MINUTES
DICOM WORKING GROUP 15
MAMMOGRAPHY AND CAD
PLACE OF MEETING
AMERICAN COLLEGE OF RADIOLOGY, RESTON, VA
DATE AND TIME
MAY 30, 2007: 10:00AM – 6:00PM
MAY 31, 2007: 8:30AM – 3:00PM
MEMBERS PRESENT:
Carestream Health
Fujifilm Medical Systems
GE Healthcare
Hologic, Inc.
iCAD, Inc.
Northwestern Memorial (ACR)
Philips Medical Systems
Siemens Medical Solutions
Zhimin Huo
Paul Morgan
Guy Hersemeule
Janet Keyes
Topher Gedeon
Judith Wolfman
Bas Revet
Renate Hoecker
MEMBERS ABSENT:
*Medical College of Wisconsin (ACR)
Planmed Oy
Charles Kahn
Mari Varjonen
* = Does not count toward quorum.
OTHERS PRESENT:
American College of Radiology Staff
American College of Radiology Staff
American College of Radiology Staff
FDA
Guardian Healthcare Systems
Guardian Healthcare Systems
Siemens Medical Solutions
PRESIDING OFFICER:
Penny Butler
Edna Moreno
Laura Passarelli
Richard Kaczmarek
John Paganini
Andrew Underhill
Kallol Chaudhuri
(Thu)
(Wed)
(Thu)
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 group welcomed Edna Moreno, the new Director for Breast Imaging Accreditation
Programs at the ACR. The group also welcomed Zhimin Huo, the new representative from
Carestream Health, formerly Eastman Kodak. On Thursday the group welcomed Andrew
Underhill, representing Guardian Healthcare Systems.
2. REVIEW OF PREVIOUS MINUTES
The meeting minutes for the February 15, 2007 meeting were approved as distributed.
3. REVIEW OF PREVIOUS ACTION ITEMS
Digital Breast Tomosynthesis:
 Janet: Present Supplement 125, Rev 4 to WG 6 in March (26-30) to request approval
for Public Comment. Completed.
 Janet, Guillaume, Mari, Renate: Research the Open Issues in Supplement 125 within
your organizations. Completed.
Correction Proposals:
 Janet: Draft a CP regarding Reason for Requested Procedure Code Sequence,
circulate to the group, and submit to WG 6 for their March 16 teleconference.
Completed.
 Janet: Make sure that CP-687 is discussed at the March WG 6 meeting. Completed
 Janet: Follow the progress of CP-724 and CP-736, to request that they be included in
the March 2007 ballot packet. Completed
 Julian: Draft a CP regarding Calculated Value at the Impression/Recommendation
level for Mammography CAD SR, circulate to the group, and submit to WG 6 for
their March 16 teleconference. Completed
Colon CAD SR:
 Topher: Update Supplement 126 based on meeting discussion, and present it to WG 6
in March (26-30) to request approval for Public Comment. Completed, but Public
Comment approval postponed by WG 6.
Other:
 Bas, Laura: Continue to seek additional vendor and clinical participants for DOT
mammography work item. In progress.
On Hold:
 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-687: Dose Reporting for Mammography: discussed WG 15’s latest version with WG
6 in March, and it was approved for the June 2007 voting packet. WG 15 reviewed the
latest version, and approved requesting WG 6 to move it forward to Letter Ballot.




CP-724: Add Terms to Calculated Value & Methods CIDs: approved for Letter Ballot in
CPACK 41, due June 4.
CP-736: TID 4023, CID 6028 updates (related to CP-624): approved for Letter Ballot in
CPACK 41, due June 4.
CP-767: Add Calculated Value, Laterality to TID 4002, submitted to WG 6 in March,
assigned to David Clunie. WG 15 reviewed the latest version, and approved requesting
WG 6 to move it forward to Voting Packet.
CP-790: Reason for Requested Procedure for Mammography, submitted to WG 6 in
March, assigned to David Clunie. Bas Revet and Michael Jonas (Siemens Medical) will
request feedback from WG 6 at their June meeting.
5. DIGITAL BREAST TOMOSYNTHESIS
Janet Keyes presented the Public Comment version of Supplement 125, highlighting changes
made since the February WG 15 meeting. The document was approved for Public Comment
at the March WG 6 meeting, and the public comment period closed on May 28. The group
reviewed public comments received from GE Medical, Hologic, and Siemens Medical,
primarily focused on responses to the Open Issues.
