User definable scanning protocols for use with mammographic
Contents
1. a2ueuuopad Qqriueneg sindino sio301o1d Sujuueos Zz deyeyuDjebewy US 7 929 740 B2 Sheet 4 of 9 Apr 19 2011 U S Patent ep Old oo enen 2 352319 ya7 dn 40M 25nsouBeig uondu gt sag Apms Wooig 9ev wO sg ar wf SISYIPON zero quasalg uejduyj O main emed SLY os mo 110 om O mx WA DxO owl 0 2 9 MIA oep 9Lv AA og C 6 O y1 pis elt St de JAQUIDY 80v rir ol SUN SI PUES PO r zor J9MI3SYJ23BRLUI US 7 929 740 B2 Sheet 5 of 9 Apr 19 2011 U S Patent su E j wl iv E bs nif sK ol wf SIBYIPON zer qr 914 1UIS34d juejduuj O oer jseaug 437 dn yJoM os0ubeig uondu seg Apms WODIG MBIA Jee al eer vir 8iv os wid aO om Q wox WO DxO ow 9 ox O MBIA apis civ OMWSKT mjd OLD FE og w n yw1 0 39X 1 991 LEE ee PO Zp J9MDIYJSBRU US 7 929 740 B2 Sheet 6 of 9 Apr 19 2011 U S Patent du Buuaans ys tun 1461 tun OMWSNT OTN 1 R 99X 1 39X 1 991 ERES dwj uuaa s ya un fry iun Buuaans ony Bunuug 5ueuuoji9q Ql ang smdno Jo DDUPUAJUIE N moqy US 7 929 740 B2 Sheet 7 of 9 Apr 19 2011 U S Patent f i ET Vete etel SEE WO GENE SOT MESSER RAGIN Serien EPR MIT Rt fe 190900 U S Patent Apr 19 2011 Sheet 8 of 9 US 7 929 740 B2 User indicates int2. 120 comprises a digitizer user interface and control unit 124 a computer aided detection CAD unit 126 a scheduling unit 128 and a data storage unit 130 According to one embodiment the functionalities of the digitizer user interface unit 124 the computer aided detection CAD unit 126 the scheduling unit 128 and the data storage 20 25 30 35 40 45 50 55 60 65 6 unit 130 are combined into a single off the shelf personal computer PC box having an Intel Pentium IV processor with hyper threading capability and running the Linux operating system The user interface scanning control data transfer and scheduling functionalities described herein can be pro grammed in C using the GTK toolkit and G compiler The data storage unit 130 stores received digital cases and scanned film cases along with their associated CAD results according to a circular buffer arrangement based on times received and scanned Cases are queued for CAD processing in the order of priority and within a particular priority in the order of time received or scanned In one embodiment all film cases are assigned a medium priority while digital cases are assigned a high medium or low priority according to which digital mammography acquisition device they origi nated from this priority level being assigned at the installa tion time of the CAD station 102 or during a maintenance session thereof In another embodiment the CAD st
3. ABSTRACT nm A system and method for processing mammographic data are Related U S Application Data described The system includes a user input output system 63 Continuation in part of application No 10 998 121 adapted and configured to receive from a user a user defined filed on Nov 26 2004 now abandoned scanning protocol that identifies the laterality and view type for each mammographic film in a film case to be scanned A 51 Int Cl storage system stores the user defined scanning protocol for G06K 9 00 2006 01 subsequent use in scanning film cases A scanning system 52 U S CI DE 382 128 382 31 1 715 700 scans film cases and generates digitized versions of each 58 Field of Classification Search 382 128 mammographic film A processor then assigns laterality and See application file for complete search history view types to the digitized versions of the mammographic film according to the user defined scanning protocol The 56 References Cited system also receives user alterations to stored scanning pro U S PATENT DOCUMENTS 5 917 929 A 6 1999 Marshall et al 382 128 6 031 929 A 2 2000 Maitz etal 382 132 6 574 629 B1 6 2003 Cooke etal 1 1 6 734 880 B2 5 2004 Chang et al 715 738 6 853 857 B2 2 2005 Pfeiffer et a 600 436 6 873 717 B2 3 2005 Lureetal 382 128 6 915 154 B1 7 2005 Docherty et al
4. RCC LCC RMLO LMLO RCCID LCCID RMLOID LMLOID The user preferably selects the desired scanning protocol using the touch screen on protocol selection area 234 After selection the selected scanning protocol is highlighted to indicate which protocol will be used for scanning If no user selection is made a default scanning protocol is used for the scanning which is preferably the first scanning protocol listed in selection area 234 The first scanning protocol listed can be changed by the user in order to change the default 20 25 30 35 40 45 50 55 60 65 8 scanning protocol by means of Move Up button and Move Down button as described below Below selection area 234 the case composition 240 is preferably displayed in terms of the laterality and views listed as they are expected to be loaded into the scanner with the top film listed on the top FIG 3 illustrates display screen 202 corresponding to the CAD station of FIG 1 for creating editing and removing scanning protocols according to embodiments The user ini tiates the process by touching the controls tab 226 Controls selection area 302 is shown with various control options that are touch screen selectable The user selects the scanning control 304 from the list in controls selection area 302 By selecting scanning controls 304 the system generates and displays a list of existing scanning protocols in scanning protocol list area 306 Note that t
5. before the acquisition of the film mammogram in accordance with whichever HIS RIS data base system is used at that clinic As described in WO 02 43457 A2 during scanning of the film stack the film scanner reads the barcode of each separator sheet to differen tiate the respective film cases as well as to allow association between that CAD case ID and the rest of the information for that film case The technologist can preferably simply scan the barcode on the separator sheet using the handheld barcode scanner 132 and the information is instantly displayed on the display 122 FIG 2 illustrates a display screen 202 corresponding to the CAD station of FIG 1 according to an embodiment As described more fully in Published US Patent Application No US20060126909A1 Ser No 10 998 121 incorporated herein by reference display screen 202 comprises a graphical status indicator 204 which comprises a plurality of case icons 206 each case icon corresponding to one of the cases film or digital received by the CAD station 102 Display 202 further comprises a detail display area 216 within which the user can view any of the details associated with a studies tab 220 an alerts tab 224 and a controls tab 226 The alerts tab 224 invokes an alert history listing and the tab itself shows a triangular alert icon if there are any alerts present since last US 7 929 740 B2 7 being cleared The controls tab 226 allows access to a variety of maintenan
