Download DICOM Digital Mammography Subgroup

MINUTES
DICOM WORKING GROUP 15
MAMMOGRAPHY AND CAD
PLACE OF MEETING
AMERICAN COLLEGE OF RADIOLOGY, RESTON, VA
DATE AND TIME
FEBRUARY 1, 2005: 10:00AM – 6:00PM
FEBRUARY 2, 2005: 8:30AM – 3:00PM
MEMBERS PRESENT:
Eastman Kodak
Fujifilm Medical Systems
GE Healthcare
Hologic, Inc.
IDX Systems
Mammography Reporting Systems (MRS)
Northwestern Memorial (ACR)
Planmed Oy
R2 Technology
Tom Puckett
Paul Morgan (Tues)
Guy Hersemeule
Janet Keyes
Carol Moore
Steve Vellella
Judith Wolfman
Mari Varjonen
Julian Marshall
MEMBERS ABSENT:
Fischer Imaging
*iCAD, Inc.
*Massachusetts General Hospital (ACR)
*Massachusetts General Hospital (ACR)
Siemens Medical Solutions
Dan Hansen
Topher Gedeon
Daniel Kopans
Richard Moore
Michael Jonas
* = Does not count toward quorum.
OTHERS PRESENT:
American College of Radiology Staff
American College of Radiology Staff
American College of Radiology Staff
American College of Radiology Staff
American College of Radiology Staff
Confirma
PRESIDING OFFICER:
Sandra Bjork (Wed)
Penny Butler
Joyce Hahn
Marilyn McIntyre
Christine Waldrip
Vishnu Srimurthy
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.
The meeting started with a round of introductions, to welcome new participants from the
ACR staff and Confirma, and to welcome back Mari Varjonen, representing Planmed Oy.
2. REVIEW OF PREVIOUS MINUTES
The meeting minutes for the October 12-13, 2004 meeting were approved as distributed.
3. REVIEW OF PREVIOUS ACTION ITEMS
Correction Proposals:
 Julian, Janet, Topher: Agree on final changes to CP-479 for resubmission to WG 6 in
November. Completed.
 Janet: Make arrangements to present CP-478, CP-479, and CP-480 to WG 6 for letter
ballot authorization in November, and to request adding CP-492 and CP-493 to the
January 2005 voting packet. Completed.
 Janet: Check with Hologic on adding “HTC” to the list of Defined Terms for Grid
(0018,1166) and write a correction proposal if appropriate. Withdrawn.
 Janet, Tom: In CP-475, inquire to WG 6 why Retrieve AE Title (0008,0054) is
included at the Series level rather than the SOP Instance level. Completed.
Digital Breast Tomosynthesis:
 Guy, Michael: Evaluate Supplement 83, Public Comment for potential use for
reconstructed slices for digital breast and general radiography tomosynthesis, discuss
with WG 2 representatives, return comments to NEMA by November 8, and share the
comments with WG 15. Completed.
 All FFDM representatives: Discuss the use of Digital Mammography X-Ray Image
IOD with a few additional attributes versus a multi-frame image IOD patterned after
Enhanced XA/XRF Image for the reconstructed slices, and report back the
preference. Completed. Enhanced XA/XRF is for projection images.
BI-RADS® Atlas:
 Carol, Janet: Prepare and submit the latest draft of the correction proposal for the
Mammography and Ultrasound sections to WG 6 in November. Inquire whether WG
8 input is needed for the coded terminology updates. Completed.
 Carol, Judith: Work on additions or corrections to procedure and procedure modifier
context groups (CIDs 6050, 6058, 6060), regarding representing “guided” procedures
that are not biopsy, and representing aspiration versus drainage, catheter placement,
and fluid collection. Completed during meeting.
 Carol, Steve, Judith: Provide comments to Christine regarding technical
classifications and specific inconsistencies in the MRI section of the Atlas. ACR to
meet with MRI section contributors and vendors mid-year.
 Christine: Collect feedback on the MRI section. Compare the report, classification
form, and data dictionary components of the MRI section to look for additional
inconsistencies, and report collective feedback to the BI-RADS® Committee. Report
to WG 15 the response from the BI-RADS® Committee. ACR to meet with MRI
section contributors and vendors mid-year.
