Abstract:
A system and method for electronically displaying CAD results are disclosed. In one exemplary embodiment, a flat panel display is attached to a film multi-viewer via an articulated arm that allows a radiologist to position the flat panel display with respect to the multi-viewer. A barcode scanner is mounted to the back of the display, allowing case identifiers on CAD hardcopy printouts to be read in order to indicate which results are to be viewed. A small embedded computer is mounted with or near the flat panel display and the barcode scanner, and retrieves CAD results from a remote CAD server when a case identifier is read by the barcode scanner. Other embodiments are described and claimed.

Description:
RELATED CASES  
       [0001]     This case claims priority to and incorporates by reference copending U.S. Provisional Patent Application 60/525,228, filed Nov. 24, 2003. 
     
    
     FIELD OF THE INVENTION  
       [0002]     The present invention pertains generally to Computer-Aided Detection (CAD) of features on medical imagery, and more particularly to systems, system components, and methods for use in CAD mammography.  
       BACKGROUND OF THE INVENTION  
       [0003]     CAD mammography systems have existed now for more than a decade. Such systems digitize traditional film mammograms, and then use computer algorithms to locate suspicious regions in one view, several views, or a time-series of mammograms. Additionally, some imaging systems now directly produce digital mammogram data and thus can be integrated with embedded CAD algorithms without digitization of film output.  
         [0004]     A radiologist uses a CAD system by first viewing a set of mammogram films (or digital equivalent), and then checking the CAD results for the same set of films on a computer monitor. The computer monitor in a film-based system shows lower-resolution images of the films, with marks superimposed to show suspicious regions located by the CAD algorithms. If the radiologist has noted nothing suspicious in the films, but the CAD system identifies a suspicious region, the radiologist may re-evaluate the identified region on the films. Obviously, the more effective the CAD algorithms are at identifying real trouble regions without falsely identifying normal tissue, the more weight the radiologist will give to the CAD results. Also important, however, is the ease of use of the system, both for radiology technicians and for radiologists, so that the system provides a real benefit without unduly increasing workload.  
         [0005]     Many radiologists view a large number of cases at a single sitting on a motorized film “multi-viewer,” which can be loaded with films for tens, or sometimes even hundreds, of cases. The radiologist manipulates controls on the multi-viewer to advance films and thus efficiently process a batch of cases.  
         [0006]     Commercial CAD systems generally locate a computer monitor near a film viewer, where the radiologist can view both comfortably. Commercial CAD systems locate and display CAD results for a set of films in several ways.  
         [0007]     Some CAD systems locate a keyboard on the multi-viewer to allow a radiologist to retrieve CAD results by entering a patient name or other identifier, where a technician has previously entered that information in the system.  
         [0008]     Some CAD systems require that a unique barcode sticker be affixed to the films. Some systems simply use a barcode sticker peeled from a roll of unique stickers and affixed to the films prior to scanning, and read the barcode during film scanning. Other systems generate and print out a barcode when a case is scanned, and the technician affixes the barcode after scanning but before the films are transferred to a multi-viewer. After scanning and after the barcode is affixed, the radiologist uses a barcode wand or gun to read the sticker and cause the CAD system to display CAD results for that case.  
         [0009]     Finally, some CAD systems are directly integrated with a multi-viewer, so that a radiologist can advance to the next film and advance to the next set of CAD results simultaneously. The latter systems require that a technician load cases to a scanner with cardboard separators interspersed between the cases. The scanner scans a set of films, and then scans the cardboard separator and reads a barcode affixed to the cardboard. When the technician subsequently hangs films on a multi-viewer, he slides the cardboard separators through a barcode-reader slot on the side of the machine, which then loads the corresponding CAD results in the same order.  
         [0010]     Another integrated CAD system is described in U.S. Pat. No. 5,748,173. This integrated system uses a camera, bar code reader, or magnetic decoder to read identification information for a film loaded on a viewer, once that film is presented to an operator. The identification information is used to locate CAD images and results associated with the presented film. The located CAD images and results are retrieved from a database and displayed on a computer monitor.  