6. made via a wide area network 9 A system according to claim 1 wherein said processor is further adapted to process the digitized versions according to at least one computer aided detection CAD algorithm for detecting anatomical abnormalities therein 10 A method for processing film based mammographic data comprising the steps of receiving from a user a user defined scanning protocol identifying at least a view type for one or more mammo graphic films in a film case to be scanned using the user defined scanning protocol storing the user defined scanning protocol in a storage system scanning a film case comprising plurality of mammo graphic films and generating therefrom a digitized ver sion of each mammographic film and assigning view types to one or more digitized versions of the mammographic films according to the user defined scanning protocol wherein said storage system stores a plurality of scanning protocols and wherein said method further comprises receiving a user s instruction to re assign a case scanned according to a first scanning protocol to a second scan ning protocol wherein said step of assigning automati cally assigns the view type to each digitized version according to the second scanning protocol in response to the user s instruction 11 A method according to claim 10 wherein the user defined scanning protocol further identifies the number of films the sequence of films and the laterality of ea
7. the single term patient is used herein for simplicity and clarity of description The group of digitally acquired mammogram images forming the digital case is usually obtained during the same patient visit The network 108 transfers the digital cases to the CAD station 102 for CAD processing Upon successful completion of the CAD processing CAD results are then transferred over the network 108 to a softcopy workstation 110 for review by a radiologist or other medical professional in conjunction with the digi tally acquired mammogram images There may be more than one digital mammogram acquisition device each having a different hardware address with respect to the network 108 As used herein the term film case refers to a group of mammogram images corresponding to a patient the mam mogram images being acquired using a film based mammo US 7 929 740 B2 5 gram acquisition device The group of mammogram images forming the film case is usually obtained during the same patient visit Illustrated in FIG 1 are film cases 112 that are physically carried over to the CAD station 102 for scanning and optionally CAD processing and subsequently physi cally carried over to a film review station 114 which may or may not be configured to display CAD results Upon success ful completion of any CAD processing CAD results are transferred over the network 108 to the film review station 114 In one common scenario the film review statio
8. up and move down buttons 314 and 316 respectively For example the newly created scanning protocol 510 can be assigned as the default by selecting it and repeatedly touching move up button 314 until protocol 510 is at the top of the list FIG 6 illustrates a display screen 202 corresponding to the CAD station of FIG 1 according to an embodiment The embodiment illustrated in FIG 6 is similar to the screen shown and described with respect to FIG 2 except that a force button 602 if provided Force button 602 is used to override the scanning protocol used to originally scan the case and instead assign another scanning protocol to the case For example if the Auto scanning protocol was used for scan ning the case shown in FIG 6 and in fact the case should have been scanned using the Diag L scanning protocol the user can select Diag L from protocol selection area 234 and then touch force button 602 The system will retroactively assign the selected scanning protocol for the current case and identify all the films in the case according to the newly selected scanning protocol This feature advantageously pro vides for quick and efficient identification of films by avoid ing a manual identification process FIG 7 illustrates steps involved in creating a new scanning protocol according to embodiments In step 712 the user indicates an intention to add a new scanning protocol In the example of FIG 3 this is accomplished by sel
9. 04 is preferably identical to the name used in the scanning protocol selection area 234 shown and described with respect to FIG 2 Also provided in screen 402 is a DICOM study description area 430 DICOM study description 430 is used for entry display and editing of the DICOM study descrip tion which is preferably used by workstations to determine how to display or hang the digitized film images when using a system such as DigitiaINow from R2 Technology a Hologic company For users who make use of the DICOM study description field the DICOM study description and the scanning protocol name can be the same or the scanning protocol name can be an abbreviation of the DICOM study description or any other unique string Film list area 406 is used to display the order of the films that will be included for each case in the scanning protocol In the example of FIG 4a one film is shown that is currently identified as L CC The user indicates an intention to modify the settings for a film in the case by selecting the film such as L CC film 408 in film list area 406 New button 410 allows for the user to add new films to the protocol for the case Remove button 412 allows for the user to delete a selected film The name of the current film is preferably displayed in area 414 which corresponds to the film selected and preferably highlighted in area 406 Area 416 is used to identify the film as left right or both Area 418 is used to identify t
