Digital Breast Tomosynthesis – PACS/Workstation Vendor Perspective Ron Muscosky – Product Line Manager for Carestream Health

• Digital Breast Tomosynthesis (DBT) is an important emerging technology

• Carestream fully embraces DBT

• Interoperability is of utmost importance

Digital Breast Tomosynthesis

• Data – Format – Size

• Workflow Efficiency

Key Challenges

Challenge Impact Solution

• Different modality used between acquisition device vendors (MG and CT) – outside the US

• Proprietary format – exams are stored in DICOM Secondary Capture format (slice or projection data is maintained in private attributes)

Data Format

Challenge Impact Solution

• Different modality used between acquisition device vendors (MG and CT) – outside the US

• Proprietary format – exams are stored in DICOM Secondary Capture format (slice or projection data is maintained in private attributes)

Industry: • Vendor specific implementations • Proprietary format – limited to storage, since pixel data contains the center slice or projection

Data Format

Challenge Impact Solution

• Different modality used between acquisition device vendors (MG and CT) – outside the US

• Proprietary format – exams are stored in DICOM Secondary Capture format (slice or projection data is maintained in private attributes)

Industry: • Vendor specific implementations • Proprietary format – limited to storage, since pixel data contains the center slice or projection

Industry: • DICOM Breast Tomosynthesis Image Storage SOP Class is now available to standardize the data format • Modality vendors need to adhere to the DICOM standard

Data Format

Challenge Impact Solution

• Different modality used between acquisition device vendors (MG and CT) – outside the US

• Proprietary format – exams are stored in DICOM Secondary Capture format (slice or projection data is maintained in private attributes)

Industry: • Vendor specific implementations • Proprietary format – limited to storage, since pixel data contains the center slice or projection

End User: • Potential interoperability issues between various vendor equipment • Decide how store data moving forward and how to deal with priors

Industry: • DICOM Breast Tomosynthesis Image Storage SOP Class is now available to standardize the data format • Modality vendors need to adhere to the DICOM standard

Data Format

Challenge Impact Solution

• Different modality used between acquisition device vendors (MG and CT) – outside the US

• Proprietary format – exams are stored in DICOM Secondary Capture format (slice or projection data is maintained in private attributes)

Industry: • Vendor specific implementations • Proprietary format – limited to storage, since pixel data contains the center slice or projection

End User: • Potential interoperability issues between various vendor equipment • Decide how store data moving forward and how to deal with priors

Industry: • DICOM Breast Tomosynthesis Image Storage SOP Class is now available to standardize the data format • Modality vendors need to adhere to the DICOM standard End User: • Conversion tool to convert from proprietary format • Store new exams in a DICOM complaint manner to maintain interoperability moving forward • Convert priors for interoperability

Data Format

Challenge Impact Solution

• 2D Synthetic Images can be stored as MG or BTO – no conversion available between formats

Data Format

Challenge Impact Solution

• 2D Synthetic Images can be stored as MG or BTO – no conversion available between formats

Industry: • Implementation needs to consider both formats • Hanging protocols, pre-fetching, and routing of images need to consider both formats

Data Format

Challenge Impact Solution

• 2D Synthetic Images can be stored as MG or BTO – no conversion available between formats

Industry: • Implementation needs to consider both formats • Hanging protocols, pre-fetching, and routing of images need to consider both formats

Industry: • Standard format needs to be decided upon • IHE could be the place to define this

Data Format

Challenge Impact Solution

• 2D Synthetic Images can be stored as MG or BTO – no conversion available between formats

Industry: • Implementation needs to consider both formats • Hanging protocols, pre-fetching, and routing of images need to consider both formats End User: • Potential interoperability issues between various vendor equipment

Industry: • Standard format needs to be decided upon • IHE could be the place to define this

Data Format

Challenge Impact Solution

• 2D Synthetic Images can be stored as MG or BTO – no conversion available between formats

Industry: • Implementation needs to consider both formats • Hanging protocols, pre-fetching, and routing of images need to consider both formats End User: • Potential interoperability issues between various vendor equipment

