WG-15_2008-09-23_Mindoc - DICOM Digital Mammography Subgroup by decree

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									  MINUTES                      DICOM WORKING GROUP 15
                               MAMMOGRAPHY AND CAD

  PLACE OF MEETING             AMERICAN COLLEGE OF RADIOLOGY, RESTON, VA

  DATE AND TIME                SEPTEMBER 23, 2008: 10:00AM – 6:00PM
                               SEPTEMBER 24, 2008: 8:30AM – 3:00PM

  MEMBERS PRESENT:

  Fujifilm Medical Systems                   Paul Morgan
  GE Healthcare                              Guillaume Peter
  Hologic, Inc.                              Janet Keyes
  iCAD, Inc.                                 Topher Gedeon
  Northwestern Memorial (ACR)                Judith Wolfman
  Philips Medical Systems                    Bas Revet
  Siemens Medical Solutions                  Renate Hoecker

  MEMBERS ABSENT:

  *CareStream Health                         Zhimin Huo
  *Medical College of Wisconsin (ACR)        Charles Kahn
  Planmed Oy                                 Mari Varjonen

                              * = Does not count toward quorum.
  OTHERS PRESENT:

  American College of Radiology Staff        Penny Butler
  American College of Radiology Staff        Laura Coombs          (Tues PM)
  American College of Radiology Staff        Barbara Hirsch
  American College of Radiology Staff        Lu Meyer              (Tues PM)
  FDA                                        Richard Kaczmarek
  Independent observer                       Steve Vellella

  PRESIDING OFFICER:           Janet Keyes, Industry Co-chair


1. WELCOME AND REVIEW AGENDA

  Janet Keyes called the meeting to order and provided an overview of the proposed agenda.
  Barbara Hirsch (ACR) is now our secretariat representative.

2. REVIEW OF PREVIOUS MINUTES

  The meeting minutes for the June 4-5, 2008 meeting were approved as distributed.

3. REVIEW OF PREVIOUS ACTION ITEMS

  Correction Proposals:
      Bas: Present cp837_vp3 to WG 6 in June for Ballot Packet approval. Completed.
      Bas: Submit new Patient Orientation correction proposal to WG 6 in June.
       Completed.
      Bas: Request WG 6 to approve CP-857 for the June Ballot Packet. Completed.
      Janet: Provide cp875_03 to Penny Butler, Judy Wolfman. Based on ACR Digital
       Clinical committee feedback, determine whether to request approval for the August
       voting packet, and request SRT codes for the new terms. Report to WG 6 that CP-
       889 is being withdrawn, as the content was incorporated into CP-875. Completed.
      Janet: Request that CP-880 be approved for the August voting packet. Completed.
      Janet: Provide cp886_03 to Dave Heaney (IHE Mammography), and request that this
       version be presented to WG 6 in June. Completed.
      Janet: Submit new Tracking Identifier correction proposal to WG 6 in June.
       Completed.

Digital Breast Tomosynthesis:
    Janet: Prepare draft final text of Supplement 125 to present to WG 6 in August.
        Completed.

Colon CAD SR:
    Topher, Chuck: Finalize work on definition and use of RadLex codes and SRT codes
      in Supplement 126. Ongoing.
    Topher: Contact Howard Clark, to request the GE contact who provided the
      Supplement 126 public comments, and interact with the GE contact to resolve issues.
      Completed.
    Topher: Resolve remaining open issues, and prepare draft letter ballot of Supplement
      126 to circulate to WG 15 prior to the August WG 6 meeting. Postponed.
    All: Decide if Supplement 126 is ready to submit to WG 6 in August for letter ballot.
      Postponed.

DOT Mammography:
   Janet: Investigate additional contacts researched by Internet during the February
     meeting, to seek a new supplement editor. Not completed.