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Christine: Obtain a copy of the French translation of BI-RADS® Atlas for the ACR.
Completed.
Other:
 Topher: Draft a white paper for the Colon/Abdomen CAD SR, based on Chest CAD
SR. Research sources for the terminology familiar to clinicians that is currently used
to report such findings. Julian Marshall provided initial draft during meeting.
On Hold:
 Janet: Finish extracting the portions of Supplement 65, Chest CAD SR, revision 20 that
were postponed, into a white paper as future work.
 Julian: Prepare the vascular calcifications CP, and circulate to the group.
4. CORRECTION PROPOSALS
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CP-393, Add Partial View Code Sequence: Final Text approved in January 2005.
CP-467, VOI LUT Function: Final Text approved in January 2005.
CP-478, Move term from CID 6054 to CID 6016: Final Text approved in January 2005.
CP-479, CAD Rendering Intent Level: Final Text approved in January 2005.
CP-480, Add Mammography Series Attribute for Screening/Diagnostic: Final Text
approved in January 2005.
CP-492, Add Calculated Value to Mammography CAD SR: Out for Letter Ballot in
CPACK 30, due March 16.
CP-493, Add Rolled Inferior, Rolled Superior View Modifiers to CID 4015: Out for
Letter Ballot in CPACK 30, due March 16.
5. DIGITAL BREAST TOMOSYNTHESIS
Janet Keyes presented to the group the work item proposal and the initial draft requirements
from WG 2 (Projection Radiography and Angiography) for the XA 3D Storage object. WG
15 will monitor the activity of WG 2 on this work item, to determine whether collaboration is
possible. Supplement 83, Enhanced XA / XRF Image, already in progress by WG 2, does
not apply because it is intended for projection images.
The group discussed the existing DICOM image objects that could be considered candidates
for storage of digital breast tomosynthesis reconstructed slices, in order to determine the
constraints and shortfalls that would impede conformant and interoperable usage. The
Enhanced CT Image, CT Image, and Digital Mammography X-Ray Image IODs are being
evaluated. In the short term, for the purpose of clinical trials, the digital mammography
manufacturers may use one of these objects to store the reconstructed slices before a new
object is defined. The Enhanced CT Image is a less likely candidate, because it is new and
not likely to be widely accepted by PACS/Archive during the clinical trials time frame.
The group produced an outline of basic categories of information that need to be included in
a new image object for digital breast tomosynthesis reconstructed slices (see
DigitalBreastTomosynthesisReconstructedSlices-Ideas.doc).
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Geometry: Based on the potential downstream uses of reconstructed slices (e.g.,
screening, diagnosis, treatment), is it necessary to provide absolute coordinates of the
image pixel data with respect to the patient? Is a reference coordinate system needed
to relate the projection images to the reconstructed slices? Is the existing Image
Position (Patient) / Image Orientation (Patient) paradigm sufficient? Is geometry
described with respect to the bucky preferred?
Acquisition Context: which information regarding the original projection images
should be represented in the header for reconstructed slices?
Visualization Techniques: what types of attributes should be included to facilitate
interoperable visualization of the reconstructed slices? (e.g., tissue classification,
calibration of pixel data values)
Single frame versus Multi-frame: define in terms of multi-frame, but do not preclude
the ability to store one slice per instance (see Enhanced MR and Enhanced CT)
Each digital mammography representative will discuss the questions within their respective
organization, and bring responses to the next meeting. The group plans to draft a work item
proposal at the next meeting, for presentation to the DICOM Standards Committee in
September.
6. BI-RADS® ATLAS
The October 2004 draft of the correction proposal to update the Breast Imaging Report and
Relevant Patient Information templates and context groups based on new and changed
information in the Mammography and Ultrasound sections of the BI-RADS® Atlas, was
submitted to WG 6 in January, and assigned the number CP-527. WG 6 assigned the CP to
Alexey Ulanov (IDX Systems).