10. 2 45437 A2 which is incorporated by reference herein which describes automatic film orientation and identification based on lead view marker and breast outline segmentation Another example is Published US Patent Application No US20060126909A1 Ser No 10 998 121 filed on Nov 26 2004 which describes a graphical status indicator having a plurality of spatially ordered film case icons that graphically communicate a current state of the scanning to a technologist who may be performing other duties while the digitization is taking place However practical problems may still arise which may cause the technologist to spend substantial time and attention in the scanning and image identification pro cess In order for the scanned images to be correctly identified and properly stored each image must have information cor rectly associated with it This information includes the case to which it belongs as well as type of image which side and which view Film based medical image scanning systems have conventionally assumed that each case to be scanned has a certain number of films and the films are stacked in a particular order This predefined standard scanning protocol is defined by the manufacturer in advance based on what the manufacturer expects its most likely application to be In many cases this standard scanning protocol is chosen as the common mammography screening case in the United States This is commonly comprised of four films per s
11. 600 431 User selects an existing scanning protocol to use 91 User loads stack of films of one or more cases into scanner 916 User loads initiates scanning using selected scanning protocol 917 ilms correctly scanned tocols The system can also re assigns a case scanned accord ing to one scanning protocol to another scanning protocol in response to a user s instruction to do so The system processes the digitized versions according to at least one computer aided detection CAD algorithm for detecting anatomical abnormalities therein 17 Claims 9 Drawing Sheets User manually corrects film information or re assigns case to a different scanning protocol 920 US 7 929 740 B2 Sheet 1 of 9 Apr 19 2011 U S Patent L OIJ 901 AVISO ND E BOL OLL NNNAAHOS 7020108d 221 SINS NOLLO3130 POL Tn gaaiv uaindwoo OR Oct n ONS IN Y3ZILIDIO DEL a eene US 7 929 740 B2 Sheet 2 of 9 Apr 19 2011 U S Patent BLE I en S kossen YA BEES LATE OA Sag WT i i H i DG US 7 929 740 B2 Sheet 3 of 9 Apr 19 2011 U S Patent Old sjonuog 4 umog 3A0N 4 oe emo men gl FL ve Auy duu Duuaaine yoy un 14614 tun Suuaans ony dn aaow o PO 331498 Auy Buluuers dui 6uru 1J3S ya un ry tun buiu3ans any HO 3zueu lulelN inoqy
12. D systems are described for example in U S Pat No 5 729 620 U S Pat No 5 815 591 and U S Pat No 5 917 929 each of which is incorporated by reference herein Mammography CAD algo rithms analyze digital or digitized images of standard mam mographic views e g CC MLO for characteristics com monly associated with breast cancer such as calcifications masses and architectural distortions The outputs of CAD systems generally referred to herein as CAD results are sets of information sufficient to communicate the locations of anatomical abnormalities or lesions in a medical image and can also include other information such as the type of lesion degree of suspiciousness and the like CAD results are most often communicated in the form of reduced resolution ver sions of the different mammographic views containing anno tations that identify the location and type of potential abnor mality The radiologist analyzes the original mammogram either in film format on a light box or in digital form on a softcopy workstation and then reviews the CAD results usu ally on a display monitor or a paper printout Workflow processes associated with mammography including CAD related workflow processes implicate sub stantial cost issues in practical clinical environments All digital mammography environments in which digitally cap tured mammograms could be automatically shepherded with little or no human intervention through CAD s
13. United States Patent US007929740B2 12 10 Patent No US 7 929 740 B2 Marshall et al 45 Date of Patent Apr 19 2011 54 USER DEFINABLE SCANNING PROTOCOLS 7 015 808 BI 3 2006 Sattler et al 340 531 FOR USE WITH MAMMOGRAPHIC 7 406 150 B2 re Minyard et al U ANI COMPUTER AIDED DETECTIONAND FILM np 73 780 821 122000 Mindat al 787 SCANNING SYSTEMS 2003 0013951 Al 1 2003 Stefanescu et al 600 407 2004 0114714 Al 6 2004 Minyard et al 378 37 75 Inventors Julian Marshall Los Altos CA US 2005 0114039 Al 5 2005 Kennedy etal 702 19 a ea n a 2006 0173303 Al 82006 Yuet a ml 600 437 u el SENSERI zl Brita Te Matuska Stockton CA US 2008 0049996 Al 2 2008 Marshall et al 382 128 y I 2008 0069416 A1 3 2008 Luo ee 382 128 73 Assignee Hologic Inc Marlborough MA US 2008 0279439 Al 11 2008 Minyard et al 382 131 2009 0003679 A1 1 2009 Nietal 382 132 Notice Subject to any disclaimer the term of this 2010 0131873 Al 5 2010 Mejiaetal 715 764 patent is extended or adjusted under 35 U S C 154 b by 977 days FOREIGN PATENT DOCUMENTS WO WO2004 049908 6 2004 21 Appl No 11 803 558 cited by examiner 22 Filed May 15 2007 Primary Examiner Sath V Perungavoor 3 M 74 Attorney Agent or Firm Brian J Daiuto 65 Prior Publication Data US 2008 0049996 A1 Feb 28 2008 57
14. ation 102 may expose more than one port or expose more than one DICOM Application Entity AE to the HIS RIS network with each port or AE corresponding to a different priority level In this case each of the digital mammogram acquisition workstations can establish associations with the desired port or AE according to a desired CAD processing priority deter mined at the digital mammogram acquisition workstation and priority levels can thereby be assigned on a per case basis Any of a variety of other prioritization schemes are within the scope of the embodiments According to embodi ments data storage unit 130 also stores scanning protocols to be used in scanning film cases and assigning to each scanned film laterality views and other information as described fur ther herein CAD station 102 further comprises a handheld barcode scanner 132 that facilitates convenient access to any particu lar film case based on the barcode of its case separator sheet In a typical film based CAD workflow a separator sheet having a CAD case ID is placed on top of the first sheet of each film case in a stack of film cases being fed into the film scanner 118 as described in WO 02 43457 A2 The CAD case ID which is temporarily unique but generally re usable according to the number of separator sheets in use at the clinic is associated with a patient ID case ID accession number etc of a particular patient for a particular mammo gram case usually just