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0011]     The detailed description of the embodiments is best understood when read in view of the attached Figures, wherein:  
         [0012]      FIG. 1  shows a CAD system according to some embodiments of the invention;  
         [0013]      FIG. 2  shows a functional block diagram of a CAD station embodiment useful in the CAD system of  FIG. 1 ;  
         [0014]      FIG. 3  shows components of a viewing station embodiment useful in the CAD system of  FIG. 1 ;  
         [0015]      FIG. 4  illustrates the configuration of the CAD station of  FIG. 2  in a portable cart;  
         [0016]      FIG. 5  shows the cart embodiment of  FIG. 4  with film scanner and printer removed;  
         [0017]      FIGS. 6A-6D  show the lower enclosure of the cart, illustrating the rack mount for servers and UPS, both with and without the servers and UPS installed;  
         [0018]      FIGS. 7A-7E  depict a fully assembled cart from a variety of angles;  
         [0019]      FIGS. 8, 9 , and  10  show the viewing station of  FIGS. 1 and 2  attached to a film multi-viewer;  
         [0020]      FIG. 11  illustrates the appearance and outside configuration of an embedded computer useful in the viewing station embodiments;  
         [0021]      FIG. 12  shows a block diagram of the major components and ports of an embedded computer embodiment;  
         [0022]      FIG. 13  contains a process diagram embodiment showing how the CAD station responds to user and other events;  
         [0023]      FIGS. 14 and 15  show the appearance of the CAD station touch screen display at two times during CAD film input and processing;  
         [0024]      FIG. 16  contains a process diagram embodiment showing how the viewing station responds to user events in a Load Cases mode;  
         [0025]      FIGS. 17-19  show representative printouts generated by the CAD system;  
         [0026]      FIGS. 20-24  show the appearance of the viewing station display in response to various user events in Load Cases mode;  
         [0027]      FIG. 25  contains a process diagram embodiment showing how the viewing station responds to user events in a View Cases mode;  
         [0028]      FIGS. 26-32  show the appearance of the viewing station display in response to various user events in View Cases mode; and  
         [0029]      FIGS. 33 and 34  show a second viewing station embodiment integrated with a film multi-viewer. 
     
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS  
       [0030]     CAD System Overview  
         [0031]     The present disclosure describes a CAD system, system components, and methods for operation. Referring to  FIG. 1 , one exemplary CAD system configuration  100  is shown. A CAD station  200  and a viewing station  300  are coupled to a Local Area Network (LAN)  20 . A second CAD station  201  (optional) is likewise coupled to LAN  20 , such that viewing station  300  can receive CAD results from either CAD station. Preferably, any number of viewing stations and CAD stations can be connected within such a network. A computer  400  (a workstation, desktop personal computer, etc.) can also communicate over LAN  20  with CAD stations and/or viewing stations, e.g., to monitor case status/workflow status for films processed by the CAD system.  
         [0032]      FIG. 2  shows a functional block diagram for some embodiments of CAD station  200 . CAD station  200  contains components necessary to scan films into the CAD system, perform CAD processing, print results, and serve results to viewing stations. The major components of CAD station  200  are a film scanner  210 , a touch screen display  220 , a color laser printer  230 , an Uninterruptible Power Supply (UPS)  240 , and two servers  250  and  260 . All of these components are integrated in a single compact cart, as will be described shortly.  
         [0033]     Film scanner  210  provides a capability for high-resolution scanning of medical imaging films. Film scanner  210  may be, for instance a CAD Pro scanner available from Vidar Systems Corporation.  
         [0034]     Touch screen display  220  provides an interactive interface for a technician. The technician manipulates a few simple buttons displayed on display  220  to start and stop the system, but has no more-detailed access to the system. Any commercial LCD touch screen display can be used for this task, for instance an ET1247L display available from Elo Touchsystems, Inc.  
         [0035]     Color laser printer  230  is used to create case printouts, as will be described below. Although other types of printers (inkjet, black-and-white laser, etc.) can be substituted, a color laser printer is preferred to reduce cost/sheet and increase reliability, particularly for high-volume applications. Color is preferred in order to permanently and visibly record any marks found by the CAD algorithms. Any commercial color laser printer can be selected, for instance a C720 or C510 printer available from Lexmark International, Inc.  
