DICOM Digital Mammography Subgroup - Download Now DOC by 9n8IpO7k


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             MINUTES t-con
                                    DICOM WG-15
                         (Mammography and CAD)
                                     April 17, 2012

    Members Present                       Represented by

    Agfa Healthcare                       Ron Hitzelberger
    Fujifilm Medical Systems              Paul Morgan
    GE Healthcare                         Jeanne Couder
    Hologic, Inc.                         Janet Keyes
    iCAD, Inc.                            Topher Gedeon
    Siemens Medical Solutions             Renate Hoecker

    Members Absent                        Voting Representative

    American College of Radiology         Judith Wolfman
    FDA                                   Kish Chakrabarti
    *Planmed Oy                           Mari Varjonen
    Philips Medical Systems               Bas Revet

* = Does not count toward quorum.

    Alternate Representatives, Observers and Others Present:

    American College of Radiology Staff   Wil Creech
    American College of Radiology Staff   Anthony Levering
    American College of Radiology Staff   Dwight Chandler
    Hologic, Inc.                         Julian Marshall

    Presiding Officer:                    Janet Keyes, Industry Co-Chair

Page 1                          DICOM Working Group 15                          April 17, 2012

  Janet Keyes called the meeting to order at 10:05 am Eastern Time.

  Note: Based on the DICOM Standards Committee Procedures, the following members that
  have missed at least four consecutive face-to-face meetings are being converted to observer
  (mailer) status. They may be reinstated the next time they attend a face-to-face meeting:
         Carestream Health                     Zhimin Huo


  The meeting minutes for the April 3, 2012 teleconference were presented and approved.


  Correction Proposals:
      Janet: Provide feedback to WG 6 regarding CP-1194 draft letter ballot text (mGy).
      Janet: Update and distribute the proposed CP, Stereotactic Information for Breast
         Tomosynthesis: Image Type (0008,0008) Value 3 for review and consensus prior to
         WG 6 submission. Completed.

  Digital Breast Tomosynthesis Projections:
      Modality producers: Provide a list of attributes that can be used to distinguish 2D
          images from digital breast tomosynthesis projection images stored using Digital
          Mammography X-Ray Image. Completed. Siemens provided a list.
      Workstation producers: Evaluate impact of detecting and displaying digital breast
          tomosynthesis projection images stored using Digital Mammography X-Ray Image.
          Discussed during the meeting.

  Digital Breast Tomosynthesis CAD Results:
      Janet: Redistribute the link to the proposed CP and a file summarizing the e-mail
          feedback to date. Completed.


        CP-1077: Add CR report type to Dose SR: Final Text published April 6, 2012.
        CP-1194: Clarify dose for breast X-Ray: Janet presented the Letter Ballot version that
         incorporated WG 15 feedback. CPack 66 ballot is due May 25, 2012.
        Proposed CP: Stereotactic Information for Breast Tomosynthesis: Image Type
         (0008,0008) Value 3: Janet presented the updated version. The updates to the Breast
         View module (for reconstructed slices) were accepted. The updates to the
         Mammography Image module (for projection images) were accepted pending further
         discussion of interoperable projection images. A request was made to revisit the
         possibility of adding post-clip to the list of stereo identifiers to differentiate it from
         post-biopsy for hanging order purposes. Currently post-clip images are labeled as
         post-biopsy. The group will seek clinician feedback regarding whether or not this
         differentiation is important on a review workstation with respect to hanging order.

  Page 2                           DICOM Working Group 15                           April 17, 2012

  Julian had spoken with a few review workstation producers regarding DICOM formats for
  exchange of digital breast tomosynthesis projection images, and summarized their feedback:
  1) receiving many (11-22) individual Digital Mammography X-Ray Image – For
  Presentation objects per laterality+view representing tomosynthesis projection images would
  likely result in many thumbnails per study (44-88) rather than the typical 4 thumbnails per
  conventional screening mammography study, 2) extra work would be required to add logic to
  distinguish 2D from tomosynthesis projection images, not desirable, 3) seemed resistant to a
  new multi-frame image SOP Class given current demand versus the long lead-time for
  DICOM definition and approval, followed by implementation..

  If existing Digital Mammography X-Ray Image is used, would it be possible for workstations
  to learn to stack tomosynthesis projection images for display using distinguishing attributes
  from the image headers? Janet presented the list of potential distinguishing attributes
  provided by Siemens (available in the WG 15 ftp folder under Tomosynthesis).

  The question was raised, would it be possible with some changes to use the Breast
  Tomosynthesis Image SOP Class to store projection images as well as reconstructed slices?
  The group concluded that reconstructed slices and projection images are too different, and
  the SOP Class is specifically structured for reconstructed slices, so this is not a viable option.