Other:
    Julian: Copy Tomosynthesis CAD slide presentation to the WG 15 ftp folder.
       Completed.
    All: Evaluate the potential use of Mammography CAD SR versus a new IOD to store
       breast tomosynthesis CAD results, and report back at the next meeting. In progress.
    Laura Coombs: Investigate providing a specific mapping of previous NMD terms and
       related DICOM context group terms to the new NMD terms. Completed.
    Judy: Investigate logistics for hosting WG 15 at Northwestern in September.
       Completed.
    Paul: Copy the trial implementation version of the IHE Mammography Acquisition
       Workflow supplement to the WG 15 ftp folder. Completed.

On Hold:
    Topher: Update the CAD SR finding description correction proposal.
        Janet: Complete initial draft of correction proposal to incorporate French translation
         of new Breast Imaging Report terms from CP-527.
        Janet: Finish extracting the portions of Supplement 65, Chest CAD SR, revision 20
         that were postponed, into a white paper as future work.

4. CORRECTION PROPOSALS

        CP-837: Add Filter Attributes to X-Ray Acquisition Dose and X-Ray Filtration
         modules, submitted September 2007, Letter Ballot completed September 5, 2008.
         Janet Keyes submitted letter ballot comments on behalf of WG 15, to add the two
         new attributes to the X-Ray 3D Angiographic Acquisition and Breast Tomosynthesis
         Acquisition modules, since the attribute tag numbers were not assigned in time to
         include them in Supplement 125 final text.
        CP-857: Template format corrections to TID 40xx, submitted January 2008, Letter
         Ballot completed September 5, 2008.
        CP-874: Fixes for Radiation Dose Reporting, Letter Ballot due October 24, 2008. The
         group reviewed the letter ballot version, and noted changes to Reference Point in TID
         10001, TID 10002 and TID 10003, which deleted <A typical reference point for
         digital mammography is: “Entrance exposure to a 4.2 cm breast thickness”>. Janet
         Keyes will submit a letter ballot comment on behalf of WG 15, to add this as a coded
         term to the new CID zzzz2 Radiation Dose Reference Points, incorporating the
         definition and FDA document reference provided by Penny Butler.
        CP-875: Update CID 4014 and CID 4015, submitted February 2008, assigned to
         Marie-Jose Lacroix. Penny Butler presented feedback from the ACR Subcommittee
         on QA, and the following decisions were made:
             o Retire “XCC” from CID 4014. This is not a clinically used view. Only
                 “XCCL” and “XCCM” are used clinically.
             o Add ISO to CID 4014.
             o Leave SIO as-is in CID 4014. Dr. Daniel Kopans sent the following diagram:
             o Accept the proposed view modifier additions to CID 4015, pending final
                approval by the ACR Subcommittee on QA, BI-RADS® Committee, and
                Stereotactic Breast Biopsy Committee.
             o Via e-mail, Heinrich Wimmer (Philips) questioned adding NP and IMF,
                stating that, “with good positioning practice, Nipple and IMF must be visible.”
                The response is that these specific additional views may be performed when
                the entire breast does not completely fit in the active area of the detector.
             o Janet Keyes will update the Rationale section of CP-875, to clarify changes to
                CID 4014 versus changes to CID 4015.
             o Request approval for the January 2009 voting packet.
             o There was some discussion regarding the potential need for “Angle” view
                modifiers (AL=lateral, AM=medial, AI=inferior, AS=superior), or
                “Additional” view modifiers (A1, A2, A3), but this was tabled for future
                consideration in a separate correction proposal. The idea is to identify
                supplemental or repeated images of the primary views, to keep them out of
                standard display protocols.
        CP-880: Add Breast Composition as numeric value in Dose SR: submitted February
         2008. Letter Ballot due October 21, 2008.
        CP-881: Add Reason For Performed Procedure Code Sequence, Letter Ballot due
         October 21, 2008.
        CP-886: Add codes describing procedure type and indication for Mammography
         scheduling, submitted by Dave Heaney March 2008. Letter Ballot due October 21,
         2008.
        CP-910: Add Tracking Identifier to TID 4004 and TID 4006, submitted June 2008,
         assigned to October voting packet.
        CP-911: Add Condition to DX Patient Orientation, submitted June 2008, assigned to
         October voting packet.

