KODAK DIRECTVIEW CR Mammography Feature User`s Guide

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KODAK DIRECTVIEW
CR Mammography Feature
User’s Guide
17 September 2010
9G3741
Version 1.0
Carestream Health, Inc.
150 Verona Street
Rochester, NY 14608
CARESTREAM, DIRECTVIEW, and DRYVIEW are trademarks of Carestream Health, Inc.
The Kodak trademark and trade dress are used under license from Kodak.
© Carestream Health, Inc. 2010
Table of Contents
1 CR Mammography Feature
Document Conventions ....................................................................................................................................... 1
About This Guide................................................................................................................................................. 1
For European Markets ........................................................................................................................................ 2
Safety and Related Information............................................................................................................................ 2
Mammography Imaging Chain............................................................................................................................. 4
Acquisition.................................................................................................................................................... 5
Capture and Processing................................................................................................................................. 5
Softcopy Viewing / Storage ............................................................................................................................ 6
Hardcopy Printing / Viewing.......................................................................................................................... 6
CR Mammography Feature .................................................................................................................................. 6
Indications for Use........................................................................................................................................ 6
CR Systems.................................................................................................................................................... 6
CR Mammography Cassettes.......................................................................................................................... 7
Before You Begin .......................................................................................................................................... 8
Workflow and Operation................................................................................................................................... 10
Performing a Mammography Exam ................................................................................................................... 11
Preparing the Cassettes ............................................................................................................................... 11
Creating a Patient Record............................................................................................................................ 12
Using CR Mammography Cassettes .............................................................................................................. 14
Exposing the Cassette .................................................................................................................................. 14
Compatibility with X-ray Systems ....................................................................................................................... 15
Technique Considerations........................................................................................................................... 16
X-ray Techniques ........................................................................................................................................ 16
Automatic Exposure Control (AEC) ............................................................................................................. 17
Automatic Exposure Control (AEC) Calibration ........................................................................................... 18
Exposure Index........................................................................................................................................... 19
Recording Exposure Parameters ....................................................................................................................... 19
Mammography X-ray Interface .................................................................................................................... 19
General Radiography Workflow............................................................................................................. 20
Mammography Workflow...................................................................................................................... 20
Transmitted Data................................................................................................................................... 21
Scanning the Cassette ........................................................................................................................................ 22
i
Scanner Bar-Code Messages ...................................................................................................................... 22
Reviewing and Accepting Images....................................................................................................................... 22
Skin Line Enhancement............................................................................................................................... 25
Using the Image Processing Preference Editor .................................................................................................. 26
The Family of Looks.................................................................................................................................... 27
For Software Versions 5.1 and 5.2 ........................................................................................................ 27
For Software Version 5.2 Additional Looks Mammography Patch and Version 5.4 Default .................... 28
For Software Version 5.4 Mammography Update 2010-01 License Enabled .......................................... 28
For Software Version 5.4 SNP Parameter Database................................................................................ 29
Preference Editor Controls.......................................................................................................................... 30
Slider Control Behavior............................................................................................................................... 32
Defining a Look .......................................................................................................................................... 32
Brightness................................................................................................................................................... 32
Latitude....................................................................................................................................................... 33
Contrast ...................................................................................................................................................... 33
Sharpness ................................................................................................................................................... 33
Noise .......................................................................................................................................................... 33
Delivering Mammography Images..................................................................................................................... 34
Justification of Right Mammography images................................................................................................ 34
Presentation of Images................................................................................................................................ 34
Printing Mammography Images .................................................................................................................. 35
Creating Multi-format Prints........................................................................................................................ 35
Mammography Cassette Use Instructions .......................................................................................................... 37
Opening the Cassette................................................................................................................................... 37
Cleaning the Cassette Shell .......................................................................................................................... 38
Handling and Maintaining the Screen.......................................................................................................... 39
Cleaning the Screen .................................................................................................................................... 40
Cleaning Method......................................................................................................................................... 40
Disinfecting the Screen or the Cassette........................................................................................................ 41
Disposing of the Screen .............................................................................................................................. 41
Quality Control.................................................................................................................................................. 42
Acceptance and Quality Control Testing ...................................................................................................... 42
Troubleshooting ............................................................................................................................................... 42
Black Surround Masking ............................................................................................................................ 43
Manual Black Surround.............................................................................................................................. 43
Overscan Check .......................................................................................................................................... 45
Getting Help...................................................................................................................................................... 45
Glossary............................................................................................................................................................ 46
Acronyms.......................................................................................................................................................... 48
ii
CR Mammography Feature
1
CR Mammography Feature
The information contained herein is based on the experience and knowledge
relating to the subject matter gained by Carestream Health, Inc. prior to
publication. No patent license is granted by this information.
Carestream Health reserves the right to change this information without
notice, and makes no warranty, express or implied, with respect to this
information. Carestream Health shall not be liable for any loss or damage,
including consequential or special damages, resulting from any use of this
information, even if loss or damage is caused by Carestream Health’s
negligence or other fault.
Document Conventions
This manual uses three types of messages to emphasize information or
potential risks to personnel or equipment: Notes, Important, and Caution.
NOTE: Notes provide additional information, such as expanded explanations,
hints, or reminders.
IMPORTANT:
Important highlights critical policy information that
affects how you use this manual and this product.
CAUTION:
Cautions point out procedures that you must follow precisely
to avoid injury to yourself, others, damage to the system or any
of its components, loss of data, or corruption of files in
software applications.
About This Guide
Use the KODAK DIRECTVIEW CR Mammography Feature User’s Guide for
specific information on the use of the CR Mammography Feature. This guide
does not provide all operational use information on KODAK DIRECTVIEW CR
Systems and is intended to be used in conjunction with the following
document:
• KODAK DIRECTVIEW CR Systems User Guide information
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1-1
CR Mammography Feature
NOTE: All references in this document to CR Mammography Cassettes and
screens apply to the following unless otherwise specified:
• KODAK DIRECTVIEW CR Mammography Cassette with EHR-M
Screen
• KODAK DIRECTVIEW CR Mammography Cassette with EHR-M2
Screen
• CARESTREAM CR Mammography Cassette with EHR-M3 Screen.
• CARESTREAM CR Mammography Cassette with SNP-M1 Screen.
NOTE: CR Mammography Cassettes are not available for sale in the United
States.
NOTE: See the Glossary section for a brief description of terms used in this
guide.
NOTE: Use of the term applicable regulations throughout this document
means: as per current country, state, local, and/or facility-specific
regulations applicable for use in mammography.
For European Markets
Authorized European Agent:
Carestream Health France
LES MERCURIALES
40, rue Jean Jaures
93176 BAGNOLET CEDEX
France
Safety and Related Information
NOTE: The following information applies to any KODAK DIRECTVIEW CR
System that has the CR Mammography Feature installed. For more
information, see the KODAK DIRECTVIEW CR System Safety and
Regulatory Information included in your CR Systems User’s Guide.
CAUTION:
A trained Service Representative is to install and verify the CR
System is set up and functioning properly for use of the
Mammography Feature.
See: “Before You Begin” on page 1-8.
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CR Mammography Feature
CAUTION:
Calibrate all components in the Mammography Imaging Chain at the
recommended intervals, according to the manufacturer’s instructions,
and before use.
See: “Mammography Imaging Chain” on page 1-4.
CAUTION:
A Medical Physicist or qualified personnel is to establish or approve the
exposure techniques used. A technique chart should be posted near the
X-ray unit generator control panel.
See: “Technique Considerations” on page 1-16.
CAUTION:
The Medical Physicist or qualified personnel is to perform the
Acceptance and Quality Control Tests as mandated by applicable
regulations.
CAUTION:
Follow and perform the Quality Control procedures for all components
in the Mammography Imaging Chain at the recommended intervals,
according to the manufacturer’s instructions and per applicable
regulations. The facility must ensure that the image quality produced by
all equipment in the Mammography Imaging Chain meets the
requirements for clinical use.
See: “Mammography Imaging Chain” on page 1-4.
CAUTION:
Primary interpretation of softcopy images shall be performed on a
workstation cleared for mammography and supporting the DICOM 3.0
standard. The workstation shall have at least two displays, each with a
minimum image array size of five megapixels.
CAUTION:
Primary interpretation of hardcopy images shall be performed on a
printer cleared for mammography and supporting the DICOM 3.0
standard. The printer shall have a 50 micrometer m pixel pitch or less
and maximum film optical density of at least 3.6.
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CR Mammography Feature
CAUTION:
Use CR Mammography Cassettes only for Mammographic Imaging. Do
not use CR Mammography Cassettes for general radiography imaging
applications. Do not use CR Cassettes, intended for general
radiography, for Mammography imaging applications.
CAUTION:
KODAK DIRECTVIEW CR Systems allow CR Mammography Cassettes
with EHR-M, EHR-M2, EHR-M3, and SNP-M1 screen types to be
scanned. Only scan cassettes with the same screen type on the CR
System, and do not intermix the cassette/screen types when performing
a patient exam. Intermixing the cassette/screen types may result in an
inconsistency in the quality of the image.
NOTE: For hardcopy printing of Mammography images, Carestream Health
recommends that you configure the CR System for use with a KODAK DRYVIEW
Mammography Laser Imager using KODAK DRYVIEW Mammography Laser
Imaging Film. Contact your Carestream Health Sales Representative for more
product information.
NOTE: For softcopy viewing of Mammography images, Carestream Health
recommends that you configure the CR System for use with a KODAK
DIRECTVIEW Mammography Workstation. Contact your Carestream Health
Sales Representative for more product information.