  A point raised in favor of a new SOP Class is the need for archives to be able to distinguish
  (typically by SOP Class) which images may be eligible for deletion if they are not used for
  diagnostic purposes, such as Digital Mammography X-Ray Image – For Processing (delete)
  vs. For Presentation (keep) with conventional digital mammography. If tomosynthesis
  projection images (For Presentation) eventually fall into this category of being eligible to
  delete, there should be a way for archives to distinguish them easily from 2D For
  Presentation images and tomosynthesis reconstructed slices.

  The clinical need for interoperable tomosynthesis projection images was reiterated based on
  current clinical usage by radiologists along with the reconstructed slices. Some radiologists
  who are teaching others how to review digital breast tomosynthesis images specifically
  instruct to review the projection images: Eventually with experience there may be a transition
  away from radiologists reviewing the projection images, but until then they are needed.

  The group agreed to write a DICOM work item proposal for a new SOP Class, with the goal
  of presenting at the June 26 DICOM Standards Committee meeting upon reaching consensus.
  Given current demand for interoperable projections, the group is concerned that the time line
  for defining a new SOP Class will be too long, risking a variety of undesirable interim
  solutions. Incorporating similar existing DICOM models may shorten the time line.

  A new SOP Class should provide for storing raw projections (e.g. to CAD devices, for later
  reconstruction) and processed projections (for review workstation display).

  What are the advantages / disadvantages of a single-frame SOP Class versus a multi-frame
  SOP Class? Would multi-frame objects be too large? Should mammography-specific
  compression be considered, potentially in the form of a new compression transfer syntax?

  Page 3                            DICOM Working Group 15                            April 17, 2012

  Other topics took precedence, so Janet quickly presented the collection of December 2011 e-
  mail responses that is available on the ftp site. Discussion tabled until the next meeting.


  Fifth edition status update: The ACR is awaiting some final narrative. Internal review of
  some parts has started.


  ACR guidelines for noting in a digital mammography image why a marker (scar, mole, lump,
  bbs) was used. Modality producers have received questions from clinicians stating there are
  new guidelines, and asking where to record this information in digital mammography images.

  Wil Creech reported: The use of markers to indicate skin lesions and, to a lesser extent,
  palpable lesions was discussed with the recommendation that different shapes of markers be
  used to differentiate between skin lesions and palpable lesions for physicians within the same
  facility and noted either on the image or in the report for extramural interpreting physicians
  (excerpt below).

  Wil Creech provided the following draft text from the BI-RADS Atlas fifth edition as of
  April 12, 2012 (subject to change):

  “(Finally, because the clinical significance of a palpable lesion is greater than that of a raised
  skin lesion, because the radiopaque devices used to mark both palpable and skin lesions are
  available in several different shapes, and because there has been no consensus in establishing
  the use of specific-shaped markers to represent palpable versus skin lesions, the following
  two practices are recommended.
  [1] To properly inform interpreting physicians within a given mammography facility, the
  facility should adopt a policy requiring consistent use of two different shapes of radiopaque
  devices for palpable and skin lesions, respectively.
  [2] To properly inform interpreting physicians outside the facility, there should be an
  indication of the type of underlying lesion marked by every radiopaque device (palpable
  versus skin lesion), either as a permanent annotation on the appropriate mammographic
  image(s) or as a description in the mammography report.)”

  SIIM roundtable discussion Friday, June 8 in Orlando, FL, 11:30am – 12:15pm Eastern,
  David Clunie as moderator. Nothing new to report.


  Correction Proposals:
      All: Seek clinician input regarding whether or not there is a need to differentiate post-
         clip from post-biopsy images on review workstations for hanging order purposes.
      All: Review the proposed CP, Stereotactic Information for Breast Tomosynthesis:
         Image Type (0008,0008) Value 3 updates to the Mammography Image module for
         tomosynthesis projection image identification.

  Page 4                            DICOM Working Group 15                            April 17, 2012
  Digital Breast Tomosynthesis Projections:
      Janet: Provide DICOM work item proposal template and preliminary text for group to
          review and complete.
      Julian: Start a first draft Supplement outline for a new multi-frame SOP Class.

  Digital Breast Tomosynthesis CAD Results:
      All: Review the proposed CP and the file summarizing the e-mail feedback to date.


  Thursday-Friday, July 12-13, 2012 at the ACR in Reston, VA, pending ACR confirmation.


  The meeting was adjourned at 12:10pm Eastern.

  Reported by:                                     Janet Keyes (co-Chair)
                                                   WG 15 of the DICOM Stds. Comte.
                                                   April 18, 2012

  Reviewed by Counsel: CRS 2012-04-30

  Page 5                        DICOM Working Group 15                       April 17, 2012

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