const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// ─── Fetch images as base64 ───────────────────────────────────────────────────
const imageUrls = [
  "https://cdn.orris.care/cdss_images/63ec402be6773d3bcbacfe0c2e03bd7177a03bdf5f72cd29a2242a470095dbe3.png", // CC+MLO screening mammogram
  "https://cdn.orris.care/cdss_images/6a99cca715592e5a6353178ceb0c7c4ffb2cdc0c58db90cfa00656c2cae7867d.png", // O'clock lesion localisation
  "https://cdn.orris.care/cdss_images/0c49d18a63e987617a125718f66e6edc3a3b5bc20a14c2c45d451c0ed1d96c7e.png", // Screening + US cyst BIRADS 2
  "https://cdn.orris.care/cdss_images/464ec36ed2f09b6a57ebea0eb71097cb040ac2a0fa40eb085c00445befc41228.png", // CESM CC+MLO architectural distortion
  "https://cdn.orris.care/cdss_images/3a80620441565bdc352639d87c074e4946f2cfafd944ca60653348d706209016.png", // CESM recombined IDC
  "https://cdn.orris.care/cdss_images/b0e7ac4dfaa8b903494b8a9a017b9b93ecb3dd39cfb73fa75af4c7e8e1dd39cf.png", // Breast density comparison
  "https://cdn.orris.care/cdss_images/3a50c239aefc37202d31437732e94d88069923f12bed284cb5a6b0dc7c9c30f9.png", // US BIRADS 5 irregular mass
  "https://cdn.orris.care/cdss_images/175a4ed28b76544aafae0d9fdb95fba7550e0f5f88b37418e36e6056c4cc4b60.png", // US malignant lesions 4-panel
];

console.log("Fetching images...");
let images = [];
try {
  images = JSON.parse(
    execSync(
      `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
      { maxBuffer: 50 * 1024 * 1024 }
    ).toString()
  );
} catch (e) {
  console.log("Image fetch error:", e.message);
  images = imageUrls.map(u => ({ url: u, base64: null, error: e.message }));
}

const imgMap = {};
images.forEach(img => { imgMap[img.url] = img; });

function addImg(slide, url, x, y, w, h) {
  const img = imgMap[url];
  if (img && img.base64 && !img.error) {
    slide.addImage({ data: img.base64, x, y, w, h });
  }
}

// ─── Color palette (deep navy + teal accent + warm gold) ─────────────────────
const C = {
  navy:     "0D1B2A",
  teal:     "1B8CA3",
  tealDark: "136478",
  gold:     "E8A838",
  white:    "FFFFFF",
  offWhite: "F0F4F7",
  lightGray:"D8E4EC",
  text:     "1A2B3C",
  subText:  "4A6070",
};

const pres = new pptxgen();
pres.layout = "LAYOUT_WIDE"; // 13.3 x 7.5 in
pres.title  = "Mammography & BI-RADS – MD Radiodiagnosis 2025";
pres.author = "MD Radiology Lecture Series";

// ══════════════════════════════════════════════════════════════════════════════
// HELPER FUNCTIONS
// ══════════════════════════════════════════════════════════════════════════════

function titleSlide(title, subtitle) {
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  // Teal accent strip
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 5.92, w: 13.3, h: 0.06, fill: { color: C.gold }, line: { color: C.gold } });
  // Title
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    x: 0.8, y: 1.8, w: 11.7, h: 1.8,
    fontSize: 44, bold: true, color: C.white,
    fontFace: "Calibri", align: "center", valign: "middle",
  });
  // Subtitle
  s.addText(subtitle, {
    x: 0.8, y: 3.9, w: 11.7, h: 0.8,
    fontSize: 22, color: C.teal, fontFace: "Calibri",
    align: "center", valign: "middle",
  });
  // Footer
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    x: 0.5, y: 6.6, w: 12.3, h: 0.4,
    fontSize: 13, color: C.lightGray, fontFace: "Calibri", align: "center",
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  return s;
}

function sectionTitle(heading, colorBg) {
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    fontSize: 38, bold: true, color: C.white,
    fontFace: "Calibri", align: "center", valign: "middle",
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}

function contentSlide(title, bullets, opts = {}) {
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  // Top header bar
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    fontSize: 26, bold: true, color: C.white, fontFace: "Calibri",
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    options: {
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      color: C.text,
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    valign: "top",
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  if (opts.imgUrl) {
    addImg(s, opts.imgUrl, 7.8, 1.4, 5.1, 5.5);
    // Caption
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      s.addText(opts.caption, {
        x: 7.8, y: 6.95, w: 5.1, h: 0.35,
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}

