The Conversion to Digital
Mammography : A Personal Tale
William Geiser, MS DABR
Senior Medical Physicist
MD Anderson Cancer Center
Houston, Texas
wgeiser@mdanderson.org
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FDA Statistics 5/3/2010
• Certified Facilities: 8664
• Certified Systems: 12,519
• Certified FFDM: 8193
• Implies – 65% of systems are FFDM
– Was 60% in January 2010
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Introduction
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More than just testing the equipment
Preplanning
Room Design
Network
Equipment Selection
Storage (PACS)
Image Review
Work List
Reporting
Acceptance Testing
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In the beginning…
• 2000 install of GE 2000D
• 2003 install of Fischer SenoScan, new
construction begins
• 2004 install of two more Fischer systems
– Printed everything
– Start process of soft copy read (screening
mammography only)
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My First Digital Installation
• Fischer SenoScan
• New room build out near existing area
• Already had a GE 2000D – print everything
• Plan to shift from printing to soft copy
review for screening
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The New Facility
• Split Screening and Diagnostic
Mammography
• Screening all digital
– Four Fischer SenoScans
• Diagnostic Clinic
– Film screen to start
– Digital system for procedures (needle locs)
– Planning to go digital
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Pre-Plan
• Try to anticipate everything
• How many rooms
• Room layout
• Network configuration
• Room location
• Workflow
• Meetings, meetings and more meetings
• Make lists
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Room Layout
• Placement of mammo system
• Power requirements
– Fischer 408V, 3 phase power
– Film screen systems 220V, single phase
– Other Digital, 220V
• Auxiliary equipment
– Radiology information computers
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Network
Power
Phone
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Auxiliary Equipment Storage
• Test Equipment
– Phantoms
• Flat field
• ACR accreditation phantom
• Disinfectant wipes
• Markers
– Nipple markers
– Scar markers
– others
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Network
• Speed/Duplex
• Fixed IP Address or Dynamic Host
Configuration Protocol (DHCP)
– Never DHCP for imaging equipment
• Subnet selection
• Security
• Where do we place ports and how many do
we need
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Work list
Backbone
PACS
CAD
1 Gbit Backbone
Image Review
Image
Acquisition
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Equipment Selection
• Not so easy!
• Approved digital mammography vendors
– Fuji CR
– GE
– Hologic/Lorad
– Siemens
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Lots of Choices
• GE
– DS
– Essential
• Hologic
– Selenia
– Selenia S
– Dimensions 2D
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More Choices
• Siemens
– Novation DR
– Novation S
– Inspiration (not yet, but soon?)
• Fuji CRm
• What meets your needs now and in the
future!
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Dedicated Mammography System
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Requirements List
• Resolution
• Field Size
• Screening only, Diagnostic only, mixed use
– Paddles
– Other auxiliary equipment
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More Requirements
• Is the image LUT supported by PACS
– GE needs PACS to support VOI LUT display
• Is the DICOM information IHE compliant
– Industry standard
• Get full DICOM demo images and put them
on PACS and view them!
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Image Storage (PACS)
• Existing PACS
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Go with the flow
Fully DICOM ?
IHE?
Display MQSA compliant?
• New PACS
– Requirements
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DICOM
Supports CAD SR
IHE
Mult-modality workstations
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Questions to Ask
• Can you Print from PACS?
– If yes, with same quality?
– With same grey scale (Same LUT)?
• Is PACS IHE compliant?
– Allows for display that meets MQSA
requirements for image information including
markers.
– Will support CAD SR
• Can you design individual hanging protocols
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More PACS
• Load up demo images on existing PACS
• Check image quality of images on PACS
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Image Review
• Two Choices
– Mammo Specific Workstation
– PACS Review Station (multi-modality)
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Hologic
Securview
GE Seno
Advantage 2.1
PACS
Workstation
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Vendor Review Station
• Advantages:
– Image display of images is optimized
– Plug and play for mammography
– Applications training available
• Disadvantages
– May not be multi modality
– May not display images from other vendors
equipment properly
– Need to fetch priors and other stored studies
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PACS Review Station
• Advantages
– Can display all patient images from any study
– May not need to pre-fetch images
– Should display all vendors mammo images
properly
• Disadvantages
– May have trouble with hanging protocols
– May not have good support
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Work List
• Radiology Information System
– A definite must have!
• Prevents a lot of patient information errors
• Keeps you from having to hand type in all
patient data
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Reporting System
• To dictate or not to dictate?
• Lots of choices for reporting mammograms
– PenRad
– MRS
– MagView
– RIS Vendors
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Siemens
GE
Carestream
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Reporting system requirements
• Needs to be able to meet MQSA reporting
requirements
• BIRADS reporting
• Generation of letters
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Mammography System Setup
• IP addresses
• AE Titles
• Port activation
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Acceptance Testing
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Do you have the proper equipment
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kVp meter for new anode filter combos
Luminance and illuminance meter
Resolution patterns
Lead blocking material
Vendor supplied phantoms
– Flat field phantoms
– Resolution patterns
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Acceptance Testing Mammography System
• Follow manufacturers QC manual for testing
– Assembly evaluation
– Collimation
– Artifacts
– Resolution
– kVp
– HVL
– Automatic exposure control
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Acceptance Testing Mammography System
• Manufacturer guidelines
– Phantom image quality
• SNR/CNR measurements
– Average glandular dose
– Ghosting (always at acceptance)
– Resolution
– Radiation output
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Setting baselines
• Technologist QC program
– SNR/CNR
– Artifact evaluation parameters
– Phantom mAs
– Printer O.D.’s
– Phantom scores
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Acceptance Testing - Communications
• Do you have network connectivity
• Worklist management
– Does the work list populate properly
• Daily list
• Automatic query
• Manual query
• Sending Images
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Auto push
All images arrive
Image quality adequate
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Acceptance Testing – Reading Room
• Reading Room
– Lighting levels
– Glare
– Set up for display
– Proper placement of review station and view
boxes
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Soft Copy Review Station
• Calibration
– DICOM GSDF
– Peak brightness 500 – 600 cd/m2
– Black level < 1 cd/m2
• Acceptance Testing
– TG-18 protocol
• Phantom Image Quality
– Patient information in correct place
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Patient Info
Patient Info
View Info
Technique Info
Technique Info
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