Mammography Image Integration Profile Carolyn Reynolds Hologic Inc

Mammography Image Integration Profile Carolyn Reynolds Hologic, Inc. Vendor co-chair, IHE Mammography Committee IHE Workshop – June 2006 1

Mammography Image The Problem/Assumptions What’s the big deal? Full Field Digital Mammography (FFDM) is just another modality to PACS Most existing PACS will handle FFDM fine once: Ø the FDA approves the monitor hardware, Ø and workstations have 510 K approval for FFDM applications IHE Workshop – June 2006 2

Mammography Image Not just another modality! What makes it different or challenging: Ø Two types of image data Ø Variances among vendors in image data and attributes Ø Common use of CAD (Computer Aided Detection) Ø Importance of prior study comparisons Ø Image size, orientation, & layout Ø Regional governance such as MQSA (Mammography Quality Standards Act – USA) IHE Workshop – June 2006 3

Mammography Image Use Case Modality Archive Workstation CAD “For Presentation” Image Data “For Processing” Image Data Mammo CAD Structured Rpt IHE Workshop – June 2006 Printer 4

Hanging Protocol Differences Example Preferred Layout Hanging protocol determined by: v. View Type (i. e. CC vs. MLO) R CC L CC R MLO v. Specialty View Type (i. e. Spot, Mag) L MLO v. Laterality v. Patient Orientation IHE Workshop – June 2006 5

Generic Image Display Layouts Applied to Mammo Images v. Hanging based upon series or study descriptions v. Image order as acquired v. Image orientation as acquired R CC v. Stacked series example L CC L MLO IHE Workshop – June 2006 R MLO 6

Variances in FFDM Vendor Data Detector Size Example Typical “Fit to Viewport” effect R L Prior Exam from Vendor A’s system R L Current Exam from Vendor B’s system v. Different resolution v. Different pixel matrix IHE Workshop – June 2006 7

Workstation Tool Enhancements Tissue vs. Air Detection Example Window/Center Adjustments IHE Workshop – June 2006 8

Printing Considerations True Size 10 in x 12 in Film size 8 inx 10 in Film size Precision of <2% error IHE Workshop – June 2006 Film size vs. Detector Size 9

Printing Considerations Positioning-minimal borders at chestwall Centered images can create large borders at chestwall IHE Workshop – June 2006 Image offset with chestwall side having minimal borders 10

Mammography Image Integration Value proposition Helps meet desire to have multiple FFDM vendors and use any vendor’s workstation for diagnosis Ensures that FFDM modalities provide adequate information to facilitate downstream applications IHE Workshop – June 2006 11

Mammography Image Integration Value proposition Ensures systems support required data objects for interoperability Defines image display and printing operations required for effective and efficient diagnoses IHE Workshop – June 2006 12

Mammography Image Integration Scope Based upon existing actors and transactions Expanded requirements within each transaction Actors Acquisition Modality Transactions Optionality Section in Vol. 2/3 Modality Images Stored [RAD-8] R 4. 8 Storage Commitment [RAD-10] R 4. 10 Evidence Document Stored R 4. 43 Storage Commitment [RAD-10] R 4. 10 Modality Images Stored [RAD-8] R 4. 8 Evidence Document Stored R 4. 43 Storage Commitment [RAD-10] R 4. 10 Query Images [RAD-14] R 4. 14 Retrieve Images [RAD-16] R 4. 16 Query Evidence Documents [RAD-44] R 4. 44 Retrieve Evidence Documents [RAD-45] R 4. 45 Print Composer Print Request with Presentation LUT [RAD-23] R 4. 23 Print Server Print Request with Presentation LUT [RAD-23] R 4. 23 Evidence Creator Image Manager/Archive Image Display IHE Workshop – June 2006 13

Mammography Image Integration Scope IHE Workshop – June 2006 14

Mammography Image Expanded Requirements Acquisition Modality Ø Send both for processing and for presentation images with reference that ties them together Ø Additionally required DICOM attributes Ø Detection and indication of tissue vs. air gap Ø Partial View Option (breast is larger than detector) Ø Modified requirements for film digitizers IHE Workshop – June 2006 15

Mammography Image Expanded Requirements Image Display Ø Hanging protocols based upon view, laterality, patient orientation, and specialty views Ø Maintain a black air gap during window/center operations and inverted pixel data Ø Sizing • • • Same relative size True size 1: 1 detector pixels to display pixels IHE Workshop – June 2006 16

Mammography Image Expanded Requirements Image Display cont’d Ø Measurement calculation requirements Ø Display calibration and grayscale rendering Ø Labeling requirements Ø Mammo CAD Structured Report rendering on “for presentation” images Ø Partial View Option (breast larger than detector) IHE Workshop – June 2006 17

Mammography Image Expanded Requirements Image Manager Ø Storage and retrieval of For Presentation and For Processing SOP Classes for Digital Mammography XRay Ø Storage and retrieval of Mammography CAD Structured Report SOP Class IHE Workshop – June 2006 18

Mammography Image Expanded Requirements Evidence Creator (CAD) Ø Support for Mammography CAD SR SOP Class and Storage Commitment Ø No specifics on how Evidence Creator obtains mammography images IHE Workshop – June 2006 19

Mammography Image Expanded Requirements Print Composers/Print Servers Ø True Size printing (Requested Image Size) Ø Justify chestwall and print with 5 mm borders or less Ø Render VOI LUTS if present Ø Specify/Support maximum density Ø Specify/Support Presentation LUT Ø Labeling requirements Ø Support for 12 bit pixel depth IHE Workshop – June 2006 20

Mammography Image Questions? ? ? IHE Workshop – June 2006 21

IHE Workshop – June 2006 22