Integrating the Healthcare Enterprise

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Integrating the Healthcare Enterprise

• Mammography Image MAMMO

Chris Lindop, GE Healthcare Co-Chair Radiology
Planning Committee
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A content profile for Mammo
Patient Info. Reconciliation
Import Reconciliation Workflow


Scheduled Workflow



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Post-Processing Workflow

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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

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Example of different image sizes
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Image Contrast Adjustment
VOI LUT
Linear LUT
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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).

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Mammography ImageActors and Transactions
Acquisition Modality
Evidence Creator
RAD 8 Modality Images Stored ? RAD 10 Storage
Commitment ?
? RAD 18 Evidence Document Stored ? RAD 10
Storage Commitment
Image Manager
Image Archive
? RAD 14 Query Images ? RAD 16 Retrieve
Images ? RAD 44 Query Evidence Documents ? RAD
45 Retrieve Evidence Documents
Image Display
Print Composer
?RAD-23 Print Request with Presentation LUT
Print Server
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Mammography ImageProcess Flow
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Mammo Image Profile

• Acquisition Modality
• FFDM CR are required to create MG objects
• Create MG objects as specified
• 40 Attributes with specific requirements defined
• 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

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Mammo Image Profile (contd)

• 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

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Mammo Image Profile (contd)

• Print Composer
• Support Print Request with Presentation LUT
• 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
• Use Requested Image Size to achieve true size
  printing
• Support 12 bits printing

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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)

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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)

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