This page is part of the IHE Interactive Multimedia Report (IMR) (v1.0.0-comment: Public Comment Ballot 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

2:4.Y5 Display Images [RAD-Y5]

2:4.Y5.1 Scope

This transaction is used to present the images referenced in a multimedia report to someone, such as a radiologist or a clinician, in such a way that permits the user to interact with the images.

This transaction is not a typical IHE transaction between two devices; the primary focus is on the required behavior of the display rather than messaging between two actors. This can be thought of as an “informational transaction” between a display device and a user.

The specification is about the baseline display behaviors required for image references included in multimedia reports. As with many IHE specifications, the display may have behaviors in addition to those required by this transaction.

2:4.Y5.2 Actors Roles

The roles in this transaction are defined in the following table and may be played by the actors shown here:

Table 2:4.Y5.2-1: Actor Roles

Role	Description	Actor(s)
Display	Presents images to a user, such as a radiologist	Report Reader Image Display

Transaction text specifies behavior for each role. The behavior of specific actors may also be specified when it goes beyond that of the general role.

2:4.Y5.3 Referenced Standards

DICOM PS3.3: A. Composite Information Object Definitions

2:4.Y5.4 Messages

Figure 2:3.Y5.4-1: Interaction Diagram

2:4.Y5.4.1 Display Images Message

The Display presents the images referenced in a report to the user.

2:4.Y5.4.1.1 Trigger Events

A user or an automated function determines that one or more images should be presented.

2:4.Y5.4.1.2 Message Semantics

The images are encoded as DICOM SOP instances.

Display of images does not depend on how the images were obtained by the Display.

2:4.Y5.4.1.3 Expected Actions (i.e., Display Requirements)

The behaviors in this section are specified as baseline capabilities. Displays may have additional or alternative capabilities that may be invoked or configured.

This transaction does not specify particular SOP classes that must be displayed.

The Image Display shall display all requested DICOM objects for which it claims compliance in any IHE Content or Workflow profile or DICOM Conformance Statement. This includes images (single frame and multi-frame), DICOM SR (including Evidence Documents and Key Image Notes), and Presentation State objects with their referenced images. All supported DICOM information objects included in the selected studies shall be displayable, except images identified as “for processing”, raw data instances, and instances of private SOP Classes. It is permissible to display “for processing”, raw data instances, and instances of private SOP Classes. There are no specific requirements placed on the manner in which non-image objects are displayed.

Note: Grouping with other profiles, such as CPI, SINR, and KIN, may require more specific behavior for non-image objects.

The Display shall support image viewing capabilities as defined in Basic Image Review (BIR) Profile, Section 4.16.4.2.2.5 as defined in Table 2:4.Y5.4.1.3-1:

Table 2:4.Y5.4.1.3-1: Image Viewing Capability Required in IMR

Capability	BIR Reference	Requirement
Simple Restricted Feature Set	Section 4.16.5.2.2.5.1	Not Required
Layout, Tiling, Selection, Rotation and Flipping	Section 4.16.5.2.2.5.2	Required only Rotation and Flipping
Navigation	Section 4.16.5.2.2.5.3	Not Required
Windowing and Rendering	Section 4.16.4.2.2.5.4	Required
Scrolling	Section 4.16.4.2.2.5.5	Required if IMR Series/Study Navigation Option is supported
Zooming and Panning	Section 4.16.4.2.2.5.6	Required
Laterality and Spatial Cross-Referencing	Section 4.16.4.2.2.5.7	Required only Laterality
Annotation	Section 4.16.4.2.2.5.8	Required
Cine	Section 4.16.4.2.2.5.9	Required if the Display supports sop classes that cine is applicable
Measurements	Section 4.16.4.2.2.5.10	Required
Viewport and Tool Section	Section 4.16.4.2.2.5.11	Not Required
Report Display	Section 4.16.4.2.2.5.12	Not Required
Tool Icons and Actions	Section 4.16.4.2.2.5.13	Not Required

The Display may provide basic viewing tools for the user to interactive with the images.

Note that the Display is only required to display objects specifically referenced in the DiagnosticReport resource.

Multiplanar reconstruction, or MPR, involves the process of converting data from an imaging modality acquired in a certain plane, usually axial, into another plane such as coronal or sagittal or oblique. It is most commonly performed with thin-slice data from volumetric CT in the axial plane, but it may be accomplished with scanning in any plane and whichever modality capable of cross-sectional imaging, including magnetic resonance imaging (MRI).

Although MPR is a feature available in many PACS implementations, it is a advanced operation that is computational intensive. For the interactive image viewing capability on interactive multimedia report, MPR is not expected to be available. If viewing of the images from different planes is desirable, then the acquired data should be reconstructed to other planes and then be saved as separate set of images. These new set of reconstructed images can then be referenced in the DiagnosticReport resource.

The Display is not required to support reconstruction.

2:4.Y5.5 Security Considerations

This transaction involves presenting DICOM objects that typically constitute personal health information (PHI) to human observers who are typically clinicians. Typical access controls and audit trails in accordance with local policies would be appropriate.

2:4.Y5.5.1 Security Audit Considerations

The Radiology Audit Trail Option in the ITI Audit Trail and Node Authentication Profile (ITI TF-1:9) defines audit requirements for IHE Radiology transactions. See RAD TF-3: 5.1.

2:4.Y5.5.2 Display Specific Security Considerations

Since this transaction involves the display of PHI, it may be reasonable for the Displays to implement typical access controls for patient records, such as logins for users and role-based access policies. Since this transaction involves parsing datasets generated by other systems, it may be reasonable for the Displays to implement basic digital hygiene, such as sanitizing datasets to avoid malicious executable scripts that might be executed by a browser-based viewer.