Abstract:
A method and apparatus for providing testing a computer aided diagnosis (CAD)-based system comprising receiving radiological image of a patient acquired using at least one piece of radiological equipment at least partially controlled by a technologist, the patient being controlled by the technologies relative to the radiological equipment in acquiring said radiological image. The method further comprising processing the radiological image by computer to test the radiological image to determine if the image meets a preselected standard relating to at least one of: technologist control of the patient relative to the radiological equipment during the image acquisition and technologist preparation of the radiological equipment for the image acquisition, wherein said preselected standard relating to technologist control of the patient relative to the radiological equipment during the image acquisition relates to one of (a) proper placement of anatomical part of the patient relative to a detector of the radiological equipment, and (b) controlling movement of the anatomical part of the patient relative to the detector during image acquisition. The method further comprising recording the results of the testing in a manner that associates said results with said technologist for facilitating evaluation of a performance of said technologist.

Description:
FIELD OF THE INVENTION 
     The present invention relates to radiological systems, and more specifically, to quality assurance and quality control in radiological systems. 
     BACKGROUND 
     Radiological systems are used for X-rays, mammograms, MRIs, and similar procedures. In general, quality assurance and quality control tests are mandated. For example, for mammograms, there are a series of quality control tests, which are carried out daily, weekly, and monthly. These tests generally require the imaging technician to take a sample image, and analyze it for various error indications. For example, images may be analyzed to determine whether there are phantom images, fog, development errors, etc. Similarly, specific tests for the particular type of device may be made as well. For example, for mammograms a compression test and screen-film contact tests may be carried out. 
     In the prior art, these tests are carried out manually. The technician takes one or more images, using standard procedures, and then either the technician or a radiologist analyses the image(s) to determine whether there are any problems. In general, these results are then charted on a “processing control chart” or similar chart. These results are used to review the equipment as well as the technician, and to potentially adjust the equipment, or instruct the technician in the correct procedures to produce better quality images. 
     SUMMARY OF THE INVENTION 
     A method and apparatus for using a computer-aided diagnosis system for quality evaluation of radiological equipment. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present invention is illustrated by way of example, and not by way of limitation, in the figures of the accompanying drawings and in which like reference numerals refer to similar elements and in which: 
         FIG. 1  is a block diagram of a network with which the present system may be used. 
         FIG. 2  is a block diagram of a computer system that may be used in conjunction with the present system. 
         FIG. 3  is a diagram illustrating one embodiment of the quality control and quality assurance (QA/QC) system. 
         FIG. 4  is an overview flowchart of one embodiment of using the QA/QC system. 
         FIGS. 5A-B  are flowcharts of one embodiment of using quality assurance (QA) periodic testing. 
         FIG. 6  is a flowchart of one embodiment of using quality control (QC) continuous testing. 
         FIG. 7  is a table showing a comparison between QA and QC testing. 
         FIG. 8A  is a flowchart of one embodiment of setting up the system to perform QA/QC procedures. 
         FIG. 8B  is a flowchart of one embodiment of setting up the system to perform personalized QA/QC procedures. 
     
    
    
     DETAILED DESCRIPTION 
     The present invention is a method and apparatus for using a computer-aided diagnosis system for quality evaluation of radiological equipment. A computer-aided diagnosis (CAD) system is designed to assist a radiologist in analyzing radiological images, such as mammograms, chest X-rays, MRIs, and similar radiological images. U.S. Pat. No. 6,014,452 describes one exemplary CAD system that may be used with the present invention. However, any CAD system may be used. The CAD systems all analyze images for unexpected elements. This methodology can be used for quality assurance (QA) and quality control (QC). The QA and QC processes together will be referred to as quality evaluation. 
     For one embodiment, the system is initially provided with the “clean” or ideal set of images. Subsequent images are compared to that set. For another embodiment, the system is provided with a large initial set of images. These images form a “basis” for evaluating subsequent images. The quality evaluation is whether the subsequent images match this basis set. For another embodiment, each image that is evaluated using the standard CAD procedures is further evaluated for QC and QA problems. If such a problem is found, it is automatically brought to the attention of the technician. 