15. ce and configuration screens and the tab itself shows a small wrench icon if there is something requiring maintenance related attention e g it is time to perform peri odic calibration or other maintenance activity or a diagnostic error occurred on startup etc According to an embodiment controls tab 226 is also used to access the facility for creating editing and deleting scanning protocols as described more fully below The studies tab 220 causes the details of the currently selected case to be displayed including text details 227 a patient flash area 228 containing the flash of a scanned film and a thumbnail area 230 showing thumbnails of mammo graphic views that have been scanned and or processed thus far The display 202 further comprises a search area 232 allowing searching by any of a variety of criteria e g patient ID patient name CAD case ID accession number etc Patient ID area 233 allows for the display of the patient ID A scanning protocol selection area 234 allows the user to select between several different scanning protocols As used herein the term scanning protocol refers to a defined composition of films in a stack of films loaded in the scanner feeder The scanner assumes that the films will be separated in to cases each having the composition according to the selected scan ning protocol As used herein the term user refers to a lead technician technician or other scanner operator that is ge
16. ch mam mographic film in the film case to be scanned using the user defined scanning protocol and said step of assigning further comprises assigning a laterality to each digitized ver sion of the mammographic films according to the user de fined scanning protocol 12 A method according to claim 10 further comprising the step of receiving from the user alterations to one or more scanning protocols stored in said storage system 13 A method according to claim 10 said method further comprising the step of receiving from the user a user s selec tion of which scanning protocol to use for scanning one or more film cases and wherein said step of assigning uses the user s selection if available and a default scanning protocol if no user s selection is available 14 method according to claim 10 further comprising the step of processing the digitized versions according to at least one computer aided detection CAD algorithm for detecting anatomical abnormalities therein 15 A method for processing film based mammographic data comprising the steps of scanning a plurality of mammographic film cases each comprising plurality of mammographic films and gen erating therefrom a digitized version of each mammo graphic film and assigning laterality and view types to each digitized ver sion of the mammographic films according to a stored user defined scanning protocol the user defined scan ning protocol having been received from a use
17. combinations of the devices of FIG 1 can be placed adja cently to each other or integrated into the same hardware boxes without departing from the scope of the embodiments By way of still further example the network 108 can be a wide area network with the different nodes being distributed throughout a city a country or the world Alternatively and by way of still further example some or all of the transfer of digital information can be achieved by physical transfer of disks memory sticks or other digital media devices without departing from the scope of the embodiments It is to be appreciated that although FIG 1 illustrates a combined film digital environment many of the embodiments herein are applicable in film only environments and or in digital only environments as well CAD station 102 comprises a film scanner 118 which can also be termed a film digitizer for scanning and digitizing the film cases 112 The film scanner 118 can comprise a laser scanner such as the Model 2908 Laser Film Digitizer from Array Inc Alternatively the film scanner 118 can comprise a CCD scanner or other scanner having similar film scanning capabilities as the above laser and or CCD scanners The CAD station 102 further comprises a processor 120 and a display 122 which is preferably a touchscreen display but which can alternatively be implemented on a non touch screen monitor using an associated mouse or other pointing selection device The processor
18. e user indicates an intention to edit and existing scanning pro tocol In the example of FIG 3 this is accomplished by selecting controls tab 226 scanning control 304 and then edit button 310 In step 813 the user enters information relating to the study to be scanned In the example of FIGS 4a b this is accomplished by entering the scanning protocol name in area 404 and study description in area 430 In step 814 the user modifies information for one or more films In the example of FIGS 4a b this is accomplished by entering or altering the information in fields 416 418 420 and 422 for each film In step 816 the user adds new films or deletes films from the scanning protocol In the example of FIGS 4a b this is accomplished using new and remove buttons 410 and 412 respectively In step 818 the user re arranges the order ofthe films of the case as necessary to correspond to the expected stack order of the films as will be loaded in the scanner with the top being scanned first In the example of FIGS 4a b selecting films in area 406 and up and down buttons 424 and 426 are used to accomplish this step In step 820 the user saves the modified scanning protocol FIG 9 illustrates steps involved in scanning films using a scanning protocol according to embodiments In step 914 the user indicates an intention to scan a new case or a multiple cases and selects an existing scanning protocol to use In the example of FIG 2 this is acco