On Tuesday the group stepped through the latest draft of the correction proposal prepared by
Carol Moore, to review the proposed SNOMED code assignments and resolve the remaining
open issues. Carol updated the document, and on Wednesday the group reviewed and
accepted the changes (see CP527_01_BIRADS_ATLAS.doc). One open issue remains
regarding the wording of the synonym code meanings for the breast composition descriptors,
pending Errata in progress by the ACR BI-RADS® committee. Carol and Steve will provide
feedback to the ACR regarding the proposed changes.
Carol and Janet will work with WG 6 and WG 8 (Structured Reporting) to determine the
steps necessary to advance this correction proposal at the March 21-25 WG 6 meeting, with
the goal of assignment to the June voting packet.
As soon as CP-527 is ready for letter ballot, WG 15 will use the French publication of the BIRADS® Atlas to prepare a correction proposal to update Annex E of DICOM Part 16, the
French translations of the coded terminology.
The group agreed that it is too soon to determine whether any of the additions to the Breast
Imaging Report templates should also be applied to the Mammography CAD SR templates.
This topic will be addressed separately at a future time.
Regarding the MRI section of the Atlas, the ACR is planning to hold a meeting mid-year
with the contributors to the MRI section and the BI-RADS® licensed vendors, to discuss the
issues raised by the vendors and plan the next revision. In the interim, each licensed vendor
is encouraged to work with the ACR to set expectations for implementation adherence to the
MRI section. WG 15 will wait for the outcome of updates to the MRI section before starting
a correction proposal that incorporates MRI section content into the Breast Imaging Report
templates.
7. ABDOMEN CAD SR PROPOSAL
Julian Marshall (R2) presented three documents. First, a report from the Fifth International
Symposium on Virtual Colonoscopy held in Boston (VC Reporting.doc), where Dr. Michael
Zalis presented preliminary results regarding the current effort to develop a standardized
reporting system for CT colonography (C-RADS). Second, an initial draft of a white paper
describing the clinical needs and technological rationale for development of a DICOM
Abdomen CAD Structured Report. The proposed scope is to limit the Structured Report
content to findings and features, similar to the Chest CAD SR. Third, an initial draft of an
abdomen lexicon (Abdomen lexicon.xls). Sandy Bjork reported that the RSNA’s RadLex®
lexicon (http://www.rsna.org/radlex) should be considered as a source. Curt Langlotz chairs
the steering committee.
The immediate objective is to determine whether WG 15 is the appropriate venue for such a
work item, and whether the ACR as secretariat would support such an effort. Janet, Topher,
and Tom will review the white paper and provide comments to Julian. Then Julian will send
the white paper to Dr. Wolfman, who will circulate it within the ACR to the committee that
oversees DICOM involvement (Dr. Steve Horii and others). If the concept is supported by
the ACR, WG 15 will proceed to contact additional virtual colonscopy and abdomen CAD
vendors and clinical specialists to ensure balanced and sufficient participation, and present a
work item proposal to the DICOM Standards Committee in September.
8. OLD BUSINESS
Supplement 94 (Radiation Dose SR): Penny Butler (ACR) expressed interest in this topic.
Janet Keyes stepped through the work item and the initial draft Supplement, to remind the
group of the intent. There has been no published activity on this work item since the
presentation by Heinz Blendinger (Siemens) to WG 6 in September 2004. WG 15 will
continue to monitor activity on this work item. One concern is that the half value layer is
often measured rather than calculated, which may impact the accuracy of organ dose
reporting.
CP-475, Add SOP Instance Access to Relevant Patient Information Query. Between Letter
Ballot and Final Text in January, this correction proposal was withdrawn from CPACK 29
and reassigned to Harry Solomon. WG 6 did not address WG 15’s question of whether
Retrieve AE Title should be included at the Series or Instance level.
Supplement 101, HL7 Structured Document Object References (sup101_lb), that contains
additions to the Relevant Patient Information C-FIND response identifier, has completed
public comment and will be submitted for Letter Ballot approval in March.
9. NEW BUSINESS
DICOM 2004, Part 3 inadvertently removed View Code Sequence and View Modifier Code
Sequence from the Mammography Image module. CP-535 is in progress to restore them.