     For one embodiment, the results are charted, and stored in a database. These results are then made available to the technician, as well as to others, for review. 
       FIG. 1  is a block diagram of a network that may be used with the present invention. The system includes one or more image acquisition modules  130 A,  130 B. The image acquisition modules  130 A,  130 B may be conventional medical image acquisition systems, which are known in the art, and/or digital image acquisition systems. Standard methods—such as mammogram films, CAT scans, chest X-rays, or others—may be used to obtain the analog or digital images, whether two or three-dimensional. The outputs of the image acquisition modules  130 A,  130 B, are digital or analog images. 
     These images are passed to image analysis system  120 . For one embodiment, the images are sent through network  110  to image analysis system  120 . Network  110  may be an internal local area network (LAN), a wide area network (WAN), the Internet, or any other type of network. For one embodiment, if the network  110  is not a local internal network, then the images sent by image acquisition modules  130 A,  130 B are encrypted or in some other way protected to ensure the patient&#39;s privacy. This permits the use of a centralized image analysis system  120  which may receive images from multiple offices that may be located anywhere in the world. Similarly, the analyzed images/output may be sent to review stations  150 ,  160  anywhere in the world. 
     The image analysis system  120  performs the preprocessing, recognition, and/or post-processing of the images. Exemplary image acquisition systems  120  that may be used for this are described in U.S. Pat. No. 5,828,774 to Wang, and co-pending application Ser. No. 09/992/059, by Roehrig et al. entitled “A Method and Apparatus for an Improved Computer Aided Diagnosis System.” 
     The HIS/RIS (hospital information system/radiology information system) system  170  is coupled to the image analysis system  120 , either directly or through network  110 . The HIS/RIS system  170  provides patient information, in one of a variety of formats. Patient information may include patient data identifying the patient, as well as patient historical data, providing relevant historical information. For one embodiment, the HIS/RIS system  170  may provide data in the HL7 format. Alternative formats may be used. 
     The images processed by image analysis system  120  may be stored within a patient record, in the DICOM format. Alternative standardized, non-standardized, or proprietary formats may be used to store the image data, with or without the patient information. 
     For one embodiment, copies of the processed images are stored in system archive  145 , such that at a later time, the previous images may be retrieved. For one embodiment, auto-converter  140  converts the images to a DICOM format. For one embodiment, the auto-converter  140  further converts the image to a lower resolution image, which is stored. For one embodiment, the stored image does not include any tagging or other indicators added by image analysis system  120 . For another embodiment, the owner of the system may set the preferences as to the images stored in system archive  145 . 
     The images are displayed to a reviewer at review station  150 . Review stations  150  may be directly coupled to image analysis system  120 , or coupled through a network. Review stations  150  may be incorporated into a motorized viewer, as described in U.S. Pat. No. 5,917,292, to Marshall et al. Alternatively, a review station  150  may be an independent display. Such an independent display review station  150  is described in more detail below. 
     For one embodiment, the images may further be viewed at remote viewing stations  160 . Remote viewing stations  160  may be conventional computer systems coupled to the network  110 . For one embodiment, the remote viewing station  160  may be a handheld device. Remote viewing stations  160  permit a doctor in a remote location to review the images, and may be used to allow the patient or others to review the images remotely. Thus, for example, a radiologist at a central location may initially review and analyze the images, and annotate them. Then, the images, and notation—or a report generated based on the images and notation—is sent to a remote system where the doctor can review the data with the client. 
     The images, report, or other output may be sent to a printer  180 . The printer  180 , for one embodiment, may print to film, to permit conventional review of the enhanced images. For one embodiment, the printer  180  may print multiple images, for example, one set of original images, a set of enhanced images, and a set of enhanced images with markers indicating the abnormalities found by the image analysis system  120 . The printer  180  may be coupled to the image analysis system  120  and/or the system archive  140  either directly or through network  110 . As discussed above with respect to the review stations  150 ,  160 , the printer  180  need not be in the same location as the image analysis system  120 . 
