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

2. IHE Workshop – June 2006 2 Mammography Image The Problem/Assumptions Whats 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

3. IHE Workshop – June 2006 3 Mammography Image 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)

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

5. IHE Workshop – June 2006 5 Hanging Protocol Differences Example Preferred Layout 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 Orientation Patient Orientation R CC L CC L MLO R MLO

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

7. IHE Workshop – June 2006 7 Variances in FFDM Vendor Data Detector Size Example R R L L R L Prior Exam from Vendor As system RL Typical Fit to Viewport effect Current Exam from Vendor Bs system Different resolution Different resolution Different pixel matrix Different pixel matrix

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

9. IHE Workshop – June 2006 9 Printing Considerations True Size Precision of <2% error 10in x12in Film size 8inx10in Film size vs. Detector Size

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

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

12. IHE Workshop – June 2006 12 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

13. IHE Workshop – June 2006 13 Mammography Image Integration Scope Based upon existing actors and transactions Expanded requirements within each transaction ActorsTransactionsOptionalitySection in Vol. 2/3 Acquisition ModalityModality Images Stored [RAD-8]R4.8 Storage Commitment [RAD-10]R4.10 Evidence CreatorEvidence Document StoredR4.43 Storage Commitment [RAD-10]R4.10 Image Manager/ArchiveModality Images Stored [RAD-8]R4.8 Evidence Document StoredR4.43 Storage Commitment [RAD-10]R4.10 Query Images [RAD-14]R4.14 Retrieve Images [RAD-16]R4.16 Query Evidence Documents [RAD-44]R4.44 Retrieve Evidence Documents [RAD-45]R4.45 Image DisplayQuery Images [RAD-14]R4.14 Retrieve Images [RAD-16]R4.16 Query Evidence Documents [RAD-44]R4.44 Retrieve Evidence Documents [RAD-45]R4.45 Print ComposerPrint Request with Presentation LUT [RAD-23]R 4.23 Print ServerPrint Request with Presentation LUT [RAD-23]R 4.23

14. IHE Workshop – June 2006 14 Mammography Image Integration Scope

15. IHE Workshop – June 2006 15 Mammography Image Expanded 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

16. IHE Workshop – June 2006 16 Mammography Image Expanded Requirements 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

17. IHE Workshop – June 2006 17 Mammography Image Expanded Requirements Image Display contd 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)

18. IHE Workshop – June 2006 18 Mammography Image Expanded Requirements 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

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

20. IHE Workshop – June 2006 20 Mammography Image Expanded Requirements 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

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

22. IHE Workshop – June 2006 22