1. IHE Workshop – June 2006 1 Note to IHE Committees: This is my draft of the IHE Mammography Image Integration Profile talk for the workshop. If I have the time between now and the final draft, my intention is to add a few more examples of the problems customers face w/o the profile and to review my topics for coverage. I also will add a little animation in stepping through bulleted points. I tried to follow Kevin’s basic outline, but took a few liberties with it to share the info that I felt was important for the time allotted. I welcome your feedback which you can send me at creynolds@hologic.com creynolds@hologic.com Thanks, Carolyn Reynolds

2. IHE Workshop – June 2006What IHE Delivers 2 Carolyn Reynolds Hologic, Inc. Vendor co-chair, IHE Mammography Committee Mammography Image Integration Profile

3. IHE Workshop – June 2006 3 Mammography Image Integration 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:  the FDA approves the monitor hardware,  and workstations have 510K approval for FFDM applications

4. IHE Workshop – June 2006 4 Mammography Image Integration Not just another modality! What makes it different or challenging:  Image layout & orientation  Variances among vendors in image data and attributes  Two types of image data  Common use of CAD (Computer Aided Detection)  Importance of prior study comparisons  Regional governance such as MQSA (Mammography Quality Standards Act – USA)

5. IHE Workshop – June 2006 5 Mammography Image Integration Typical components & data Modality CAD Archive Workstation “For Processing” Image Data “For Presentation” Image Data Mammo CAD Structured Rpt

6. IHE Workshop – June 2006 6 Generic Image Display Layouts Applied to Mammo Images  Stacked series example  Display in order of images taken  Image orientation as acquired R RL L

7. IHE Workshop – June 2006 7 Example Preferred Layout Hanging protocol determined by:  View Type  Laterality  Patient Orientation vs. or R R L L R RL L

8. IHE Workshop – June 2006 8 Variances in FFDM Vendor Data Detector Size Example R R L L R L Prior Exam from Vendor A’s system R L Typical “Fit to Viewport” effect Current Exam from Vendor B’s system

9. IHE Workshop – June 2006 9 Mammography Image Integration Value proposition Initiated by Radiologist’s challenges of having multiple FFDM vendors and desire to use PACS vendor’s workstation Ensures that FFDM modalities provide adequate information to facilitate downstream applications

10. IHE Workshop – June 2006 10 Mammography Image Integration Value proposition Ensures components support required data objects for interoperability Defines image display and printing operations required for effective and efficient diagnoses

11. IHE Workshop – June 2006 11 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

12. IHE Workshop – June 2006 12 Mammography Image Integration Scope

13. IHE Workshop – June 2006 13 Mammography Image Integration 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

14. IHE Workshop – June 2006 14 Mammography Image Integration 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

15. IHE Workshop – June 2006 15 Mammography Image Integration Expanded Requirements 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)

16. IHE Workshop – June 2006 16 Mammography Image Integration 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

17. IHE Workshop – June 2006 17 Mammography Image Integration Expanded Requirements Evidence Creator (CAD)  No specifics on how CAD obtains mammography images  Support for Mammography CAD SR SOP Class and Storage Commitment

18. IHE Workshop – June 2006 18 Mammography Image Integration Expanded Requirements Print Composers/Print Servers  True Size printing  Justify chestwall and print with 5mm borders or less  Render VOI LUTS if present  Specify maximum density  Specify Presentation LUT  Labeling requirements  Support for 12 bit pixel depth

19. IHE Workshop – June 2006 19 Mammography Image Integration Questions???

20. IHE Workshop – June 2006 20