1. Renate Höcker, Antje Schroeder, Siemens Healthcare IHE Radiology – DBT Supplement Supplement Development Kick-Off

2. Introduction Huge success of MAMMO Image Profile 21 Modalities, 44 Image Manager/Archives, 30 Image Displays in Product Registry Tomosynthesis shares many features with 2D Mammography but has additional specific requirements, which are needed for interoperability Use cases Review DBT Images (simple Usecase) In repeated screening mammography current and prior Mammograms/DBT images are reviewed prior exam was Tomosynthesis prior exam was ordinary digital mammography (FFDM) only current or prior Tomosynthesis also includes FFDM ("combination study") current or prior Tomosynthesis also includes synthetic (MIP) view

3. Scope In addition to functionality defined in MAMMO Storage of digital breast Tomosynthesis image Viewing of breast Tomosynthesis Images Simultaneous review of Tomosynthesis images and mammograms In scope? Out of scope? Storage/Review of Projection X-Ray objects? What are requirements / use cases that mandate support for this object Support of CAD on Tomosynthesis images? Can existing SR templates be used or would new ones be needed Synthetic Images? Partial View? Is this an option to MAMMO or a new profile?

4. DBT Supplement Topic to be addressed in a DBT Supplement: Volume 1 –If option: update Option Table for relevant actors (MOD, IM/IA, ID) –Add use case for Tomosynthesis review including the following scenarios Breast Tomosynthesis Images prior exam was Tomosynthesis prior exam was ordinary digital mammography (FFDM) only current or prior Tomosynthesis also includes FFDM ("combination study") current or prior Tomosynthesis also includes synthetic (MIP) view

5. DBT Supplement Volume 2 Creation and Storage of relevant objects (Rad-4) Define additional SOP Classes that are needed Define restrictions on DICOM Header for each additionally supported SOP Class –Information that is needed in order to properly hang and display images »Patient Orientation/Plane Position/View information/… –Information that is needed for annotation »Patient Information/Acquisition Parameters/…

6. DBT Supplement Volume 2 Retrieval and display of relevant objects (Rad-16) Display of Breast Tomosynthesis Images Describe simultaneous display of involved objects –FFDM images/Tomosynthesis objects/Projection images/synthetic images »Which objects need to be displayed simultaneously (screen real-estate)? –Describe hanging and ‘proper’ orientation of displayed objects –Describe how different sizing options (image size, same size, true size and actual pixel viewing) effect display of Tomosynthesis objects (in simultaneous as well as full size display)

7. DBT Supplement Retrieval and display of relevant objects (Rad-16) - continued Describe contrast adjustments (in simultaneous as well as full size display) –Do we need to say something toggling between different LUTs when displaying multiple object types? Scrolling through the Tomosynthesis object / Projection images –User driven / automatic –Synchronized scrolling of different views –Scrolling performance –Scrolling direction

8. DBT Supplement Retrieval and display of relevant objects (Rad-16) – continued Describe annotations –Patient Information –Acquisition parameters (per supported object type) including e.g. acquisition angle, dose –View information –Orientation in volume »which is the detector side, where in the volume is the current frame located »Frame numbers »Identify synthetic images

9. DBT Supplement Depending on the decision on CAD additional changes to the following transactions are needed: Storage of Evidence Objects (Rad-43) –How to record findings on DBT images »Does current TID 4000 work or are there any changes necessary (how to reference coordinates)? Retrieval and display of CAD marks (Rad-16) Effects on MAWF and SMI still need to be investigated

10. Clinical Questions Are there any Use Cases missing? Is support of projection images necessary? How are those clinically used? Is there a use case for simultaneously reviewing all type of images (FFDM, Tomosynthesis, Projection images, synthetic Images)? If yes, how should all these objects be displayed simultaneously Are partial views used/relevant in Tomosynthesis How should orientation information be displayed Do contrast adjustments need to be performed on a per image basis or for the complete object?