DRAFT: PLEASE DISCARD WHEN FINAL VERSION IS APPROVED
MINUTES DICOM WORKING GROUP 15
MAMMOGRAPHY AND CAD
PLACE OF MEETING TELECONFERENCE
DATE AND TIME JUNE 27, 2002: 3:00 PM EDT
American College of Radiology Fred Behlen
Fuji Film Medical Systems Bob Uzenoff
Lorad, A Hologic Company William Johnson
Mammography Reporting Systems (MRS) Steve Vellella
Qualia Computing Topher Gedeon
R2 Technology Janet Keyes
R2 Technology Julian Marshall
Deus Tech Xin-wei Xu
IDX Systems Carol Moore
Kodak Tom Puckett
LaGrange-Chicago (ACR) Carl Vyborny
Penrad Greg Gustafson
Siemens Wen Qian
Thomas Jefferson Univ. (ACR) Andrew Maidment
Univ. of North Carolina (ACR) Brad Hemminger
American College of Radiology Staff Carla Morrisey
MagView Shelly Loconto
PRESIDING OFFICER: Janet Keyes, Co-chair
1. WELCOME AND REVIEW AGENDA
Janet Keyes called the meeting to order.
2. REVIEW OF PREVIOUS MINUTES
Howard Clark (NEMA) requested “Reported by” and “Reviewed by Counsel” lines to be
added at the end of the minutes.
The meeting minutes for May 22-23 will be approved along with these minutes at the
October 1-2 meeting.
3. REVIEW OF PREVIOUS ACTION ITEMS
Chest CAD SR (to be completed by June 4):
Carl: Provide Inferred Disease and Differential Diagnosis/Impression for Example 4.
Completed, but questioned the concept names for this inference structure.
Carl: Check the value multiplicity (VM) of the content items in TID XX08 Modifiers.
Completed. They are acceptable.
Carl: Review the RECIST documentation.
Janet: Merge CID YY57.1 and YY57.2 back into CID YY57. Completed in sup65_19.
Janet: Add the three CT Quality Control Standards from the ACR to CID YY56.
Completed in sup65_19.
Janet: Add “or (0028,0030)” to condition on Rows 11 & 12 of TID 4020. Completed in
Janet: Add anatomy categories Systemic Vascular and Muscular to CID YY00.
Completed in sup65_19.
Janet: Update Examples with TID number changes due to reused templates from
Mammography CAD SR. Completed in sup65_19.
Julian: To complement the RECIST information, investigate comparable tracking metrics
in the U.S., from SWOG, ECOG, CALGB, RTOG and ACRIN.
Julian: Populate the Heart and Osseous Inferred Anatomy context groups with researched
Julian: Look at Baseline vs. Defined for the various context groups in sup65, and remove
empty context groups.
Julian: Add definitions to terms listed in Part 16, Annex D.
Julian: Do the context groups for Composite Feature categories and terms make sense
compared to the context groups for Single Image Finding categories and terms? (Open
Julian: Evaluate the term “Estimation” as a Calculation Method in CID YY61, and
provide a more clear term, if possible.
Topher/Julian: Obtain feedback from their respective algorithm development teams
regarding calcium scoring.
Julian: Represent WG 15 at WG 6 with letter ballot draft for Chest CAD SR (week of
June 18). Completed.
Patient Clinical History:
Janet: E-mail Dr. Joel Chabriais regarding whether “needle gauge” is interpreted
similarly internationally, and whether there is a standard international unit for it.
Completed, response in sup75_07.
Janet: Prepare the next draft of Supplement 75 for the WG 8 meeting in August.
Breast Imaging Report:
Steve: Finish edits for early draft presentation of Breast Imaging Report by June 4.
Completed in supXX_06BreastImaging.doc
Carl: Look at supXX_06BreastImaging.doc figures and examples. Completed, but had
Julian: Represent WG 15 at WG 6 with early draft of Breast Imaging Report, and request
a supplement number. Completed, assigned as Supplement 79.
Carla: Make arrangements to present Breast Imaging Report to BI-RADS® committee.
Carol: Create a document of thoughts for potential interventional procedure descriptors
for reporting, for the Breast Imaging Report, and circulate to group.