19. ecting controls tab 226 scanning control 304 and then new button 308 In step 714 the user defines a name for the new scanning pro tocol and optionally a DICOM study description In the example of FIGS 4a b this is accomplished by entering the information in areas 404 and 430 In step 716 the user enters the identification information such as laterality side view modifiers etc associated with the first film in the case In the example of FIGS 4a b this is accomplished by entering the information in fields 416 418 420 and 422 In step 718 new films are added as necessary and the identification informa tion is added for each new film In the example of FIGS 4a b This is accomplished by selecting new button 410 and then entering information in fields 416 418 420 and 422 for each new film In step 720 the user re arranges the order of the films of the case as necessary to correspond to the expected stack order of the films as will be loaded in the scanner with the top being scanned first In the example of FIGS 4a b selecting films in area 406 and up and down buttons 424 and 426 are used to accomplish this step In step 722 the user 20 25 30 35 40 45 50 55 60 65 10 saves the newly created scanning protocol In the example of FIGS 4a b this is accomplished using OK button 436 FIG 8 illustrates steps involved in editing an existing scan ning protocol according to embodiments In step 812 th
20. ention to add a new scanning protocol 712 User defines a name for new scanning protocol and b DICOM Study Description 714 User enters a side b view c modifiers and d other information for firstfi im 716 User adds new films and associated information as necessary 718 User re arranges order of films in case as necessary 20 User saves new scanning protocol 722 User selects which protocol will be the default scanning protocol 124 FIG 7 U S Patent Apr 19 2011 Sheet 9 of 9 US 7 929 740 B2 User indicates intention to edit exsisting scanning protocol 812 User modifies information relating to study 813 User modifies information for one or more films 814 User adds new films or deletes films from scanning protocol 816 User selects an existing scanning protocol to use 91 User re arranges order of films in case as necessary 818 User saves modified scanning protocol 820 User loads initiates scanning F G I 8 using selected scanning protocol 917 User loads stack of films of one or more cases into scanner 916 User manually corrects film information or re assigns case to a different scanning protocol 920 ilms correctly scanneq FIG 9 US 7 929 740 B2 1 USER DEFINABLE SCANNING PROTOCOLS FOR USE WITH MAMMOGRAPHIC COMPUTER AIDED DETECTION AND FILM SCANNING SYSTEMS CROSS REFERENCE TO RELATED APPLICATION This patent application is a c
21. he scanning protocols listed in area 306 preferably corresponds to the list displayed in protocol selection area 234 The user indicates the intention to create a new scanning protocol by touching new button 308 Also shown in FIG 3 is Edit button 310 used to indicate the user s intention to edit and existing scanning protocol Remove button 312 is used to indicate the user s intention to permanently delete an existing scanning protocol After remove button 312 is touched there is preferably a warning window displayed with text such as You are about to remove a scanning protocol Are you sure Move Up button 314 and Move Down button 316 are used for re ordering the list of scanning protocols The scanning protocol at the top of the list is preferably always the default scanning protocol FIGS 4a b illustrate scanning protocol template screen 402 for creating and editing scanning protocols according to embodiments In response to receiving the user s intention to create and or edit a scanning protocol scanning protocol template screen 402 is preferably displayed as shown in FIG 4a Screen 402 includes scanning protocol name area 404 which either displays the name of the protocol being edited or in the case where a new protocol is being created allows the entry of the name of the new scanning protocol The user can preferably use this field to edit the name of an existing scanning protocol The name of the scanning protocol in area 4
22. he view type of the film Area 420 is used to add modifiers to the film and Area 422 used to indicate when the film is a partial view and or there is an implant present FIG 45 illustrates an example with a total of five US 7 929 740 B2 9 films added using new button 410 and the identifying fields 416 418 420 and 422 Film L M S MLO 440 is currently highlighted and is shown in area 414 Up and down buttons 424 and 426 are used to re arrange the order of the films in the scanning protocol and as displayed in film list area 406 Ifthe user is not satisfied with changes made the user has the option of cancelling all the current changes by touching the cancel button 432 Ifthe user is satisfied with the changes made then the OK button 436 is touched and the edited or new scanning protocol is saved FIG 3 illustrates display screen 202 corresponding to the CAD station of FIG 1 for creating editing and removing scanning protocols according to embodiments In particular FIG 5 shows a view of screen 202 with a newly added scanning protocol 506 named Diag L in scanning protocol list area 306 The new scanning protocol is also preferably displayed in protocol selection area 234 When a protocol is selected in area 306 the order of films in the case is displayed in area 512 According to an embodiment the default scanning proto col can be assigned by re arranging the order of the scanning protocol list in area 306 using the move
23. id processor is further adapted to assign laterality to each digitized version of the mammographic films according to the user defined scanning protocol 3 A system according to claim 1 wherein the user defined scanning protocol further defines the number of films and the sequence of films for each case to be scanned using the user defined scanning protocol 4 A system according to claim 1 wherein said user input output system is further adapted and configured to receive a user defined name for the user defined scanning protocol 5 A system according to claim 1 wherein said user input output system is further adapted to receive alterations to one or more scanning protocols stored in said storage system 6 A system according to claim 1 wherein said storage system stores a plurality of scanning protocols and said user input output system is further adapted to receive a user s selection of which scanning protocol to use for scanning one or more film cases 7 A system according to claim 6 wherein said user input output system is further adapted to receive a user s selection of which of the plurality of scanning protocols is be used as a default scanning protocol in cases where there is no user selection received 20 25 30 35 40 45 50 55 60 65 12 8 system according to claim 1 wherein said user input output system and said storage system are located in different facilities and said communication is
