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Mammography and DICOM

Mammography. Mammography is a film-based modalityWorldwide mammo machines:25,500 film-screen500 digital. 98.1 % 1.9 %. Reading Mammograms. ACR position:Radiologist must read original imageUS clinical practice:Read film-screen mammograms on filmDo not digitize films and read softcopyPriors

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Mammography and DICOM

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    1. Mammography and DICOM Adapting an Analog Modality to the Digital World Julian Marshall R2 Technology, Inc.

    2. Mammography Mammography is a film-based modality Worldwide mammo machines: 25,500 film-screen 500 digital

    3. Reading Mammograms ACR position: Radiologist must read original image US clinical practice: Read film-screen mammograms on film Do not digitize films and read softcopy Priors can be read softcopy

    4. Digitized Film Mammograms are digitized Wide variation Scanners vary: Resolution Maximum O.D. Noise

    5. Digital Mammography Mammograms are acquired digitally Detectors do still vary: Resolution Bit depth (CR) Noise (CR)

    6. Mammography Imaging demands are extreme: Typical resolutions: Film: 43 to 50 microns x 12 bits Digital: 50 to 100 microns x 14 bits Typical image sizes: 18x24 cm 85% 24x30 cm 15%

    7. Mammography Imaging demands are extreme: Typical data volume: 4 film case: 180 MB avg 100 case/day: 18.0 GB/day 250 days/yr: 4.5 TB/year Film scanner will generate: 45 MB per minute, all day long!

    8. Mammography and PACS Images are recalled regularly Scheduled pre-fetching is easy But … each image is accessed each year!

    9. Computer-Aided Detection Use a computer to look for regions-of-interest that might be overlooked by a radiologist Simple example: Count the ‘F’s

    10. Computer-Aided Detection Simple example: Count the ‘F’s

    11. Computer-Aided Detection Most people find these three

    12. Computer-Aided Detection Many people do not find all six!

    13. Computer-Aided Detection Mammography CAD first became available: 1998 Film-screen mammography 2000 Digital mammography At that time: DICOM support for images No DICOM support for CAD output

    14. DICOM WG 15 Standards development: Digital X-ray (includes mammo) 1998 Mammography CAD SR 2001

    15. Mammography CAD SR Allows encoding of ACR’s BI-RADSTM reporting structure via an inference tree “Simple” CAD devices can create “simple” Mammo CAD objects “Complex” CAD devices can create full mammography report inference tree

    16. Mammography CAD SR Single image finding – found in one image Composite object – findings correlated in one or more images: Temporal – comparison over time Spatial – e.g. mass behind the nipple, or mammo/ultrasound correlation Contra-laterally – e.g. left/right comparison

    17. Inference Tree

    18. Inference Tree

    19. Inference Tree

    20. Inference Tree

    21. Inference Tree

    22. Inference Tree

    23. Inference Tree

    24. Inference Tree

    25. Inference Tree

    26. Inference Tree

    27. A Vast Array of Adjectives Every Single Image Finding and Composite Object has a set of common descriptors: Rendering intent Certainty of finding Probability of cancer Plus a variety of context-specific descriptors: Calcs: rod-like, pleomorphic, etc.

    28. Other Information Breast outline (border) Pectoral muscle outline Nipple location Other findings: BBs J-wires

    29. Other Information Image quality findings Motion blur Artifacts

    30. Coming Soon Breast Imaging Report SR Relevant Patient History Query

    31. Summary Mammography is almost entirely a film-based modality Slowly this is changing And with that change comes DICOM!

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