When working at a high volume breast imaging provider, radiologists can’t afford speed bumps. But hiccups in workflow are inevitable when a radiologist is forced to constantly switch between different workstations, each with their own interfaces and controls. How can an imaging workflow be considered efficient with this kind of distraction bringing interpretation to a screeching halt?

That was the question asked by Radiology Regional Center, a diagnostic imaging provider with nine locations throughout Southwest Florida. Radiologists there had been tied to a dedicated mammography workstation, but viewing a patient’s full history of scans—including tomosynthesis, MRI and ultrasound—required the user to bounce back and forth from the dedicated mammography workstation and the main radiology PACS.

“It delayed the efficiency of really being able to read out the studies,” says Mary Kay Peterson, MD, Director of the Women's Imaging at Radiology Regional. “It’s not just different monitors—meaning ergonomically it wasn’t easy—it was cumbersome to have to load two different studies. It was a distraction, and the more distractions you have, the less sensitive and specific you are.”

Radiology Regional looked to its McKesson Radiology™ PACS to simplify and consolidate its workflow. Leveraging the latest version of McKesson Radiology Mammography Plus™, the vendor’s native embedded breast imaging workflow for full field digital mammography and digital breast tomosynthesis, the practice made the move to ditch the dedicated mammography workstation in an effort to increase efficiency.

“Most of us felt that it was hard at times to use [a dedicated mammography workstation] separate from our regular PACS, where we would have ultrasound, MRI and other information that would be pertinent to interpreting a mammogram,” says Margaret Taha, MD, an experienced radiologist with Radiology Regional. “As radiologists, we were happy to have everything in one location.”

All the modalities, all the functionality

Peterson and Taha say they understand the impulse to stick with the typical dedicated mammography workstation set up, but after considering the options, Radiology Regional found the added efficiency of having all prior studies and current updated tomosynthesis images in the same system made the switch a no-brainer. Plus, they found they didn’t have to sacrifice on functionality. McKesson bills its embedded Mammography Plus technology less as an integrated add-on for the McKesson PACS, and more as a robust breast imaging system built from the ground up.

Taha says this dedication to breast imaging workflow comes through in the functionality. Historical Similar Image Comparison, for example, allows the user to stack similarly oriented views into a single viewport, which Taha says makes practice efficient. “You just scroll through and you can look at all these other years very quickly.”

Other important functionality Radiology Regional gained in their PACS with the switch to McKesson Mammography Plus included sector zoom enhancements that eliminate manual zoom interaction, with support for multiple sector zoom maps. Dynamic cine tools allow users to embed cine mode tomosynthesis into display protocols. The system also has the capability to interface with industry computer aided detection vendors to extract breast density information and systematically present this information at a glance.

One of Taha’s favorite features is the BI-RADS “At a Glance” display, which shows BI-RADS assessment categories from prior year scans without needing to open individual reports. Color coding makes this process particularly efficient, she says. “I just glance and I see last year’s date and I see it’s green, meaning it was a benign reading last year, and I don’t necessarily have to read through the whole report.”

Scaling up

By bringing mammography reading in from the cold and embedding it in the PACS, Radiology Regional was able to eliminate some issues that had plagued the large practice. With numerous locations providing mammography, there was always the potential that one location might not be able to view all the annotations made by another location if a scan is not on the integrated PACS.

“It’s efficient to use it on one system and have it all work together,” says Peterson. “To have a platform that functions along with other systems but is also simple to use. You don’t want anything that makes your day hard or a struggle.”

Not having to manage separate systems is also a boon to the bottom line, according to Peterson. One of the big reasons Radiology Regional made the change in workflow was to save on IT expenses.

In the end, the ever-present dedication to value, a ubiquitous term across medicine these days, made the decision easier for Radiology Regional. In today’s environment, it’s no longer a debate of jack-of-all-trades versus a master of one, but instead providers will be looking for that master-of-all system to boost value.

“Once we were on McKesson and we got our protocol down—that’s the thing, you have to have your hanging protocol figured out—shortly after that we moved everything straight to McKesson,” says Taha.