function imageContentSlide(title, leftBullets, imgUrl, caption, imgUrl2) {
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  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: C.offWhite }, line: { color: C.offWhite } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 1.1, fill: { color: C.navy }, line: { color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 1.1, w: 13.3, h: 0.07, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText(title, {
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    fontSize: 26, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0,
  });

  const bItems = leftBullets.map((b, i) => ({
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    options: {
      bullet: { code: "25CF", color: C.teal },
      breakLine: i < leftBullets.length - 1,
      fontSize: 17, color: C.text, fontFace: "Calibri", paraSpaceAfter: 5,
    }
  }));
  s.addText(bItems, { x: 0.4, y: 1.35, w: 5.9, h: 5.8, valign: "top" });

  if (imgUrl2) {
    addImg(s, imgUrl, 6.5, 1.35, 6.4, 2.6);
    addImg(s, imgUrl2, 6.5, 4.15, 6.4, 2.6);
    if (caption) {
      s.addText(caption, {
        x: 6.5, y: 7.1, w: 6.4, h: 0.3,
        fontSize: 10, color: C.subText, italic: true, align: "center",
      });
    }
  } else {
    addImg(s, imgUrl, 6.5, 1.35, 6.4, 5.8);
    if (caption) {
      s.addText(caption, {
        x: 6.5, y: 7.15, w: 6.4, h: 0.28,
        fontSize: 10, color: C.subText, italic: true, align: "center",
      });
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  }
  s.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.2, fill: { color: C.navy }, line: { color: C.navy } });
  return s;
}

function tableSlide(title, headers, rows, note) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: C.offWhite }, line: { color: C.offWhite } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 1.1, fill: { color: C.navy }, line: { color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 1.1, w: 13.3, h: 0.07, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText(title, {
    x: 0.4, y: 0.1, w: 12.5, h: 0.9, fontSize: 26, bold: true, color: C.white,
    fontFace: "Calibri", valign: "middle", margin: 0,
  });

  const tableData = [];
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    text: h,
    options: { bold: true, fontSize: 14, color: C.white, fill: C.tealDark, fontFace: "Calibri", align: "center", valign: "middle" }
  })));
  rows.forEach((row, ri) => {
    tableData.push(row.map((cell, ci) => ({
      text: cell,
      options: {
        fontSize: 13, fontFace: "Calibri", color: C.text,
        fill: ri % 2 === 0 ? "EEF4F7" : C.white,
        bold: ci === 0,
        align: ci === 0 ? "center" : "left",
        valign: "middle",
      }
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  s.addTable(tableData, {
    x: 0.4, y: 1.25, w: 12.5,
    rowH: 0.55,
    border: { type: "solid", color: C.lightGray, pt: 0.5 },
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      fontSize: 11, italic: true, color: C.subText, fontFace: "Calibri",
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function biradsCategorySlide(cat, assessment, ppv, mgmt, color, detail) {
  const s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 13.3, h: 7.5, fill: { color: C.offWhite }, line: { color: C.offWhite } });
  // Left accent panel
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 3.5, h: 7.5, fill: { color: color }, line: { color: color } });
  // Category number
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    x: 0, y: 1.8, w: 3.5, h: 2.8,
    fontSize: 80, bold: true, color: C.white, fontFace: "Calibri",
    align: "center", valign: "middle", margin: 0,
  });
  s.addText("BI-RADS", {
    x: 0, y: 4.4, w: 3.5, h: 0.5,
    fontSize: 16, color: C.white, fontFace: "Calibri", align: "center", margin: 0,
  });
  // Top bar
  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 0, w: 9.8, h: 1.1, fill: { color: C.navy }, line: { color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x: 3.5, y: 1.1, w: 9.8, h: 0.07, fill: { color: C.gold }, line: { color: C.gold } });
  s.addText(assessment, {
    x: 3.7, y: 0.1, w: 9.4, h: 0.9,
    fontSize: 24, bold: true, color: C.white, fontFace: "Calibri", valign: "middle", margin: 0,
  });
  // PPV badge
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    x: 3.7, y: 1.3, w: 3.2, h: 0.65,
    fill: { color: color }, line: { color: color }, rectRadius: 0.1,
  });
  s.addText(`Malignancy: ${ppv}`, {
    x: 3.7, y: 1.3, w: 3.2, h: 0.65,
    fontSize: 14, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle", margin: 0,
  });
  // Management box
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    x: 7.2, y: 1.3, w: 5.7, h: 0.65,
    fill: { color: C.navy }, line: { color: C.navy }, rectRadius: 0.1,
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  s.addText(`Management: ${mgmt}`, {
    x: 7.2, y: 1.3, w: 5.7, h: 0.65,
    fontSize: 14, bold: true, color: C.gold, fontFace: "Calibri", align: "center", valign: "middle", margin: 0,
  });
  // Detail bullets
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    text: b,
    options: {
      bullet: { code: "25B6", color: color },
      breakLine: i < detail.length - 1,
      fontSize: 17, color: C.text, fontFace: "Calibri", paraSpaceAfter: 6,
    }
  }));
  s.addText(dItems, { x: 3.7, y: 2.15, w: 9.2, h: 5.0, valign: "top" });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 7.3, w: 13.3, h: 0.2, fill: { color: C.navy }, line: { color: C.navy } });
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}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ══════════════════════════════════════════════════════════════════════════════
titleSlide(
  "MAMMOGRAPHY & BI-RADS",
  "Principles • Technique • 2025 ACR Classification\nMD Radiodiagnosis Lecture Series"
);