24. ing protocols according to embodiments FIG 5 illustrates a display screen corresponding to the CAD station of FIG 1 for creating editing and removing scanning protocols according to embodiments FIG 6 illustrates a display screen corresponding to the CAD station of FIG 1 according to embodiments FIG 7 illustrates steps involved in creating a new scanning protocol according to embodiments FIG 8 illustrates steps involved in editing an existing scan ning protocol according to embodiments and FIG 9 illustrates steps involved in scanning films using a scanning protocol according to embodiments DETAILED DESCRIPTION FIG 1 illustrates a CAD station 102 in a combination film based and digital mammography environment according to an embodiment including a film screen mammogram acquisition device 104 and a digital mammogram acquisition device 106 The digital mammogram acquisition device 106 is coupled to a network 108 usually a network containing a HIS RIS Hospital Information System Radiology Informa tion System and a PACS Picture Archiving and Communi cations System As used herein the term digital case refers to a group of mammogram images corresponding to a patient and acquired from a digital mammogram acquisition device Although asymptomatic persons undergoing the mammo graphic imaging process are often termed clients rather than patients in many clinics to denote that they are not symptomatic
25. mplished by choosing and selecting a scanning protocol from protocol selection area 234 In step 916 the user loads a stack of films making up one or more cases into the scanner This is preferably accom plished by placing a separator sheet on the top of each case as more fully described in WO 02 45437A2 The stack of films is positioned in the input tray of the scanner feeder In step 917 the user initiates scanning using the selected scanning protocol This is preferably accomplished by the user press ing the start button on display 202 If no scanning protocol was selected in step 914 then the default scanning protocol will be used In step 918 the user monitors the scanning process as described more fully in Published US Patent Appli cation No US20060126909A1 Ser No 10 998 121 If an error is detected in the scanning process in step 920 the user can manually correct the film information using a screen that is similar to that shown in FIGS 4a b or the user can re assign the case to a different scanning protocol as shown and described with respect to FIG 6 In step 922 the scanning process is completed Whereas many alterations and modifications ofthe present invention will no doubt become apparent to a person of ordi nary skill in the art after having read the foregoing descrip tion it is to be understood that the particular embodiments shown and described by way of illustration are in no way intended to be considered limiti
26. n erally employed by or otherwise associated with the medical facility where the scanning and or CAD systems are installed and operated The term user is not intended to refer to employees contractors or agents of the manufacturer and or designers of the scanning and or CAD systems According to an embodiment display screen 202 includes a number of predefined scanning protocols Scanning proto col selection area 234 is shown including six different scan ning protocols The Auto scanning protocol provides auto matic film orientation and identification based on lead view marker and breast outline segmentation is performed see WO 02 43457 A2 supra Auto assumes that 1 there are likely to be four films per study 2 the films are taken using recognized lead markers for correct identification the 3 the cases consist of the four standard screening views RCC LCC RMLO and LMLO The Any scanning protocol makes no assumption about what films are in the cases This scanning protocol requires manual identification of each image after scanning Other scanning protocols can be pro vided as listed in the Table 1 however according to embodi ments described herein the user can edit delete and create new scanning protocols in order to customize and improve the scanning process TABLE 1 Scanning Protocol Composition Screening RCC LCC RMLO LMLO Uni Right RCC RMLO RXCC Uni Left LCC LMLO LXCC Screening Imp
27. n 114 comprises a motorized viewer upon which the film cases 112 are loaded and synchronized with digital displays 116 that show reduced resolution versions of the mammogram images annotated with CAD markers and other information derived from the CAD results Also shown in FIG 1 is a second CAD station 140 connected to network 108 Accord ing to embodiments CAD stations 102 and 140 can be used for creation editing storage and use of various scanning protocols as described in further detail herein According to an embodiment scanning protocols can be created and edited on one CAD station and then transmitted via network 108 for storage and use by another CAD station According to yet further embodiments stations 102 and 140 can be film scan ning systems or film scanning platforms without CAD capa bility such as DigitalNow systems available from R2 Tech nology Inc Thus according these alternative embodiments references herein to CAD station refer instead to film scanning station or film scanning platform Notably the environment of FIG 1 around the CAD station 102 is presented by way of example only and is not intended to limit the scope of the embodiments to this particular sce nario By way of example many different setups can be used for reviewing film cases and their associated CAD results such as simple light boxes in conjunction with paper printouts of the CAD results By way of further example different