Mammography Imaging Chain
The Mammography Imaging Chain with the KODAK DIRECTVIEW CR System diagram
shows an overview of the equipment necessary for producing diagnostic quality
mammograms. Obtaining high quality mammography images is dependent on many
factors. All equipment in the Mammography Imaging Chain must be properly calibrated
for use and quality control checked for proper functionality per each manufacturer's
recommendations.
The Technologist plays a key role in successfully achieving high quality digital
mammograms by understanding the best exposure techniques to use, based on breast
thickness and composition, and the capabilities of the equipment in the imaging chain.
In addition to the KODAK DIRECTVIEW CR System with CR Mammography Feature,
Carestream Health provides Mammography Workstation and Mammography Printer
solutions, thus optimizing the system performance of this equipment in the
Mammography Imaging Chain.
1-4
9G3741
CR Mammography Feature
As depicted in the diagram, the equipment can be described under these main
functional categories:
a. Acquisition
b. Capture and Processing
c. Softcopy Viewing and Storage
d. Hardcopy Printing / Viewing
Mammography Imaging Chain
Acquisition
The Mammography X-ray Unit is used with the KODAK DIRECTVIEW CR System in the
same manner as with conventional screen/film mammography. The techniques (target,
filtration, kVp setting, proper positioning and compression, etc.) used are similar for
exposing the CR Mammography Cassettes, and requires that the X-ray Unit components
(i.e. X-ray generator, AEC, compression paddles, cassette holder/grid, etc.) are
calibrated and maintained to function according to the manufacturer's stated
requirements.
Capture and
Processing
The KODAK DIRECTVIEW CR System with CR Mammography Feature, using CR
Mammography Cassettes, provides the means to capture and process mammography
images. Insert the CR Mammography Cassettes in the Mammography X-ray Unit's
cassette holder for exposure, then place them in the KODAK DIRECTVIEW CR System,
where they are scanned and image processed to produce high resolution images. The
patient's exam record is created on the CR System and associated with the patient's
images. A DICOM-compliant network connection with the CR System is used. You can
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CR Mammography Feature
search Patient Worklist information from a site's HIS/RIS and use it to create the
patient's exam record on the CR System. The patient record and images are then sent
via the DICOM network to the desired output destination for diagnostic interpretation.
Softcopy
Viewing /
Storage
From the KODAK DIRECTVIEW CR System, digital mammogram images can be sent to a
DICOM-compatible Mammography Workstation where a diagnostic review can be
performed in softcopy. The workstation consists of a mammography-capable,
high-resolution display monitor, keyboard, mouse and computer. The Technologist uses
the mouse and keyboard to select, review, and manipulate images for desired viewing.
You can save preferences for selecting digital images and patient information and recall
them for later use. The operator can send images from the workstation to an archive
image storage system, or to other network DICOM compatible devices, including
hardcopy printers.
Hardcopy
Printing /
Viewing
From the KODAK DIRECTVIEW CR System, digital mammogram images can be sent to a
DICOM compatible Mammography Printer. The Mammography Printer can produce
high-resolution, diagnostic quality, hardcopy (film) output of the digital mammogram
images. The hardcopy print is then viewed for diagnosis on a View Box. The View Box
must be of adequate brightness with uniform light output across the entire viewing area
to ensure that the image captured on the film can be effectively diagnosed.
CR Mammography Feature
Indications for
Use
The CR Mammography Feature together with CR Mammography Cassette comprise a
device which, when used in conjunction with a KODAK DIRECTVIEW CR System and a
mammographic X-ray machine, generates digital mammographic images that can be
used for screening and diagnosis of breast cancer. It is intended for use in the same
clinical applications as traditional screen-film based mammographic systems. The
mammographic images can be interpreted by a qualified physician using either
hardcopy film or softcopy display at a workstation.
CR Systems
You can install and use the CR Mammography Feature in the following KODAK
DIRECTVIEW CR Systems:
• CR 850
• CR 950
• CR 975
• Classic/Elite CR
NOTE: See the KODAK DIRECTVIEW CR System Hardware Guide for descriptions of
these systems. Older manufactured CR 850/950/975 Systems may require
hardware and software updates in order to use the CR Mammography Feature.
Contact your Carestream Health Sales Representative for information.
1-6
9G3741
CR Mammography Feature
NOTE: The KODAK DIRECTVIEW CR System with CR Mammography Feature, using CR
Mammography Cassettes is designed to work under normal room light
conditions.
IMPORTANT:
Keep the CR System, its surrounding area, and the storage locations
for the CR Mammography Cassettes clean. This will help prevent dust
or debris from entering the CR System and cassettes, which can
result in image artifacts.
To enable the CR Mammography Feature:
1. Purchase and install the CR Mammography Feature Option.
2. Log on as the Key Operator.
3. Enter the Mammography Feature code to automatically enable the feature.
When the CR Mammography Feature is enabled, the KODAK DIRECTVIEW CR System
produces high-resolution Mammography images using CR Mammography Cassettes.
Only CR Systems with the CR Mammography Feature enabled will support the use of the
CR Mammography Cassettes.
Digital images are produced as follows:
Cassette Size
Sampling Rate
Image Size
(approximate)
Pixel Spacing
18 x 24 cm
20 pixels/mm
34 MegaBytes / image
48.5 microns
24 x 30 cm
20 pixels/mm
57 MegaBytes / image
48.5 microns
CR
Mammography
Cassettes
CR Mammography Cassettes are designed for Mammography applications only. They
contain a high-resolution Mammography storage phosphor screen and are available in
two sizes: 18 x 24 cm and 24 x 30 cm. To readily identify that a CR System can accept a
CR Mammography Cassette, one of the following two labels will be attached to the CR
System:
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1-7
CR Mammography Feature
The Mammography storage phosphor screen is not physically contacted when
transported or scanned by the CR System. Not withstanding possible wear conditions,
there is no established total number of times the CR Mammography Cassette can be
used for image exposure before replacement is required.
IMPORTANT: CR Mammography Cassettes should not be stored or left unattended
in the exam room. When an X-ray exposure occurs, scatter radiation
can expose the cassettes that are located in the exam room, resulting
in fogged or low contrast appearance in image quality. You can use
the Erase Cassette function on the CR System to assure the cassette
is fully erased prior to using for patient exposure.
Before You Begin
After installing the CR Mammography Feature in the CR System and before clinical use:
1. A trained Service Representative should check that the CR System:
– Is properly configured and contains KODAK DIRECTVIEW CR Software Version
5.1 or higher.
– Has the CR Mammography Feature enabled.
– Is calibrated for use with CR Mammography Cassettes.
– Operates within specification to produce expected image quality.
2. A Medical Physicist or, if permitted by applicable regulations, qualified personnel
under direction of a Medical Physicist, should:
– Performs the necessary acceptance testing according to applicable regulations.
– Check the Mammography X-ray Unit’s Automatic Exposure Control (AEC) is
properly calibrated for use with CR Mammography Cassettes and meets
applicable regulations. AEC calibration is to be performed by a qualified X-ray
equipment service representative.
– Establish and/or approve the use of an exposure technique control chart.
3. A Carestream Health Applications Consultant can:
– Configure various interface features and functions as desired.
– Train Key Operators/Radiographers on use of the CR System, CR Mammography
Cassettes, and on the use of an established technique control chart.
– Work with Key Operators/Radiographers/Radiologists to make X-ray exposures,
modify mammography views, and optimize image quality.
1-8
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CR Mammography Feature
IMPORTANT:
See the KODAK DIRECTVIEW CR System User Guide Information for
information on operating parameters and configuring the CR
System.
Recommended Mammography-specific configurations include
Mammography views to use for producing mammography images.
IMPORTANT:
New CR Systems are configured from the factory with default views
to be used for General Radiography and Mammography applications.
• Breast Type
– Breast
– Breast Homogeneously Dense
– Breast Heterogeneously Dense
– Breast Implant
– Breast Fatty
• Mammography Projection
– Cranio-Caudal (CC)
– Mediolateral Oblique (MLO)
– Lateral (ML and LM)
– MLO_Mag (Mediolateral Oblique_Magnification)
– CC_Mag (Craniocaudal_Magnification)
NOTE: These 36 combinations, with both Left and Right laterality, result in 72
Mammography Views. Select the view that matches the exam.
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1-9
CR Mammography Feature
Workflow and Operation
Collect patient demographic
data.
HIS/RIS
Broker?
YES
NO
Manually enter the Patient
data on the
ROP
CR System, or
Remote Patient Data
Entry Station.
Enter Patient Data
Scan the Patient ID bar code.
Query the Local database.
Query the HIS/RIS
database.
1. Enter Exam data.
2. Scan the cassette bar code label.
3. Touch Save Changes.
Scheduled Workflow
Option?
YES
Message sent to HIS/RIS
that the Procedure Step is started.
Status on CR changes
from Scheduled to Started.
Status on CR changes
from Scheduled to Started.
5. Position the patient.
6. Collimate properly.
7. Expose the cassette.
Expose additional cassettes if
necessary.
Load the cassette(s)
in the CR System.
Review and evaluate images.
If acceptable, send to destinations
and release patient.
Select End Study when complete
or D/C to cancel Procedure Step.
000EC
1-10
NO
9G3741
CR Mammography Feature
Performing a Mammography Exam
This section describes the steps necessary to perform a typical four-view breast exam
using the CR System:
• CC
• MLO
IMPORTANT:
Preparing the
Cassettes
See the KODAK DIRECTVIEW CR Systems User Guide
Information for configuration use differences, entering patient
and exam data, viewing and maintaining image quality, and
printing and managing images.
