Mammography Plug-in

The mammography plug-in module includes a collection of features, tools, and hanging protocols dedicated to the display and handling of mammography studies. They include skin line detection, displaying CAD overlays, mammography-specific hanging protocols and built-in grid layouts, image positioning tools and support for optional image processing algorithms.

The mammography plug-in module requires an eRAD PACS Mammography plug-in module license. When the Viewer launches for the first time, if a valid license exists on the server and the user account is configured to use the plug-in module, the mammography module features are activated. The mammography plug-in module requires the workstation environment specified for an eRAD PACS diagnostic workstation plus FDA-cleared mammography monitors.

If reading breast tomography studies, the following enhancements are strongly recommended:

• Processor speed: greater than 2GHz

• RAM: minimum is twice the size of a breast tomography study

• Disk space (Viewer cache): minimum is three times the size of all breast tomography studies read from the workstation in one day

Mammography Tools

The Mammography toolbar provides access to the breast imaging tools that are part of the mammography plug-in module.

Icon	Function	Menu Item	Description
	Show CAD	ToolsMammoShow CAD	Show/hide mammography CAD markers
	Fit to breast	ToolsMammoFit to breast	Magnify the image so the breast is maximally displayed to the shorter edge of the image frame.
	Snap to anatomy	ToolsMammoSnap breast<selected area>	Render the selected image at full resolution with the first detected part of the breast positioned in the selected area respectively justified in the image frame.
	Enhanced ROI	ToolsMammoEnhanced ROI	Activate a floating panel containing the AIE enhanced image data of the image behind it. Requires an AIE enhanced image exist in the thumbnail panel
	Invert breast image	ToolsMammoInvert breast image	Invert the window/level settings of breast image data, leaving the remaining data unchanged.
	Show skin line	ToolsMammoShow skin line	Show/Hide the skin line.

Skin Line Detection

The skin line detection tool outlines the breast skin line in mammography images. To show or hide the skin line of the selected image click the Show Skin Line icon from the mammography toolbar. When calculated, an icon appears in the top left corner of the image frame indicating processing is incomplete. If skin line detection fails, the icon turns into a warning icon. Place the mouse over the warning icon to display the message indicating the skin line could not be calculated.

Anatomical Greyscale Inversion

The anatomical greyscale inversion tool inverts the window and level settings for the breast image only leaving the remaining area uchanged. To invert the greyscale slope of the selected breast image, click the Invert W/L on Anatomy icon from the mammography toolbar. To identify the breast data, the tool requires successful generation of the skin line. If the skin line could not be calculated, a warning pops up and there is no change to the window/level settings.

Snap-To Image and Anatomy

The snap-to functions sets the image resolution to full (1:1) and reorients the image in the image frame as directed by the user.

There are two Snap-To icons available:

• Snap To Image - used if skin line is not generated successfully
• Snap To Anatomy - skin line must be generated successfully

Both of these functions pop up a selection grid consisting of eight regions:

 Select the region and the tool will display that portion of the image justified to the respective borders. Built-in accelerator keys and shortcuts exist for snapping to specific regions of the selected image both of which are available on the Tools/Mammo menu.

Function	Menu Item	Hot Key	Description
Snap to next quadrant	ToolsMammographySnap progressionNext quadrant	Ctrl+Alt+{	Snap to the next quadrant (left to right, top to bottom). If no snap-to quadrant is applied, snap to the top left quadrant. Uses the snap-to-anatomy tool.
Snap to previous quadrant	ToolsMammographySnap progressionPrevious quadrant	Ctrl+Shift+Alt+{	Snap to the previous quadrant (right to left, bottom to top). If no snap-to quadrant is applied, snap to the top left quadrant. Uses the snap-to-anatomy tool.
Snap to next segment	ToolsMammographySnap progressionNext segment	Ctrl+Alt+}	Snap to the next of the nine defined segments used in the snap-to-anatomy toolbar. The first instance snaps to the top left segment.
Snap to previous segment	ToolsMammographySnap progressionPrevious segment	Ctrl+Shift+Alt+}	Snap to the previous of the nine defined segments used in the snap-to-anatomy toolbar. The first instance snaps to the top left segment

Progression Mode

The progression tool is similar to the snap-to tools with the additional feature that it splits the image into equal size segments such that each pixel exists in a single segment. The user can then progress through each segment, thereby displayed the full image without any duplication of data. They are available in the Tools/Mammo menu. Built-in accelerator keys exist for advancing to the next and previous segments.