     Of course, not all of these elements must be present in order to implement the present system. At its simplest, the system includes an image acquisition module  130 A, an image analysis system  120 , and a handheld device  160  that permits viewing of the images. These systems  120 ,  130 A,  150  may be coupled directly, without the use of a network  110 . At its most complex, the system may be a distributed system having image acquisition modules  130 A,  130 B at various remote locations, while a central archive  140  and one or more image analysis systems  120  are used to process the acquired images. Then, the images may be sent to various local or remote review stations  150 ,  160 . Note that although the image analysis system  120  illustrated as once central device, it may be a distributed system. 
       FIG. 2  is one embodiment of computer system on which the present invention may be implemented. It will be apparent to those of ordinary skill in the art, however that other alternative systems of various system architectures may also be used. 
     The computer system illustrated in  FIG. 2  includes a bus or other internal communication means  215  for communicating information, and a processor  210  coupled to the bus  215  for processing information. The system further comprises a random access memory (RAM) or other volatile storage device  250  (referred to as memory), coupled to bus  215  for storing information and instructions to be executed by processor  210 . Main memory  250  also may be used for storing temporary variables or other intermediate information during execution of instructions by processor  210 . The system also comprises a read only memory (ROM) and/or static storage device  220  coupled to bus  215  for storing static information and instructions for processor  210 , and a data storage device  225  such as a magnetic disk or optical disk and its corresponding disk drive. Data storage device  225  is coupled to bus  215  for storing information and instructions. 
     The system may further be coupled to a display device  270 , such as a cathode ray tube (CRT) or a liquid crystal display (LCD) coupled to bus  215  through bus  265  for displaying information to a computer user. An alphanumeric input device  275 , including alphanumeric and other keys, may also be coupled to bus  215  through bus  265  for communicating information and command selections to processor  240 . An additional user input device is cursor control device  280 , such as a mouse, a trackball, stylus, or cursor direction keys coupled to bus  245  through bus  265  for communicating direction information and command selections to processor  210 , and for controlling cursor movement on display device  270 . 
     Another device that may optionally be coupled to computer system  200  is a communication device  290  for accessing other nodes of a distributed system via a network. The communication device  290  may include any of a number of commercially available networking peripheral devices such as those used for coupling to an Ethernet, token ring, Internet, or wide area network. Note that any or all of the components of this system illustrated in  FIG. 2  and associated hardware may be used in various embodiments of the present invention. 
     For one embodiment, display  270 , input device  275 , and cursor control  280  may be combined into a single touch-screen. The touch screen display permits data entry using a touch sensitive screen. 
     It will be appreciated by those of ordinary skill in the art that any configuration of the system may be used for various purposes according to the particular implementation. The control logic or software implementing the present invention can be stored in main memory  220 , mass storage device  225 , or other storage medium locally or remotely accessible to processor  210 . Other storage media may include floppy disks, memory cards, flash memory, or CD-ROM drives. 
     It will be apparent to those of ordinary skill in the art that the methods and processes described herein can be implemented as software stored in main memory  250  or read only memory  220  and executed by processor  210 . This control logic or software may also be resident on an article of manufacture comprising a computer readable medium having computer readable program code embodied therein and being readable by the mass storage device  225  and for causing the processor  210  to operate in accordance with the methods and teachings herein. 
     The software of the present invention may also be embodied in a dedicated appliance containing a subset of the computer hardware components described above. For example, the dedicated appliance may be configured to contain only the bus  215 , the processor  210 , and memory  250  and/or  225 , and a touch screen. 
     The device may also be configured to include a set of buttons or input signaling components with which a user may select from a set of available options. The dedicated appliance may also be configured to include an output apparatus such as a liquid crystal display (LCD) or display element matrix for displaying information to a user of the dedicated appliance. Conventional methods may be used to implement such a dedicated appliance. The implementation of the present invention for such a device would be apparent to one of ordinary skill in the art given the disclosure of the present invention as provided herein. 