CP-545: A correction to add two relationship permutations that are missing from the
Mammography CAD SR IOD relationship constraints in DICOM 2004, Part 3, that are used
in the Mammography CAD SR templates in Part 16.
An Internet news group discussion was brought to the attention of WG 15, regarding
concerns about the relationship between Digital Mammography X-ray Image For Processing,
Mammography CAD SR, and Digital Mammography X-ray Image For Presentation
instances, given that most mammography CAD devices perform CAD on For Processing
images, most softcopy workstations display only For Presentation images, and workstations
need to be able to display CAD results with the images. Workstations that are not directly
associated with a digital mammography manufacturer need assurance that sufficient accurate
information is provided to display CAD findings correctly on a For Presentation image
whose coordinates are taken from a Mammography CAD SR instance that references the
corresponding For Processing image. WG 15 will draft a correction proposal to add text to
the Mammography CAD SR informative annex in DICOM Part 17, to explain the
relationship between Digital Mammography X-ray Image For Processing, Mammography
CAD SR, and Digital Mammography X-ray Image For Presentation instances.
A Collaborative Workgroup on Image Quality, led by Dr. Tony Seibert (UC-Davis) and Dr.
Etta Pisano (UNC-Chapel Hill), is developing a white paper regarding image quality
requirements for digital mammography, to address image quality as the endpoint of
acquisition, processing, display, transport, and archiving. The white paper, targeted for the
end of 2005, will be made available to manufacturers at that time for comment. The ultimate
goal of the group is to develop a collaborative technical standard for digital mammography
image quality, and incorporate it into ACR standards and guidelines.
Discussion of defined terms for Exposure Control Mode (0018,7060). Are MANUAL and
AUTOMATIC sufficient, given that digital mammography manufacturers offer variations on
automatic exposure control? Each manufacturer uses different terms and techniques for
automatic exposure control, so converging on a standard list of terms is not desired. Group
consensus is that the existing defined terms should be used for Exposure Control Mode, and
any manufacturer dependent customizations should be conveyed in Exposure Control Mode
Description (0018,7062).
Supplement 108, Relevant Patient Information Query for Orders, is currently out for public
comment, with comments due March 7. A new SOP Class and corresponding template
structure are proposed for the Relevant Patient Information Query Service Class.
10. NEW ACTION ITEMS
Digital Breast Tomosynthesis:
 Janet: Check with WG 2 regarding progress on XA 3D Storage object, and distribute
updates to WG 15.
 All with interest in Tomosynthesis: Discuss the ideas for content of an image object
for tomosynthesis reconstructed slices within your organization and bring feedback to
next WG 15 meeting.
BI-RADS® Atlas:
 Janet: Provide Carol with contact information for WG 8 and SNOMED, to confirm
code assignments for CP-527.
 Carol: Follow up with Alexey to obtain WG 6 feedback on CP-527 from January.
 Carol, Janet: Prepare and copy a revision of CP-527 to the WG 6 folder for the March
21-25 meeting (1-2 weeks prior), to request assignment to the June voting packet.
 Carol, Steve: Provide feedback to the ACR regarding the proposed Errata regarding
wording of breast composition descriptors.
Other:
 Janet, Tom, Topher: Provide feedback to Julian on the initial draft of the Abdomen
CAD SR white paper as soon as possible.
 Julian: Incorporate feedback on Abdomen CAD SR white paper, and send to Dr.
Wolfman to present to the ACR DICOM committee.
 Janet, Julian, Tom, Paul: Write a correction proposal to add text to the Mammography
CAD SR informative annex to explain the relationship between Digital
Mammography X-ray Image For Processing, Mammography CAD SR, and Digital
Mammography X-ray Image For Presentation instances. Submit to WG 6 in March.
 Janet: Check on progress of the Radiation Dose SR supplement, and distribute
updates to WG 15.
11. NEXT MEETING
The next meeting will be May 10-11, at the American College of Radiology in Reston, VA.
12. ADJOURNMENT
The meeting was adjourned at 2:45pm on February 2.
Reported by:
Reviewed by Counsel:
Janet Keyes (co-Chair)
WG 15 of the DICOM Stds. Comte.
February 8, 2005
February 20, 2005