         [0036]     Server 1   250  contains dual Central Processing Units (CPUs), CPU A  252  and CPU B  254 , which are, e.g., Intel® Xeon® processors available from Intel Corporation, and a magnetic hard drive  256  to store case images and results. CPU A runs software to integrate and control overall system function, as will be described throughout this specification. Accordingly, CPU A: controls film scanner  210  through, e.g., a SCSI (Small Computer System Interface) or USB (Universal Serial Bus) port; interfaces with a technician through a touch screen display  220  connected to Server 1  through a Video output and a serial or USB port; interfaces with color laser printer  230  over, e.g., an Ethernet connection; interfaces with viewing stations over an Ethernet connection; and interfaces with Server 2  over an Ethernet connection. In some embodiments, each server is configured with only two Ethernet ports, and thus color laser printer  230  connects to the second Ethernet port on Server 2 , and CPU A spools print jobs to color laser printer  230  through its Ethernet connection to Server 2 . Alternately, any or all of the Ethernet devices in station  200  could connect directly to a LAN instead of to each other. Dedicated connections are preferred, however, as this allows the CAD system to function whether an external LAN is available or not. Server 1  preferably has other ports, such as keyboard and mouse ports, that remain unconnected during normal system operation but are available for use during system configuration and/or maintenance. A modem port is also provided, and a modem optionally can be installed on CAD station  200 , e.g., as a backup or alternative to an external LAN connection. Maintenance can also preferably be performed remotely through an Ethernet port.  
         [0037]     CPU B is used for CAD processing, i.e., it processes cases assigned to it by CPU A and then notifies CPU A when results are available.  
         [0038]     Server 2   260  is optional, but increases system performance by providing third and fourth CPUs (CPU C  262  and CPU D  264 ) to process cases concurrently with CPU B. Like with CPU B, CPUs C and D are assigned cases by CPU A and return results to CPU A. Server 2  may contain identical hardware to Server 1 , which provides redundancy and simplifies maintenance. Minor variations, such as no hard disk or a different size hard disk, may be incorporated as well. When a hard disk is part of Server 2 , Server 2  can also export the disk or a partition of the disk (using, e.g., NFS (Networked File System) or CIFS (Common Integrated File System) software) to Server 1  for additional case storage. As yet another alternative or supplement, Server 2  and/or Server 1  can mount a remote disk available to CAD station  200  over its external Ethernet connection.  
         [0039]     UPS  240  supplies battery power to film scanner  210 , touch screen  220 , Server 1 , and Server 2  in the event of power interruption. UPS  240  notifies Server 1  through a USB connection when power is interrupted, and Server 1  notifies Server 2 . Server 1  finishes scanning any case that is currently being scanned by film scanner  210 , waits for CPUs B, C, and D to complete any cases currently being processed or requests that the cases be suspended, displays a message on the touch screen stating that main power has been lost, and then initiates an orderly shutdown if the power interruption has not been resolved. This allows the system to reach an orderly stopping point that will not leave a technician confused as to what has and has not been processed, and should not result in a missing case.  
         [0040]     Viewing station  300  provides the remaining functionality for CAD system  100 . A typical viewing station  300  is illustrated in  FIG. 3 . An embedded computer  310  provides viewing functionality through five ports. An Ethernet port allows embedded computer  310  to communicate with CAD stations to retrieve case results for display. A video output port sends viewable CAD results to a CAD results display. Two input device ports, e.g., USB or serial ports, provide connections for a barcode scanner  330  and a mouse  340  or other input device. Another USB or serial port can provide an optional connection to a motorized film viewer, allowing synchronized navigation between CAD results panels and corresponding multi-viewer film panels.  
         [0041]     The embedded computer can be a custom standalone unit, as will be described in one embodiment. In other embodiments, the display and embedded computer can be integrated into the display case. For instance, an Apple iMac G5 can be adapted to provide the viewing station functions, as will be described in more detail below.  
         [0042]     With the preceding general system overview as background, a more detailed description of various features and components of CAD system  100  will now be undertaken. The CAD station general design, view station general design, and the case scanning/processing function, case loading function, and case viewing function will each be described in turn.  
         [0043]     CAD Station Hardware  
         [0044]      FIG. 4  shows a side view of a CAD station  200  embodiment configured as a wheeled cart. The cart comprises a lower enclosure  202 , shelf struts  204  (one visible), and a cantilevered shelf  206 . Cantilevered shelf  206  includes a mounting bracket  208  for touch screen display  220 . The cart can be moved as necessary, and then operated by connecting a single external power cable. When results from the CAD station are desired, the cart must be located where an Ethernet jack (or other suitable LAN connection or modem connection) is available (if desired, however, a wireless LAN transceiver could be used for LAN connection, removing the Ethernet jack limitation).  
         [0045]     Lower enclosure  202  houses UPS  240 , servers  250  and  260 , and in some embodiments a modem (not shown). The top of enclosure  202  forms a shelf  203 , upon which color laser printer  230  rests. This design places the heavy UPS at the bottom of the cart, and places the printer low on the cart, thus lowering the center of gravity of the cart and increasing stability. Further, since radiology technicians will seldom if ever need access to the servers, UPS, and fan tray, these components are located out of the way so that easy access can be provided to the components that the technician will access.  