       FIG. 3  is a block diagram of one embodiment of a quality evaluation system. The quality evaluation system  310  (or QA/QC system) receives a digital image. The image may be an image from a digital detector or a digitized film image. The image may be a standard medical image, which may be prepared for CAD analysis for the continuous QC analysis, or a special testing image for the periodic QA analysis. For the periodic QA testing, the periodic test alert  365  may be programmed to alert the user that the periodic test should be performed, and the test exposures should be taken. 
     The image is input to the image analysis system  315 . The image analysis system  315  analyzes the image. The image may be a digital image from a digital detector. For another embodiment, the image may be a digitized image, originally obtained from a film, and digitized. A QC image may be any medical image, such as a mammogram, an X-ray, a CT scan, or any other type of medical image. The QA images are prescribed test exposure images, used to test the technologist&#39;s technique as well as the elements of the imaging system. 
     Deviation detector  320  compares the image to standards  325 . As will be discussed in more detail below, the standards  325  may be international or national standards, such as the FDA standard prescribed for medical procedures in the United States. Alternatively and additionally, the standards may be variable standards defined by user, through user interface  355 . The deviation detector  320  determines how much, if any, the current image deviates from the standards set up for the particular medical or testing image. The results of the deviation detector&#39;s  320  analysis are stored in results database  335 . 
     The results of the analysis are passed to trend analysis logic  330 . Trend analysis logic  330  uses historical results, from results database  335 , to determine whether there are any negative trends. Negative trends are generally increasing deviations from a standard. The trend analysis logic  330  identifies any trends in the results. For one embodiment, the trends are recorded in results database  335  as well. 
     If the trend is negative—e.g. deviations are increasing—the trend analysis logic  330  passes the data to the solution predictor  340 . The solution predictor uses solutions database  345  to attempt to identify likely causes of the negative trend. For one embodiment, deviation detector  320  further passes any detected deviations from the norm to solution predictor directly, if the deviation is sufficient to require a solution. In this way, trends are caught before they reach a problem stage, while problems are caught immediately. 
     If the deviation from the standard is sufficiently severe, e.g. above a certain threshold, the data is passed to alert logic  350 . The alert logic  350  alerts the user that there is a significant problem that must be corrected. The alert may be visual, text based, auditory, or any other form or combination of forms. The alert logic  350  may also alert the user if the current image needs to be retaken. An image may need to be retaken because the patient moved, or there was some other problem that sufficiently impacts the image that it cannot be successfully analyzed. 
     For one embodiment, one or more of the systems including the deviation detector  320 , trend analysis logic  330 , solution predictor  340 , and alert logic  350  log the results in logging database  365 . The logging database  365  logs the results of the trend analysis, and solution predictor. For one embodiment, the user may enter the resolution of the problem as well, through user interface  355 . 
     For one embodiment, if the image must be retaken, alert logic  350  passes the information to discarding logic  330 . Discarding logic  330  then discards the image from the logging database  365 . Otherwise, all results are logged in logging database  365 . For one embodiment, even if an image must be retaken, it is stored in the logging database  365 , and archived. 
     The user may request results either from results database  335  and/or from logging database  365 . The reports created by reporting logic  360 , for one embodiment comply with requirements, such as FDA reporting requirements. For one embodiment, the reporting logic  360  uses the PenRad Mammography Information, Reporting, Tracking System by PenRad Technologies of Minnesota. For one embodiment, the user may set the format and output preferences, and the reporting logic  360  can create reports focusing on results, technicians, hardware, overall performance, or any other characteristics that may be of interest. 
       FIG. 4  is an overview flowchart of on embodiment of using the present quality evaluation system. The process starts at block  410 . Note that this process applies both to continuous testing (QC) and periodic testing (QA). In general, QA is mandated by the FDA or similar regulatory agencies. The QC process makes sure the quality of the images is generally good. The QC process may be used to monitor particular technicians&#39; performance, hardware performance, as well as overall effectiveness of the tests. At block  415 , a digital image is received. The image may be digitally obtained, or digitized from a film-based image. 
     At block  420 , the standards that apply to the image are retrieved. In general, for QC continuous testing, there are modality-specific and generic standards. For QA testing, most of the standards are prescribed by various regulatory agencies such as the FDA.  FIG. 7  is a table showing some of the potential standards and deviations tested.  FIG. 7  shows some mammogram specific tests, such as compression. However, in general, the tests described in  FIG. 7  may be used as a basic set. The standard, for example, for “dirt on the screen” may be that dirt may be “no more than a grouping of three pixels.” Alternatively, there may be an absolute rule that states that “any indication of dirt on the screen is a deviation from the standard.” The actual details of such standards are described for example in Mammography Quality Standards Act (MQSA) of 1992. 
     At bock  425 , the images are tested against the standards. For one embodiment, in addition for testing for unexpected characteristics such as dirt on the screen, fog, or motion blur, the system tests for expected characteristics. For example, for a mammogram an expected characteristic is that the pectoral muscle reaches from approximately the center of the top to approximately the center of the side of the image. The absence of such expected characteristics is also considered a failure to meet a standard. 
     At block  430 , any problems are identified. As will be described below in more detail, the problems may be a failure to meet a minimum required standard, or a negative trend based on historical data. The process further notifies the technician if the deviation or is sufficiently severe to require immediate action. The immediate action may be retaking the image, adjusting the hardware, or making changes. 
     At block  440 , the results are recorded in databases. For one embodiment, QA results are recorded in a preset format, as mandated by government standards. For one embodiment, the QC results are also recorded. This type of record provides full data for later review, for learning, training, retraining, and corrections. 
     At block  445 , the process determines whether results have been requested. For one embodiment, the administrator may request reports. For one embodiment, a technician may create reports. If no results have been requested, the process continues to block  465 , and ends. If a report has been requested, the process continues to block  450 . 
     At block  450 , the process determines whether the requested report has specified certain limitations. The report may request a certain date range, a certain technician, or any other quantifiable aspect of the reports. For one embodiment, the limitation may be to create a report in compliance with regulatory requirements. If limitations have been set, the process continues to block  455 , and data is gathered with the identified limitations. The process then continues to block  460 , and a report is generated. If no limitations are specified, the process continues directly to block  460 , to generate a report. The format of the report, as discussed above, may be specified by the user. For one embodiment, the format complies with the reporting requirements for the FDA. For one embodiment, the report may further comply with regulation of other regulatory agencies, as appropriate. 
       FIGS. 5A-B  are flowcharts of one embodiment of using quality assurance, the periodic testing of the system. The process starts at block  510 . At block  515 , the technologist is prompted to set up the test exposures. In general, QC procedures require the exposure of various test images, and blank images to test the equipment and the process. At block  520 , the test exposures are received for analysis. For one embodiment, in a film-based system, the technologist exposes the test exposures, develops them, digitizes them, and then activates the QC process. For one embodiment, in a digital test system, the technologist exposes the test images and activates the QC process. 
     At block  523 , the standards are retrieved. As discussed above, the standards are based, for one embodiment, on government-mandated standards. For example, for mammograms, the FDA prescribes certain QA test procedures, and requires tracking of the results. The FDA further indicates what are acceptable response ranges or responses for the test. These standards, other applicable standards from other countries, and any variable standards set up by the user, are retrieved. As described below in more detail, the user may set up which standard or set of standards is used for this evaluation. 
     At block  525 , the test exposures are analyzed to determine whether they deviate from the norm provided by the standards. For one embodiment, the norm may be a particular range, or a particular maximum or minimum value. For example, for the resolution test, the standard may be that the modulation transfer function (MTS) value is between 20 and 30 percent. 
     At block  527 , the results of the tests are recorded in the database. For many government-mandated standards, the recording of the results is required. The database, for one embodiment, records in a format that can be used for compliance with such standards. 
     At block  530 , the process determines whether there are any deviations from the acceptable results. If there are, the process continues to block  532 , shown on  FIG. 5B . Otherwise, the process continues to block  546 . 