Industry: • Standard format needs to be decided upon • IHE could be the place to define this

End User: • MG format recommended for backwards compatibility • Ultimately needs to be standardized

Data Format

Challenge Impact Solution

• DBT data is significantly larger than FFDM data

• DBT data size can vary significantly between vendors

Data Size

Challenge Impact Solution

• DBT data is significantly larger than FFDM data

• DBT data size can vary significantly between vendors

Industry: • Review system specifications • Review data storage and routing optimization

Data Size

Challenge Impact Solution

• DBT data is significantly larger than FFDM data

• DBT data size can vary significantly between vendors

Industry: • Review system specifications • Review data storage and routing optimization

Industry: • Update system specifications • Use of lossless compression when transferring and storing data • Update intelligent data routing rules with minimal data duplication ; especially important for tele-radiology and multi-site facilities

Data Size

Challenge Impact Solution

• DBT data is significantly larger than FFDM data

• DBT data size can vary significantly between vendors

Industry: • Review system specifications • Review data storage and routing optimization

End User: • Evaluate network bandwidth/performance • Evaluate local and archive storage sizing • Evaluate data retention

Industry: • Update system specifications • Use of lossless compression when transferring and storing data • Update intelligent data routing rules with minimal data duplication ; especially important for tele-radiology and multi-site facilities

Data Size

Challenge Impact Solution

• DBT data is significantly larger than FFDM data

• DBT data size can vary significantly between vendors

Industry: • Review system specifications • Review data storage and routing optimization

End User: • Evaluate network bandwidth/performance • Evaluate local and archive storage sizing • Evaluate data retention

Industry: • Update system specifications • Use of lossless compression when transferring and storing data • Update intelligent data routing rules with minimal data duplication ; especially important for tele-radiology and multi-site facilities End User: • 1 Gigabit network recommended • Choose appropriate slice/plane thickness • Size local storage/archive accordingly

Data Size

Challenge Impact Solution

• Different vendor data will need to be compared, but no interoperability guidelines exist for DBT as they do for FFDM

• DBT exams contain significantly more data than FFDM exams, so specialized tools are needed to optimize reading and help localize pathology

Workflow Efficiency

Challenge Impact Solution

• Different vendor data will need to be compared, but no interoperability guidelines exist for DBT as they do for FFDM

• DBT exams contain significantly more data than FFDM exams, so specialized tools are needed to optimize reading and help localize pathology

Industry: • Implementation of tools and unique capabilities to minimize manual manipulations

Workflow Efficiency

Challenge Impact Solution

• Different vendor data will need to be compared, but no interoperability guidelines exist for DBT as they do for FFDM

• DBT exams contain significantly more data than FFDM exams, so specialized tools are needed to optimize reading and help localize pathology

Industry: • Implementation of tools and unique capabilities to minimize manual manipulations End User: • Different vendor data displayed in a dissimilar manner increases the time to read exams • Lack of tools creates fatigue and an inefficient reading environment

Workflow Efficiency

Challenge Impact Solution

• Different vendor data will need to be compared, but no interoperability guidelines exist for DBT as they do for FFDM

• DBT exams contain significantly more data than FFDM exams, so specialized tools are needed to optimize reading and help localize pathology

Industry: • Implementation of tools and unique capabilities to minimize manual manipulations End User: • Different vendor data displayed in a dissimilar manner increases the time to read exams • Lack of tools creates fatigue and an inefficient reading environment

Industry and End User: • IHE needs to be extended to include DBT

• Carestream has proactively implemented existing IHE capabilities, along with specialized tools across both 2D and DBT exams:

•Auto and manual cine •Auto scaling and positioning • Localize pathology • Catalog Pathology • Ease of comparing priors • Navigation

Workflow Efficiency

• Interoperability – Standards need to maintain pace with industry – IHE needs to be extended to include DBT – Equipment vendors need to adhere to the standards – Modality vendors need share sample data as early

as possible

Interoperability benefits the end user and equipment vendors alike

Summary

Thank You!