         [0046]     Another benefit of this design is that the mechanical noise generated by the system cooling fans is attenuated at walking level. Air enters the lower enclosure through slots in the bottom of the enclosure along the front and one side of the enclosure floor (see  FIG. 6C ), and exits the lower enclosure through a grill located on the back of the lower enclosure (see  FIG. 7E ). This directs much of the fan noise towards the floor or back wall. Additionally, the sides and/or back of lower enclosure  202  can be fitted with sound insulation to further decrease noise.  
         [0047]     The lower enclosure also provides rack space, so that rack-mounted servers and a rack-mounted UPS can be used (see  FIG. 6A , front of rack;  FIG. 6B , rear of rack;  FIG. 6C , front of rack with UPS, Server 1 , and Server 2  in place; and  FIG. 6D , rear of rack with UPS, Server 1 , and Server 2  in place). This rigidly attaches the components in a minimal amount of space, which diminishes the size and weight of the cart. Also, having the UPS mounted in the cart ensures that connections to the system components are properly maintained.  
         [0048]     Lower enclosure  202  also provides a secure shelf for laser printer  230 . The sides of the lower enclosure extend up along the sides of the printer shelf  203  to prevent the laser printer form shifting off the sides of the cart. The front and rear of the shelf are left open to allow access to paper trays and other replenishable-printer-supply doors.  
         [0049]      FIG. 5  shows a front three-quarters view of the cart with the film scanner and printer removed for visibility. Shelf struts  204  are positioned at the rear of the cart, and upper shelf  206  is cantilevered forward from struts  204 . This provides easy access to the top of printer  230  from three sides. The shelf struts, as well as the other major structural components of the cart, are constructed of aluminum.  
         [0050]     Shelf  206  provides a support for film scanner  210 . The footprint of shelf  206  approximates the footprint of the film scanner, so that a technician has easy access to the film loading slot  212  and the film discharge slot  214  of scanner  210 . Additionally, the close proximity of film discharge slot  214  to printout discharge slot  232  of printer  230  makes it easy for a technician to gather scanned films and CAD printouts for transfer to a viewing station.  
         [0051]     Mounting bracket  208  attaches to shelf  206 . Preferably, the film scanner discharge slot  214  slides between the two sides of mounting bracket  208 , thus positioning and mechanically constraining the scanner on the cart. Touchscreen display  220  mounts to the front of bracket  208 , thus placing the display in an easily viewable position.  
         [0052]      FIGS. 7A through 7E  show a fully assembled CAD station from a variety of viewing angles from which one can appreciate the compact and ergonomic design of the station, as well as the other features of the station design.  
         [0053]     Viewing Station Hardware  
         [0054]     The viewing station is designed for mounting on or near an existing film viewer, although the components could be integrated into a new film viewer and provided as a package.  FIGS. 8-10  show a typical installation on a multi-viewer for one embodiment. In recognition that space is often limited on and around such multi-viewers, the described embodiment is designed to impact that space as little as possible.  
         [0055]     Referring to  FIGS. 8 and 9 , the only viewing station components visible to the radiologist are a CAD results display  320  and mouse  340 . Display  320  attaches to a mounting arm  350 , which leaves most of the radiologist&#39;s workspace free by placing the display above the space. Mounting arm  350  also allows the radiologist to place the display at a comfortable height, angle, and position for viewing.  
         [0056]     Also visible on the tabletop in  FIG. 9  is scattering  360  from a laser beam emitted from an activated barcode scanner  330 . Scanner  330  is not visible in  FIG. 9  because it is mounted to the backside of display  320 .  FIG. 10  shows the backside of display  320 , and clearly shows the position of barcode scanner  330  and mounting arm  350 . The barcode scanner can be positioned on the opposite bottom corner of display  320  when the mounting arm is positioned in a left-handed position on the multi-viewer workspace, or can be positioned more centrally along the backside of display  320 .  
         [0057]     Embedded computer  310  is not shown in  FIGS. 8-10  as it is designed to be mounted or placed in an out-of-the-way location, such as under the multi-viewer desk, beside the multi-viewer, on the backside of display  320 , etc.  
         [0058]      FIG. 11  shows front, top, and perspective views of one embodiment of embedded computer  310 .  FIG. 12  shows a corresponding block diagram of embedded computer  310 . Computer  310  comprises a CPU  312  (e.g. an Intel® Pentium III with a supporting chipset  314  and 1 GB of attached flash memory  316 . The chipset supports a display out port for an LCD monitor, an Ethernet port for attachment to a LAN, and three USB ports USB 1 , USB 2 , and USB 3  for a barcode scanner, a mouse, and a film viewer interface. The CPU, chipset, and flash memory are mounted in a small metal enclosure, including cooling fins  320 , that is designed to dissipate heat from the CPU and chipset without need for a fan. The lack of an internal fan and electromechanical disk drive allows for a very small package size and silent operation. The default storage capacity of flash memory  316  is sufficient to store results from about 160 typical cases, plus the executable code needed to operate the viewing station, but other sizes of flash memory can be selected.  
         [0059]     The embedded computer could be replaced in some embodiments with a more traditional desktop or tower unit, although this would generally increase bulk, power consumption, and noise, and would make the system more susceptible to theft and damage.  
         [0060]     Another preferred viewing station embodiment is illustrated in  FIGS. 33 and 34 .  FIG. 33  shows a commercially available multi-viewer  300 , e.g., a Rolloscope, including its panel controls  370 . Display  320  is a commercially available Apple iMac G5, which includes an embedded computer mounted behind the display. Display  320  has a 16:9 aspect ratio, which better matches the aspect ratio of a film multi-viewer than a traditional 4:3 aspect ratio display. Also shown in  FIG. 33  are the mouse  340  for controlling the CAD viewing station and the mounting bracket for a display arm  350 .  
         [0061]      FIG. 34  shows the backside of display  320  and additional features of the embodiment. Display  320  is mounted in a case  325 , along with the embedded computer. Although the embedded computer can be equipped with only solid state memory, in the illustrated embodiment an internal 80 Gb hard drive stores CAD viewing station software and currently loaded cases.  
         [0062]     The various connections to the embedded computer are shown in a connector region  380  along one side of the back of case  325 . Wires for the mouse, LAN, barcode reader, and film viewer interface are routed along a hollow enclosure  355  on the top of mounting arm  350  to corresponding connectors in connector region  380 . Optionally, one or more of these connections can be replaced with a wireless interface, e.g., an IEEE 802.11g or Bluetooth interface.  
         [0063]     Other structural features of the viewing station are also depicted in  FIG. 34 . A bracket at the end of mounting arm  350  attaches through case  325  to the metal chassis structure to provide secure mounting for the viewing station. Directly below the mounting arm attachment, a bar code reader enclosure  335  attaches to case  325 . The bottom section of enclosure  335  is angled such that bar code reader  330  can project its scan line below and slightly forward of display  320 .  
         [0064]     CAD Station User Operation  
         [0065]     CAD station  200  preferably presents a simple user interface to a technician responsible for loading cases into the CAD system.  FIG. 13  shows the basic “events” that Server 1  responds to during case entry.  FIGS. 14 and 15  show images from touch screen display  220  during film scanning and CAD processing, respectively.  
         [0066]     Referring first to  FIG. 14 , the basic interface contains two user controls, a “Start” touch screen button and a “Stop” touch screen button. Two informational display areas are displayed in the center region of the touch screen. The first has four sub-regions that display up to four scanned films for the currently scanning case. As a particular film is being scanned, a white bar progresses across the sub-region corresponding to that film. For instance, in  FIG. 14  the “LCC” film is currently being scanned, and the white bar shows approximately how much of the film remains to be scanned. Once the film is completely scanned, a reduced-size digitized version of the film is displayed in the corresponding sub-region (see the “RCC” region for an example). The technician can view the scans and detect mis-ordered, flipped, or inverted films, or other scanning problems from the display.  
         [0067]     The second informational display informs the technician of CAD progress on the newly-scanned cases. In the example of  FIG. 15 , one case is being processed, is 7% finished, and has 13 seconds left to completion. With the “Marks On” option selected, marks will be displayed for the current case on the four small images when CAD processing is completed.  
         [0068]     Returning to  FIG. 13 , the major events in a new CAD run are shown. When the “Start” touch screen button is pressed, Server 1  activates the film scanner, creates a new case, and then reads in digitized film data for four films. The touch screen display is updated periodically to indicate scan progress. Note that in one embodiment, if an incomplete set of films is used the technician is expected to load a blank film into the scanner to replace each missing film in the set, such that a complete four-film set is still processed. During CAD processing, the blank films will be detected and not used to calculate CAD results.  
