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WG 15 (Mammography and CAD)
Secretariat
American College of Radiology
Secretary
Christine Waldrip, ACR
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Industry Co-Chairman
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Clinical Co-Chairman
Date of Last Update:
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ChristineW@acr.org
Janet E. Keyes, Hologic, Inc.
jkeyes@hologic.com
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Vacant
August 13, 2004
Scope:
To develop extensions to DICOM to support breast imaging and reporting thereof, including structured
reporting of Computer-Aided Detection / Diagnosis (CAD) results.
Roadmap:
The following are potential work items with respect to Structured Reporting:
 Maintenance of the existing Mammography CAD, Chest CAD, and Breast Imaging structured
reports and associated coded terminology, based on the BI-RADS® Atlas.
 Reporting of Mammography CAD output across modalities: expansion beyond X-Ray projection
into Ultrasound and/or MR breast imaging analysis.
 Reporting of CAD output results that are 3-Dimensional.
 Reporting of CAD output for additional anatomy.
The following are potential work items with respect to Image IODs:
 Evaluation of the Ultrasound and MR Image IODs for completeness with respect to attributes
specific to breast imaging, based on the BI-RADS® Atlas.
 Addition of attributes or modules for new breast imaging technologies, such as energy subtraction
or “tomosynthesis”.
 Addition of attributes or modules to describe DX/Mammography quality control and phantom
images.
Risks:
 Long term: Incorporation of multi-dimensional CAD results is dependent on the adoption of multidimensional objects into the DICOM Standard.
 Long term: Future extensions to Chest CAD SR are dependent on the clinical input received
toward reaching consensus on a subset of chest radiography terminology to use in describing
Chest CAD output results, and assignment of codes for that terminology.
 Roadmap: Requests for future work items will be dependent on the active participation of vendors
and clinicians that perceive a need to expand the DICOM Standard in a specific area, and support
of the Secretariat for those work items. Some items may require cooperation from other working
groups.
Short Term Goals:
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CP-393, Partial View Code Sequence: Add an attribute to the Mammography Image module to use
coded terminology to indicate the section of the breast included in a partial view image, to voting
packet September 2004.
CP-467, VOI LUT Function attribute: Define sigmoid interpretation of Window Center and
Window Width values, to voting packet September 2004.
CP-478, Move term from CID 6054 to CID 6016: to voting packet October 2004.
CP-479, CAD Rendering Intent Level: Convey CAD algorithm operating points for Presentation
Optional findings and features, to next available voting packet.
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Current Status:
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CP-480, Add Mammography Series Attribute for Screening/Diagnostic procedure reason: to
voting packet October 2004.
Add Calculated Value to Mammography CAD SR: submit to WG 6 in September 2004.
Add View Modifiers for Mammography to CID 4015: Rolled Inferior and Rolled Superior are
used with MLO-like views, submit to WG 6 in September 2004.
Maintenance of the Digital Mammography X-Ray Image IOD, Mammography CAD SR IOD, and
Chest CAD SR IOD.
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The Digital Mammography working group was convened initially in February 1998, to ensure that
Supplement 32: Digital X-Ray Supplement would meet the needs for the storage of digital
mammography image objects in DICOM. The Secretariat is the American College of Radiology
(ACR).
Digital Mammography X-Ray Image Storage – For Presentation and For Processing SOP Classes
in Supplement 32: Digital X-Ray Supplement, Final Text, 1 September 1998 (DICOM 1999).
Supplement 50: Mammography CAD SR SOP Class – an extension to DICOM to standardize the
reporting of CAD results for mammography, using DICOM Structured Reporting; Final Text,
May 2001.
Supplement 65: Chest CAD SR SOP Class – an extension to DICOM to standardize the reporting
of CAD results for the chest; Final Text, January 2003.
Supplement 79: Breast Imaging Report and Supplement 75: Relevant Patient Information Query
Service Class; Final Text, January 2004.
“Rejected for Quality Reasons” and “Quality Issue” included in Supplement 59, Key Object
Selection Document, Final Text, May 2001 (in lieu of CP-192: Add Type 3 Rejected/Replacement
image attributes to DX or Mammography Image module, withdrawn).
CP-193: Add Type 3 Partial View image attributes to the Mammography Image module; Final
Text, September 2000.
CP-265: for TID 1400, Linear Measurement Template, to allow numeric measurements to be
defined without requiring a reference to spatial coordinates; Final Text, January 2002.
CP-290: Replace initial DICOM code assignments with SNOMED code assignments, for terms in
context groups of Mammography CAD SR; Final Text, September 2002.
CP-305: Correction to TID 4006, Mammography CAD Single Image Finding, row 17 relationship;
Final Text, January 2003.
CP-339: Fill in remaining definitions in PS 3.16, Annex D, for Mammography CAD SR terms;
Final Text, March 2003.
CP-389: Add TID 1402 (Volume Measurements) to Single Image Finding templates (TID 40xx);
Final Text, January 2004.
CP-390: Add definitions to PS 3.16, Annex D, for terms used in TID 1400, 1401 and 1402; Final
Text, January 2004.
CP-391: Update name of PS 3.16, Annex B, CID 6018, and correct code meanings for terms in
CID 6019; Final Text, January 2004.
CP-396: Correct TID 4017, 4018, 4020: Correct editing errors when incorporating Supplement 65
into PS 3.16-2003; Final Text, March 2004.
CP-411: Detector Angle Corrections: Make corrections to the detector angle and related attribute
descriptions with respect to digital mammography detectors; Final Text, March 2004.
Current Work Items:
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None. Considering whether work item is needed for digital breast tomosynthesis image IOD(s).
Challenges and Opportunities:
 Monitor future developments in breast imaging technologies, and the need to store and exchange
resulting images and related information in DICOM.
 Monitor future developments in CAD research, particularly those that make the technology
actively interactive with radiologists.
DICOM STRATEGIC DOCUMENT
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Relationships to other Standards:
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Use of American College of Radiology (ACR) BI-RADS® Atlas terminology as the basis of coded
terminology for Structured Reporting for Breast Imaging
Use of the Mammography Quality Control Manual 1999, available from the American College of
Radiology (ACR), as a basis of coded terminology for the reporting of mammography image
quality characteristics
Use of the Mammography Quality Standards Act (MQSA) regulations, a federal regulation of the
United States government, as a basis of coded terminology for the reporting of mammography
image quality characteristics (21 CFR 900)
American College of Radiology. ACR Standard for the Performance of Pediatric and Adult Chest
Radiography. In: Standards. Reston, Va: 2001:95-98
American College of Radiology. ACR Standard for the Performance of Pediatric and Adult
Thoracic Computed Tomography (CT). In: Standards. Reston, Va: 2001:103-107
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DICOM STRATEGIC DOCUMENT
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