<H3>Special Instructions</H3><p> <p>Image Display please use the <em><a href=system_con_object.php>Objects Information</a></em> page to find out what your peers have uploaded on the central archive </p>  <p>This tests focuses on the requirements for display of NM Images for Image Display actors which support the Cardiac NM Option. When entering results for this test in Kudu, the Image Display should initiate an instance of this test when the results are complete. This allows you to also give credit to the Acquisition Modality which supplied the images without locking that system out of other testing while the Image Display is working on the rendering and evaluation.</p> <p>A clinical expert will evaluate this test. The representative of the Image Display system is responsible for arranging a time for him/her to do the evaluation with you.</p> </p>  <H3>Description</H3> <p>The NMI_MOD_Display_Cardiac_NM_Option test is used to determine if the Acquisition Modality is entering the proper data in the DICOM NM images, and to determine if the Image Display is rendering the images properly. Several types of datasets will be required for this test. The Image Display can retrieve sample images which the Modality stored to the Connectathon CENTRAL_ARCHIVE in test NMI_MOD_Store. Alternatively, the Modality can send images directly to the workstation (DICOM C-STORE, though not an IHE transaction in the NMI profile</p>  <H3>Evaluation</H3>  <p>Connectathon Monitors may find it helpful to dump the DICOM header in the images when evaluating this test.  Use Image Display to dump DICOM headers and to display images. If the Image Display cannot dump the DICOM header, we will find another method to check attribute values.</p>  <p>Problems identified during each evaluation step should be noted in the Kudu chat window.</p><p>(1) These requirement are specific to the Cardiac NM option.</p> <p> Depending on the test images available, or other factors, the Connectathon Monitor <strong>may choose to evaluate a subset of the items listed below</strong>.</p>  <p> The Connectathon Monitor <strong>will ask the Image Display to demonstrate that</strong>:</p>  <ul> <li>E24: it can take a cardiac short axis data set and generate the corresponding vertical long axis, and horizontal long axis data sets.  For each axis, multiple frames are displayed, in a left-to-right (preferred) or top-to-bottom format.</li> <li>E25: when two SPECT image sets are compared, they are displayed simultaneously as a series of frames, either one above the other (preferred) or one next to the other.</li> <li>E26: short axis data is displayed as serial frames with the apical slices first, progressing from the cardiac apex to the base of the heart.  The heart shall be displayed with the following orientation: <ul> <li>E27: short axis data is  displayed as serial frames with the apical slices first, progressing from the  cardiac apex to the base of the heart.   The heart shall be displayed with the following orientation:</li> </ul> </li> </ul><pre> Anterior wall Septum    (heart)     Lateral wall Inferior wall </pre>  <ul> <li>E27: short axis slices are labeled to convey they are “Short axis, apex to base”.  </li> <li>E28: vertical long axis data is displayed as serial frames with the septal slices first, progressing to the lateral wall.  The heart shall be displayed with the following orientation:</li> </ul><pre> Anterior wall  Base    (heart)     Apex Inferior wall </pre>  <ul> <li>E29: vertical long axis slices are labeled to convey they are “Vertical long axis, septal to lateral”.</li> <li>E30: horizontal long axis data is displayed as serial frames with the inferior slices first, progressing to the anterior wall.   The heart shall be displayed with the following orientation:</li> </ul>  <pre>     Apex Septum    (heart)     Lateral Wall     Base </pre>  <ul> <li>E31: horizontal long axis slices are labeled to convey they are “Horizontal long axis, inferior to anterior”. </li> <li>E32: images with the value of "ATTN" (i.e. Attenuation Corrected) in Corrected Image (0028,0051) are labeled as such.</li> <li>E33: images with the value of "prone" in the Patient Orientation Modifier Code Sequence (0054,0412) are labeled as such.</li> <li>E34: it allows the user to window the Stress data independently of the Rest data, such that windowing affects all displayed Stress frames in the short and long axis views.</li> <li>E35: it allows the user to window the Rest data independently of the Stress data, such that windowing affects all displayed Rest frames in the short and long axis views.</li> <li>E36: it allows the user to window both Stress and Rest simultaneously in a manner that preserves the relative scaling of the two datasets.    In other words, when  both images are selected and the desired window is changed, the changes occur in a proportional manner for each image.  </li>  <p>Note:  The following example is included in RAD TF-2:4.16.4.2.2.3.2:  The stress image is displayed with a window settings of (0,100), corresponding to the lower and upper window levels.  The rest image is displayed with window settings of (0,50).  The user adjusts the stress upper level to yield a window setting of (0,120).  The user then selects both the stress and rest images, and adjusts the windowing to perform a 10% background subtraction on both images simultaneously, resulting in (12,120) for the stress image set, and (5,50) for the rest image set.  Thus the relative scaling of the two images is preserved during this last adjustment.</p>  <li>E37: allows the user to  adjust the Stress and Rest frame positions so that corresponding frames are  displayed. (This typically appears as  sliding one row of frames to the right or to the left.)</li> <li>E38: the display order  of the data sets follows the profile requirements. Regardless of the order in which the data  sets were selected by the user, the display order in the ACC NM Cardiac Display  is determined by the Patient State (the value is stored within the Acquisition Context Sequence (0040,0555) in  the Concept Code sequence (0040,A168)).  </li> </ul>  <p>The display order for different Patient   State values is as  follows:</p> <ol> <li>Cardiac Stress</li> <li>Resting, Reinjection</li> <li>Redistribution</li> <li> Delayed Redistribution</li> </ol>  <p>  Note: If the  user selects two data sets with the same Patient State,  the display order is undefined. </p>  <ul> <li>E39: the value of Patient State for each data set is displayed.</li> </ul> <p>Note: The following example is included in RAD  TF-2:4.16.4.2.2.3.2: A typical set of cardiac images will include one Cardiac  Stress short axis image, and because it has highest precedence in the above  list, it is placed into the first image position in the ACC NM Cardiac  Display. Images are typically selected  in pairs, and the pair of selected data sets will typically include a Cardiac  Stress data set, which is therefore placed in the first position in the  ACC NM Cardiac Display, and a Cardiac Rest data set, which is placed in the  second position ( in the ACC NM Cardiac display. If the selected data sets consist of only a  rest image and a redistribution image, then the rest image is placed into the  first position, since it has the highest precedence.</p>  <ul> <li>E40: it is able to perform multiplanar reconstruction (MPR)  of two re-oriented (short axis) cardiac RECON TOMO data sets to display the  data in the standard format endorsed by the American College  of Cardiology (ACC NM Cardiac Display). </li> <li>E41: is able  to display simultaneously multiple framesets. These may be from the same Image,  different Images, different Series, or different Studies. (The Image Display is not required to display  simultaneously multiple framesets with different Image Types.)</li> <li>E42: for each  Image Type, it displays simultaneously at least the number of framesets  required in the Cardiac NM Option column of RAD TF-2: Table 4.16-1</li> </ul> 