Mammography Acquisition and CAD Workflow - Brief Proposal

1. Proposed Profile: Mammography Acquisition and CAD Workflow

Proposal Editor: Carolyn Reynolds/Rita Zuley
Date: N/A (Wiki keeps history)
Version: N/A (Wiki keeps history)
Domain: Radiology

2. The Problem

There are common practices in mammography which can have a wide variety of workflow results. Even when deploying the Scheduled Workflow and Mammography Image Profiles, variances in the way users and systems behave can lead to department inefficiencies, ambiguous data, special cases for automated billing, and less than optimal acquisition and reading environments.

Below are just a few examples of such concerns:

Additional Views

There are quite a few circumstances when radiologists will request retakes or additional views, after the initial imaging service is completed. Doing so can lead to some of the following issues:

• Technologists may have to add views as another study or accession number, leading to archiving, billing, and display presentation problems.

• Additional views may effectively change the type of the exam (i.e. screening to diagnostic or uni-lateral to bi-lateral). The resulting final exam type is not evident to systems and users.

• Some workstation behaviors are incompatible with the needs of mammography, such as not allowing the addition of images to studies that are open or have already been viewed.

• Additional views can be mistaken for complete prior exams.

CAD Processing and Workflow Race Conditions

• CAD systems do not know precisely when to start and stop case level processing and exactly what objects should be considered for processing. Common practice uses a timeout strategy which has its own issues.

• Race conditions between image and CAD availability can bring about reading inefficiencies.

• Additional views complicate case level processing and can result in multiple CAD reports, leaving the workstation and radiologist uncertain as to which CAD report(s) to view.

Determining Exam Completion

• Because additional views are common practice (both on the day of the study and at a later time) and other objects (annotations, CAD results) can be added to studies at a later time, it is difficult for both users and systems to determine when a patient exam is actually complete. Many systems have implicit ways of treating exams as complete or open which can be inconflict with the actual state of the mammography exam.

Correcting Mistakes

• A common problem for technologists is the incorrect labeling of views. When the view is corrected at the acquisition modality and resent, the corrected view may appear as a separate study with a different accession number.

3. Key Use Case

<Describe a short use case scenario from the user perspective. The use case should demonstrate the integration/workflow problem.>

4. Standards & Systems

<List existing systems that are/could be involved in the problem/solution.>

<If known, list standards which might be relevant to the solution>

5. Discussion

<Indicate why IHE would be a good venue to solve the problem and what you think IHE should do to solve it.>

<Try to keep the proposal to 1 or at most 2 pages>