1C The time of the frame selection. Required if Measurement Frame (7117,0010) is present. (7117,1024) 3 The name of the analyst who did the frame selection for the measurement. (7117,1025) 3 The description of the measurement frame, added by the analyst. (7117,1026) 3 The frame number selected for the measurement, as defined in the original source of the image data. (see description) Date: September 1,

31 Table 8.20 Contour Measurement Frame Selection Parameters. The results of a caliper line measurement are described in Table 8.11, storage of these results is optional. Measurement Name (7117,1031) 3 The (user defined) name of the measurement. Contour Length (7117,1032) 3 Length of the measured contour. Contour Area (7117,1033) 3 Area enclosed by the measured contour. Contour (7117,1034) 3 The measured contour. Table 8.21 Contour Measurement Result Parameters QCA Analysis QCA can be applied to each of the frames within an image run. The QCA results are described in Table QCA Analysis (7311,0010) 3 QCA result tag describing that QCA analyses are stored. QCA Analysis Version Number (7311,1011) 1C Version number of the QCA analysis module used. Required if QCA Analysis (7311,0010) is present. Table 8.11 QCA Result Sequence. QCA results are calculated given a number of (default) settings. The QCA settings are described in Table Mean Aortic Pressure Maximal Coronary Flow Coronary Flow Velocity (7311,1021) 1C The mean aortic pressure used during the flow calculations. Required if QCA Analysis (7311,0010) is present. (7311,1022) 1C The maximal coronary flow used during the flow calculations. Required if QCA Analysis (7311,0010) is present. (7311,1023) 1C The coronary flow velocity used during the flow calculations. Date: September 1,

32 Velocity Required if QCA Analysis (7311,0010) is present. Table 8.12 QCA Settings Parameters. QCA can be applied to each frame within an image run. The frames on which QCA is applied are described in Table QCA Analyzed Frames Sequence (7311,1099) 3 QCA segment sequence describing the frames onto which QCA was applied. Table 8.13 QCA Analyzed Frames Sequence QCA Analyzed Frames Sequence QCA can be applied to each of the frames within an image run. Each individual frame is started with the QCA Frame delimiter, described in Table Further, each frame is uniquely identified by the QCA Analysis UID. QCA Frame (7313,0010) 3 QCA frame describing an individual frame to which QCA was applied. QCA Analysis UID (7313,1010) 1C UID for the identification of the QCA analysis. Required if QCA Frame (7313,0010) is present. Table 8.14 QCA Frame. The frame selection attributes are described in Table Frame Selection Number Frame Selection Date Frame Selection Time Frame Selection Analyst Name (7313,1021) 1C The selected frame number for QCA. Required if QCA Frame (7313,0010) is present. (7313,1022) 1C The date of the frame selection. Required if QCA Frame (7313,0010) is present. (7313,1023) 1C The time of the frame selection. Required if QCA Frame (7313,0010) is present. (7313,1024) 3 The name of the analyst who did the frame selection. Frame Selection D i ti (7313,1025) 3 The description of the frame selection, dd d b th l t Date: September 1,

33 Description Frame Selection Original Number added by the analyst. (7313,1026) 3 The frame number selected for QCA, as defined in the original source of the image data. (see description) Table 8.15 Frame Selection Parameters. Original Frame Numbering The frame number is based on the images actually stored in this DICOM file or message. The original source and with that the original numbering can be lost this way. When working with an analog input (cinefilm), the original frame numbering is not available at all. Therefore, the original frame number can be stored, and can be especially useful in case this frame number is needed for reanalysis on the original image source later. The original frame number is always greater than zero. QCA can be applied to each segment visible within a selected frame. The segments onto which QCA is applied are described in Table QCA Analyzed Segments Sequence (7313,1099) 3 QCA segment sequence describing the segments onto which QCA was applied. Table 8.16 QCA Analyzed Segments Sequence QCA Segment Sequence QCA can be applied to each segment visible in the frame. The QCA segments are described in Table Further, each segment is uniquely identified by the QCA Segment UID. QCA Segment (7315,0010) 3 QCA segment describing an individual segment to which QCA was applied. QCA Segment UID (7315,1010) 1C UID for the identification of the QCA segment. Required if QCA Segment (7315,0010) is present. Table 8.17 QCA Segment. The general information for an analyzed segment is described in Table Segment System (7315,1020) 1C The standardization system used for the naming and numbering of the arterial Date: September 1,

34 segments. Allowed system names are: AHA, CASS, OTHER. (see description) Required if QCA Segment (7315,0010) is present. Segment Name (7315,1021) 1C The name of the segment. Standardized names are used according to the segment system used. Required if QCA Segment (7315,0010) is present. Segment Number (7315,1022) 1C The number of the segment. Numbers are standardized according to the AHA. Required if QCA Segment (7315,0010) is present. Segment Date (7315,1023) 1C The date of the analysis. Required if QCA Segment (7315,0010) is present. Segment Time (7315,1024) 1C The time of the analysis. Required if QCA Segment (7315,0010) is present. Segment Analyst Name Segment Analyst Comment Segment Phase Label (7315,1025) 3 The name of the performing analyst. (7315,1026) 3 Comment of the performing analyst. (7315,1027) 1C The name of the phase/stage of this analyzed segment Table 8.18 Segment General Parameters. Standardization of the Length of the Arterial Segment To guarantee a reproducible assessment of the morphology of coronary arterial segments, such segments should be selected in a standardized manner. Currently allowed naming systems are AHA, CASS and OTHER. The American Heart Association (AHA) system is used only in this version of the QCA-CMS. According to the recommendations by the AHA, the following coronary segments are distinguished: the Right Coronary Artery (RCA), the Main, the Left Anterior Descending artery (LAD) and the Left Circumflex artery (LCX). RCA LAD LCX 1. Proximal 6. Proximal 11. Proximal 2. Mid 7. Mid 12. Obtuse 3. Distal 8. Distal Marginal branch Date: September 1,

