1. What IHE Delivers 1 Mammography Image Integration Profile Carolyn Reynolds Connectivity Manager/Hologic, Inc.

2. Mammography Image What’s so different about Mammography Use cases & clinical examples Profile requirement highlights Industry Demonstration Questions

3. Mammography Image 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. 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)

5. Mammography Image Use CaseModality CAD Archive Workstation “For Presentation” Image Data “For Processing” Image Data Mammo CAD Structured Rpt Printer

6. Hanging Protocol Differences Example Preferred Layout Hanging protocol determined by:  View Type (i.e. CC vs. MLO)  Specialty View Type (i.e. Spot, Mag)  Laterality  Patient Orientation R CC L CC L MLO R MLO

7. Generic Image Display Layouts Applied to Mammo Images  Stacked series example  Hanging based upon series or study descriptions  Image order as acquired  Image orientation as acquired R MLO R CC L CC L MLO

8. Variances in FFDM Vendor Data Detector Size ExampleR R L L R L Prior Exam from Vendor A’s system RL Typical “Fit to Viewport” effect Current Exam from Vendor B’s system  Different resolution  Different pixel matrix

9. Workstation Tool Enhancements Tissue vs. Air Detection Example Window/Center Adjustments

10. Printing Considerations True Size Precision of <2% error 10in x12in Film size 8inx10in Film size vs. Detector Size

11. Printing Considerations Positioning-minimal borders at chestwall Centered images can create large borders at chestwall Image offset with chestwall side having minimal borders

12. Mammography Image Integration Value 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

13. 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

14. 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

15. Mammography Image Integration Scope

16. 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

17. 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

18. Mammography Image 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)

19. 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

20. 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

21. 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

22. Mammography Image Industry Demonstration What we did in Feb 2007  Society of Breast Imaging Conference  Very successful education seminar  Small group demonstrations (well attended)  Attended by over 500 radiologists  Fees for varying levels of participation ($3K and $1.5K) What is being planned for 2008  Industry conference Feb – Mar 2008  Similar to 2007 – education & demonstration  Budget approx. $4K  Stay tuned for details as they become available

23. Mammography Image Questions???

24. What IHE Delivers 24