Analog & Digital: The Mammography Workflow Primer

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Workflow is the key driver of digital mammography investment. When implementing digital, be sure to analyze all aspects of the workflow efficiency equation - not just digital acquisition systems, but also human resources and scheduling patterns and ancillary systems such as workstations, reporting systems and CAD.

Efficient workflow is critical in mammography. From a financial perspective, mammography is notoriously under-reimbursed. The site that fails to implement optimal practices could go out of business. There is also the patient care element; women are nervous and want results - fast. Breast imaging centers across the country are turning to digital mammography for a variety of reasons, increasingly for the potential boosts in workflow efficiency. "The ability to manipulate images digitally reduces callbacks, which improves workflow and patient satisfaction," sums Sharon Chambers, site supervisor at Sarasota Memorial Health System (Sarasota, Fla.). Digital streamlines CAD with CAD images available at the click of a button and the extra mammogram digitization process completely bypassed.

Developing efficient digital workflow processes is a delicate operation; factors in the workflow equation include staffing processes and patterns as well as the digital mammography solution, information systems and workstations. Prior analog films are a reality, so sites need to develop a plan for handling comparisons, and image-viewing ergonomics can make or break the entire arrangement. Can radiologists efficiently and comfortably read analog and digital mammograms as well as multi-modality images?

It's no surprise that optimal digital workflow is a work in progress for many facilities. Still, a comprehensive evaluation of all phases of the mammography process can reveal a number of ways that sites can move closer to the promise of digital workflow.

  • Start with a thorough digital vision, from acquisition through display and archiving, and involve all key players, including radiologists, technologists, facility IT staff and even experts in refining workflow.
  • Develop efficient staffing assignments, scheduling and reporting patterns and processes.
  • Implement processes and systems to simplify analog to digital image reading and multi-modality and multi-vendor digital comparisons.

Conquering the dual environment

Many facilities using digital mammography operate in a dual environment with both analog and digital equipment, which can create workflow challenges. Take for example, Beth Israel Deaconness Medical Center in Boston. The center has operated in a dual environment since 2002 with GE Healthcare and Hologic Inc.'s analog systems as well as GE's Senographe and Fischer Imaging's SenoScan digital solutions and iCAD's SecondLook CAD system.

"The dual environment is a challenge," confirms Janet Baum, MD, director of breast imaging at Beth Israel Deaconness. It's difficult to compare analog and digital mammograms, and in facilities with systems by multiple vendors, radiologists need to learn to comfortably read on different mammography systems and workstations (unless they utilize multimodality workstations).

"Digital systems are not interchangeable, so we try to keep our patients, especially screening patients, on one digital acquisition system," explains Baum. The center aims to smooth workflow with written protocols outlining what studies should be completed in specific locations. For example, if a patient requires a repeat study, a protocol should specify whether the repeat should be repeated on the same digital unit or an analog system. "The six-month follow-up is a problem," Baum notes. "We try to leave decisions up to the interpreting physicians and ask them to put recommendations in the report."

Elizabeth Wende Breast Clinic (Rochester, N.Y.) reports a similar situation. The facility primarily utilizes analog mammography systems by Hologic, GE and Siemens as well as R2 Technology's ImageChecker CAD. The clinic is headed in the digital direction with Fischer, GE, Hologic and Sectra digital mammography systems and a planned installation of a Sectra PACS. Currently, Elizabeth Wende Breast Clinic does not schedule patients by specific digital or analog units; however, Business Manager Tess Wade indicates that the clinic expects to schedule patients by unit in the future as it further implements digital mammography. This could aid workflow by limiting comparisons among mammograms generated by various digital systems.

In the interim,