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — LEARNING OBJECTIVES
// ══════════════════════════════════════════════════════════════════════════════
contentSlide("Learning Objectives", [
  "Understand the physics and technique of mammography (FFDM, DBT, CESM)",
  "Describe standard mammographic projections and indications",
  "Apply the ACR BI-RADS breast composition categories (A–D)",
  "Recognise and describe masses, calcifications, asymmetries & architectural distortion using BI-RADS lexicon",
  "Assign correct BI-RADS final assessment categories (0–6) per 2025 ACR criteria",
  "Formulate appropriate management recommendations based on BI-RADS category",
  "Recognise imaging features of breast malignancy on mammography and ultrasound",
  "Know indications and role of supplemental imaging (US, MRI, CESM)",
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION: INTRODUCTION
// ══════════════════════════════════════════════════════════════════════════════
sectionTitle("SECTION 1\nIntroduction to Mammography");

// SLIDE 3 — What is Mammography
contentSlide("What is Mammography?", [
  "Low-dose X-ray imaging of the breast — the primary modality for breast cancer screening",
  "Detects cancers 1–4 years before they are clinically palpable",
  "Reduces breast cancer mortality by ~20–40% in screened populations (RCT evidence)",
  "Two types:",
  "   Screening mammography: asymptomatic women, at least 2 views per breast (CC + MLO)",
  "   Diagnostic mammography: symptomatic patients or recalls from screening (BI-RADS 0)",
  "Standard views: Craniocaudal (CC) + Mediolateral Oblique (MLO)",
  "Compression paddle used to reduce thickness, decrease radiation dose, reduce blur",
  "Current standard: Full-Field Digital Mammography (FFDM) — superior image quality vs. film-screen",
],
{ imgUrl: "https://cdn.orris.care/cdss_images/63ec402be6773d3bcbacfe0c2e03bd7177a03bdf5f72cd29a2242a470095dbe3.png",
  caption: "Fig 1. Bilateral CC (left) and MLO (right) screening mammogram views" });

// SLIDE 4 — Indications
contentSlide("Indications for Mammography", [
  "SCREENING (asymptomatic):",
  "   Average risk: Annual from age 40 (ACR 2024 guidelines; ACS 40-44 optional, 45+ annual)",
  "   High risk (BRCA1/2, strong FH): Annual from age 30 + annual MRI",
  "   Women 40–49: Individualized decision-making; shared decision with clinician",
  "DIAGNOSTIC:",
  "   Palpable breast lump or thickening (age >30)",
  "   Nipple discharge (spontaneous, unilateral, blood-stained)",
  "   Skin or nipple changes (dimpling, retraction, Paget's disease)",
  "   Recalled from screening (BI-RADS 0) — needs further views or US",
  "   Post-treatment follow-up / monitoring implants",
  "CONTRAINDICATIONS: pregnancy is relative (low dose); use clinical judgment",
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 2: TECHNIQUE & PROJECTIONS
// ══════════════════════════════════════════════════════════════════════════════
sectionTitle("SECTION 2\nTechnique & Mammographic Projections");

// SLIDE 5 — Standard Projections
imageContentSlide(
  "Standard & Special Mammographic Views",
  [
    "STANDARD VIEWS (all screening exams):",
    "CC (Craniocaudal): X-ray beam travels top to bottom; shows medial & lateral breast",
    "MLO (Mediolateral Oblique): ~45° angled; shows posterior tissue & axillary tail",
    "ADDITIONAL DIAGNOSTIC VIEWS:",
    "Spot compression: evaluates focal asymmetry / mass margins",
    "Magnification view: characterises microcalcifications (morphology & distribution)",
    "Lateral view (ML/LM): confirms lesion plane, distinguishes real lesion from overlap",
    "Rolled views: resolves asymmetric density (tissue superimposition vs. true lesion)",
    "Cleavage view: evaluates posteromedial lesions",
    "Tangential view: skin lesions, palpable areas",
  ],
  "https://cdn.orris.care/cdss_images/6a99cca715592e5a6353178ceb0c7c4ffb2cdc0c58db90cfa00656c2cae7867d.png",
  "Fig 2. Lesion localisation using o'clock notation (physician facing patient). Orange = left breast."
);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 3: MAMMOGRAPHIC MODALITIES
// ══════════════════════════════════════════════════════════════════════════════
sectionTitle("SECTION 3\nAdvanced Mammographic Modalities");