28. ng It is to be appreciated for example that several of the user interface embodiments described supra are applicable in a digital only mammo graphic environment where easy monitoring and control or the digital case receiving processing and dispensing is desired The graphical status indicator can be horizontally oriented diagonally oriented etc without departing from the scope ofthe embodiments Further types oftemporal changes inicon appearance other than blinking such as rotating icons can be used as visual textures or cues without departing from the scope of the embodiments Even further although par ticular reference is made to digital x ray mammography the scope of the embodiments includes any of a variety of medi cal imaging modalities that either presently or prospectively US 7 929 740 B2 11 are amenable to CAD analysis and or softcopy display Present or prospective examples including computerized tomography CT imaging magnetic resonance imaging MRI positron emission tomography PET single photon emission computed tomography SPECT and ultrasound as well as less conventional medical imaging modalities such as thermography electrical conductivity based modalities etc Therefore reference to the details of the embodiments are not intended to limit their scope which is limited only by the scope of the claims set forth below What is claimed is 1 A system for processing film based mammographic data c
29. omprising a user input output system adapted and configured to receive from a user a user defined scanning protocol identifying at least a view type for one or more mammo graphic films in a film case to be scanned using the user defined scanning protocol a storage system in communication with said input output system programmed and arranged to store the user defined scanning protocol for subsequent use in scan ning film cases a scanning system adapted to receive and scan a plurality of film cases generating therefrom a digitized version of each mammographic film and a processor in communication with said storage system and said scanning system adapted and programmed to assign view types to one or more digitized versions of the mammographic film according to the user defined scanning protocol wherein said storage system stores a plurality of scanning protocols and said user input output system is further adapted to receive a user s instruction to re assign a case scanned according to a first scanning protocol to a second scanning protocol said processor further adapted to automatically assign the view type to each digitized version according to the second scanning protocol in response to the user s instruc tion 2 A system according to claim 1 wherein the user defined scanning protocol further identifies the laterality of each mammographic film in the film case to be scanned using the user defined scanning protocol and sa
30. ontinuation in part of U S Ser No 10 998 121 filed Nov 26 2004 now abandoned published as US 20060126909A1 which is incorporated by reference herein FIELD This patent specification relates to processing medical images More particularly this patent specification relates to processing film based medical images for storage display and or computer aided detection CAD applications BACKGROUND Computer aided detection CAD generally refers to the use of computers to analyze medical images to detect ana tomical abnormalities therein Sometimes used interchange ably with the term computer aided detection are the terms computer aided diagnosis computer assisted diagnosis or computer assisted detection CAD results are mainly used by radiologists and other medical professionals as secondary reads or secondary diagnoses tools When analyzing a medi cal image the radiologist usually makes his or her own ana lytical determinations before looking at the CAD results which either verify those determinations or trigger further inspection of the image Some CAD implementations have used CAD results in a concurrent reading context in which the radiologists look at the CAD results at the same time that they look at the images In the field of mammography thousands of mammography CAD systems are now installed worldwide and are used to assist radiologists in the interpretation of millions of mam mograms per year Mammography CA
31. r and identifying a laterality and a view type for each mam mographic film in each film case wherein a storage system stores a plurality of scanning protocols the method further comprising receiving a user s instruction to re assign a case scanned according to a first scanning protocol to a second scanning proto US 7 929 740 B2 13 col wherein said step of assigning automatically assigns the laterality and view type to each digitized version according to the second scanning protocol in response to the user s instruction 16 A method according to claim 15 said plurality of scan ning protocols comprising one or more user defined scanning protocols and one or more manufacturer defined scanning protocols the method further comprising the step ofreceiving from the user a user s selection of which stored scanning protocol to use for said step of scanning and wherein said step 5 14 of assigning uses the user s selection of scanning protocol if available and a default scanning protocol if no user s selec tion is available 17 A method according to claim 15 further comprising the step of processing the digitized versions according to at least one computer aided detection CAD algorithm for detecting anatomical abnormalities therein
32. rating therefrom a digitized version of each mammographic film A processor in commu nication with said storage system and said scanning system is adapted and programmed to assign laterality and view types to the digitized versions of the mammographic film according to the user defined scanning protocol The user defined scan 20 25 30 35 40 45 50 55 60 65 4 ning protocol preferably includes the number of films in each case and the sequence of the films The system is preferably adapted to receive user alterations to stored scanning proto cols The system is also preferably adapted to re assign a case scanned according to one scanning protocol to another scan ning protocol in response to a user s instruction to do so The system is also preferably adapted to process the digitized versions according to at least one computer aided detection CAD algorithm for detecting anatomical abnormalities therein BRIEF DESCRIPTION OF THE DRAWINGS FIG 1 illustrates a CAD station in a combination film based and digital mammography environment according to embodiments FIG 2 illustrates a display screen corresponding to the CAD station of FIG 1 according to embodiments FIG 3 illustrates a display screen corresponding to the CAD station of FIG 1 for creating editing and removing scanning protocols according to embodiments FIGS 4a b illustrate a scanning protocol template screen for creating and editing scann