You will need four unexposed CR Mammography Cassettes, 18 x 24 cm or 24 x 30 cm,
as needed, for the four views.
NOTE: If you have purchased the X-ray Interface, it is not necessary to apply a reusable
sticker on each cassette to indicate the image view (RCC, LCC, LMLO, or RMLO)
that will be exposed on the cassette, or the kVp and mAs settings used for the
exposure, or a possible comment regarding the patient exam. See
“Mammography X-ray Interface” on page 1-19.
IMPORTANT:
Erase CR Mammography Cassettes each day prior to clinical imaging,
when you suspect the cassettes have been exposed to any X-ray
radiation, or when you use the local user interface on the
Classic/Elite CR System.
Insert the cassette into the CR System. This procedure erases all
information on the cassette.
Main Menu
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1-11
CR Mammography Feature
Creating a
Patient Record
To create a patient record (at the CR System or on a Remote Operations Panel (ROP):
1. At the Main Menu, touch Study Data.
The Patient Query Screen appears.
Patient Query Screen
2. To search for an existing patient (already in the system):
– Use the bar-code scanner or virtual keyboard to enter known search criteria.
– Touch Find Local to search the CR System’s database.
– Touch Find Remote to search the HIS/RIS.
The Patient Worklist Screen appears with a list of patient studies that match
the search criteria. To open the patient record you searched for, touch anywhere
in the row. For more information about using the Patient Worklist Screen, see
the CR System Online Help.
3. To create a record for a new patient (not in the system or unavailable):
a. Touch New Patient. The button appears on the Main Menu or in Study Data.
The Patient Input Screen appears.
b. Enter the required (yellow highlighted) information using the virtual keyboard,
or by using the bar-code scanner. Select the Mammography category for
Procedure.
• If your system uses Procedure Mapping, the four views will appear
automatically (RCC, LCC, RMLO, LMLO) or, as programmed by your Key
Operator.
1-12
9G3741
CR Mammography Feature
• If your system does not use Procedure Mapping, select Add View and
manually add each view, and configure the Laterality for each image.
c. The image icons appear for the four views. These icons are associated when you
scan the cassette bar code.
Mammography View Selection
d. Select the cassette for the RCC view.
e. Scan the cassette’s bar code and confirm that the Cassette ID field displays the
bar-code number.
f. To change the default view, select the image and go to the Image Viewer
Screen.
g. Select View Name and select the appropriate view from the list.
h. Select Reprocess.
i. Select the proper Laterality. Use Right for RCC and RMLO views and Left for LCC
and LMLO views.
j. Touch Save Changes. This records all of the patient, exam, and cassette ID
information in the CR System database.
NOTE: For more information about search techniques or entering patient data, see the
CR System Online Help.
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CR Mammography Feature
Using CR
Mammography
Cassettes
• Use only CR Mammography Cassettes for creating Mammograms.
• Do not use CR Mammography Cassettes for general radiography imaging
applications.
• Do not use CR Cassettes, intended for general radiography, for Mammography
imaging applications. See “CR Mammography Cassettes” on page 1-7.
• Carestream Health recommends using the same type of CR Mammography screen
for all images within the study.
Exposing the
Cassette
Take the CR Mammography Cassettes to the Mammography X-ray unit, where the patient
is prepared for the exam.
1. Insert the cassette into the Mammography unit’s cassette holder the same way you
would insert a traditional mammography screen-film cassette.
Chest Wall Edge
T
U
B
E
S
ID
E
Tube Side Label
Bar Code
2. Make sure the cassette is oriented with the narrow edge next to the chest wall and
the Tube Side label is facing up.
IMPORTANT: Make sure the collimator blades are fully open to cover the
image receptor.
3. Position the breast for the selected View and ensure adequate compression is
applied.
4. Select the appropriate exposure technique for the breast thickness and type. See
“Compatibility with X-ray Systems” on page 1-15.
5. Repeat the above steps for each cassette.
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CR Mammography Feature
Compatibility with X-ray Systems
The KODAK DIRECTVIEW CR System with CR Mammography Feature, using CR
Mammography Cassettes, is specifically designed to be compatible with mammography
X-ray systems and all other system accessories (such as anti-scatter grids and
magnification options) that use screen-film cassettes. The CR Mammography Cassettes
are intended to be used in the same manner as mammographic screen-film cassettes.
They operate over the same range of kVp and target filter combinations as screen-film
cassettes and can be exposed under manual or automatic exposure control.
• The X-ray tube must have as a minimum a molybdenum target and molybdenum
filter (Mo/Mo) combination (needed for calibration of the CR System) and, as is
clinicially practiced with screen-film, support use of the following anode target and
filter combinations: molybdenum target with rhodium filter (Mo/Rh), rhodium
target with rhodium filter (Rh/Rh), and tungsten target with rhodium filter (W/Rh).
• Automatic Exposure Control (AEC) may be of the type controlling mAs only, or mAs
and kVp, or mAs, kVp and filter, or mAs, kVp, filter, and target.
The following items list some of the features of the CR Mammography Cassettes that
allow their use in place of conventional screen-film cassettes:
• The physical dimensions of the CR Mammography Cassettes are the same as
screen-film mammography cassettes (18 x 24 cm and 24 x 30 cm) and comply
with the ISO 4090 standard for cassette design.
Therefore, CR Mammography Cassettes are physically compatible with modern
mammography X-ray unit 18 x 24 and 24 x 30 cassette holders.
• The CR Mammography Cassettes are specifically designed for use with the
Mammography X-ray unit's Automatic Exposure Control (AEC). The cassettes
contain a low absorption region for compatibility with the X-ray systems Automatic
Exposure Control (AEC) detector. The dimensions of the low absorption region
comply with the ISO 4090 standard for possible placements of the AEC detector.
NOTE: Adjustment of the AEC configuration may be necessary to account for the
transmission of the CR Mammography Cassette. This is similar to the adjustment
necessary when a new screen-film system is first introduced into the clinic. This
should be done under guidance of the X-ray equipment service personnel
and/or a qualified Medical Physicist.
• The CR Mammography Cassettes are constructed to provide chest wall imaging
access. The distance between the edge of the storage phosphor screen to the
outside edge wall of the cassette is specified to be 3 mm or less.
IMPORTANT: Mammography X-ray systems use anti-scatter moving grids or
cassette holders. As with screen-film systems, failure of the grid to
reciprocate, especially during a short exposure time, may result in a
wavy artifact in the produced image known as a moire‘pattern,
when using a CR Mammography Cassette. Ensuring proper operation
of the reciprocating grid will prevent this artifact from occurring.
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1-15
CR Mammography Feature
Technique
Considerations
• The KODAK DIRECTVIEW CR System has a wide exposure latitude and will operate
over a broad range of mammographic exposure conditions, but is intended for use
with acquisition techniques similar to those used with modern screen-film systems.
• When using the CR System the same care and attention to detail should be taken to
ensure high-quality images as was practiced with screen-film systems.
• Medical Physicist should be consulted for assistance with technique factor
selections and to ensure that the patient dose complies with applicable regulations.
• When using the Automatic Exposure Control (AEC) of the X-ray machine, the
facility should ensure the AEC is appropriately calibrated.
• A technique chart should be produced and posted near each X-ray unit. The chart
should summarize the acquisition parameters for producing X-ray images that
comply with all local and national regulations on patient dose. It should also
ensure the image quality is consistent with the local clinical expectations.
IMPORTANT:
The dose shall be determined with technique factors and conditions
used clinically for a standard breast. The maximum dose must
comply with applicable regulations.
The following sections provide general guidance on X-ray techniques to use with the CR
System and on configuration of the AEC.
X-ray
Techniques
1-16
The selection of X-ray technique includes the selection of specific beam parameters
(kilovoltage, target, filtration) and the exposure level (mAs) as a function of patient
thickness and glandularity.
• Personnel familiar with screen-film mammography have become accustomed to
X-ray technique factors designed for the screen-film image receptor. For example,
if film processing is maintained in control, the use of insufficient X-ray technique
produces images that are too light. Likewise the use of excessive X-ray technique
produces images that are unacceptably dark. As with all digital imaging modalities,
CR Mammography images may not appear too light or too dark if inappropriate
X-ray technique is used. Hence, it is essential to develop and consistently utilize an
appropriate X-ray technique chart to avoid suboptimal image quality or excessive
radiation dose.
• Due to the wide variety of different X-ray machine capabilities, user preference for
noise and image sharpness, and the range of applicable regulations that control
the allowed patient dose, there is no single specific recommendation for
acquisition techniques that can be provided for use with the CR System.
As a guide, a “typical” acquisition technique for a “standard” 4.5 cm thick breast
with 50/50 composition might be 26 kVp, Mo/Mo and ~100 mAs. This technique
produces a mean glandular dose (MGD) of ~2 mGy. There could be considerable
variation from this typical technique as an institution adjusts for its local
preferences.
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• In general, when imaging thinner or more fatty breasts, it is common to use a softer
X-ray spectrum and lower mAs values. Softer X-ray spectra are achieved by using
lower kVp settings as well as choosing the molybdenum target and filter
combination. When imaging thicker and denser breasts, it is common practice to
use a harder X-ray spectrum and higher mAs values. Harder X-ray spectra are
achieved by using higher kVp settings as well as choosing the rhodium filter and
rhodium or tungsten target where available.