Janet: E-mail a Correction Proposal template file to Carol. Completed.
Carol: Draft a Correction Proposal for the desired changes to the code meanings in Part
16, Annex B, Context ID 6019, 6020, 6021.
Julian: Encourage WG 6 to proceed to letter ballot with CP-305 (Harry Solomon is
Julian: Discuss IOD/SOP Class issues for Chest CAD SR and Breast Imaging Report
with WG 6. Completed.
Janet: Make a list of terms that do not yet have definitions in Part 16, Annex D, from
Mammography CAD SR, and circulate, to collect definitions. Write a Correction
Proposal to add the definitions to Part 16, Annex D. Completed, and e-mailed to Carla.
4. WG 6 (BASE STANDARD) UPDATE
CP-274 – Template Parameters, Final Text was approved.
CP-275 – Transitivity of Enumerated and Defined Templates. Approved for Letter
Ballot. Julian protested the removal of version tracking attributes such as Template
Version (0040,DB06) from the Template Identification Macro, but WG 6 stood its
ground. They suggested that we that we state that we support a certain template as of
a publication date (e.g. 2001 PS 3.16) or something like that. It amounts to a version,
although annual granularity.
CP-290 – SNOMED code updates for Mammography CAD SR context groups, in
letter ballot form. WG 6 questioned whether there are any Mammography CAD SR
instances archived in the field using the existing codes from DICOM 2001. Julian
confirmed with R2 Technology and Qualia/CADx that there are not. A few
adjustments were made to the PS 3.16, Annex D portion of the CP, and it was
approved for Letter Ballot.
CP-305 – Fix requested for TID 4006, Row 17 Relationship with Parent error (see
cp305_01.doc). WG 6 had not yet addressed this before Julian left the meeting, so
Janet will follow up.
Regarding the Structured Reporting SOP Classes issue, WG 6 came to a consensus:
There will be a new Evidence SR IOD and SOP Class, for device generated reports
that are not radiologist’s reports.
Radiologist’s reports will be specified as different root template possibilities within
the existing Enhanced SR and Comprehensive SR IODs.
Specific SR IODs and SOP Classes will still be allowed, based on how tightly
constrained the content tree is, and whether specific knowledge of the content tree is
necessary “to convey the full meaning of the report in an unambiguous manner” (e.g.,
Rendering Intent for CAD SR).
There will be a way to Query/Retrieve based on the root template identifier within a
more general SR SOP Class.
A new standard error code will be defined to allow an SCP to reject a SOP instance if
the root template identifier is not handled, while still being conformant to the SR SOP
Julian reported that the lengthy discussions regarding Supplement 26, OB-GYN Ultrasound
Procedure Reports, confirmed in his opinion that the approach that WG 15 has taken with
respect to the template structures for its Structured Reports has benefited from using the
power of DICOM Structured Reporting, and is accepted much more favorably by WG 6.
5. CHEST CAD SR
Before arriving at the WG 6 meeting, Julian had determined that Supplement 65 was not
ready for Letter Ballot in its current form. This was based on discussions held internally at
R2 Technology, and with Topher at Qualia/CADx. There are still too many open questions
regarding the reporting structure and terminology for the inference mechanisms for
Anatomy/Pathology Interpretations, Disease Interpretations, and Association of Inferred
Diseases. The CAD vendors do not yet have experience in these areas, and there is no
standard for reporting on these.
Julian presented a proposal to WG 6 to remove the three higher-level inference sub-trees, and
just keep the Image Library, CAD Processing and Findings Summary, Summary of
Detections, and Summary of Analyses sub-trees. The Root template will be extensible
(according to CP-275, which is going to Letter Ballot over the summer), so that the other
sub-trees can be added at a later time, when there is a better understanding of the most
effective way to present those CAD results.
Both WG 6 and WG 15 agreed with Julian’s proposal. The downsized version of
Supplement 65 will be prepared for presentation to WG 6 for Letter Ballot at the end of
October. Before returning to WG 6, however, the downsized version of Supplement 65 will
be presented to WG 8 in August, to discuss the list of terms that need codes to be assigned.