5. DIGITAL BREAST TOMOSYNTHESIS

  Janet Keyes presented the Final Text of Supplement 125. Final Text was approved by WG 6
  on August 28, 2008, and submitted for publication on September 8, 2008. The only change
  resulting from the WG 6 meeting was to remove the two new filter attributes that are being
  added in CP-837, because the attribute tag numbers are not assigned yet.

  The group will need to pay attention to DICOM correction proposals that affect modules and
  macros that are shared with the other multi-frame (e.g. Enhanced MR, Enhanced CT) and X-
  Ray 3D IODs, for example, CP-878 in Ballot Pack 48.

6. BI-RADS® ATLAS

  Barbara Hirsch is the new ACR Director, Breast Imaging Accreditation Programs. Barbara
  has scheduled a meeting with the ACR BI-RADS Committee to discuss future updates to the
  Atlas (Mammography, Ultrasound, and MRI sections).

  Laura Coombs and Lu Meyer visited the group on Tuesday afternoon to provide an update on
  progress of the new ACR NMD. Vendors have started implementing the new NMD. Testing
  will follow, with pilot targeted for Jan-Mar 2009. The group discussed questions from Dr.
  Sickles relating to the mapping between DICOM coded terms and NMD codes for “finding”.
  Many of the DICOM coded terms will map to the “9-Other” NMD code. There was concern
  that the “4-Asymmetries” NMD code was not represented in DICOM. The DICOM context
  groups are nested, so we found the path to coded terms for asymmetry as follows: DICOM
  PS 3.16, TID 4206, row 4 is “Finding”, with the value set defined by CID 6054. CID 6054
  includes CID 6016, CID 6057 and CID 6064. CID 6016 includes CID 6014 and CID 6017.
  CID 6017 contains (F-01792, SRT, “Focal asymmetric breast tissue”) and (F-01793, SRT,
  “Asymmetric breast tissue”).

7. COLON CAD SR

  Topher Gedeon presented the PC+1 version of Supplement 126 to the group on Tuesday,
  made updates based on the discussion, and presented the PC+2 version to the group on
  Wednesday. The group did a line-by-line review of PC+2, and approved the Supplement
  with some minor edits (PC+3) to be presented to WG 6 in October for letter ballot approval.
      All of the open issues from the public comment phase are closed, with the resolutions
         recorded in Closed Issues. The group confirmed that all of the public comments
         submitted by GE have been addressed. Topher had responded to GE (Marie-Jose
         Lacroix) directly.
      Topher will confirm that the Value Type and Relationship constraints defined for the
         Colon CAD SR IOD are consistent with the templates.
      The group discussed and agreed with the definition of the ELLIPSOID graphic type
         for SCOORD3D.
      In TID XX02, existing CID 20 is used for the value set of row 11 “Patient Position
         with respect to gantry”.
      “Baseline Category” is removed from TID XX05 and TID XX07.
      “Severity” is removed from TID XX08, and “Associated Morphology” is VM=1-n.
      “Tumor of colon” is added to CID YY20.
      “Ulcerated” is added to CID YY80.
      CID YY86 contains Calculated Value terms for colon. “Polyp size, largest
         dimension” is included.
      Some RADLEX codes are used.
      The informative examples are updated to match the final template structure.

8. OLD BUSINESS

  DOT Mammography. This work item is on hold until another DOT Mammography
  organization steps forward to take over editing Supplement 136.

  Identification of Specimen images for digital mammography. Supplement 122 Final Text was
  published September 15, 2008, which adds the (G-8310, SRT, “tissue specimen from
  breast”) view code to CID 4014. CP-911 changes the Patient Orientation (0020,0020) in the
  DX Image module to Type 1C, so that it can be omitted from specimen images that are stored
  using one of the Digital X-Ray image IODs.