• Increasing the mAs for a given beam spectra will lower the noise and increase the
dose. Conversely lowering the mAs for a given beam spectra will lower the dose
and increase the level of noise in the image. (It is important to operate the system
at a dose that meets applicable regulations. Consult a Medical Physicist for help in
ensuring the technique is appropriate).
IMPORTANT: Test or change X-ray exposure factors only after consultation with a
qualified Medical Physicist. The site is responsible for ensuring that
the system is in compliance with applicable regulations or
restrictions on X-ray exposures.
IMPORTANT:
Automatic
Exposure
Control (AEC)
The dose shall be determined with technique factors and conditions
used clinically for a standard breast. The maximum dose must
comply with applicable regulations.
The KODAK DIRECTVIEW CR System is compatible for use with the AEC function of the
X-ray equipment.
• If you are currently using a screen-film system it is possible to adjust the density
setting of the X-ray machine to account for the difference in X-ray transmission
between your current screen-film cassette and the CR Mammography Cassette (see
below).
• If you are not using a screen-film system, it is necessary to contact a qualified
service professional to perform a calibration of the AEC function to implement your
specific technique chart.
IMPORTANT: Test or change X-ray exposure factors only after consultation with a
qualified Medical Physicist. The site is responsible for ensuring that
the system is in compliance with applicable regulations or
restrictions on X-ray exposures.
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CR Mammography Feature
Automatic
Exposure
Control (AEC)
Calibration
CR replacing an existing Screen-Film Combination:
The following procedure can be used for changing from screen-film to CR
Mammography Cassettes by using the density control adjustment of the X-ray machine.
IMPORTANT: This procedure assumes that the AEC function of the X-ray
equipment is properly calibrated for use with the current
screen-film system to meet applicable regulations.
IMPORTANT:
This procedure must be performed for each mammography unit.
Attempting to use the same density control change for multiple
mammography units without verification is strongly discouraged.
The effect of changing a single step (e.g., from 0 to +1 density) of
density control can vary dramatically among different
manufacturers or even for the same manufacturer and model
number, depending on the AEC software revision level.
1. Use a standard phantom that represents the “average” breast. If no standard
phantom is available, use 4 cm of PMMA or BR-12 breast-equivalent material.
2. Under AEC control, determine the mAs for an exposure of the phantom with the
X-ray unit settings (exposure mode, filtration, kVp, density setting) that would be
used with the current film-screen system or CR Mammography Cassette type.
3. For the same X-ray unit settings, determine the mAs for the image of the same
phantom taken with the CR Mammography Cassette.
4. If there is a difference in the mAs, then adjust the density setting (- to lower mAs, +
to raise mAs) to achieve the closest match in mAs. This density setting should be
used in place of the screen-film density setting for CR exposures.
5. Repeat steps 1 to 4 for PMMA thicknesses of 2cm and 6cm and for each
operational mode of the system.
IMPORTANT: The X-ray exposure influences the level of noise in the image.
Increasing the density control setting increases the exposure and
patient dose, but reduces the perceived noise in the image.
Conversely, a lower density control setting lowers the exposure and
patient dose, but may increase the perceived noise in the image.
IMPORTANT:
If you cannot achieve a similar technique, it may be necessary for a
qualified X-ray equipment service representative to recalibrate the
X-ray System's Automatic Exposure Control (AEC) using the CR
Mammography Cassette.
CR without an existing Screen-Film System:
The AEC system must be specifically calibrated using the CR Mammography Cassettes by
a qualified X-ray equipment Service Representative.
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Exposure
Index
The system provides an exposure index (EI), which is displayed on the CR Console's
image viewer screen. This is a measure of the X-ray exposure incident on the CR
Mammography Cassette. The EI is calculated from knowledge of the signal values in the
clinically relevant portion of the patient image. EI can be useful as a guide to
understanding the exposure in a given image.
IMPORTANT:
The Exposure Index is a measure of cassette input exposure and IS
NOT a measure of entrance skin exposure or patient absorbed dose.
• For a correctly calibrated system, the equation below provides the nominal
relationship between Exposure Index and Cassette Input Exposure:
Exposure Index = 1000 × log10 (Cassette Input Exposure in mR) + 1000
It should be recognized that this relationship between EI and cassette input
exposure is only valid for the specific beam conditions used for system calibration
(i.e. the service performed CR System calibration using conditions of 28 kVp
Mo/Mo with added 2 mm Al filtration). For other acquisition conditions (including
different kVp, target filter combinations and patient thickness/composition) this
relationship becomes less accurate.
• Typical Exposure Index values displayed for the range of patient thickness,
composition, and acquisition techniques used, should be in the range 2100 ±200.
Individual site preference for patient dose and image quality can change this
exposure index range.
• If the Exposure Index value is lower than typically expected, check the image for
excessive noise. To improve noise, increase mAs or use a softer X-ray spectrum. If
the Exposure Index value is higher than typically expected, check the technique
used as patient dose may be higher than necessary.
Recording Exposure Parameters
Information about the patient, the exam and the exposure parameters may be
electronically recorded on the Mammography image using a Text Box. CR cassettes do
not use a flash exposure device and a cassette ID window as traditional screen-film
cassettes do. For more information, see Text Box Configuration in the CR Systems
User Guide Information.
Mammography
X-ray Interface
The DIRECTVIEW Mammography X-ray Interface is an accessory device that
automatically transfers technique information from the X-ray generator to the CR image.
The information is displayed at the CR System on the More Information Tab on the
Patient Input Screen. If you purchase the CR Mammography Feature, you may want to
add the Mammography X-ray Interface to your workflow. This device is installed by your
Carestream Health Service Representative, and sends exposure information from the
Mammography X-ray generator to the CR System or ROP. The Mammography X-ray
Interface associates exposure information from selected X-ray generators and
automatically associates with the Mammography image that is highlighted on the
Patient Input Screen.
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CR Mammography Feature
The Mammography X-ray Interface has three elements:
• Interface box
• Connecting cable
• Installations and connection to the X-ray device
To ensure that the data associates with the correct image, make sure the following
is true:
• Connect the Mammography X-ray Interface to an ROP whenever the CR System is
shared between Mammography and General Radiography exams, or when shared
among several Radiographers.
• The highlighted icon on the Patient Input Screen is the next exposure.
• The Patient Input Screen remains open until the study is complete.
The following image states may be reflected in the border of the image:
• Unavailable—The corresponding image has not been scanned.
• Exposed—Exposure report has been received from the X-ray Interface for the
indicated view, but the image has not been scanned.
NOTE: Unassigned images or image icons that are not highlighted at the time of
exposure will not capture the transmitted data. There is no way to resend this
exposure information from the mammography unit, and it must be entered
manually into the appropriate fields. See “General Radiography Workflow” on
page 1-20 and “Mammography Workflow” on page 1-20.
General
Radiography
Workflow
In the General Radiography Workflow, you use the bar-code scanner to enter the
cassette ID prior to exposing and receiving the exposure report. The manual selection
of the correct icon is not needed.
1. Highlight the View icon.
2. Scan the Cassette ID bar code.
3. Expose the cassette.
4. Scan the cassette. The next View icon is automatically highlighted. The highlight
always moves left to right, top to bottom through the Views.
Mammography
Workflow
In the Mammography Workflow, you must manually select the icon, assign it, and
expose each View one at a time.
1. Select the icon of the first View in the exam.
2. Assign a cassette to the View by scanning its ID number.
3. Expose the cassette with the image while the View icon is still highlighted. The
X-ray Interface forwards the exposure report to the CR System. The next View icon
is automatically highlighted. The CR System can read the cassettes in any sequence.
To change the sequence, select any unexposed View and proceed with step 2.
Repeat steps 2 and 3 to select, assign, and expose for the remaining views.
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4. Scan the cassette.
When the X-ray Interface is used with the CR System, the highlight on the Patient Input
Screen moves to the next icon when the System receives the exposure report from the
Interface. Scanning the bar code on a cassette does not advance the highlight to the next
icon.
NOTE: When General Radiography and Mammography workflows are both needed on
the same CR System, attach the Interface to an ROP (with mammo workflow)
and use the General Radiography workflow at the CR Console.
Transmitted Data
The DIRECTVIEW Mammography Interface can receive most data sent by the generator.
The specific data fields vary by generator, but generally include the following items:
• kVp
• mAs
• Source to Image Distance (SID)
• Compressed Thickness
• Compression Force (N)
• Angle of Exposure
• Anode Target Material
• Filter
• Magnification Ratio
NOTE: The Key Operator can select from 15 different screen layouts that accommodate
this data.
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CR Mammography Feature
Scanning the Cassette
Take the exposed cassettes to the CR System and load them correctly. See the CR
Systems User Guide Information.
The CR System reads the cassette bar code, scans and stores the image from the
cassette, then erases the cassette for its next use.
If the CR System cannot read the cassette bar code, the following messages will appear.
Take the appropriate actions as described in “Scanner Bar-Code Messages” on
page 1-22.
Scanner
Bar-Code
Messages
Cause
Message
Action
• Select Cancel to remove the cassette, or
• Select the cassette size to continue
processing the cassette. If this occurs,
the image will be unassigned. Assign the
image and apply the correct view.
When the scanner is unable to
read the bar code and cannot
identify the size, this message
appears so that you can select
the size manually from the
following screen:
Reviewing and Accepting Images
See the KODAK DIRECTVIEW CR Systems User Guide Information for information
about viewing images and maintaining image quality on a CR System.