         [0069]     After a four-film set has been successfully scanned, if the scanner detects additional films in its loading tray, Server 1  loops back to create a new case and repeat the steps to enter digitized films for that case. Meanwhile, a “New Case Ready for CAD” event causes a process to determine one of CPUs B, C, or D to receive the first set of digitized films for CAD processing. The case is transferred to the appropriate CPU, and Server 1  updates the “Cases Processing” region of the touch screen display periodically to indicate the progress of the CAD processing.  
         [0070]     When the “Stop” button is pressed by a technician, the system aborts scanning of the current case, but continues CAD processing on any cases already entered into the system.  
         [0071]     When CAD results for a case are available, Server 1  saves the results to the case database. A results page is then generated and printed on the color laser printer. The ordering of the results pages on the printer is the same order as the films sets fed into the film scanner. This allows the technician to take the two stacks (films and printouts) to a viewing station for loading, or easily distribute films and results pages to case files.  
         [0072]      FIGS. 17-19  show sample results pages. Each has several useful features. For instance, the top of each results page contains a unique barcode generated for that case by Server 1 . The barcode quickly associates the results page with a results file for that case stored in Server 1 . The printout serves as a receipt that CAD has been performed on the displayed film set.  
         [0073]     Below the barcode are left and right headers. The left header indicates whether the results page was generated with “Marks On” or “Marks Off.” For instance, in  FIG. 17 , the caption “Marks Disabled” indicates that this results page was generated without any indication of the CAD results for the case. In  FIG. 18 , the caption “2 Marks Found” indicates that the results page was generated with CAD results indicated. The two marks are indicated, respectively on the RCC and RMLO images printed on the results sheet. A solid red line surrounding a region (such as shown in  FIG. 18 ) indicates a suspicious density. A dashed red line (not shown in  FIG. 18 ) outlines a suspicious architectural distortion, and a dotted red line (also not shown in  FIG. 18 ) outlines a calcification. In  FIG. 19 , the caption “No Marks Found” indicates that CAD processing found no suspicious regions in the film set. Also, should the CAD processing be unable to successfully process a case, an error message “ERROR PROCESSING CASE” can be printed on the results page.  
         [0074]     The right header indicates the CAD software version used to process the film set, the clinic name, date and time of processing, and case number.  
         [0075]     The printout is preferably of suitable quality that it can be placed in the file to verify that CAD was used on the film set and the results obtained. In addition to header and results, the printout shows printed versions of the four film scans, each having a corresponding label data extracted from that film placed directly below it. The label is extracted from each image during CAD processing. A technician or radiologist can verify from this data that the films were properly loaded and that each belongs to the same patient.  
         [0076]     Returning briefly to  FIG. 13 , the last event indicated is a case request from a viewing station. When a viewing station reads a barcode from one of the printouts, it queries the CAD station for the case corresponding to that barcode. Server 1  searches its case database for the case, and if found, returns displayable film images, displayable label images, and CAD results symbology to the viewing station.  
         [0077]     Some embodiments are designed such that when the case storage database reaches a certain size, new cases begin to replace the oldest cases in the database. The oldest cases could simply be deleted, or moved to an off-system archive database. Also, when two or more CAD stations operate in the same clinic, the requested case may be valid but not stored on this CAD station. In all of these cases, the CAD station would respond to the viewing station that the requested case is not in the system.  
         [0000]     Viewing Station Load Cases Mode  
         [0078]     The viewing station has two basic modes of user operation, a “Load Cases” mode and a “View Cases” mode. The Load Cases mode will be explained first.  
         [0079]      FIG. 16  shows the basic user events that can be initiated by a technician during case loading.  FIGS. 20-24  illustrate the appearance of the viewing station display during or after certain of these events, and will be referred to as necessary.  
         [0080]      FIG. 20  shows the Load Cases screen when no cases are loaded into the viewing station, and  FIG. 21  shows the same screen with cases loaded. A central region displays numbered “panels” corresponding to cases loaded in the system, and resembles the numbered panels of a film multi-viewer. A slider bar at the right of the central panel display can be manipulated to cause scroll events that change the three panels currently visible in the display. Note that the region under the slider bar provides a visual indication of which panels are currently loaded with case data (a dark bar indicates a loaded panel) and which are empty. The number of “bars” in the slider bar region is configurable to match the maximum number of panels that can be loaded. Normally, this maximum number of panels is set to match the number of panels in a film multi-viewer to which the viewing station is attached.  
         [0081]     A row of buttons across the bottom of the display can be selected with a mouse to cause most of the other events in  FIG. 16 .  