33. re sim ply not scanned Ifthe case is not scanned at all not only does the case forego the potential benefits of CAD processing the case is also unavailable for analysis and comparison in later years at a time when the move to all digital mammography may have taken place at the particular medical facility Itis important to note that there are many ways in which the case may not conform to the manufacturer s standard scan ning protocol For example diagnostic mammography cases commonly have more than four films and include other types of views such as ML LMO LM XCC XCCL XCCM FB and SIO for each breast Certain types of populations may have different imaging procedures For example in some medical imaging facilities certain ethnic populations may have a different standard screenings A patient my have only one breast due to a prior mastectomy Some geographic regions may have different screening protocols For example in the Netherlands after a standard four film screening in subsequent years screening mammography cases typically consist only of two films R MLO and L MLO Some systems allow the user to specify a different number of films per case One example is the SecondLook 700 system from iCAD Inc which allows users to specify the number of slides per study However if one case in a large stack of cases has a missing film or and extra film then all of later scanned cases in the stack can have costly identification erro
34. rs Moreover the user still must go through a time con suming process for each film of each case to identify the laterality view and other critical information if the cases do not match one the standard cases supplied by the manufac turer Accordingly it would be desirable to provide a system for medical film digitization that is easier for a technologist cases that do not correspond to a standard case that has been defined by the manufacturer thereby leading to cost savings and increased productivity Tt would be further desirable to provide such a digitization and or processing system in a manner that flexibly accommo dates cases of different composition thereby increasing the likelihood that the case is digitized and stored thereby facili tating evolution from film environments to digital environ ments SUMMARY Asystem method and related computer program products are provided for processing film based mammographic data The system preferably includes a user input output system adapted and configured to receive from a user a user defined scanning protocol that identifies the laterality and view type for each mammographic film in a film case to be scanned A storage system is in communication with said input output system and is programmed and arranged to store the user defined scanning protocol for subsequent use in scanning film cases A scanning system is preferably adapted to receive and scan a plurality of film cases gene
35. tudy ordered as follows R MLO L MLO R CC and L CC However a problem with such conventional approaches arises when the scanning system receives a case that does not have the same number of films the films are ordered differ ently and or the views do not correspond to the standard scanning protocol set by the manufacturer Even when auto matic film orientation and identification is available the lead markers may be inadequate For example the lead marker may be partially out of the frame or may be overlapping with part of the breast tissue or patient label Further the lead marker detection systems may especially have trouble cor rectly identifying view types that are not one of the four standard screening views Errors in film identification are costly and time consuming to correct Ifthe error is noticed by the technologist during the scanning process the technologist may use a user interface to manually identify each image If the technologist does not notice the error the film may be associated with the wrong US 7 929 740 B2 3 case The radiologist may recognize the error during his or her review and expend valuable time making a correction If the technologist or technician responsible for scanning the cases knows ahead of time that the case does not conform to the standard scanning protocol the information may be manually entered However this may be unduly time con suming and in many cases such non standard cases a
36. ystems and related HIS RIS Hospital Information System Radiology 10 20 40 45 55 60 65 2 Information System equipment directly to the radiologists viewing workstations have not yet become common According to one estimate approximately 90 percent of all mammography systems worldwide are still film based units and an equivalent percentage of all mammograms taken yearly are film based mammograms rather than digital mam mograms Because film based mammograms require digiti zation prior to performance of CAD algorithms a substantial number of workflow related issues can arise One important issue relates to the scanning and identifica tion process for film based mammograms For a CAD algo rithm to be effective itis usually desirable for a typical 18x24 cm or 24x30 cm film mammogram to be digitized at about 50 microns of spatial resolution and about 12 bits of dynamic range Even using today s scanning technologies it can take acommercial film scanner 15 60 seconds to digitize one film at these resolutions and therefore it can take 1 4 minutes to digitize a typical film case having 4 views A stack of 20 cases can therefore take an hour to run through the digitizer At least theoretically the technologist who placed the film stack in the scanner should be able to perform other duties while the digitization is taking place Progress has been made toward automation of the film scanning process One example is WO 0
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