CAUTION:
The CR System or ROP monitor displays a sub-sampled
(lower-resolution) version of the full-resolution, stored,
mammography image. Do NOT use the sub-sampled mammography
image displayed on the CR System or ROP monitor for screening or
diagnostic interpretation purposes. The CR System monitor or ROP
must only be used to verify correct positioning and image processing
selection. Do not use the display to evaluate CR System performance.
NOTE: Carestream Health recommends that you set your viewing mode to QA by image
mode, to review and accept the mammography images before sending them to
their destinations. Pass-through mode, which delivers images to destinations
without inspection, can be used, but is not recommended. For more
information about viewing modes, see the CR System Online Help.
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CR Mammography Feature
1. On the CR System monitor, or the ROP display, make sure that a thumbnail image is
present on the Patient Input Screen for each cassette scanned. If the thumbnail
images do not display, open another image or exit and re-enter the Patient Input
Screen.
NOTE: Wait for all of the images to appear. If they do not appear, exit the Patient
Input Screen and re-enter.
2. Enter the kVp and mAs (if recorded) on the More Image Information Screen
and any comment information on the More Patient Information Screen. Press
Save Changes to store this information as part of the Patient Record.
3. Select the thumbnail image you want to review. The Image Viewer Screen
appears. Verify that the View displayed on the Image Processing Tab is correct.
Image Viewer Screen
CAUTION:
The CR System or ROP monitor displays a sub-sampled
(lower-resolution) version of the full-resolution, stored, mammography
image. Do NOT use the mammography image displayed on the CR
System or ROP monitor for screening or diagnostic interpretation
purposes. The CR System monitor or ROP are not diagnostic monitors
and must only be used to verify correct positioning and image
processing selection. Do not use the display to evaluate CR
performance.
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CR Mammography Feature
4. Review the image and check the following:
a. All breast tissue is present.
b. The image is correctly captured.
c. There is no motion.
d. Markers are visible.
e. Exposure index value is as expected. See “Exposure Index” on page 1-19.
If any of these items are unacceptable, re-exposure may be necessary.
5. If image quality is not acceptable, ensure that the correct body part and projection
have been selected. See the CR System Online Help for information on making
image quality adjustments, such as Brightness and Contrast and Image Tonescale.
NOTE: Image Processing Parameters are turned on and off by touching the check box
on one of the four the Image Processing Parameters Tabs. To apply a
parameter, select a check box for the following adjustments on the Tabs in the
Image Viewer Screen and touch Save Changes. For more information on
using the Image Viewer Screen, see the CR System Online Help.
Features and Adjustments:
Image Adjustment Tab (brightness, latitude, and detail contrast)
Markers Tab (adding, moving, deleting markers)
Surround Mask Tab (applying, moving, removing surround mask)
View / Look Adjustment Tab (change views, apply grid suppression, invert
image)
Crop Box Adjustment Tab (True-size Printing, Manual Cropping, Multi-format
Printing)
Print Tab (add text boxes, rotate, flip image)
Magnification Tab (pan and zoom, change magnification)
Comments Tab (add comments to the image using the virtual keyboard).
Quick Menu (Logout, Shutdown, Flag image for review)
6. Place a Left or Right digital marker on the LCC / LMLO and RCC / RMLO views.
a. With the LCC or LMLO image displayed, select the Left marker check box.
—or— With the RCC or RMLO image displayed, select the Right marker check
box.
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CR Mammography Feature
b. Select the point on the image where you want to locate the marker.
The marker appears on the image.
c. To move the marker, select another location.
d. To remove the marker, clear the check box.
e. Select Save Changes when finished.
NOTE: When you select Save Changes, the marker is stored and printed as part of the
image.
7. Select the Accept Image button when the review and image processing are
complete.
The image is sent to its default destination, such as a Mammography
Workstation or Printer for a Radiologist to read. You can configure
Destinations at installation or the Key Operator can select them.For complete
information about Key Operator Functions, see the CR System Online Help.
Skin Line
Enhancement
Skin Line Enhancement increases or decrease the amount of enlargement of the skin
line in mammography images modified on the Surround Mask Tab in the
Image Viewer Screen.
The Skinline Enlargement slider influences the amount of non-mask border that is
created around the breast when you send an image to PACS. This capability is only used
by PACS systems, and is a requirement of Integrating the Healthcare Enterprise, IHE, for
mammography. This mask enables the direct exposure of a mammography image to
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CR Mammography Feature
always present black, even when black-bone (or reverse polarity) is utilized. If you
want to see more of the direct exposure/skin line margin, increase the skin line
enlargement slider.
Surround Mask Tab
Using the Image Processing Preference Editor
To access the Image Processing Preference Editor:
1. Log in as a Key Operator.
2. From the Main Menu, select Image Review.
3. Select an image. Select Image Processing Preferences.
NOTE: KODAK DIRECTVIEW EVP Plus Software enables the creation of custom looks,
which are recipes for processing the images. Looks consider the degree of
brightness, latitude, detail contrast, sharpness and noise suppression that
Radiologists prefer. Each institution chooses its look from a family of looks
provided by Carestream Health. The institution can then use the Preference
Editor to customize the views.
The Image Processing Preference Editor lets you change and control the image
processing defaults for an image, all images in a secondary category, or all images in a
primary category.
The controls for image processing are located behind the tabbed icons on the
Preference Editor Screen. These controls work as sliders, with the minimum values
at the bottom of the slide, and the maximum values at the top.
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CR Mammography Feature
The Family of
Looks
The CR System provides a family of looks to choose from. The look is described on the
interface of the Preference Editor.
For Software
Versions 5.1 and
5.2
The following table describes the available looks for Software Version 5.1 and 5.2.
Updates to this table are described on page 1-28.
Look Look Name
Code
No.
General Description
1
Premium Processing with noise
suppression
Default Look from factory (no biases). Noise suppression
consistent with the Low Exposure Optimization.
2
Fixed Processing with medium contrast,
detail, and sharpness
Models that have fixed rendering tonescale parameters with
noise suppression.
3
Premium Processing with brighter
processing, more detail, and sharpness
Default Look biased to produce brighter, sharper, more
detailed renderings than Look 1 (Premium Processing
with noise suppression).
4
Premium Processing with high contrast and Default Look biased to be higher in contrast (less latitude)
detail
and detail than Look 1 (Premium Processing with noise
suppression).
5
Premium Processing with more latitude
6
Premium Processing with medium latitude Default Look biased to be less digital in appearance, in line
with a medium latitude analog film look.
7
Baseline Image Processing
Mimics Non-EVP Plus processing.
8
European Mammography
For general radiography, Look 8 is the same as Look 1
(default). For mammography, the look is based upon the
European preference.
9
Premium 2 Image Processing with noise
suppression
An alternate premium look.
Default Look biased to provide slightly greater latitude and
detail than Look 1 (Premium Processing with noise
suppression).
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CR Mammography Feature
For Software
Version 5.2
Additional Looks
Mammography
Patch and
Version 5.4
Default
Looks 6 and 9 from the table on Page 1-27 were updated to address the overall
concerns about the noise texture and amplitude. These new looks overwrite the
previous looks if the Additional Looks Mammography Patch is added to the Software
Version 5.2 or if you are using the Version 5.4 Default.
Look Look Name
Code
No.
Update Description
6
Premium Processing with medium latitude Softer and more streamlined parenchymal tissues are
presented with a finer noise texture. The result is an image
with a reduction in anatomical clutter and large texture
noise. DMin areas of the image are brighter.
9
Premium 2 Image Processing with noise
suppression
For Software
Version 5.4
Mammography
Update 2010-01
License Enabled
Looks 2, 3, and 5 from the table on Page 1-27 were updated to address the concerns of
handling the small and medium edges. All looks introduced in the 5.4 2010-01 update
use a specially-tailored recombination of seven frequency bands to uniquely handle the
small and medium edges. If the Mammography Update 2010-01 option is enabled on
your system, you will have access to these additional looks. If enabled, these looks will
overwrite the previous looks.
Look Look Name
Code
No.
1-28
Look 9 was changed for mammography to enhance the
finer detail, decrease noise, and to make the skin line/skin
fold areas less apparent.
Up date Description
2
Fixed Processing with medium contrast,
detail and sharpness
Look 2 is similar in appearance to the updated Look 3.
However, small structures with qualities similar to MCCs
are enhanced to a lesser degree. Look 2 is the
recommended starting point for sites using very low dose
due to the presence of additional noise.
3
Premium Processing with brighter
processing, more detail, and sharpness
The softness of the parenchymal tissues resembles
screen/film. Small structures with qualities similar to the
MCCs are enhanced.
5
Premium Processing with more latitude
Look 5 is similar to the updated Look 3 with even more
enhancement to details.
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CR Mammography Feature
For Software
Version 5.4 SNP
Parameter
Database
In Software Version 5.4, additional mammography looks were incorporated to support
the CARESTREAM CR Mammography Cassette with SNP.-M1 screen. Looks 1–6 in the
SNP looks database use a specially-tailored recombination of seven frequency bands to
uniquely handle the small and medium edges. This new processing is a second
generation algorithm of Enhanced Frequency Processing (EFP). Looks 7–9 use first
generation EFP processing as developed for EHR-M screens.
Look Look Name
Code
No.
Up date Description
1
Premium Processing with noise
suppression
Default Look from factory (no biases). Employs a smooth
noise texture.
2
Fixed Processing with medium contrast,
detail, and sharpness
Fixed Processing with medium contrast, detail, and
sharpness. Employs a smooth noise texture.
