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

1IHE Workshop – June 2006 What IHE Delivers

Carolyn ReynoldsCarolyn Reynolds

Hologic, Inc.Hologic, Inc.

Vendor co-chair, IHE Mammography CommitteeVendor co-chair, IHE Mammography Committee

Mammography Image Mammography Image Integration ProfileIntegration Profile

2IHE Workshop – June 2006IHE Workshop – June 2006

Mammography ImageMammography ImageThe Problem/AssumptionsThe 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: the FDA approves the monitor hardware, and workstations have 510K approval for FFDM

applications


Mammography ImageMammography ImageNot just another modality!Not just another modality!

What makes it different or challenging: Two types of image data Variances among vendors in image data and

attributes Common use of CAD (Computer Aided Detection) Importance of prior study comparisons Image size, orientation, & layout Regional governance such as MQSA

(Mammography Quality Standards Act – USA)


Mammography ImageMammography ImageUse CaseUse Case

ModalityModality

CADCAD

ArchiveArchive WorkstationWorkstation

““For Presentation” Image DataFor Presentation” Image Data““For Processing” Image DataFor Processing” Image DataMammo CAD Structured RptMammo CAD Structured Rpt

PrinterPrinter


Hanging Protocol DifferencesHanging Protocol DifferencesExample Preferred LayoutExample Preferred Layout

Hanging protocol determined by:Hanging protocol determined by:

View Type (i.e. CC vs. MLO)View Type (i.e. CC vs. MLO)

Specialty View Type (i.e. Spot, Mag)Specialty View Type (i.e. Spot, Mag)

Laterality Laterality

Patient OrientationPatient Orientation

R CCR CC L CCL CC

L MLOL MLOR MLOR MLO


Generic Image Display LayoutsGeneric Image Display LayoutsApplied to Mammo ImagesApplied to Mammo Images

Stacked series exampleStacked series example

Hanging based upon series or Hanging based upon series or study descriptionsstudy descriptions

Image order as acquired Image order as acquired Image orientation as acquiredImage orientation as acquired

R MLOR MLO

R CCR CC L CCL CC

L MLOL MLO


Variances in FFDM Vendor DataVariances in FFDM Vendor DataDetector Size ExampleDetector Size Example

RR RRLL LL

RR LL

Prior Exam fromPrior Exam fromVendor A’s systemVendor A’s system

RR LL

Typical “Fit to Viewport” effectTypical “Fit to Viewport” effect

Current Exam fromCurrent Exam fromVendor B’s systemVendor B’s systemDifferent resolutionDifferent resolutionDifferent pixel matrixDifferent pixel matrix


Workstation Tool EnhancementsWorkstation Tool EnhancementsTissue vs. Air Detection ExampleTissue vs. Air Detection Example

Window/Center Adjustments Window/Center Adjustments


Printing ConsiderationsPrinting ConsiderationsTrue SizeTrue Size

Precision of <2% errorPrecision of <2% error

10in x12in10in x12inFilm sizeFilm size

8inx10in8inx10inFilm sizeFilm size

Film size vs. Detector SizeFilm size vs. Detector Size


Printing ConsiderationsPrinting ConsiderationsPositioning-minimal borders at chestwallPositioning-minimal borders at chestwall

Centered images canCentered images cancreate large borders create large borders at chestwallat chestwall

Image offset with Image offset with chestwall side having chestwall side having minimal bordersminimal borders


Mammography Image IntegrationMammography Image IntegrationValue propositionValue 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


Mammography Image IntegrationMammography Image IntegrationValue propositionValue proposition

Ensures systems support required data objects for interoperability

Defines image display and printing operations required for effective and efficient diagnoses


Mammography Image IntegrationMammography Image IntegrationScopeScope

Based upon existing actors and transactions

Expanded requirements within each transactionActors Transactions Optionality Section in Vol. 2/3

Acquisition Modality Modality Images Stored [RAD-8] R 4.8

Storage Commitment [RAD-10] R 4.10

Evidence Creator Evidence Document Stored R 4.43


Image Manager/Archive Modality Images Stored [RAD-8] R 4.8

Evidence Document Stored R 4.43


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

Image Display 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


Mammography Image IntegrationMammography Image IntegrationScopeScope


Mammography ImageMammography ImageExpanded RequirementsExpanded Requirements

Acquisition Modality Send both for processing and for presentation

images with reference that ties them together Additionally required DICOM attributes Detection and indication of tissue vs. air gap Partial View Option (breast is larger than detector) Modified requirements for film digitizers



Image Display Hanging protocols based upon view, laterality, patient

orientation, and specialty views Maintain a black air gap during window/center

operations and inverted pixel data Sizing

• Same relative size• True size• 1:1 detector pixels to display pixels



Image Display cont’d Measurement calculation requirements Display calibration and grayscale rendering Labeling requirements Mammo CAD Structured Report rendering on “for

presentation” images Partial View Option (breast larger than detector)



Image Manager

Storage and retrieval of For Presentation and For Processing SOP Classes for Digital Mammography X-Ray

Storage and retrieval of Mammography CAD Structured Report SOP Class



Evidence Creator (CAD)

Support for Mammography CAD SR SOP Class and Storage Commitment

No specifics on how Evidence Creator obtains mammography images



Print Composers/Print Servers True Size printing (Requested Image Size) Justify chestwall and print with 5mm borders or less Render VOI LUTS if present Specify/Support maximum density Specify/Support Presentation LUT Labeling requirements Support for 12 bit pixel depth


Mammography ImageMammography Image

Questions???