  IHE Mammography. On Tuesday the group participated in a conference call with the IHE
  Radiology/Mammography committee. The group agreed that the 2008-2009 IHE year should
  focus on promoting and implementing the IHE Mammography Acquisition Workflow
  profile, and continuing to refine a Mammography Reporting Workflow profile proposal, for
  consideration in the 2009-2010 IHE year. Dr. Ellis (Gunderson) has provided a proposal to
  use as a foundation for a white paper. The next IHE Radiology/Mammography Technical
  committee in-person meeting is scheduled for the week of November 10. A demonstration of
  the Mammography Image and Mammography Acquisition Workflow profiles is planned at
  SBI, April 26-29, 2009 in Colorado Springs. Participants (Order Filler, Acquisition
  Modality, Image Display) must test at the February 2009 IHE Connectathon. IHE MESA
  test results are due January 16, 2009.

  Storage and exchange of CAD results for breast tomosynthesis. The group reviewed the
  PowerPoint presentation from the June meeting. It is not clear which images will be sent to
  CAD systems: raw projections, processed projections, and/or reconstructed slices. Some
  CAD algorithm developers would prefer the raw projections, which create a challenge for
  correlating the CAD results from the projection images to the reconstructed slices, for display
  on a workstation. Example 3 (slide 7) suggests providing information about the
  reconstructed slices along with the raw projections to the CAD system. It is not clear if we
  have a clear reference coordinate system defined between the projection images and the
  reconstructed slices, or if additional information would be needed in the Digital
  Mammography X-Ray Image IOD (projections). No decisions made, pending further study.

9. NEW BUSINESS

  Composite Features in Mammography CAD SR. The group discussed the expected
  representation of composite features within a Mammography CAD SR object, given the
  current convention used by some CAD systems to create one Individual
  Impression/Recommendation container per image on which there are reported single image
  findings. This convention does not apply when there are composite features, which may be
  correlated on more than one image. There is concern that Mammography CAD SR parsers
  will not be prepared for this structure change. However, the creators and parsers should be
  flexible according to the defined templates, and the examples provided in DICOM PS 3.17,
  Annex E. See Examples 2 and 3, which follow the intended inference structure.

  DICOM Strategy update. The group reviewed and updated the WG 15 chapter of the DICOM
  Strategy document.

  Quality Standard updates for digital mammography. A question was raised re: who is
  involved in this process (e.g. MITA, FDA, ACR). Changes to MQSA Part 900 were
  proposed two years ago, and are being reviewed by FDA staff. This is a long process. There
  will be opportunity for comment. The FDA is aware of ACR and IEC efforts in this area.
  Meanwhile, the FDA can publish guidance regarding QC procedures, which are difficult to
  standardize given the various digital mammography technologies.

10. NEW ACTION ITEMS

  Correction Proposals:
      Janet: Submit a letter ballot comment for CP-874 on behalf of WG 15 to define a
         reference point coded term for mammography dose reporting.
      Bas, Janet: Request WG 6 to approve CP-910 and CP-911 for the October ballot
         packet.
        Penny: Report results from the ACR committees regarding approval and/or
         adjustment to the proposed view modifiers in CP-875.
        Janet: Update CP-875 based on feedback from the ACR committees, distribute to the
         group, and request WG 6 to approve for the January 2009 voting packet.

  Colon CAD SR:
      Topher: Finalize and present PC+3 of Supplement 126 to WG 6 in October, for letter
        ballot approval.
      Topher: Finalize work on use of RadLex codes and SRT codes in Supplement 126.

  Other:
      Janet: Notify the group when Supplement 125 final text is published.
      All: Continue to investigate breast tomosynthesis CAD needs, and report back at the
         next meeting.
      Topher, Janet: Determine if clarification is needed in DICOM regarding the
         representation of composite features in Mammography CAD SR.
      Janet: Send the WG 15 DICOM Strategy update to the DICOM Standards
         Committee.

11. NEXT MEETING

  The next meeting is scheduled for March 31 and April 1, 2009.

12. ADJOURNMENT

  The meeting was adjourned at 2:40pm on September 24.

  Reported by:                                      Janet Keyes (co-Chair)
                                                    WG 15 of the DICOM Stds. Comte.
                                                    October 10, 2008

  Reviewed by Counsel:                              October 23, 2008

								
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