3
Premium Processing with brighter
processing, more detail, and sharpness
Premium Processing with brighter processing, more detail,
and sharpness. Employs a smooth noise texture.
4
Premium Processing with high contrast and Premium Processing with high contrast and detail. Employs
detail
a slightly coarse noise texture that some radiologists prefer.
5
Premium Processing with more latitude
6
Premium Processing with medium latitude Premium Processing with medium latitude. Employs a
slightly coarse noise texture that some radiologists prefer.
7
Baseline Image Processing
Baseline Image Processing uses first generation EFP
processing as developed for EHR-M series screens.
8
European Mammography
Previous European processing from Software Versions
5.1–5.4 use first generation EFP processing as developed
for EHR-M series screens.
9
Premium 2 Image Processing with noise
suppression
Previous Image Processing with noise suppression from
Software Versions 5.1–5.4 use first generation EFP
processing as developed for EHR-M series screens.
Premium Processing with more latitude. Employs a slightly
coarse noise texture that some radiologists prefer.
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CR Mammography Feature
Preference
Editor
Controls
Once a change is made in the Preference Editor and saved, the change stays with the
view. The Key Operator and the Technologist see the changes on their slider controls.
햴
햲
햵 햶햷
햸
햳
햻
햹
21
햽
햺
헄
햾
햿
헀
헁
헂
헃
헅
헆
Image Processing Preference Editor
1-30
Item
Description
햲
Thumbnail Gallery
Previews all of the images related to the view selection.
햳
Preference Editor Display
Displays the selected image. Lets you see the changes applied to
the image processing values.
햴
Patient Name
Patient ID
Searches the local database for a patient by name or by Patient
ID.
햵
Brightness Tab
Access to brightness, latitude. and detail contrast controls,
including the kernel, which influences the detail frequency band
(tone scale kernel).
햶
Sharpness Tab
Access to the sharpness controls.
햷
Noise Suppression Tab
Access to the noise suppression controls.
햸
Grid Suppression Tab
Access to the Grid detection and suppression processing.
Detects if a stationary grid was used, and if found, suppresses the
appearance of the grid lines.
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CR Mammography Feature
Item
Description
햹
Category Display
Displays the Primary Category, the Secondary Category, the View
Name, and the Look selected.
햺
Region of Interest
Provides image information (such as, mean pixel value,
standard deviation, minimum, maximum) of a touched region
on the image. Useful to determine if exposure in a specific
anatomical region is adequate.
햻
Slider Controls
Controls fine, independent changes for image processing values
that affect all images in a view, such as brightness, latitude, detail
contrast, sharpness, and noise.
햽
Histogram
Displays a graph of the distribution of pixel values in the image.
If the histogram displays a linear LUT (straight line Look-Up
Table), image processing has failed.
햾
Quick Menu
Accesses Logout and Shutdown functions. Enter Look Code
values here.
햿
Select New View
Selects a Primary Category, Secondary Category, or an individual
view. When you select an entire Category, the changes you make
affect every view in that category.
헀
Change Look
Process the image with a different look.
헁
Deliver
Selects the workstation or printer.
헂
View Before and After
Displays the image before adjustment and after.
헃
Save Changes
Submits the change to the database. Save Changes becomes
active whenever you change the settings on the Preference
Editor Screen.
NOTE: There is no way to undo changes. Save configurations
before making changes. See Backup and Restore in
the Key Operator Online Help.
헄
Zoom
Enlarges image for evaluation. To return to normal view, select
Zoom to clear the check box. In Zoom mode, you can Pan
across the image or select the image and drag across.
헅
Main Menu
Exits the Preference Editor and returns you to the Main Menu.
헆
Cancel
Returns you to the previous function without changing to
another screen. Cancel toggles to the Back button after you
select Save Changes.
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CR Mammography Feature
Slider Control
Behavior
Two user image adjustment interfaces reside on the Console. They are selected based on
the login that was used and the task that was performed, such as reviewing a single
image or defining image preferences. The slider control behavior is different for each of
these interfaces.
• Image Viewer—This simple interface allows the Technologist to adjust contrast,
latitude, and detail contrast. Note that the detail contrast slider is a single slider
that equally influences both the low and high density detail settings in the
rendering process. Therefore, if the Technologist increases the detail contrast
slider by five, both the lower and upper density detail contrast settings are
increased by the same amount (each click is a 5% change), roughly a 25%
increase for both.
• Key Operator Preference Editor—A more complex interface, where the Key
Operator can set preferences (deltas) on the brightness, latitude, detail (single
slider for both upper and lower) sharpness (single slider for both upper and
lower), and noise. Any changes in detail contrast and sharpness are equally
applied to both the upper and lower density controls.
Defining a
Look
KODAK DIRECTVIEW EVP Plus Software enables the creation of custom “looks,” which
are recipes for processing the images. Looks consider the degree of brightness,
latitude, detail contrast, sharpness and noise suppression that Radiologists prefer. Each
institution chooses its look from a family of looks provided by Carestream Health. The
institution can then use the Preference Editor to customize the views
When a look is selected as a starting point for a view, the sliders are set to a neutral
position (or zero). All slider adjustments are relative to the look being used for that
view, except for the kernel, grid suppression, and skin line enlargement sliders, which
adjust absolute values. The adjustment of a slider by one click is designed to produce a
difference that is just noticeable or a “difference that matters.”
Brightness
The Brightness parameter defines the log exposure code value that is mapped by the
tone-scale LUT to mid-density. The slider adjustment is in output density space in order
to produce a change that is perceptually meaningful across images. The density change
is mapped back through the tone-scale LUT to calculate the log exposure code value,
which is used in EVP Plus Software. Each slider click produces a 0.05 density change
relative to the selected look.
Increasing the Slider
Brightens the image.
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Decreasing the Slider
Darkens the image.
CR Mammography Feature
Latitude
Latitude is proportional to the number of shades of gray (or range of exposures) that
are visible in an image, and is inversely proportional to the degree of difference between
the lightest and darkest areas of an image (global contrast). Each slider click produces
a 5% change in latitude relative to the selected look.
Increasing the Slider
Widens the latitude (or decreases
the global contrast).
Contrast
Decreasing the Slider
Narrows the latitude (or increases the
global contrast).
Controls the local contrast of medium sized structures such as joint spaces, vertebral
body spacings, and ribs in lower density regions of the image.
NOTE: In the Image Viewer, and the Key Operator Image Viewer, the low and high
contrast controls are linked together and adjusted simultaneously by the
Contrast control. This affects the appearance of the image to the Technologist.
The Technologist can affect the appearance of only one image at a time.
Increasing the Slider
Makes medium sized structures in
brighter areas more pronounced.
Decreasing the Slider
Makes medium sized structures in
brighter areas less pronounced.
Sharpness
Controls the sharpness of finer structures, such as bony trabeculae, lung markings and
microcalcifications in lower density regions of the image.
Increasing the Slider
Increases the sharpness of finer
structures in the lower-density
regions of the image.
Noise
Decreasing the Slider
Decreases the sharpness of finer
structures in lower-density regions of
the image.
Controls the level of noise suppression applied to the image. Each slider click produces
a 0.03 change in noise suppression level relative to the selected look.
Increasing the Slider
Reduces the level of noise
suppression.
9G3741
Decreasing the Slider
Decreases the appearance of noise in
the image (or increases the level of
noise suppression).
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CR Mammography Feature
Delivering Mammography Images
See the KODAK DIRECTVIEW CR Systems User Guide Information for information
about printing and managing images on a CR System. The following information applies
specifically to mammography images.
Justification of
Right
Mammography
images
In previous versions of software, it was necessary to select Laterality (Right or Left) on a
Mammography image. Selecting Laterality automatically rotated an image for proper
chest-wall display and printing.
When using Software Version 5.1, you must select Left and Right Views that have the
appropriate Rotation and Flip settings to achieve the proper printing with the KODAK
DRYVIEW 8900 Laser Imager or KODAK DRYVIEW 6800 Laser Imager. On the Image
Viewer Screen, fill in the laterality field for PACS systems.
The KODAK DRYVIEW 5850 Laser Imager supports CR Mammography printing but does
not support justification of Mammography images.
Presentation
of Images
Presentation on the CR System
• If the image does not present as expected, verify that you are using the correct
view.
• Check that the correct laterality has been used.
Presentation on a DX Workstation
This may be workstation-dependent. Check that the correct view (body part, projection,
position) and laterality are correctly entered.
Presentation on a Printer
• Lines—If lines appear in images that are not on the original CR image, print a test
page and check the film to see if the lines reappear. If the lines are present, it could
be a film or printer problem. Call your Carestream Health Service Representative.
• Text Box misplaced—If the Text Box appears on the chest wall of the image when
it is sent to the printer, check that the correct view (body part, projection) and
laterality were entered on the Patient Input Screen. In addition, make sure the
image on the CR System monitor displays the Text Box in the correct position.
• Poor image contrast—If the contrast has changed since installation, re-calibrate
for that film size and reprint the image.
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CR Mammography Feature
Printing
Mammography
Images
Creating
Multi-format
Prints
• Use only a Mammography Printer that is intended for use in Mammography
applications when reviewing hardcopy printed images.
• For hardcopy printing of Mammography images, Carestream Health recommends
that you configure the CR System for use with a KODAK DRYVIEW Mammography
Laser Imager using KODAK DRYVIEW Mammography Laser imaging Film. Contact
your Carestream Health Sales Representative for more product information
• When you select justification on multi-format mammography prints, only one
millimeter separates the prints for comparison viewing.