// SLIDE 6 — DBT (Tomosynthesis)
contentSlide("Digital Breast Tomosynthesis (DBT)", [
  "X-ray tube moves in an arc (~15–50°) acquiring multiple low-dose images → reconstructed as 1 mm slices",
  "Dramatically reduces tissue superimposition — the main source of false positives and false negatives on 2D",
  "ADVANTAGES over FFDM:",
  "   Cancer detection rate: +1.2 cancers per 1,000 exams (retrospective studies)",
  "   Recall rate: reduced 15–65% (fewer false positives)",
  "   Architectural distortion: significantly better detected on DBT than FFDM",
  "   Asymmetries: recall rate lower for DBT vs. FFDM (13.3% vs. 32.3%)",
  "LIMITATIONS: increased acquisition time, longer reading time",
  "2025 status: Rapidly becoming standard of care — most new mammography installations are DBT-capable",
  "C-View / Synthesized 2D: reconstructed 2D image from DBT data — reduces total radiation dose",
]);

// SLIDE 7 — CESM
imageContentSlide(
  "Contrast-Enhanced Spectral Mammography (CESM)",
  [
    "Iodinated IV contrast + FFDM; leverages tumor angiogenesis (leaky vessels enhance)",
    "Two exposures per view: low-energy (like standard mammo) + high-energy → subtraction = recombined image",
    "Acquired at 2 minutes post-contrast injection; CC + MLO views bilaterally",
    "Sensitivity improvement: >20% in dense breasts vs. standard 2D",
    "Equal sensitivity to MRI; no significant difference in tumor sizing vs. MRI",
    "Faster: 6.5 minutes vs. 29+ minutes for MRI",
    "ADVANTAGES: detects lesions masked by dense tissue; useful when MRI contraindicated",
    "INDICATIONS: Dense breasts, discordant mammo/US, staging, neoadjuvant monitoring",
    "FALSE NEGATIVES: mucinous carcinomas, lobular (subtle enhancement); incomplete FOV",
  ],
  "https://cdn.orris.care/cdss_images/464ec36ed2f09b6a57ebea0eb71097cb040ac2a0fa40eb085c00445befc41228.png",
  "Fig 3A. Screening CC+MLO showing architectural distortion (circle). Fig 3B. CESM recombined images showing 1.6 cm spiculated enhancing mass — Grade 1 IDC.",
  "https://cdn.orris.care/cdss_images/3a80620441565bdc352639d87c074e4946f2cfafd944ca60653348d706209016.png"
);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 4: BI-RADS LEXICON
// ══════════════════════════════════════════════════════════════════════════════
sectionTitle("SECTION 4\nACR BI-RADS Lexicon & Reporting");

// SLIDE 8 — What is BI-RADS
contentSlide("ACR BI-RADS: Overview", [
  "Breast Imaging Reporting and Data System (BI-RADS) — published by the American College of Radiology (ACR)",
  "Purpose: Standardise mammography interpretation, reduce variability, guide management",
  "Current edition: BI-RADS 5th Edition (2013); 2025 updates under ACR revision process",
  "BI-RADS Atlas covers: Mammography | Ultrasound | MRI",
  "Every mammogram report must include:",
  "   1. Breast composition/density category (A, B, C, D)",
  "   2. Description of any findings using BI-RADS lexicon",
  "   3. Comparison with prior studies",
  "   4. Final assessment category (0–6)",
  "   5. Management recommendation",
  "Standardised lexicon prevents ambiguous terms (e.g. 'probably benign' without category assignment)",
]);

// SLIDE 9 — BREAST DENSITY TABLE
tableSlide(
  "BI-RADS Breast Composition (Density) Categories",
  ["Category", "Description", "Masking Risk", "Clinical Significance"],
  [
    ["A", "Almost entirely fatty (< 25% glandular tissue)", "Very low", "Highest mammographic sensitivity (~98%)"],
    ["B", "Scattered areas of fibroglandular density (25–50%)", "Low", "Minor masking; good sensitivity"],
    ["C", "Heterogeneously dense (51–75%)\n— may obscure small masses", "Moderate", "Supplemental imaging considered in some guidelines"],
    ["D", "Extremely dense (> 75%)\n— lowers sensitivity of mammography", "High", "Many states mandate patient notification; consider US/MRI"],
  ],
  "Categories A & B: routine mammographic screening. Categories C & D: supplemental screening may be considered per 2024 ACR/SBI guidance."
);