Fred suggested that the segments that are removed from Supplement 65 be transferred to a
white paper describing future work, so that the original ideas will not be lost.
6. BREAST IMAGING REPORT
Julian presented the early draft supplement to WG 6. The supplement number 79 was
assigned. WG 6 made the following suggestions:
Remove the Data Record sub-tree from the Breast Imaging Report, and make it a separate
object. It could be a non-persistent object that could be queried, like Patient Clinical
History (Supplement 75), or a composite object under the IOD and SOP Class for
The Breast Imaging Report Root template should be referenced from the existing
Enhanced SR or Comprehensive SR IOD, rather than defining a new IOD and SOP Class.
Use the latest draft of Supplement 66, or the document where the Evidence SR IOD is
defined, for an example of referencing a Root template from an existing IOD.
In the examples, make sure that all of the content items contained in the tables are
represented in the report description above them (e.g., Baseline Mammogram, First
WG 15 needs to decide whether to define the Data Record object in a separate Supplement.
The advantage of doing so is to make it a separate balloted item for the DICOM Standards
Committee. As a separate item, if there were objections to it, they would not hold back the
Breast Imaging Report. The group would still work on the two documents in parallel.
A comment was received from Kish at the FDA, regarding the use of “Impression” as the
section title in the examples, versus “Assessment”, for the paragraph that contains the BI-
RADS assessment category. Carla stated that the example reports in BI-RADS show the
assessment category under the Impression section. There is no section entitled
“Assessment”. Janet will follow-up with Kish. Steve will follow-up on comments received
The group will proceed with Public Comment preparation at the next meeting.
7. PATIENT CLINICAL HISTORY
Janet described the changes requested by the Ultrasound working group (WG 12) regarding
Patient Clinical History information that is typically needed by Ultrasound image acquisition
systems for Breast Ultrasound, which are found in sup75_07 (highlighted in yellow in Part
16). The requests sounded reasonable to the group, but some members will review it off-line
and provide feedback to Janet. This version will be discussed at the WG 8 meeting in mid-
August, to prepare for Public Comment, so feedback is requested before that time.
Dr. Chabriais confirmed that the term Needle Gauge is commonly understood internationally.
8. NEW ACTION ITEMS
Chest CAD SR:
Janet/Julian: By August 2, distribute a downsized version of Supplement 65, Chest CAD
SR, and notify WG 8 regarding the terminology.
Janet/Julian: By October 1, extract the portions of Supplement 65, Chest CAD SR,
revision 20 that are to be postponed, and copy them to a white paper as future work.
Julian, Bob, Shelly, Topher: By October 1, discuss the new (downsized) revision of
Supplement 65, Chest CAD SR with a clinical radiologist, and report feedback
Breast Imaging Report:
Janet: Check with WG 6 regarding whether the Data Record (NMD) template should be
stored as a separate Supplement from the Breast Imaging Report, to make it a separate
balloted item. WG 15 thinks so.
Janet: Respond to comment from Kish (FDA) regarding his question about the use of
“Impression” as a report section title, versus “Assessment”, and CC: Steve.
Janet: Notify WG 8 of the terminology that is intended to be used in the Breast Imaging
Steve: Follow up with Carl regarding his comments on version 6 of the Breast Imaging
Steve: By October 1, update Supplement 79, Breast Imaging Report, based on the
feedback received from WG 6.
Patient Clinical History:
Shelly, Carol, & Group: By August 9, provide feedback to Janet on version 7 of
Supplement 75, Patient Clinical History, especially regarding the additions requested for
Ultrasound of the breast.
Carla: By August 9, provide definitions for as many as possible of the list of terms that do
not yet have definitions in Part 16, Annex D, from Mammography CAD SR, and add
them to the draft Correction Proposal from Janet.
Janet: Check the minutes from the June WG 6 meeting for the status of CP-305.
9. NEXT MEETING
October 1-2, 2002 at the American College of Radiology (ACR) in Reston, VA.
The teleconference was adjourned at 4:35pm EDT.
Reported by: Janet Keyes (co-Chair)
WG 15 of the DICOM Stds. Comte.
July 2, 2002
Reviewed by Counsel: