The Conversion to Digital Mammography : A Personal Tale · – MagView – RIS Vendors • Siemens • GE • Carestream. MDACC Imaging Physics 32 Reporting system requirements •

MDACC Imaging Physics1

The Conversion to Digital The Conversion to Digital Mammography : A Personal TaleMammography : A Personal Tale

William Geiser, MS DABRSenior Medical Physicist

MD Anderson Cancer CenterHouston, Texas

[email protected]


FDA Statistics 5/3/2010FDA Statistics 5/3/2010

•• Certified Facilities: 8664Certified Facilities: 8664

•• Certified Systems: 12,519Certified Systems: 12,519

•• Certified FFDM: 8193Certified FFDM: 8193

•• Implies Implies –– 65% of systems are FFDM65% of systems are FFDM–– Was 60% in January 2010Was 60% in January 2010


IntroductionIntroduction

•• More than just testing the equipmentMore than just testing the equipment

•• PreplanningPreplanning

•• Room DesignRoom Design

•• NetworkNetwork

•• Equipment SelectionEquipment Selection

•• Storage (PACS)Storage (PACS)

•• Image ReviewImage Review

•• Work ListWork List

•• ReportingReporting

•• Acceptance TestingAcceptance Testing


In the beginningIn the beginning……

•• 2000 install of GE 2000D2000 install of GE 2000D

•• 2003 install of Fischer SenoScan, new 2003 install of Fischer SenoScan, new construction beginsconstruction begins

•• 2004 install of two more Fischer systems2004 install of two more Fischer systems–– Printed everythingPrinted everything

–– Start process of soft copy read (screening Start process of soft copy read (screening mammography only)mammography only)


My First Digital InstallationMy First Digital Installation

•• Fischer SenoScanFischer SenoScan

•• New room build out near existing areaNew room build out near existing area

•• Already had a GE 2000D Already had a GE 2000D –– print everythingprint everything

•• Plan to shift from printing to soft copy Plan to shift from printing to soft copy review for screeningreview for screening


The New FacilityThe New Facility

•• Split Screening and Diagnostic Split Screening and Diagnostic MammographyMammography

•• Screening all digitalScreening all digital–– Four Fischer SenoScansFour Fischer SenoScans

•• Diagnostic ClinicDiagnostic Clinic–– Film screen to startFilm screen to start

–– Digital system for procedures (needle locs)Digital system for procedures (needle locs)

–– Planning to go digitalPlanning to go digital


PrePre--PlanPlan

•• Try to anticipate everythingTry to anticipate everything

•• How many roomsHow many rooms

•• Room layoutRoom layout

•• Network configurationNetwork configuration

•• Room locationRoom location

•• WorkflowWorkflow

•• Meetings, meetings and more meetingsMeetings, meetings and more meetings

•• Make listsMake lists


Room LayoutRoom Layout

•• Placement of mammo systemPlacement of mammo system

•• Power requirementsPower requirements–– Fischer 408V, 3 phase powerFischer 408V, 3 phase power

–– Film screen systems 220V, single phaseFilm screen systems 220V, single phase

–– Other Digital, 220VOther Digital, 220V

•• Auxiliary equipmentAuxiliary equipment–– Radiology information computersRadiology information computers


Power

Network

Phone


Auxiliary Equipment StorageAuxiliary Equipment Storage

•• Test EquipmentTest Equipment–– PhantomsPhantoms

•• Flat fieldFlat field•• ACR accreditation phantomACR accreditation phantom

•• Disinfectant wipesDisinfectant wipes

•• MarkersMarkers–– Nipple markersNipple markers–– Scar markersScar markers–– othersothers


NetworkNetwork

•• Speed/DuplexSpeed/Duplex

•• Fixed IP Address or Dynamic Host Fixed IP Address or Dynamic Host Configuration Protocol (DHCP) Configuration Protocol (DHCP) –– Never DHCP for imaging equipmentNever DHCP for imaging equipment

•• Subnet selectionSubnet selection

•• SecuritySecurity

•• Where do we place ports and how many do Where do we place ports and how many do we needwe need


Image Review

PACS

Image Acquisition

Work list

CAD

Backbone

1 Gbit Backbone


Equipment SelectionEquipment Selection

•• Not so easy!Not so easy!