// SLIDE 10 — MASSES
contentSlide("BI-RADS Lexicon: Masses", [
  "A MASS is a space-occupying 3-dimensional lesion seen on two different projections",
  "SHAPE:",
  "   Oval / Round → favours benign (fibroadenoma, cyst)",
  "   Irregular → increases suspicion for malignancy",
  "MARGIN:",
  "   Circumscribed (well-defined): low suspicion",
  "   Obscured: partially hidden by superimposed tissue",
  "   Microlobulated: mild suspicion",
  "   Indistinct (ill-defined): moderate suspicion",
  "   Spiculated: HIGH suspicion — classic for invasive carcinoma",
  "DENSITY:",
  "   High density > equal density > low density > fat-containing (lipoma, hamartoma, oil cyst)",
  "Typical benign: oval, circumscribed, equal/low density mass",
  "Classic malignant: irregular, spiculated, high-density mass",
],
{ imgUrl: "https://cdn.orris.care/cdss_images/0c49d18a63e987617a125718f66e6edc3a3b5bc20a14c2c45d451c0ed1d96c7e.png",
  caption: "Fig 4. Oval circumscribed mass on mammo; US confirmed simple cyst — BI-RADS 2",
  fontSize: 16 });

// SLIDE 11 — CALCIFICATIONS
contentSlide("BI-RADS Lexicon: Calcifications", [
  "TYPICALLY BENIGN (do NOT describe further or biopsy):",
  "   Skin | Vascular | Coarse/popcorn (fibroadenoma) | Large rod-like (secretory)",
  "   Round | Lucent-centred | Eggshell/rim | Milk of calcium | Suture | Dystrophic",
  "SUSPICIOUS MORPHOLOGY (BI-RADS 4/5):",
  "   Amorphous: small/indistinct — mildly suspicious (low-suspicion BI-RADS 4B)",
  "   Coarse heterogeneous: irregular >0.5 mm, intermediate suspicion",
  "   Fine pleomorphic: varying size/shape, no linear component — intermediate-high suspicion",
  "   Fine linear/branching (casting): irregular rod-like, branching — HIGH suspicion for high-grade DCIS",
  "DISTRIBUTION (from least to most suspicious):",
  "   Diffuse → Regional → Grouped/Clustered → Linear → Segmental",
  "Magnification views (0.1 mm pixel, 1.5-2× geometric magnification) essential for characterisation",
]);

// SLIDE 12 — ASYMMETRIES & ARCHITECTURAL DISTORTION
contentSlide("BI-RADS Lexicon: Asymmetries & Architectural Distortion", [
  "ASYMMETRY TYPES:",
  "   Asymmetry: one view only, no mass/distortion/calcification — usually summation artefact",
  "   Global asymmetry: > 1 quadrant, present on 2 views — usually benign (normal variant)",
  "   Focal asymmetry: < 1 quadrant on 2 views — requires additional workup",
  "   Developing asymmetry: NEW or enlarging focal asymmetry — HIGH suspicion (BI-RADS 4/5)",
  "ARCHITECTURAL DISTORTION:",
  "   Radiating lines or retraction without a central mass",
  "   Causes: post-surgical scar, fat necrosis, radial scar, invasive carcinoma (especially lobular)",
  "   On DBT: significantly improved detection vs. FFDM; PPV3 ~26% for biopsy",
  "   Any distortion — even on one DBT view only — warrants further workup",
  "   Workup: additional mammographic views (CC/MLO spot compression) + ultrasound",
  "   If no US correlate: tomosynthesis-guided biopsy may be required",
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 5: BI-RADS CATEGORIES
// ══════════════════════════════════════════════════════════════════════════════
sectionTitle("SECTION 5\nBI-RADS Final Assessment Categories\n(ACR 2025)");