     At block  546 , historical data is pulled from the results database. 
     At block  548 , the process analyzes trends. Trend analysis determines the changes in the deviations from the norm over time. 
     At block  555 , the process determines whether the trends are leading to possible issues. If there is a distinct trend, which appears to lead further from the standard, the process continues to  FIG. 5B . If the process does not lead to possible issues, the process ends at block  560 . 
       FIG. 5B  is reached if there is a deviation from acceptable result, or if the trend is showing a consistent deviation. At block  532 , the problem or problems are identified. 
     At block  534 , the process determines whether it is a hardware problem. If the problem is a hardware problem, the process continues to block  536 . At block  536 , a hardware fix is prompted. In general, hardware problems—and these include problems with the hardware to take the image and the hardware to develop the image—must be remedied externally. The process then returns to block  515 . In general, after a hardware problem is resolved, the testing images are retaken. 
     If it is not a hardware problem, the process continues to block  538 . At block  538 , the process determines whether there is an alert enabled for the problem that has been detected. In general, certain types of problems require alerts. The specific problems that require alerts may be set by the user. For one embodiment, certain problems or types of problems may require an alert, according to FDA or similar regulations. For one embodiment, the alert may be set to a different level than the problem detection. For example, certain levels of the problem may not require a specific notification of the technician. Thus, at this point, the process may determine whether the deviation/problem is sufficiently significant to require an alert. 
     If so, at block  540 , the technician is notified. For one embodiment, in addition to presenting the problem, the process attempts to present a solution. The problem, once identified, is looked up in the solutions database. Possible solutions are identified, and presented to the user. For one embodiment, if possible the solutions that are not applicable—for example if other results indicate that the possible solution is not applicable. For example, if one of the other tests showed that a particular problem could not have caused the observed deviation, the solution for that problem is not presented. 
     The process then continues to block  542 . If there was no alert for the problem, the process continues directly to block  542 . 
     At block  542 , the process determines whether a retake of the image is needed. If the problem is sufficiently severe to make the other aspects of the quality impossible or difficult to evaluate, or if the problem solution would significantly change the results of the tests, the process may determine that a retake is necessary. If so, at block  544 , the image is discarded, and the process continues to block  546 , on  FIG. 5A . For one embodiment, instead of discarding the image, the image is archived at this point. This may be done for regulatory reasons, or for reasons of completeness. 
     In this manner, the test exposures are periodically evaluated, the results are logged, and possible solutions are suggested for any problems that are detected. Note that although this was described with respect to a particular image, for one embodiment, a set of images is used for this evaluation. Thus, for example, multiple images may be evaluated together to determine deviations, identify problems, and identify solutions to the problems. Furthermore, a subset or all of the images may be retaken, if appropriate. 
       FIG. 6  is a flowchart of one embodiment of using quality control. The process starts at block  610 . For one embodiment, this process is automatically started for each new image that is received for processing. The processing, in this instance, may be digitizing and storing medical images and/or performing computer aided diagnosis/detection (CAD) on the images. 
     At block  615 , an image is received. For one embodiment, the image is received for CAD analysis. For another embodiment, the image may be received for image correction, for archiving, or for another purpose. 
     At block  617 , the designated standard(s) are pulled. As discussed above, the user may set one or more standards to evaluate the image. Each standard that is selected by the user is retrieved. 
     At block  620 , the image is compared to the standard-based rules for the images. A standard specifies certain rules for an image. For example, the standard may specify that the color differential between the “empty” portion of the image and the “dense” portion of the image must be a certain depth. Similar types of standards may be applicable.  FIG. 7  lists a set of exemplary standards. Note that this set of standards is not complete. One of skill in the art would be able to identify generic as well as process and modality dependent standards that would apply. 
     At block  625 , the results of the rule evaluation are recorded. For one embodiment, all image evaluations are logged. This log may be used to evaluate technicians, hardware, and the overall system. The results may further be used to correct the CAD evaluation, if that is appropriate. 
     At block  630 , the process determines whether any of the rules set by the standard have been violated. If so, the process continues to block  635 . Otherwise, the process continues to block  670 . 
