Breast Tomosynthesis: Impact on IT Systems. dondennison.com

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1 Breast Tomosynthesis: Impact on IT Systems MIIT 2016, HAMILTON

2 Don K Dennison Industry consultant with 14+ years experience in imaging IT Society for Imaging Informatics in Medicine (SIIM) Board of Directors (2011-Current) Committees: Program, Hackathon, ecommunity American College of Radiology (ACR) Committees: Connect (Chair), Informatics Industry Activities (Chair), Clinical Data Sciences Contact 2

3 Don K Dennison Faculty/Presenter Disclosure Relationships with commercial interests: Consulting Fees: Provider and Vendor clients 2

4 Today s Talk What is Breast Tomosynthesis and why is its popularity growing? What makes the exam data so large and what factors contribute to the size of each exam? OK, how big are we talking about? OMG, that big? What will this do to my imaging IT systems? What can I do to prepare for, or avoid, negative system (or IT cost) impacts?

5 Breast Tomosynthesis (Tomo) New modality; market share leader is Hologic 1 Increasing evidence as to its effectiveness over traditional Mammograms, especially for women with dense breast tissue Increasingly adopted as physicians and patients view Breast Tomo as superior to Mammograms; traditional Mammogram exam volumes are often replaced by Breast Tomo exam volumes Healthcare providers that do not offer Breast Tomo often see a loss of volume to providers that do 1) Most technical details in this talk refer to Hologic and their products

6 Visual Differences MAMMOGRAM (MG) DIGITAL BREAST TOMOSYNTHESIS (DBT) Source: American Journal of Roentgenology: Issues to Consider Before Implementing Digital Breast Tomosynthesis Into a Breast Imaging Practice

7 Breast Tomo Data Types Several different types of series are normally contained within the study C-View 2D image that visually appears similar to a Mammogram (MG) exam; average size is 1.5 MB per image (small) Projections Average size is 8.5 MB per image (medium) Mammogram 2D Traditional MG exam data (medium) Reconstructions 3D multi-frame DICOM object with a varying number of frames, based on the size of the breast; average size ranges from 70 to 200 MB, or more (large) Note: Many facilities do not archive the Projection series data

8 Breast Tomo Data in PACS RCC LCC DBT C-View Screen captures courtesy McKesson Imaging and Workflow Solutions RCC Slab

9 Breast Tomo More Details Each exam will have a different number of Views acquired, which normally range between 4 and 6 Typical lossless image compression methods can (and should) be applied U.S. MQSA regulations do not allow lossy compression to be applied Multiplying the number of Views for each series type results in large studies If a patient requires many Views to be acquired, has large breasts, and the Projection series are archived, each study can be very large (many GBs in size!) and then there are the formats

10 Breast Tomo Multiple Formats Available BTO DICOM standard defined SOP Class object Valid DICOM Transfer Syntaxes applied Many PACS and Enterprise Viewers now support display ~2.5 times larger than SCO data SCO Secondary Capture Proprietary to Hologic Easy to store in PACS/VNA, but not display Can be converted to BTO, in future, using Hologic-provided tool Viewed using Hologic workstation Additional information from SIIM 2013:

11 Deciding on a Format: Choose Wisely BTO DICOM standard, so interoperable among systems and organization enterprises Supported by many PACS, so can reduce types of clients required, desktop integrations Also, can support integrated display of Tomo, MG, MRI, US SCO Much smaller than BTO, so will cost less to store and will take less time to transmit Cannot be viewed by any affiliate that does not have a Hologic workstation SCO can be converted to BTO by Hologic Tech workstation, tool

12 Introducing the Breast Tomosynthesis IT Impact Calculator Available for no-cost download, along with instructions: Allows entry of your study size averages, volumes, etc. Calculates the impact to your long-term archive and PACS cache, along with costs Estimates file transmission times Includes some default graphs

13 So, Exactly How Large are we Talking About? The average number of Views acquired, number of frames in the Recon object, and whether or BTO or SCO data are captured all have a large and multiplicative impact on imaging IT systems Could store both BTO and SCO data, but the cost will be prohibitive

14 Impact on the PACS Cache 2 Years 1 Year PACS cache capacity is consumed much faster, reducing the amount of data available for all studies; therefore, data is deleted from cache much sooner and more priors will need to be retrieved from the archive

15 Impact on the Archive (PACS, VNA) Costs Based on US$0.70/GB The archive storage capacity consumed is significant, requiring more to be purchased, much sooner

16 Breast Tomo Compared to Other Imaging For example: Using typical values, in 10 years, Breast Tomo (BTO) data will consume more storage than 25 years of all other imaging data types combined

17 Network Requirements for Fast Display All but the fastest networks will be a bottleneck in transmitting Breast Tomo data, especially if there are multiple priors and large Recon objects Note: Client workstations also often require a 64-bit operating system and additional RAM to be able to load the large datasets

18 Closing Comments Organizations that do not prepare for the impact of Breast Tomo data in their imaging IT systems will be caught off guard and may suffer from performance issues and/or unplanned costs The choice between SCO and BTO formats is multi-faceted, involving interoperability, accessibility, performance and costs aspects: consider all of these when making you decision Due to the size of Breast Tomo imaging study data, and the IT costs to store them, shared per-study PACS cost models may need to be revised the per-study cost charged to a facility may not cover the cost of storing the study data

19 Closing Comments Organizations will need to examine their policies, procedures, and tools regarding imaging record retention it may be time to start purging old imaging data to offset the new, higher costs caused by Breast Tomo The impact on PACS cache may require the Breast Tomo data to be segregated to its own cache, or have advanced lifecycle management policies applied to maintain expected availability of all imaging