•• Approved digital mammography vendorsApproved digital mammography vendors–– Fuji CRFuji CR

–– GEGE

–– Hologic/LoradHologic/Lorad

–– SiemensSiemens


Lots of ChoicesLots of Choices

•• GEGE–– DSDS

–– EssentialEssential

•• HologicHologic–– SeleniaSelenia

–– Selenia SSelenia S

–– Dimensions 2DDimensions 2D


More ChoicesMore Choices

•• SiemensSiemens–– Novation DRNovation DR

–– Novation SNovation S

–– Inspiration (not yet, but soon?)Inspiration (not yet, but soon?)

•• Fuji CRmFuji CRm

•• What meets your needs now and in the What meets your needs now and in the future!future!


Dedicated Mammography SystemDedicated Mammography System



Requirements ListRequirements List

•• ResolutionResolution

•• Field SizeField Size

•• Screening only, Diagnostic only, mixed useScreening only, Diagnostic only, mixed use–– PaddlesPaddles

–– Other auxiliary equipmentOther auxiliary equipment


More RequirementsMore Requirements

•• Is the image LUT supported by PACSIs the image LUT supported by PACS–– GE needs PACS to support VOI LUT displayGE needs PACS to support VOI LUT display

•• Is the DICOM information IHE compliantIs the DICOM information IHE compliant–– Industry standardIndustry standard

•• Get full DICOM demo images and put them Get full DICOM demo images and put them on PACS and view them!on PACS and view them!


Image Storage (PACS)Image Storage (PACS)

•• Existing PACSExisting PACS–– Go with the flowGo with the flow–– Fully DICOM ?Fully DICOM ?–– IHE?IHE?–– Display MQSA compliant?Display MQSA compliant?

•• New PACSNew PACS–– RequirementsRequirements

•• DICOMDICOM•• Supports CAD SRSupports CAD SR•• IHEIHE•• MultMult--modality workstationsmodality workstations


Questions to AskQuestions to Ask

•• Can you Print from PACS?Can you Print from PACS?–– If yes, with same quality?If yes, with same quality?–– With same grey scale (Same LUT)?With same grey scale (Same LUT)?

•• Is PACS IHE compliant?Is PACS IHE compliant?–– Allows for display that meets MQSA Allows for display that meets MQSA

requirements for image information including requirements for image information including markers.markers.

–– Will support CAD SRWill support CAD SR

•• Can you design individual hanging protocolsCan you design individual hanging protocols


More PACSMore PACS

•• Load up demo images on existing PACSLoad up demo images on existing PACS

•• Check image quality of images on PACSCheck image quality of images on PACS



Image ReviewImage Review

•• Two ChoicesTwo Choices–– Mammo Specific WorkstationMammo Specific Workstation

–– PACS Review Station (multiPACS Review Station (multi--modality)modality)


GE Seno Advantage 2.1

Hologic Securview

PACS Workstation


Vendor Review StationVendor Review Station

•• Advantages:Advantages:–– Image display of images is optimizedImage display of images is optimized–– Plug and play for mammographyPlug and play for mammography–– Applications training availableApplications training available

•• DisadvantagesDisadvantages–– May not be multi modalityMay not be multi modality–– May not display images from other vendors May not display images from other vendors

equipment properlyequipment properly–– Need to fetch priors and other stored studies Need to fetch priors and other stored studies


PACS Review StationPACS Review Station

•• AdvantagesAdvantages–– Can display all patient images from any studyCan display all patient images from any study

–– May not need to preMay not need to pre--fetch imagesfetch images

–– Should display all vendors mammo images Should display all vendors mammo images properlyproperly

•• DisadvantagesDisadvantages–– May have trouble with hanging protocolsMay have trouble with hanging protocols

–– May not have good supportMay not have good support




Work ListWork List

•• Radiology Information SystemRadiology Information System–– A definite must have!A definite must have!