Function	Menu Item	Hot Key	Description
Advance to next view	ToolsMammographyView progressionNext view	Shift+Ctrl+Alt+.	Advance to the next view (left to right, top to bottom). Initial position is the top left view
Advance to previous view	ToolsMammographyView progressionPrevious view	Shift+Ctrl+Alt+,	Advance to the previous quadrant (right to left, bottom to top)
Exit progression	ToolsMammographyView progressionExit progression	Shift+Ctrl+Alt+Del	Exit progression mode and restore the image to its original settings

When in progression mode, the progression mode icon ? appears in the top left corner of the image frame.

Progression mode remains active until:

• The user advances past the last segment

• Exits using the menu option

• Loads an image into the image frame

A border appears around the unique data in each segment which has a size that can be configured. The data displayed behind the border is data from the neighboring segment.

To change the size of the border:

1. Open the Customize Settings panel from the View menu
2. Select the Image tab
3. Enter the width of the border in the Progression Overlap field

If skin line was applied to the image during the viewer session, the progression mode segmentation is based on the anatomical structure. If skin line was never applied, the segmentation is performed on the entire image.

Note: When progression mode is active in an image frame, cine playback is disabled.

Fit To Anatomy Mode

Apply a calculated zoom factor to the selected image such that the anatomical structure in the image (the breast) is displayed as large as possible within the defined image frame. When applied, the anatomical structure will appear up to the edge of the image frame for the short of the two dimensions (width or height).

Note: This feature requires skin line detection to find the anatomical structure and will apply to the fit-to-image zoom factor if the skin line detection is unavailable or fails.

Enhanced ROI

The enhanced ROI tool displays the AIE enhanced images in a panel that floats over a defined region of the original image. The enhanced ROI tool requires both a mammography plug-in module license and an AIE Image Enhancement plug-in module license. It also requires the presence of an AIE enhanced image in the thumbnail panel. See details for manual and automatic generation of AIE enhanced images in the AIE Image Enhancement module section.

To activate the Enhanced ROI panel:

1. Click the Enhanced ROI icon from the Mammo tool group
2. Place over the original mammography image:
   1. The data within the panel is replaced with the corresponding data from the AIE enhanced image
   2. To pan the Enhanced ROI panel - press and hold down the left mouse button and drag
   3. To close the Enhanced ROI panel - click outside of it

The default magnification factor is defined by the Enhanced ROI Zoom Factor defined in the Settings panel.

Mammography CAD Markers

A CAD marker provides computer-aided diagnosis to mammography images.

The Viewer supports the CAD objects from the following manufacturers and systems:

• Hologic Image CheckerTM (formerly R2)
• iCAD Second LookTM and VuCOMP M-VuTM

CAD Overlays

If a study includes a CAD marker, the presentation state icon (highlighted) appears in the top left corner of the image when it is displayed in an image frame.

Selecting the presentation state icon reveals a dropdown menu consisting of current presentation state functions (show or hide):

When applied, these functions override the current CAD marker display state applied to each individual image using the image frame’s presentation state tool. When mammography CAD graphic and geometric overlays exist for an image, apply any of the options to just one image by selecting the applicable option from the list.

The default CAD overlay settings can be configured from the Tools/Mammo menu under Mammography CAD.

Mammography-Specific Layouts and Hanging Protocols

Mammography image review makes use of image layouts that differ from other study types and can be created using the hanging protocol tools. Those that cannot are included by default.

Built-in mammography-specific hanging protocols:

These hanging protocols are available when the Modality value of the primary study is MG. The HP requires the series description contain the strings RCC, LCC, RMLO and LMLO. Additional layout tools exist for creating mammography-specific hanging protocols.

See: Image Stacks