• Overscan that occurs during mammography exposures of the chest wall can be
configured to automatically crop out or display on both print and PACS.
• You can achieve a D max of 4.0 (the darkest part of the image) to display soft
tissue, without adding contrast.
To create a multi-format print:
1. Touch a 2, 3, or 4-up layout in crosswise or lengthwise format.
Multi-format Configuration Screen.
2. Touch a thumbnail and touch the layout where you want the image to appear.
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1-35
CR Mammography Feature
3. Select from the following:
True-size Printing
Justification (right, left, center)
Page External Text Box, Image Internal or External Text Box
Flip an image horizontally
Rotate 90 degrees clockwise
4. If images have been acquired, select Print.
For more information about multi-format printing, see the CR System Online
Help.
1-36
9G3741
CR Mammography Feature
Mammography Cassette Use Instructions
CAUTION:
The CR Mammography cassettes and phosphor screens are
fragile. Take care when handling the plate. Do not drop, bend
or apply pressure to the plate. Protect it from scratching and
contamination. Do not leave the plate in hot or moist places,
and protect it from sunlight, ultraviolet rays, fluorescent light,
X-ray, and gamma ray sources. Do not discard or incinerate.
Please consult federal, state, and local regulations for proper
disposal.
IMPORTANT:
When cleaning a cassette and screen, take care to maintain
the integrity of the phosphor screen and avoid introducing
artifacts. Inspect all phosphor screens monthly and clean as
necessary with KODAK Screen Cleaner used according to the
manufacturer’s instructions. When wear is evident, replace
the screen.
Opening the Cassette The following steps require a small, pointed tool such as the end of a paper
clip.
Slot A
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1-37
CR Mammography Feature
1. Position the cassette on a flat surface such as a table with the Tube Side
up.
2. Place the pointed tool in Slot A and slide the latch to the right.
Slot B
3. Pull out the screen and plate using the flat surface as a guide to avoid
4.
5.
6.
7.
touching the phosphor on the cassette shell.
Inspect the screen and plate, and clean as described in the following
procedures.
Slide the screen and plate back into the cassette using the flat surface as
a guide.
Place the pointed tool in the opening at Slot B and press lightly to lock.
Make sure the screen and plate are secure in the cassette.
Cleaning the Cassette NOTE: Read and Follow instructions in the Material Safety Data Sheets
(MSDS) for KODAK Screen Cleaner prior to use.
Shell
• Remove the screen and plate before cleaning the cassette’s outer shell.
(See “Opening the Cassette” on page 1-37.)
• Do not allow water or cleaning solution to enter the shell.
Clean the outer shell surfaces with any of the following solutions:
1-38
9G3741
CR Mammography Feature
• Mild soap-and-water.
• KODAK Screen Cleaner
CAUTION:
Do not pour the cleaning solution directly onto cassettes or
screens. Apply the solution to a lint-free cloth.
CAUTION:
Do not use soaps or detergents with brightening agents, as they
will damage the storage phosphor screen.
Handling and
Maintaining the
Screen
Handle phosphor screens with care. Hold screens by the edges. Avoid contact
with the screen’s white (phosphor) side. Make sure hands are clean and dry.
For best results, wear clean, soft, lint-free Nitrile gloves.
CAUTION:
Under normal use conditions, phosphor screens will eventually
show wear. Screen wear can result in artifacts on radiographs.
This wear may occur from abrasion of the protective overcoat
or inadvertent physical damage to the surface.
CAUTION:
Screen damage can result from contact with certain materials
used in facilities performing radiography. Contact with
Isopropyl alcohol, peroxides, citrus-based cleaners, hand
lotions, and water-less hand sanitizers, as well as surfactants
and lubricants may cause visible or hidden damage to the
screen and could result in immediate or future image artifacts.
AVOID CONTACT BETWEEN THESE MATERIALS AND PHOSPHOR
SCREENS.
CAUTION:
Moisture can cause immediate or future screen damage and
image artifacts. Minimize contact with moisture and ALWAYS
DRY SCREENS IMMEDIATELY.
CAUTION:
Read and follow instructions in Material Safety Data Sheets
(MSDS) for KODAK Screen Cleaner.
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1-39
CR Mammography Feature
Cleaning the Screen
Do not expose screens to:
• materials containing peroxides
• Isopropyl alcohol
• citrus-based hand cleaners
• hand lotions
• water-less hand sanitizers
• surfactants
• lubricants
• excessive moisture
Use a clean, dry, soft, lint-free cloth to remove dust. Use one of the following
approved cleaners to remove other dirt.
NOTE: When using a cleaning solution, apply the solution to a clean, soft,
lint-free cloth. Do not pour the cleaning solution directly onto the
screen.
Cleaning Method
1-40
Catalog Number
Cleaning Material
845 4977
KODAK Screen Cleaner
Wear soft, lint-free gloves. Do not touch the white (phosphor) side with bare
hands.
1. See “Opening the Cassette” on page 1-37. Place the screen with the white
(phosphor) side up on a clean, dry, non-abrasive surface.
2. Wipe the screen gently to remove dust.
3. Follow the directions for the cleaning product being used.
4. Wipe the surface dry with a clean, soft, lint-free cloth.
NOTE: Do NOT allow the screen to air dry.
9G3741
CR Mammography Feature
Disinfecting the
NOTE: If the cassette is visibly contaminated with blood or body fluids,
removal of the blood and/or body fluids followed by
Screen or the Cassette
intermediate-level disinfection is indicated prior to use.
The following instructions are for low-level disinfection.
CAUTION:
Dilute bleach solutions may cause eye irritation and dry skin.
Wash hands with soap and water following use. Consult
manufacturer’s material safety data sheet (MSDS) prior to use.
1. Wipe with a soft lint-free cloth thoroughly dampened with a dilute bleach
solution (dilute one part of 5.25% sodium hypochlorite (household
bleach) with 10 parts of water) or use a commercially prepared
equivalent solution of dilute bleach.
NOTE: Follow the Center for Disease Control (CDC) guidelines regarding
solution contact time to adequately disinfect the cassette or screen.
2. Remove the bleach residue with a soft, lint-free cloth dampened with
water.
3. Wipe dry with a soft, lint-free cloth. Allow screens to air dry.
Disposing of the
Screen
Dispose of the screens according to applicable regulations. They must be
managed and transported as hazardous waste.
CAUTION:
The screen, when discarded, is a hazardous waste (EPA waste
code D005) under the Resource Conservation and Recover Act
(RCRA) due to the leachability of barium. Hazardous waste
must be managed and transported in accordance with country,
federal, state, and local regulations. Please contact your local
authorities for disposal or recycling information.
For additional information, call Carestream Health at 1-800-328-2910. If
outside the USA, contact the Customer Support Center in your country.
9G3741
1-41
CR Mammography Feature
Quality Control
Carestream Health provides the following information to test the operation of
the CR System and CR Mammography Cassettes as part of an overall quality
control program.
CAUTION:
The facility must ensure a quality control program that is
established and practiced according to applicable regulations.
Quality control practices should include the manufacturer’s
quality control recommendations for all equipment in the
Mammography Imaging Chain. See the Mammography Imaging
Chain on page 3.
Acceptance and
Quality Control
Testing
For specific testing to perform and the methods to record results follow all
applicable regulations as per current country, state, local, and/or
facility-specific regulations applicable for use in mammography.
Troubleshooting
For information about troubleshooting the CR System, see the KODAK
DIRECTVIEW CR Systems User Guide Information.
Black Surround Masking may not always be applied correctly and result in
the conditions described in the table below. Should these conditions occur,
reprocess the image using the resolutions listed as follows:
Condition
Resolution
Black Surround Masking covers Reprocess the image with Manual
up 1 mm of image area along the Surround.
chest wall edge.
Black Surround Masking covers Reprocess the image with Manual
up image information along
Surround. Make sure the X-ray beam has
short edges due to collimation. not been collimated into the cassette.
Black Surround Masking may
Reprocess the image with Manual
occasionally have a jagged edge. Surround, or perform the Overscan
Check.
Black Surround Masking may
Reprocess the image with Manual
mask off the entire image or may Surround, or perform the Overscan
not be applied at all.
check.
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9G3741
CR Mammography Feature
Black Surround
Masking
Black Surround Masking darkens the unexposed area around the image and
masks that area from the rest of the image. Black Surround Masking should
be turned on by default for mammography images by the Key Operator.
To apply Black Surround Masking:
1. At the CR System Image Viewer Screen, touch the Image Processing
Tab.
2. Touch the Surround Mask check box to select it.
3. Touch Save Changes.
The image is masked automatically, making it easier to see soft tissue and
low contrast areas.
To turn off Black Surround Masking:
1. Select the Surround Mask check box to clear it.
2. Select Save Changes.
The masking process stops immediately. Unexposed areas are not
darkened.
Manual Black
Surround
The Manual Black Surround feature lets you apply Surround Masking to the
image and adjust the masked area manually. You can move the mask to a
variety of four-sided geometric shapes by dragging the edges of the mask on
the Image Viewer Screen. When the image reprocesses, you can view the
result on the Image Viewer Screen or on the thumbnail on the Patient
Input Screen. Use this feature when the Automatic Mask fails.
To mask selected image areas:
1. Make sure the Edit Mask check box is selected.
2. Circles appear at guide points on the mask.
3. Touch the edge of the mask at one of the arrows and slowly drag the
edge across the screen to change the position.