     At block  670 , the process determines whether there are any further standards to evaluate. If there are, the process returns to block  620 , to compare the image to the rules based on the new standard. In this way, the process continues evaluating the image until all standards set up by the user have been evaluated. If there are no further standards to evaluate, at block  670 , the process continues to block  675 . 
     At block  675 , the image is passed on for further processing. For one embodiment, the further processing may be CAD processing. For one embodiment, the CAD process described in U.S. Pat. No. 6,014,452 may be used to evaluate the image. For another embodiment, the processing may be archiving the image, or converting the image and associated data to a standard form such as DICOM. The process then ends at block  680 . 
     If, at block  630 , the process found that one or more of the rules have been violated, the process continued to block  635 . 
     At block  635 , the process notifies the technologist of the rule violation. For one embodiment, this notification may be visual, displaying on a screen. Alternatively, the notification may simply be a note in the file. 
     At block  640 , the process determines whether the problem is a hardware (HW) problem. Hardware problems generally must be immediately corrected. If the problem is a hardware problem, the process continues to block  645 . At block  645 , the technician is alerted to the hardware problem. For one embodiment, the alert may include a notification to stop using the system until it is fixed. For one embodiment, if the hardware problem is not locally fixable, the system may further alert the hardware vendor to the problem. For one embodiment, if the present system is integrated with the hardware, the system may further shut down the hardware. The process then continues to block  650 . If the problem is not a hardware problem, the process continues directly to block  650 . 
     At block  650 , the process determines whether the image needs to be retaken. If the problem is sufficiently severe, the image may not be of sufficient quality of analysis by a radiologist, or by the CAD process. For example, if sufficient motion blur is present, the image may not be analyzable. If the image must be retaken, the process continues to block  655 . At block  655 , the bad image is discarded and the technician is prompted to retake the image. For one embodiment, this process may take place immediately after a medical image is acquired. Thus, the patient would not need to return because the image was not of sufficiently good quality. For one embodiment, instead of discarding the bad image, the image may be archived. The process then continues to block  670 . 
     If the image does not need to be retaken, at block  650 , the process continues to block  660 . At block  660 , the process determines whether the image can be corrected. For one embodiment, for CAD processing, the image may be corrected, to compensate for certain types of problems. For example, if lack of contrast is an issue, the process described in U.S. patent application Ser. No. 10/079,327 may be used to correct the image. If the problem can be corrected for, the process continues to block  665 , and the image is corrected. For one embodiment, the image correction may be used for the displayed image. For another embodiment, only the version of the image used by the CAD process is corrected, and the original unchanged image is presented to the radiologist for analysis. 
     The present process, as described above, permits each image to be analyzed as it is received. This improves the image processing, and alerts technicians to problems immediately. Furthermore, by providing immediate feedback, the present process ensures that a good quality image is obtained from the patient in a single session. 
       FIG. 8A  is a flowchart of one embodiment of setting up the system to perform QA/QC procedures. The process starts at block  810 . For one embodiment, this process is performed only once for each modality and imaging process. For another embodiment, this process may be regularly performed to refine settings. 
     At block  815 , a set of sample images is provided, including images having anomalies. These images are used for training the present system. 
     At block  820 , standards are collected for the various features. These standards are based, for one embodiment, on the sample images. For one embodiment, the standards may further be manually added. For example, the standard levels of contrast for an image are defined by the particular film being used. 
     At block  825 , the calculations of how features are measured and found are defined. For example, the measurement of “placement” for a mammogram may be identified as having the pectoral muscle—an element having a particular characteristic density—in a particular location/zone. These calculations are known by those in the medical arts. Thus, the specifics of what defines “proper placement” for a mammogram, a CT scan, a chest X-ray, or another medical image are defined. Similarly, the characteristics that identify various anomalies and features—such as motion blur, dirt on the screen, fogging, etc. are identified. An exemplary list of characteristics that may be defined is included in  FIG. 7 . 