35 4. Posterior Descending 9. Diagonal branch Distal 10. Diagonal branch 2 5. LCA Main The segment pathline is calculated given two or three points. The pathline points are represented by a pair of double values. The pathline itself consists of a number of such points. Both are described in Table 8.19, storage of the parameters is optional. Pathline Proximal Point Pathline Distal Point Pathline Support Point (7315,1031) 3 The proximal point of the pathline analysis. (7315,1032) 3 The distal point of the pathline analysis. (7315,1033) 3 The support point of the pathline analysis. Pathline Contour (7315,1034) 3 The detected pathline through the vessel segment. Table 8.19 Pathline Parameters. The quantitative results for an analyzed segment are described in Table 8.20, storage of these results is optional. Cross-sectional areas are calculated from their corresponding diameter values, assuming a circular cross section. Minimal Maximal (7315,1051) 3 Smallest diameter of analyzed segment. (7315,1052) 3 Largest diameter of analyzed segment. Mean (7315,1053) 3 Mean diameter of the vessel segment. Standard Deviation (7315,1054) 3 Standard deviation of all measured diameters in the vessel segment. Minimal Area (7315,1055) 3 Smallest cross-sectional area of analyzed segment. Maximal Area (7315,1056) 3 Largest cross-sectional area of analyzed segment. Mean Area (7315,1057) 3 Mean cross-sectional area of segment. Date: September 1,

36 Standard Deviation Area (7315,1058) 3 Standard deviation of all measured cross-sectional areas in the segment. Vessel Length (7315,1059) 3 Length of the vessel segment. Vessel Area (7315,1060) 3 Longitudinal area of the vessel segment. GFT Used (7315,1061) 1C Named parameter if a GFT is used for the contour detection. Flagging Used (7315,1062) 1C Named parameter if Flagging is used for calculating the reference diameter. Table 8.20 Segment Quantitative Parameters. The quantitative results for an analyzed segment are calculated from two sets of contours (arterial and reference) consisting of a left and a right contour. These contour sets are described in Table 8.21, storage of these structures is optional. Left Arterial Contour Right Arterial Contour Left Reference Contour Right Reference Contour (7315,1071) 3 Left arterial contour description. (7315,1072) 3 Right arterial contour description. (7315,1073) 3 Left reference contour description. (7315,1074) 3 Right reference contour description. Table 8.21 Segment Contours. Further, the measured diameters between these contour sets are described in Table 8.22, storage of these structures is again optional. Arterial Function Left Arterial Contour Indices Right Arterial Contour Indices (7315,1081) 3 Arterial diameter function. A set of measured diameters between left and right arterial contours. * (7315,1082) 3 Indices of the arterial diameter function into the left arterial contour. (7315,1083) 3 Indices of the arterial diameter function into the right arterial contour. Date: September 1,

37 Reference Function Left Reference Contour Indices Right Reference Contour Indices Segment Flagging (7315,1084) 3 Reference diameter function. A set of measured diameters between left and right reference contours. * (7315,1085) 3 Indices of the reference diameter function into the left reference contour. (7315,1086) 3 Indices of the reference diameter function into the right reference contour. (7315,1087) 3 Parts of arterial segment flagged out for calculation of reference diameter. * Note that the lengths do not take the aspect ratio or the calibration factor into account. Table 8.22 Segment Functions. QCA can be used for a number of obstructions in a segment. The QCA obstruction sequence is described in Table QCA Obstructions Sequence (7315,1099) 3 QCA obstructions sequence describing the obstructions that were analyzed. Table 8.23 QCA Obstruction Sequence QCA Obstructions Sequence More than one obstruction can be analyzed within an arterial segment. The QCA obstructions are described in Table Each obstruction is further uniquely identified by the QCA Obstruction UID. QCA Obstruction QCA Obstruction UID (7317,0010) 3 QCA obstruction describing a single obstruction within a segment. (7317,1010) 1C UID for the identification of the QCA obstruction. Required if QCA Obstruction (7317,0010) is present. Table 8.24 QCA Obstruction. The general information for an analyzed obstruction is described in Table The label of an obstruction is optional. Obstruction Lbl (7317,1021) 3 The label of the obstruction. Labels are ti l Date: September 1,

38 Label Obstruction Method optional. (7317,1022) 1C The method used for positioning the lesion marker. Allowed methods are: RELATIVE, ABSOLUTE, MANUAL. Required if QCA Obstruction (7317,0010) is present. Proximal (7317,1023) 3 The position of the proximal marker, an index in the Arterial Function described in (7315,1081). Lesion (7317,1024) 3 The position of the lesion marker, an index in the Arterial Function described in (7315,1081). Distal (7317,1025) 3 The position of the distal marker, an index in the Arterial Function described in (7315,1081). Reference (7317,1026) 3 The position of the reference marker, an index in the Reference Function described in (7315,1084). Table 8.25 Obstruction General Parameters. Date: September 1,