•• Prevents a lot of patient information errorsPrevents a lot of patient information errors

•• Keeps you from having to hand type in all Keeps you from having to hand type in all patient datapatient data


Reporting SystemReporting System

•• To dictate or not to dictate?To dictate or not to dictate?

•• Lots of choices for reporting mammogramsLots of choices for reporting mammograms–– PenRadPenRad–– MRSMRS–– MagViewMagView–– RIS VendorsRIS Vendors

•• SiemensSiemens•• GEGE•• CarestreamCarestream


Reporting system requirementsReporting system requirements

•• Needs to be able to meet MQSA reporting Needs to be able to meet MQSA reporting requirementsrequirements

•• BIRADS reportingBIRADS reporting

•• Generation of lettersGeneration of letters


Mammography System SetupMammography System Setup

•• IP addressesIP addresses

•• AE TitlesAE Titles

•• Port activationPort activation


Acceptance TestingAcceptance Testing

•• Do you have the proper equipmentDo you have the proper equipment–– kVp meter for new anode filter comboskVp meter for new anode filter combos

–– Luminance and illuminance meterLuminance and illuminance meter

–– Resolution patternsResolution patterns

–– Lead blocking materialLead blocking material

•• Vendor supplied phantomsVendor supplied phantoms–– Flat field phantomsFlat field phantoms

–– Resolution patternsResolution patterns


Acceptance Testing Mammography SystemAcceptance Testing Mammography System

•• Follow manufacturers QC manual for testingFollow manufacturers QC manual for testing–– Assembly evaluationAssembly evaluation

–– CollimationCollimation

–– ArtifactsArtifacts

–– ResolutionResolution

–– kVpkVp

–– HVLHVL

–– Automatic exposure controlAutomatic exposure control


Acceptance Testing Mammography SystemAcceptance Testing Mammography System

•• Manufacturer guidelinesManufacturer guidelines–– Phantom image qualityPhantom image quality

•• SNR/CNR measurementsSNR/CNR measurements

–– Average glandular doseAverage glandular dose

–– Ghosting (always at acceptance)Ghosting (always at acceptance)

–– ResolutionResolution

–– Radiation outputRadiation output


Setting baselinesSetting baselines

•• Technologist QC programTechnologist QC program–– SNR/CNRSNR/CNR

–– Artifact evaluation parametersArtifact evaluation parameters

–– Phantom Phantom mAsmAs

–– Printer Printer O.D.O.D.’’ss

–– Phantom scoresPhantom scores


Acceptance Testing Acceptance Testing -- CommunicationsCommunications

•• Do you have network connectivityDo you have network connectivity

•• WorklistWorklist managementmanagement–– Does the work list populate properlyDoes the work list populate properly

•• Daily listDaily list

•• Automatic queryAutomatic query

•• Manual queryManual query

•• Sending ImagesSending Images–– Auto pushAuto push

–– All images arriveAll images arrive

–– Image quality adequateImage quality adequate


Acceptance Testing Acceptance Testing –– Reading RoomReading Room

•• Reading RoomReading Room–– Lighting levelsLighting levels

–– GlareGlare

–– Set up for displaySet up for display

–– Proper placement of review station and view Proper placement of review station and view boxesboxes



Soft Copy Review StationSoft Copy Review Station

•• CalibrationCalibration–– DICOM GSDFDICOM GSDF

–– Peak brightness 500 Peak brightness 500 –– 600 cd/m600 cd/m22

–– Black level < 1 cd/mBlack level < 1 cd/m2 2

•• Acceptance TestingAcceptance Testing–– TGTG--18 protocol18 protocol

•• Phantom Image QualityPhantom Image Quality–– Patient information in correct placePatient information in correct place


Patient Info Patient Info

Technique Info Technique Info

View Info


Documents

The Conversion to Digital Mammography : A Personal Tale · – MagView – RIS Vendors • Siemens • GE • Carestream. MDACC Imaging Physics 32 Reporting system requirements •