1. Feb 7-8, 2007IHE Participant's Workshop 1 Integrating the Healthcare Enterprise Mammography Image – MAMMO Chris Lindop, GE Healthcare Co-Chair Radiology Planning Committee

2. Feb 7-8, 2007 2 A content profile for Mammo Patient Info. Reconciliation Access to Radiology Information - Consist. Present. of Images Evid- ence Docs Key Image Notes Simp. Image & Num Reports Presentation of Grouped Procedures Post- Processing Workflow Reporting Workflow Charge Posting Scheduled Workflow Portable Data for Imaging NM Image Mammo Image Import Reconciliation Workflow Cross-Enterprise Document Sharing for Imaging Key Image Notes Image Fus- ion Teaching Files & Clinical Export

3. Feb 7-8, 2007 3 Mammo Image – The Problem Mammography image review relies on comparison with priors   increases the occurrence of simultaneous review of images from different systems Multi-vendor Mammography Systems   Vary with detector technologies and sizes result in varying image matrices sizes.   Vary with contrast presentation methods result in varying image presentation Mammography Image Review requires a minimal set of display features   zoom, LUT rendering, hanging protocols

4. Example of different image sizes

5. Image Contrast Adjustment VOI LUT Linear LUT

6. Feb 7-8, 2007 6 MAMMO – Value proposition Minimum contents for the generated DICOM instances  Image Data (for processing and for presentation SOP Classes)  CAD data (CAD SR) Basic display capabilities of Image displays to suit specific mammography review requirements CAD acting as Evidence Creators Mammography Workflow  Managing the process of creating, storing and using Mammography Image content is similar to workflow for other image content (e.g. see Scheduled Workflow and Post-Processing Workflow Profiles).

7. Feb 7-8, 2007 7 Mammography Image Actors and Transactions Acquisition Modality Evidence Creator Image Manager ↓ [RAD 18] Evidence Document Stored ↓ [RAD 10] Storage Commitment ↓ [RAD 14] Query Images ↓ [RAD 16] Retrieve Images ↓ [RAD 44] Query Evidence Documents ↓ [RAD 45] Retrieve Evidence Documents Image Archive [RAD 8] Modality Images Stored ↓ [RAD 10] Storage Commitment ↓ Image Display Print Composer Print Server ↓[RAD-23] Print Request with Presentation LUT

8. Feb 7-8, 2007 8 Mammography Image Process Flow

9. Feb 7-8, 2007 9 Mammo Image Profile Acquisition Modality  FFDM & CR are required to create MG objects  Create MG objects as specified 40 Attributes with specific requirements defined 40 Attributes with specific requirements defined Including new pixel padding range limit (0x0028,0x0121) Including new pixel padding range limit (0x0028,0x0121) Evidence Creator  Mammo CAD systems  Support Evidence Document Stored with Storage Commitment  Support Mammography CAD SR objects

10. Feb 7-8, 2007 10 Mammo Image Profile (cont’d) Image Manager/Archive  Support both Modality Images and Evidence Document Stored with Storage Commitment  Support Query/Retrieve of both Images and Evidence Documents Image Display  Support Query/Retrieve of both Images and Evidence Documents  Support specified display capabilities including background air suppression, LUT rendering, zoom management and CAD SR display

11. Feb 7-8, 2007 11 Mammo Image Profile (cont’d) Print Composer  Support Print Request with Presentation LUT including the LIN-OD presentation LUT shape including the LIN-OD presentation LUT shape  Use Requested Image Size to achieve true size printing  Support 12 bits printing Print Server  Support Print Request with Presentation LUT including the LIN-OD presentation LUT shape including the LIN-OD presentation LUT shape  Use Requested Image Size to achieve true size printing  Support 12 bits printing

12. Feb 7-8, 2007 12 Mammo Image contents Background air suppression  New tag in DICOM (CP692) extending the pixel padding concept Mammo CR generate MG instances only  specific fields (i.e. gantry ID) have been added to the required attribute list. Tiled Views option defined  Allows for large breast imaging (multiple images of the same breast)

13. Feb 7-8, 2007 13 Image Display Zoom  Adjust zoom accounting for varying acquisition pixel sizes  True size zoom accounting for display (monitor) pixel size Background air suppression  When inverting/windowing the image, the detected background stays black Image orientation  Flipping according to Patient Orientation ((0x20,0x20)) Annotations  Set of required annotations to be displayed is defined CAD rendering (using CAD SR)

14. Feb 7-8, 2007 14