         [0082]     A user can step through the panels using scroll events, generate either by grabbing the slider bar with the mouse and sliding it, or by manipulating the mouse scroll wheel. As the panels are scrolled, the middle of the three visible panels becomes the active panel which is controlled using many of the buttons at the screen bottom.  
         [0083]     In Load Cases mode, barcode scanner  330  is activated. One method of coordinating CAD results loading with loading of a film multi-viewer is to load the film set on a panel of the multi-viewer, and then run the corresponding CAD results sheet for that film set under the barcode laser scanner to cause a  FIG. 16  barcode read event. The viewing station responds to the barcode read event by noting the barcode case number and then querying the CAD station for that case number. If more than one CAD station exists in the system, or some CAD results are stored on a separate file server, the viewing station may have to issue the request to multiple sources in order to locate the case. Once found, however, the viewing station receives the case from the CAD server and stores it in flash memory, keyed to the current panel number.  
         [0084]     When the case has been loaded, the small panel display for the current panel (with a brighter border to indicate that it is the active panel) is updated with a date and case number, a patient label from a non-blank film, and a thumbnail for each of the four films stored in the case file. Finally, the current panel is incremented and scrolled to prepare the system for a next barcode read event. In some embodiments, when the current panel is incremented a message can also be sent to the controller of a coupled film multi-viewer, allowing the film multi-viewer to advance to a next panel as well.  
         [0085]     A technician can use the buttons at the bottom of the display to further control loading options. The “Clear All Panels” button creates an event that first queries the user for confirmation, and upon confirmation removes all currently loaded cases, restoring the system display to that shown in  FIG. 20 . The “Clear Panel” button creates an event that removes any case data associated with the current panel (for instance panel  5  in  FIG. 21 ), e.g., in the event of a loading sequence error.  
         [0086]     The next two buttons change the film order to correspond with radiologist preferences, and affect all loaded cases. The “Swap MLO &amp; CC” button reverses the current ordering of CC and MLO views in the panel display (and radiologist display), as shown in  FIG. 22 . The “Swap Left &amp; Right” button reverses the current ordering of left/right breast image display, for both the CC and MLO views, as shown in  FIG. 23 . By creating both events, a technician can perform both swaps to produce the display order shown in  FIG. 24 .  
         [0087]     The “Print Case” and “Print Report” buttons cause events that send a request to print case information to the CAD server that holds the full case data.  
         [0088]     Finally, the “View Cases” button switches the viewing station out of Load Cases mode and into View Cases mode, with the current panel as the displayed panel in View Case mode.  
         [0089]     Other control arrangements exist in other embodiments. For instance, instead of the swap display buttons, a single options button can activate a pop-up control panel with various display options. In one embodiment, the pop-up control panel also allows the user to set the number of panels.  
         [0090]     Viewing Station View Mode  
         [0091]      FIG. 25  shows the basic user events that can be initiated by a radiologist during case viewing.  FIGS. 26-32  illustrate the appearance of the viewing station display during or after certain of these events, and will be referred to as necessary.  
         [0092]      FIG. 26  shows a basic View Cases display screen. Dark colors predominate on the display screen so as not to negatively affect a radiologist&#39;s vision in a darkened film reading room. The upper header displays the current panel, date, and case number. The center of the display screen is filled with digitized film images for the current panel, displayed in whatever order was selected in Load Images mode. The bottom of the display contains clickable buttons that the radiologist can manipulate to operate the display.  
         [0093]     The radiologist can choose to show or hide the labels extracted from the four films, which identify the patient. To toggle, e.g., between the views of  FIGS. 26 and 27 , the radiologist clicks the show patient ID button ( FIG. 26 ) or the hide patient ID button ( FIG. 27 ), which appear in the same location in the display and change depending on the current label display mode.  
         [0094]     The radiologist navigates through the loaded panels using mouse click and/or mouse wheel events. A mouse click event that is not on one of the clickable buttons or a mouse wheel rotate down event cause the same response. If marks are hidden, like in  FIG. 27 , the display is changed to one like  FIG. 29  to show marks using the same symbology used on the CAD results printouts. Note that if no marks were found, labels “NO MARKS” are prominently displayed ( FIG. 28 ) across the film images in show marks mode, so that the radiologist does not need to search the images for marks that are not there. Similarly, should a CAD processing error occur on an image, labels “ERROR PROCESSING CASE” are prominently displayed on the image.  
