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Mammography Image Integration Profile. Carolyn Reynolds Connectivity Manager/Hologic, Inc. Mammography Image. What’s so different about Mammography Use cases & clinical examples Profile requirement highlights Industry Demonstration Questions. What’s the big deal?

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Mammography image integration profile

Mammography Image Integration Profile

Carolyn Reynolds

Connectivity Manager/Hologic, Inc.

Mammography image
Mammography Image

  • What’s so different about Mammography

  • Use cases & clinical examples

  • Profile requirement highlights

  • Industry Demonstration

  • Questions

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

Mammography ImageThe Problem/Assumptions

Mammography image not just another modality
Mammography ImageNot 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)

Mammography image use case
Mammography ImageUse Case





“For Presentation” Image Data


“For Processing” Image Data

Mammo CAD Structured Rpt

Hanging protocol differences example preferred layout
Hanging Protocol DifferencesExample Preferred Layout





  • Hanging protocol determined by:

  • View Type (i.e. CC vs. MLO)

  • Specialty View Type (i.e. Spot, Mag)

  • Laterality

  • Patient Orientation

Generic image display layouts applied to mammo images
Generic Image Display LayoutsApplied to Mammo Images





  • Hanging based upon series or study descriptions

  • Image order as acquired

  • Image orientation as acquired

  • Stacked series example

Variances in ffdm vendor data detector size example
Variances in FFDM Vendor DataDetector Size Example







Typical “Fit to Viewport” effect



Prior Exam from

Vendor A’s system

  • Current Exam from

  • Vendor B’s system

  • Different resolution

  • Different pixel matrix

Workstation tool enhancements tissue vs air detection example
Workstation Tool EnhancementsTissue vs. Air Detection Example

Window/Center Adjustments

Printing considerations true size
Printing ConsiderationsTrue Size

10in x12in

Film size


Film size

Precision of <2% error

Film size vs. Detector Size

Printing considerations positioning minimal borders at chestwall
Printing ConsiderationsPositioning-minimal borders at chestwall

Centered images can

create large borders

at chestwall

Image offset with chestwall side having minimal borders

Mammography image integration value proposition
Mammography Image IntegrationValue 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

Mammography image integration value proposition1
Mammography Image IntegrationValue proposition

  • Ensures systems support required data objects for interoperability

  • Defines image display and printing operations required for effective and efficient diagnoses

Mammography image integration scope
Mammography Image IntegrationScope

  • Based upon existing actors and transactions

  • Expanded requirements within each transaction

Mammography image expanded requirements
Mammography ImageExpanded 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

Mammography image expanded requirements1
Mammography ImageExpanded 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

Mammography image expanded requirements2
Mammography ImageExpanded 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)

Mammography image expanded requirements3
Mammography ImageExpanded 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

Mammography image expanded requirements4
Mammography ImageExpanded Requirements

  • Evidence Creator (CAD)

    • Support for Mammography CAD SR SOP Class and Storage Commitment

    • No specifics on how Evidence Creator obtains mammography images

Mammography image expanded requirements5
Mammography ImageExpanded 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

Mammography image industry demonstration
Mammography ImageIndustry 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

Mammography image1
Mammography Image