Summary of Public Comment discussion:
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1
2
3
4
5
6
7
8
Description
Breast Tomosynthesis
IOD content
Cardiac
Synchronization
Respiratory
Synchronization
Image-Equipment
Coordinate
Relationship module
Identify Partial Views
Comments
GE: OK
Hologic: under evaluation
GE: Keep
Hologic, Siemens: Remove
GE: Keep
Hologic, Siemens: Remove
GE: Keep, using isocenter
Hologic: do not need
Siemens: Not sure yet
GE, Hologic, Siemens: Yes
Breast Tomosynthesis
Acquisition Sequence
content
Cumulative organ
dose
GE, Hologic, Siemens: OK
Collimation variation,
shape
Hologic: Organ Dose must be per breast
as two independent organs. Add Organ
Dose per projection, Entrance Dose
cumulative
ACR (Penny): Entrance Dose does not
apply as cumulative; each projection’s
entrance dose is at different part of
breast
GE: polygonal is needed also,
collimation changes per projection
Hologic: collimation stays the same,
Decision
Check at next meeting
Keep as
conditional/optional
Keep as
conditional/optional
Keep as optional
Identify partial view for
reconstructed slices in XRay 3D View Positioning
macro; mandatory or
optional?
Add Organ Dose at per
projection level
Add POLYGONAL, store
at common and per source
projection levels, as
9
Collimator
information
10 Per projection info for
physicists
11 Distance Source to
Detector, Patient, Mag
Factor
12 Focal Spot
13 Positioner Secondary
Angle

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rectangular is sufficient
Siemens: collimation changes per
projection, prefer not to store detail
GE, Hologic, Siemens: relevant only to
source projections
Siemens: per projection is preferred
GE: not sure yet
Hologic, Siemens: OK
GE, Hologic: average across all
projections sufficient
GE: applicable to reconstructed slices?
Siemens: per projection, optional to
store
ACR (Penny): treat same as KVP, mAs;
used in same way to calculate organ
dose
GE, Hologic: same for all source
projections
GE: keep for future expansion, perhaps
add Detector Primary/Secondary angles
per projection
Hologic, Siemens: does not apply
optional
Store for source projections
only, if at all
Check at next meeting
Store at common and per
source projection levels?
Store at common source
projection level
Keep as conditional
Closed issue #6: Hologic requested to record Filter information conditionally at
common or per source projection level. Set up mutually exclusive conditions.
KVP attribute description in Breast Tomosynthesis Acquisition Sequence: discussed
minimum, maximum, or average; decided to keep average among all frames (dose
calculation perspective), but ask clinicians for preference
Exposure in mAs attribute description in Breast Tomosynthesis Acquisition
Sequence: Should be sum rather than average, from the dose calculation perspective
Organ Dose attribute description in Breast Tomosynthesis Acquisition Sequence:
changed to sum instead of average. Discussion of calculation of glandular radiation
dose for breast tomosynthesis (reference: January 2007 AAPM paper from Emory, by
I. Sechopoulos).
Consider if the Breast Tomosynthesis Frame VOI LUT macro should be generalized.
Do the existing DICOM pixel data encoding rules and available (lossless
compression) transfer syntax options provide efficient means for data streaming of
multiple views per patient with tens of large slices per view for immediate display,
given several patients per hour? Suggestions were made to check with Working
Group 4 (Compression), and to investigate the JPIP Referenced transfer syntaxes.
WG 15 will seek additional feedback from industry and clinical sources on the pc+1 version
of the supplement, as breast tomosynthesis clinical trials proceed. WG 15 will decide at the
next meeting if the supplement is ready to proceed to submission for Letter Ballot.
6. BI-RADS® ATLAS
Edna Moreno reported that the revised MRI guidance chapter draft is still in committee. Due
to extenuating circumstances, there is a delay in preparing a version to circulate to the
vendors. The next target is the end of this year. The committee plans to meet at RSNA 2007.
7. COLON CAD SR
On Wednesday, Topher presented Supplement 126, Rev 7, highlighting the changes since
Rev 6, resulting from WG 6 discussion in March. Primary changes were:
 The representation of 3-dimensional points in space for detection location: changed
VOLUMEROI to SCOORD3D
 Added an image properties container. WG 6 wanted something in place of the Image
Library which WG 15 had decided not to reuse
 Updated some coded terminology to use SRT codes
 Moved some terms from Linear Measurement to Calculated Value context group
 Colon Overall Assessment context group: removed subcategories
 WG 6 recommended contacting the RadLex® (http://www.radlex.org) Steering
Committee for some of the new coded terms. David Clunie provided an introduction
for Topher with Curtis Langlotz (Steering Committee Chair) by e-mail. Judy
reminded us that Chuck Kahn also is on the Steering Committee, so perhaps he can
assist with defining RadLex® codes.
The group worked on the SCOORD3D macro definition, the Image Properties container
entry template, adjusted the order of content items in TID XX08 Colon CAD Descriptors,
and made some additional context group adjustments (reuse of Chest CAD SR context
groups).
On Thursday, Topher presented Supplement 126, Rev 8, highlighting the changes made
based on Wednesday’s discussion. WG 15 approved Supplement 126 to be resubmitted to
WG 6 in August for public comment approval.
8. DOT Mammography
Bas Revet presented the initial draft supplement of DOT Mammography Image Storage.
