PP.2 3D Ultrasound Clinical Use Cases
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## PP.2 3D Ultrasound Clinical Use Cases

### PP.2.1 Use Cases

The following use cases consider the situations in which 3D Ultrasound data is produced and used in the clinical setting:

1. An ultrasound scanner generates a Volume Data set consisting of a set of parallel XY planes whose positions are specified relative to each other and/or a transducer frame-of-reference, with each plane containing one or more frames of data of different ultrasound data types. Ultrasound data types include, but are not limited to reflector intensity, Doppler velocity, Doppler power, Doppler variance, etc.

2. An ultrasound scanner generates a set of temporally related Volume Data sets, each as described in Case1. Includes a set of volumes that are acquired sequentially, or acquired asynchronously and reassembled into temporal sequence (such as through the "Spatial-Temporal Image Correlation" (STIC) technique).

3. Any Volume Data set may be operated upon by an application to create one or more Multi-Planar Reconstruction (MPR) views (as in Case7)

4. Any Volume Data set may be operated upon by an application to create one or more Volume Rendered views (as in Case8)

5. Make 3D size measurements on a volume in 3D-space

6. An ultrasound scanner generates 3D image data consisting of one or more 2D frames that may be displayed, including

   1. A single 2D frame

   2. A temporal loop of 2D frames

   3. A loop of 2D frames at different spatial positions and/or orientations positions relative to one another

   4. A loop of 2D frames at different spatial positions, orientations, and/or times relative to one another

7. An ultrasound scanner generates 3D image data consisting of one or more MPR Views that may be displayed as ordinary 2D frames, including

   1. An MPR View

   2. A temporal loop of MPR Views

   3. A loop of MPR Views representing different spatial positions and/or orientations relative to one another

   4. A loop of MPR Views representing different spatial positions, orientations, and/or times relative to one another

   5. A collection of MPR Views related to one another (example: 3 mutually orthogonal MPR Views around the point of intersection)

8. An ultrasound scanner generates 3D image data consisting of one or more Volume Rendered Views that may be displayed as ordinary 2D frames, including

   1. An Rendered View

   2. A temporal loop of Rendered Views

   3. A loop of Rendered Views with a varying observer point

   4. A temporal loop of Rendered Views with a varying observer point

   ### Note

   Images in this group are not normally measurable because each pixel in the 2D representation may be comprised of data from many pixels in depth along the viewing ray and does not correspond to any particular point in 3D-space.

9. Allow successive display of frames in multi-frame objects in cases 6, 7, and 8.

10. Make size measurements on 2D frames in cases 6, 7, and 8.

11. Separation of different data types allows for independent display and/or processing of image data (for example, color suppression to expose tissue boundaries, grayscale suppression for vascular flow trees, elastography, etc.)

12. Represent ECG and other physiological waveforms synchronized to acquired images.

13. Two-stage Retrieval: The clinician initially queries for and retrieves all the images in an exam that are directly viewable as sets of frames. Based on the review of these images (potentially on a legacy review application), the clinician may decide to perform advanced analysis of a subset of the exam images. Volume Data sets corresponding to those images are subsequently retrieved and examined.

14. An ultrasound scanner allows user to specify qualitative patient orientation (e.g., Left, Right, Medial, etc.) along with the image data.

15. An ultrasound scanner may maintain a patient-relative frame of reference (obtained such as through a gantry device) along with the image data.

16. Fiducial markers that tag anatomical references in the image data may be specified along with the image data.

17. Key Images of clinical interest are identified and either the entire image, or one or more frames or a volume segmentation within the image must be tagged for later reference.

### PP.2.2 Hierarchy of Use Cases

This section organizes the list of use cases into a hierarchy. Section PP.3 maps items in this hierarchy to specific solutions in the DICOM Standard.

1. Data

   1. 3D Volume Data

      1. Static and Dynamic volume data sets (Cases 1 and 2)

      2. Suitable for applications that create MPR and Render views (Cases 3 and 4)

      3. 3D size measurements (Case 5)

   2. 2D representations of 3D volume data (Cases 6, 7, and 8)

      1. Static and Dynamic varieties (Case 9)

      2. 2D size measurements (Case 10)

   3. Separation of data types (Case 11)

   4. Integrate physiological waveforms with image acquisition (Case 12)

2. Workflow

   1. Permit Two-step review (Case 13)

      1. Review 2D representations first (potentially on legacy viewer)

      2. On-demand operations on 3D volume data set

   2. Frame of Reference

      1. Frame-relative

      2. Probe-relative

      3. Patient-relative (Cases 14 and 15)

      4. Anatomical (Fiducials) (Case 16)

   3. Identify Key images (Case 17)

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