         [0095]     If marks are already displayed on the current panel, a mouse click or mouse wheel rotate down event advances the display to the next occupied panel and displays the images without marks. A mouse wheel rotate up event advances the display backwards to the previous occupied panel. This ability allows the radiologist to easily navigate through the loaded panels using single clicks without having to aim and click the mouse on a button each time.  
         [0096]     Mouse manipulation can also be defined to cause other display behavior. For instance, the viewing station can be set to a mode (not shown) that zooms in on an area of a digitized film image when that area is pointed to and clicked or “boxed” by a radiologist.  
         [0097]     The radiologist can also toggle between showing and hiding marks using the “Show Marks” button ( FIG. 27 ) when marks are hidden and the “Hide Marks” button ( FIG. 29 ) when marks are visible to toggle the marks and the button text.  
         [0098]     The Quick View button allows a radiologist to quickly navigate to a particular loaded case, or load an unloaded case, using a CAD results printout with a barcode. When the “Quick View” button is selected, the barcode scanner is activated (it is normally deactivated in View Mode to reduce stray light) until a single barcode is passed under the barcode scanner. The viewing station then locates the corresponding panel, or requests the case from the CAD station if it is not loaded, and then places that case on the display.  
         [0099]     The radiologist can also access the Load Panels functionality using the Load Panels button. Finally,  FIGS. 30-32  correspond to  FIGS. 22-24 , respectively, showing the different film arrangements possible by changing display modes in the Load Panels function.  
         [0100]     Other modes of panel navigation are possible. For instance, if the film multi-viewer has a serial or other electronic output indicating when panels are advanced, that output can be connected to the viewing station to step the CAD view at the same time. Another possibility would be to have the CAD viewing station instruct the film multi-viewer to step when the viewing station steps. A separate button (not shown) will appear on the display when the CAD viewing station has an established communication link with a film multi-viewer. When the film multi-viewer and CAD viewing station are not slaved to each other, the button text reads “Attach Viewer.” When the film multi-viewer and CAD viewing station are synchronized, the button text reads “Detach Viewer.” 
         [0101]     As shown in  FIG. 25 , when an operator selects the Attach/Detach Viewer button, an Attach/Detach Viewer button event is generated. This event toggles the button text, and toggles the synchronization state of the system. When the film multi-viewer and CAD viewing station are not synchronized, an initialization sequence will be communicated with the multi-viewer, allowing the CAD viewing station to advance to the current film panel and receive further panel navigation messages from the multi-viewer. When the film multi-viewer and CAD viewing station are synchronized, the CAD viewing station will change state such that it ignores panel navigation messages from the multi-viewer, and will not send panel navigation messages to the multi-viewer.  
         [0102]     When the film multi-viewer and CAD viewing station are synchronized, panel navigation messages are communicated between the CAD viewing station embedded computer and a controller in the film multi-viewer. When an operator selects a new panel on the film multi-viewer, the multi-viewer controller sends a notification message to the embedded computer, creating a viewer message received event as shown in  FIG. 25 . The CAD viewing station responds to this event by advancing to the same panel of CAD images. Also, when an operator navigates to a following or preceding occupied panel loaded on the CAD viewing station, a notification message is sent to the film multi-viewer controller. The controller can then advance the film multi-viewer to display the films corresponding to the currently displayed CAD images.  
         [0103]     Although described and shown for the viewing station view mode, synchronization between the CAD viewing station and film multi-viewer can be activated in similar fashion in the load cases mode.  
         [0104]     Although some embodiments of representative CAD systems, components, and methods have been described, many other additional or alternative features are possible. For instance, although the CAD station described requires four properly ordered films for each case, alternative embodiments can detect and correct film order/orientation. When labels are extracted by the CAD algorithms, the labels can be cross-checked to automatically verify that they belong to the same patient. Optical character recognition can also be used to retrieve identifying information directly from the film labels. Although the described process is “stickerless,” an alternate embodiment could generate one or more stickers to be applied directly to a film. Preferred embodiments use a laser barcode scanner mounted to the back of a CAD display, but other possibilities exist. Other types of barcode scanners, such as charge-coupled-device scanners, can be used. The scanner itself can be mounted in other embodiments within the display case, mounted to the bottom, front, or side of the display case, or possibly even on some part of the display arm.  
         [0105]     The preceding embodiments are exemplary. Although the specification may refer to “an,” “one,” “another,” or “some” embodiment(s) in several locations this does not necessarily mean that each such reference is to the same embodiment(s), or that the feature only applies to a single embodiment.