// SLIDE 13 — BIRADS OVERVIEW TABLE
tableSlide(
  "ACR BI-RADS Final Assessment — Quick Reference (2025)",
  ["Category", "Assessment", "Probability of Malignancy", "Management"],
  [
    ["0", "Incomplete", "N/A", "Additional imaging / prior films needed"],
    ["1", "Negative", "Essentially 0%", "Routine annual screening"],
    ["2", "Benign", "Essentially 0%", "Routine annual screening"],
    ["3", "Probably Benign", ">0% – ≤2%", "6-month short-interval follow-up"],
    ["4A", "Low Suspicion", ">2% – ≤10%", "Tissue biopsy"],
    ["4B", "Intermediate Suspicion", ">10% – ≤50%", "Tissue biopsy"],
    ["4C", "Moderate-High Suspicion", ">50% – <95%", "Tissue biopsy"],
    ["5", "Highly Suggestive of Malignancy", "≥95%", "Biopsy / surgical treatment"],
    ["6", "Known Biopsy-Proven Malignancy", "N/A", "Surgical excision / definitive therapy"],
  ],
  "Source: ACR BI-RADS Atlas 5th Ed (2013); category thresholds validated and retained in 2025 ACR guidelines."
);

// SLIDE 14 — BIRADS 0 & 1
biradsCategorySlide(
  "0 & 1",
  "Incomplete   |   Negative",
  "0%",
  "Additional imaging  OR  Routine screening",
  "4A7B8C",
  [
    "CATEGORY 0 — Incomplete Assessment:",
    "Assigned at END of screening — patient needs additional workup before a final category can be given",
    "Reasons: recall for spot views, additional projections, compare with prior films",
    "After diagnostic workup → reassign to Category 1–5",
    "Should NOT be used as a final assessment in diagnostic mammography",
    "",
    "CATEGORY 1 — Negative:",
    "No abnormality detected; breasts are symmetric; no mass, distortion, or calcification",
    "Recommendation: Continue routine annual screening",
    "Both BI-RADS 1 and 2 carry essentially 0% probability of malignancy",
  ]
);

// SLIDE 15 — BIRADS 2
biradsCategorySlide(
  "2",
  "Benign Finding",
  "Essentially 0%",
  "Routine Annual Screening",
  "27AE60",
  [
    "Positive finding that is definitely benign — important to document but no action required",
    "Examples of BI-RADS 2 findings:",
    "   Simple cysts (confirmed on US: anechoic, circumscribed, posterior enhancement)",
    "   Lymph nodes — intramammary with fatty hilum",
    "   Calcified fibroadenoma (coarse/popcorn calcifications)",
    "   Vascular calcifications, skin calcifications",
    "   Fat-containing lesions: lipoma, hamartoma, oil cysts, galactocele",
    "   Stable asymmetry unchanged over 3+ years",
    "   Post-surgical clips (after benign excision)",
    "Reporting: Describe finding + state 'BI-RADS 2: Benign' with routine recall",
  ]
);

// SLIDE 16 — BIRADS 3
biradsCategorySlide(
  "3",
  "Probably Benign",
  ">0% – ≤2%",
  "6-month Short-Interval Follow-Up",
  "F39C12",
  [
    "High probability of being benign; short-term surveillance to confirm stability",
    "CLASSIC BI-RADS 3 FINDINGS (validated in prospective studies):",
    "   Non-calcified circumscribed oval/round solid mass (likely fibroadenoma)",
    "   Focal asymmetry without associated features",
    "   Solitary group of punctate calcifications (round, <5, clustered)",
    "FOLLOW-UP PROTOCOL:",
    "   Initial 6-month unilateral short-interval follow-up",
    "   Then 12-month bilateral mammogram",
    "   If stable at 2–3 years: upgrade to BI-RADS 1 or 2",
    "   If changes (increases in size, develops margins): upgrade to BI-RADS 4",
    "NOTE: BI-RADS 3 should NOT be used on a first screening mammogram without diagnostic workup",
    "BI-RADS 3 should be avoided in patients requesting biopsy for reassurance",
  ]
);

// SLIDE 17 — BIRADS 4 (A, B, C)
biradsCategorySlide(
  "4",
  "Suspicious — Tissue Biopsy Required",
  ">2% – <95%",
  "Image-Guided Core Needle Biopsy",
  "E74C3C",
  [
    "Subcategories 4A / 4B / 4C allow refined communication of suspicion level:",
    "",
    "BI-RADS 4A — Low Suspicion (>2% – ≤10%):",
    "   Partially circumscribed oval mass, clustered amorphous calcs, focal asymmetry",
    "   Palpable mass with benign US features; biopsy expected to be benign",
    "",
    "BI-RADS 4B — Intermediate Suspicion (>10% – ≤50%):",
    "   Partially indistinct margins, coarse heterogeneous calcs, microlobulated mass",
    "   Equal probability of benign vs. malignant",
    "",
    "BI-RADS 4C — Moderate-High Suspicion (>50% – <95%):",
    "   Irregular, indistinct mass without spiculation; fine pleomorphic clustered calcs",
    "   Fine linear/branching calcs in segmental distribution (DCIS pattern)",
    "Biopsy method: Stereotactic, US-guided, or MRI-guided core needle biopsy preferred",
  ]
);