4. Select Reset to return to the original mask.
5. Select Reprocess.
6. Select Save Changes.
For more information about applying masking, see the CR System
Online Help.
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1-43
CR Mammography Feature
Manual Black Surround
1-44
9G3741
CR Mammography Feature
Overscan Check
The CR System overscans the CR Mammography Cassette to:
• Capture all the image data at the chest wall edge.
• Support proper operation of the Surround Mask feature.
When the CR System is properly calibrated, the nominal overscan width is
2.5 mm on a flat-field exposure, printed True-size for an 18 x 24 cm or
24 x 30 cm CR Mammography Cassette. In the image above, the bright image
at the chest wall is the overscan. Overscan is cropped when the image is sent
to destinations.
Getting Help
Before you contact Carestream Health for help, see “Troubleshooting” for
more information. Next, contact your Key Operator. If the problem persists, in
the U.S. and Canada, call the Technical Service Center at 800-328-2910.
Elsewhere in the world, contact your Carestream Health Service
Representative.
9G3741
1-45
CR Mammography Feature
Glossary
Accession Number A DICOM term; it is a number assigned to an exam and linked to the site's billing system.
Surround Mask
Fills in the area outside of the Region of Interest with a dark background.
Compression
To uniformly reduce the thickness of the breast using a rigid, plastic device so that the
breast is more readily and uniformly penetrated by the X-ray beam.
Dose
Measurements
The measure of the amount of energy (using a dosimeter) deposited in tissue due to
X-ray exposure.
Entrance
Exposure
That amount of radiation at the skin of the breast, quantitated by measuring the amount
of ionization in air caused by the radiation.
Exam
A collection (set) consisting of a raw image, its versions, Exam Information, and Patient
Information.
Exam Information The data that pertains to the way in which an exam is performed.
1-46
Exam Type
View. Body part and projection (from the Exam Information) and, optionally, position.
Exposure Factor
Technical factors in the design of the mammography machine that affect production of
the mammographic image. The goal is to produce consistent, high-contrast diagnostic
images.
Focal Spot Size
The focal spot dimensions.
Half-Value Layer
The thickness of a specified substance which, when introduced into the path of a given
beam of radiation, reduces the exposure rate by one-half. HVL is a measure of beam
quality and usually is specified by millimeters of aluminum for diagnostic units. The
higher the HVL, the more penetrating the X-ray beam.
Image
A data structure that contains image data, patient information, and information relating
to the method of creating the image data; in a DICOM-compliant format.
Image Receptor
The screen-film combination is the standard image receptor used in mammography. For
Computed Radiography, the image receptor is the phosphor screen.
kVp Accuracy and
Reproducibility
Test used to ensure that the indicated peak X-ray beam energy is accurate and
reproducible so that consistent X-ray output and contrast are maintained.
Mammography
Workstation
Also described as a softcopy (electronic display) viewing station, the workstation is
designed for and used by Radiologists to read mammograms.
Medical Physicist
A trained specialist who conducts a number of mammography-related tests, at least
annually, intended to assess the continuing performance of mammography equipment.
Pass-Through
Mode
The operating mode in which the CR System accepts, processes, and routes the exam
without user intervention.
Patient
Information
The demographic data pertaining to a patient.
Processed Image
An image that has been tone-scaled and unsharp-masked.
9G3741
CR Mammography Feature
Phantom
A test object that simulates the average composition of various structures within the
breast.
Positioning
The art and skill the Radiographer/Technologist uses to adequately demonstrate the
breast tissue in different projections, known as the craniocaudal and mediolateral
projections.
Projection
Also referred to as a View. Is the demonstration of breast tissue from a specific angle
depending on what area of the breast needs to be seen.
QA Mode
The operating mode in which the CR System requires user input to route an exam.
Radiographer/Tec Trained person who performs the mammography examination that creates the images
h-nologist
needed for diagnosis.
Radiopaque
Marker
A permanent identification label to indicate right or left laterality and projection. This
marker is placed on the top of the cassette holder near the auxiliary portion of the breast.
Raw Image
The image that is read from the storage phosphor plate.
Routing
The act of transferring an image from the CR System to a specified destination.
Study
A collection (set) consisting of a series of images.
Technique
Technical factors in the design of the Mammography machine that affect production of
the mammographic image. The goal is to produce consistent, diagnostic images.
Tonescale
A graduated range of gray values constructed to optimize an image for clinical diagnosis
by highlighting the body structures of interest to a Radiologist.
View
See Projection.
Worklist
The list of patient records that describes the patients to be examined during a given time
interval.
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1-47
CR Mammography Feature
Acronyms
1-48
AC
Applications Consultant
CR System
Computed Radiography System - for mammography imaging this refers to the following:
CR 850/950/975 or Classic/Elite CR Systems.
DICOM
Digital Imaging and Communication in Medicine.
EHR
Enhanced High Resolution - type of phosphor screen used with CARESTREAM CR Mammography
Cassettes.
SNP-M1
Type of screen used with CARESTREAM CR Mammography Cassettes.
EHR Scan
Mode
Sub-50 micron scan capability used within the CR System for CARESTREAM CR Mammography
Cassettes with EHR-M type screens.
EVP
Enhanced Visualization Processing: a contrast enhancement algorithm contained within the IPL.
GUI
Graphical User Interface - the user interface observed at the CR System monitor.
HIS
Hospital Information System.
HIS/RIS
See “HIS” and “RIS” - this term refers to both systems at a single site but does not imply that they
are linked, or even exist on the same network.
IPL
Image Processing Library - the suite of image processing algorithms used in the CR System as
applied to the captured image.
kV
Kilovolts (thousands of volts) - measurement unit for X-ray beam strength.
kVp
Kilovolts Peak.
LCC
Left Cranio-Caudal - view of the left breast taken from the anterior to the posterior.
LM
Latero-Medial - lateral view of the breast taken from the lateral (axilla) to the medial side.
LMLO
Left Medio-Lateral Oblique - view of the left breast taken from an oblique angle from the medial
to the lateral where the pectoralis muscle should be seen down to the level of the nipple.
mAs
Milliamp-seconds - measurement unit for the amount of X-ray energy delivered.
ML
Medio-Lateral - view of the breast taken from the center of the chest outward.
mR
Millirads - measurement unit for X-ray exposure.
RCC
Right Cranio-Caudal - view of the right breast taken from the anterior to the posterior.
RMLO
Right Medio-Lateral Oblique - view of the right breast taken from an oblique angle from the
medial to the lateral where the pectoralis muscle should be seen down to the level of the nipple.
RIS
Radiology Information System.
ROP
Remote Operations Panel - a networked connected device with the CR System used for performing
an exam.
UID
Unique identifier: a number assigned to ensure unambiguous identification of a logical object in
software (usually for a set of data).
9G3741
Index
B
bar code
error message, 22
reading, 22
selecting the cassette size, 22
Black Surround Mask
automatic, 43
automatic, applying, 43
automatic, turning off, 43
manual, 43
manual, applying, 43
manual, reset button, 43
overscan check, 43
brightness, 32
brightness tab, 30
C
cassette
exposing, 11
cassettes
placing on bucky, 2
category display, 30
collimating the cassette, 14
CR Mammography Feature
compatible CR Systems, 6
enabling, 7
CR System
requirements, 8
CR Systems, 6
creating a patient record, 12
new patient, 12
D
definition, 30
detail contrast, 26, 31, 32
diagnosing from monitor, 24
DICOM, 46, 48
DICOM-compatible, 6
DICOM-compatible printer, 6
documentation, additional, 1
E
EHR Scanning
mammography cassette, 7
Equipment and Cassettes
cleaning storage phosphor screens, 40
erasing, 11
erasing cassettes, frequency, 11
G
Grid Suppression, 30
grid suppression, 32
grid suppression tab, 30
I
Image Processing Preference Editor, accessing, 26
image quality
rejecting the image, 24
image viewer window, 30
K
key operator preference editor, 32
kVp, 5, 11, 23, 46
, 46, 48
entering, 23
L
labeling, 11
laterality, selecting, 13
looks, 27
M
mammography imaging chain
Acquisition, 5
capture and processing, 5
hardcopy printing and viewing, 6
softcopy viewing and storage, 6
mammography label, 7
manual black surround mask, 43
markers
digital, 24
9G3741
I-1
Index
left, right, 24
mAs, 11, 23
masking, 43
resetting, 43
selected image areas, 43
more buttons
More Patient Information, 22
V
Viewbox, 6
viewing modes
Pass-through, 23
QA mode, 22
viewing thumbnail images, 23
N
noise suppression tab, 30
O
overscan line, 45
P
patient ID, 30
patient name, 30
phosphor screen
cleaning, 40
disinfecting, 41
harmful materials, 40
recommended cleaning products, 39
preference editor, controls, 30
preference editor, illustration, 30
printing, 6
equipment, 4
projections, 9
R
Region of Interest, 31
S
searching for a patient, 12
sharpness tab, 30
skin line enlargement, 32
slider control behavior, 32
slider control behavior, image viewer, 32
slider controls, 31
softcopy viewing
workstation, 6
Submit button, 13
T
tabs, image viewer, 30
thumbnail gallery, 30
thumbnail images, viewing, 23
I-2
9G3741
Carestream Health, Inc.
150 Verona Street
Rochester, NY 14608
CARESTREAM, DIRECTVIEW, and DRYVIEW are trademarks of Carestream Health, Inc.
The Kodak trademark and trade dress are trademarks of Kodak used under license.
© Carestream Health, Inc., 2010
PN 9G3741

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