     At block  830 , the system receives identification of the various available standards. For one embodiment, the standards may be regulatory standards, such as those promulgated by the Food and Drug Administration, or by the Health and Human Services division. For one embodiment, the standards may be standards promulgated by other countries. For one embodiment, at least a multiplicity of standards is entered into the system. For one embodiment, the standard for each country in which the device is made available is programmed into the system. For one embodiment, additional standards may be programmed in as well. 
     At block  835 , the thresholds, ranges, and rules for each standard are set. Each standard may have different thresholds on what abnormalities cannot be present, and what features must be present. These thresholds, ranges, and rules are defined by each standard. For one embodiment, there may be a default value for any threshold, range, or rule that is not defined by the particular standard. For one embodiment, these thresholds, ranges, and rules include the settings that cause the alert to the technician, as well as the settings that are simply recorded as deviations from the expected. For one embodiment, these settings further include the trends that are considered a problem. 
     At block  840 , solutions are set for the problems that have potential solutions. Most of the problems that may be detected in an image have solutions. For example, for dirt on the screen, the solution is to clean the screen. For faulty positioning, repositioning the patient is the simple solution. In general, for each defined problem there are one or more possible solutions. There may be some problems, such as lack of contrast, which may not have a single solution. Rather, a set of possible solutions would need to be explored to identify the actual problem and its solution. 
     At block  845 , the alerts are set for each significant deviation/problem. As discussed above, these alerts may be set based on recognized standards, such as the standards provided by the FDA. For another embodiment, deviations of a certain level, e.g. more than 5% from norm, may be considered sufficient for an alert. The alerts are set at this point. The process then ends at block  850 . 
       FIG. 8B  is a flowchart of one embodiment of setting up the system to perform QA/QC procedures. The process starts at block  852 . This process customizes the device for the particular standards and preferences that the hospital or other facility wishes to use. In general, this type of setting-up is performed once when the first device is initially installed in the facility. For one embodiment, these settings may be transferred from device to device within a facility. For one embodiment, this type of programming may be transferred via a diskette, CD, network connection, or through some other means. Thus, a single facility that has multiple analysis systems only would program the system once. 
     At block  855 , the user is prompted to select a standard to use for evaluating images. For one embodiment, the standard may be chosen from among the preset standards discussed above, or a variable standard set up by the user. 
     At block  860 , the process determines if a variable standard has been selected. If one of the predefined standards is selected, the process continues to block  880 . Otherwise, the process continues to block  865 . At block  865 , the user is prompted to review the thresholds and settings of the system. For one embodiment, these are the “default” settings discussed above, set at the factory. The user is permitted to make changes to these thresholds and settings. 
     At block  870 , the user is permitted to disable calculations for various problems and deviations. For example, the facility may not wish to track, or may have no need to track “dosage” for example in a clinical setting where dosage is not adjusted by a technician, but is automatically calculated. 
     At block  875 , the user is prompted to enable and disable alerts for the various deviations. The user may change the levels of deviation/problem that causes an alert. For one embodiment, the format of the alert may also be changed. For example, an alert may range from a notation in the file to a visual and auditory alert for the technician actually taking the medical image. The process then continues to block  880 . 
     At block  880 , the process creates a report form appropriate for the standard. At block  885 , the user is permitted to alter the report form, if such alterations are permissible by the standard. For example, the FDA radiology standards have particular reports that must be presented to inspectors. The formats of those reports are set by the FDA. Thus, those report forms may not be changed by the user, if the user has selected the FDA standard. 
     At block  890 , the settings are saved. 
     At block  895 , the user is permitted to select an additional standard to use for evaluating the medical image. If an additional standard is selected, the process returns to block  855 , to prompt the user to select a standard. If no additional standards are selected, the process ends at block  899 . 
     In the foregoing specification, the invention has been described with reference to specific exemplary embodiments thereof. It will, however, be evident that various modifications and changes may be made thereto without departing from the broader spirit and scope of the invention as set forth in the appended claims. The specification and drawings are, accordingly, to be regarded in an illustrative rather than a restrictive sense.