// SLIDE 18 — BIRADS 5
biradsCategorySlide(
  "5",
  "Highly Suggestive of Malignancy",
  "≥95%",
  "Tissue Biopsy / Surgical Treatment",
  "8E1A0E",
  [
    "Classic features of malignancy — biopsy mandatory even if clinical suspicion is low",
    "CHARACTERISTIC FEATURES (any combination):",
    "   Spiculated, irregular, high-density mass",
    "   Irregular mass with associated fine linear/branching calcifications",
    "   Architectural distortion + associated irregular mass",
    "   Fine linear/branching calcifications in a segmental distribution",
    "   Developing, irregular, spiculated mass on serial imaging",
    "US correlation: taller-than-wide, irregular, angular/spiculated margins, posterior shadowing",
    "MANAGEMENT:",
    "   Core needle biopsy (14G or vacuum-assisted) before any surgery",
    "   Pre-operative wire/clip localisation or radio-guided SNLB planning",
    "   Staging workup if malignancy confirmed (CT chest/abdomen/pelvis, bone scan if indicated)",
  ]
);

// SLIDE 19 — BIRADS 6
biradsCategorySlide(
  "6",
  "Known Biopsy-Proven Malignancy",
  "N/A",
  "Surgical Excision / Definitive Therapy",
  "5D2366",
  [
    "Reserved for lesions with biopsy-proven malignancy BEFORE definitive treatment",
    "Category is assigned when imaging is performed for treatment planning or monitoring",
    "CLINICAL SCENARIOS:",
    "   Pre-operative assessment: localisation of known cancer before surgery",
    "   Neoadjuvant chemotherapy monitoring: serial imaging to assess treatment response",
    "   Staging additional ipsilateral or contralateral disease",
    "   Post-biopsy clip placement confirmation",
    "IMPORTANT POINTS:",
    "   BI-RADS 6 does NOT apply to post-surgery surveillance of treated patients",
    "   After surgery/treatment: reassign to BI-RADS 1–5 based on post-treatment findings",
    "   CESM and MRI are useful for neoadjuvant response assessment in BI-RADS 6 patients",
  ]
);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 6: IMAGING FEATURES OF MALIGNANCY
// ══════════════════════════════════════════════════════════════════════════════
sectionTitle("SECTION 6\nImaging Features of Breast Malignancy");

// SLIDE 20 — US features
imageContentSlide(
  "Ultrasound Features of Breast Malignancy",
  [
    "US is complementary to mammography — not a replacement for screening",
    "FEATURES SUSPICIOUS FOR MALIGNANCY:",
    "Taller-than-wide orientation (non-parallel to skin)",
    "Irregular shape with angular or spiculated margins",
    "Hypoechoic or heterogeneously hypoechoic echo pattern",
    "Posterior acoustic shadowing (desmoplastic reaction)",
    "Internal calcifications / micro-lobulations",
    "Disruption of surrounding tissue planes",
    "Associated skin thickening / nipple retraction",
    "Increased vascularity on Doppler (non-specific)",
    "BENIGN FEATURES (BI-RADS 3 on US):",
    "Oval, parallel, circumscribed, anechoic (simple cyst) or isoechoic mass",
  ],
  "https://cdn.orris.care/cdss_images/3a50c239aefc37202d31437732e94d88069923f12bed284cb5a6b0dc7c9c30f9.png",
  "Fig 5. US BI-RADS 5 — irregular, taller-than-wide mass with angular margins. BI-RADS 5 (malignant)."
);

// SLIDE 21 — Malignant lesion types
imageContentSlide(
  "Mammographic & US Features: Malignant Lesions",
  [
    "INVASIVE DUCTAL CARCINOMA (IDC) — most common (70-80%):",
    "Irregular, spiculated, high-density mass ± calcifications",
    "US: irregular, hypoechoic, posterior shadowing",
    "INVASIVE LOBULAR CARCINOMA (ILC):",
    "Architectural distortion without discrete mass (may be mammographically occult)",
    "MRI/CESM superior for detection",
    "DUCTAL CARCINOMA IN SITU (DCIS):",
    "Fine linear/branching or fine pleomorphic calcifications",
    "Segmental or linear distribution = high-grade DCIS",
    "MUCINOUS / MEDULLARY / PAPILLARY:",
    "May appear deceptively oval + circumscribed (low mammographic suspicion)",
    "US: heterogeneous internal echoes help distinguish from simple cyst",
  ],
  "https://cdn.orris.care/cdss_images/175a4ed28b76544aafae0d9fdb95fba7550e0f5f88b37418e36e6056c4cc4b60.png",
  "Fig 6. US — A: 25 mm irregular mass; B: 30 mm mass near implant; C: cancer with calcifications; D: 9 mm spiculated mass with posterior shadowing."
);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 7: SUPPLEMENTAL IMAGING
// ══════════════════════════════════════════════════════════════════════════════
sectionTitle("SECTION 7\nSupplemental Imaging & Special Situations");