Supplement 116 X-Ray 3D Image IOD is the basis for the DOT Mammography volume. Bas
visited with DOT mammography clinicians to find out which attributes they want to see in an
image object.
Clarification of Image Orientation (Patient) and Image Position (Patient) as they relate to
DOT Mammography. Bas presented a document that explains these attributes, which is
available in the WG 15 Breast Tomosynthesis folder.
If desired, DOT Mammography raw data can be stored using the existing DICOM Raw Data
IOD.
The next steps are to double-check the supplement content with the final text of Supplement
116, and then distribute the early draft supplement to the DOT mammography industry and
clinical community. Goal is to present early draft to WG 6 at their October/November
meeting.
9. OLD BUSINESS
IHE Mammography, Radiologist-Technologist Communications. WG 15 had a conference
call on Thursday with Guillaume Peter (GE Medical Systems) to discuss the latest proposed
options for exchange of image annotations and instructions between radiologists and
technologists. There are two proposed solutions: KIN + GSPS or Enhanced SR. The group
reviewed the latest document (IHE_RAD_TF_White_Paper_RTC_2007-04-05__CDi.doc),
focusing on the tables identifying the proposed content for each solution. Janet asked if the
“patient status flag” would better serve the objective if it were represented as “priority of
message”. The next step is to present each solution in DICOM form, meaning for KIN +
GSPS a DICOM correction proposal for additional attributes and/or content items for the
Key Object Selection Document IOD, and for Enhanced SR the proposed templates in
DICOM PS 3.16 format. Guillaume will prepare the correction proposal, and Renate will
prepare the Enhanced SR templates, to be reviewed at the next WG 15 meeting, which
immediately precedes the proposed dates for the next IHE Radiology/Mammography
committee meeting.
10. NEW BUSINESS
Identification of Specimen images for digital mammography. Judy asked what could be done
from the DICOM perspective to identify Specimen images in the DICOM image header, for
the purpose of defining automatic hanging protocols on the radiologist’s workstation. When
multiple specimen images are taken, the radiologist wants to see a label displayed with each
specimen image. The Digital Mammography X-Ray Image IOD does include the Specimen
Identification module as optional. This module contains Specimen Accession Number and
Specimen Identifier attributes. One question is whether this information would be available
to the modality that is acquiring the specimen images. Some clinicians have requested a
Specimen view. Specimen could be added to the list of coded terms for the View Modifier
for mammography, in DICOM PS 3.16, CID 4015. Janet will draft a correction proposal.
Potential future topics. Kallol indicated that Breast MR CAD results are exchanged currently
using DICOM Secondary Capture Image or DICOM 6000 Overlay. Perhaps WG 15 should
evaluate the Mammography CAD SR templates with respect to meeting the needs of storing
Breast MR CAD results. Kallol also mentioned Knowledge Driven Patient Care (KDPC), a
new knowledge based diagnosis business.
11. NEW ACTION ITEMS
Correction Proposals:
 Janet: Request WG 6 to approve CP-687 for Letter Ballot at their June (25-28)
meeting.
 Janet: Request WG 6 to approve CP-767 for the August 2007 voting packet.
 Bas, Renate: Request feedback from WG 6 on CP-790 at their June (25-28) meeting.
Renate to inform Michael Jonas (Siemens WG 6 representative).
 Janet: Write a DICOM correction proposal to extend CID 4015 to include a view
modifier for Specimen.
Digital Breast Tomosynthesis:
 Janet: Complete and distribute Supplement 125, revision pc+1.

Janet, Renate, Guillaume, Mari: Seek additional clinical and industrial feedback on
Supplement 125, pc+1.
Colon CAD SR:
 Topher: Request assistance from Chuck Kahn regarding the definition and use of
RadLex® codes in Supplement 126.
 Topher: Update Supplement 126 based on meeting discussion, and present it to WG 6
in August (27-31) to request approval for Public Comment.
DOT Mammography:
 Bas: Double-check the DOT Mammography Image Storage early draft supplement
with the final text of Supplement 116.
 Bas: Distribute the DOT Mammography Image Storage early draft supplement to WG
15, and DOT Mammography industry and clinicians to request feedback.
 Bas, Laura: Continue to seek additional vendor and clinical participants for DOT
mammography.
Other:
 Guillaume: Write a DICOM correction proposal to extend the Key Object Selection
Document template with content items needed for radiologist – technologist
communications.
 Renate: Define a DICOM template structure that contains the content items needed
for radiologist – technologist communications, to be exchanged via Enhanced SR.
12. NEXT MEETING
The next meeting will be September 13-14, 2007, at the American College of Radiology in
Reston, VA.
13. ADJOURNMENT
The meeting was adjourned at 3:00pm on May 31.
Reported by:
Reviewed by Counsel: CRS 10/17/07
Janet Keyes (co-Chair)
WG 15 of the DICOM Stds. Comte.
June 15, 2007