// SLIDE 22 — Supplemental screening
contentSlide("Supplemental Imaging: Indications & Role", [
  "BREAST ULTRASOUND:",
  "   Evaluate palpable masses (women >30 yrs or any symptomatic patient)",
  "   Distinguish cyst vs. solid mass on mammography",
  "   Guide biopsy procedures (US-guided CNB is preferred where US visible)",
  "   Supplemental screening in dense breasts (BI-RADS C/D) — detects ~3 additional cancers/1000",
  "",
  "BREAST MRI:",
  "   Gold standard for staging; superior sensitivity (~90%) but lower specificity",
  "   Indications: BRCA carriers, annual screening from age 30; dense breasts with strong FH",
  "   Pre-surgical staging: detect multifocal/multicentric disease, contralateral cancer (5.7%)",
  "   Evaluate response to neoadjuvant chemotherapy",
  "   Differentiate scar from recurrence post-breast-conserving surgery",
  "   Mandatory: dedicated breast coil; IV gadolinium; BI-RADS lexicon assigned",
  "",
  "NOTE: MRI has high false-positive rate (30-40%) → may increase mastectomy rates without improved outcomes",
]);

// ══════════════════════════════════════════════════════════════════════════════
// SECTION 8: KEY MNEMONICS & EXAM TIPS
// ══════════════════════════════════════════════════════════════════════════════
sectionTitle("SECTION 8\nKey Mnemonics & Exam Pearls");

// SLIDE 23 — Exam Pearls
contentSlide("High-Yield Exam Pearls for MD Radiodiagnosis", [
  "BI-RADS 0 is NEVER a final assessment — always resolve to 1–5 after diagnostic workup",
  "BI-RADS 3 requires PRIOR diagnostic workup — not assigned at first visit without full evaluation",
  "Spiculated mass = BI-RADS 5 (≥95% malignancy) — always biopsy first before surgery",
  "Developing asymmetry = most important soft tissue finding — high PPV, do NOT ignore",
  "Fine linear/branching calcs in segmental distribution = high-grade DCIS → BI-RADS 4C/5",
  "Oval, circumscribed, parallel mass on US + mammography = likely fibroadenoma → BI-RADS 3",
  "DBT significantly improves detection of architectural distortion vs. 2D mammography",
  "Breast density category C or D → consider supplemental US or MRI",
  "BI-RADS 4A/B/C subcategories aid communication but share the same management: BIOPSY",
  "Mucinous/ILC/papillary cancers may appear deceptively benign on mammography — US + MRI often needed",
  "CESM = MRI alternative when gadolinium contraindicated or MRI not feasible",
]);

// SLIDE 24 — FINAL SUMMARY TABLE
tableSlide(
  "Summary: BI-RADS at a Glance — 2025 ACR",
  ["BI-RADS", "Probability Malignancy", "Action", "Example Findings"],
  [
    ["0", "N/A — Incomplete", "Recall / compare priors", "Screening abnormality needing workup"],
    ["1", "~0%", "Annual screen", "Normal mammogram"],
    ["2", "~0%", "Annual screen", "Simple cyst, calcified fibroadenoma"],
    ["3", "0–2%", "6-month follow-up", "Oval circumscribed solid mass, punctate calcs"],
    ["4A", "2–10%", "Core biopsy", "Partially circumscribed mass, amorphous calcs"],
    ["4B", "10–50%", "Core biopsy", "Microlobulated mass, coarse heterogeneous calcs"],
    ["4C", "50–95%", "Core biopsy", "Fine pleomorphic calcs, irregular-indistinct mass"],
    ["5", "≥95%", "Biopsy + staging", "Spiculated mass, fine linear/branching calcs"],
    ["6", "Confirmed", "Definitive Rx", "Known cancer, neoadjuvant monitoring"],
  ],
  "ACR BI-RADS 5th Edition (2013); 2025 revisions maintain category thresholds. Source: Fischer's Mastery of Surgery 8e, Bailey & Love 28e."
);

// SLIDE 25 — CLOSING
titleSlide(
  "THANK YOU",
  "Mammography & BI-RADS — MD Radiodiagnosis 2025\nQuestions & Discussion"
);

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