Breast Imaging Workflow: Imaging and IT Bring Better Diagnosis

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Hologic's Selenia digital mammography system

When you factor together the one million women turning 40 every year, growing awareness of the importance of early detection for breast cancer and surging interest in digital mammography based on its validation by the National Cancer Society's Digital Mammographic Imaging Screening Trial (DMIST) — breast imaging is top of mind and the market is exploding. Everything on the spectrum from digital mammography and breast MRI to automated report generation and easier-to-use workstations are helping facilities meet the growing demand.

Preparing for digital mammo

Raleigh Radiology in Raleigh, N.C., is an outpatient imaging center that brought on digital mammography when it moved to a new location on October 2005. PACS Administrator Sabrina Johnson worked with Hologic when the center went live with digital mammography. When making the switch, the center was able to cut its mammography rooms in half, from four to two. "I was skeptical when Hologic said we could do as many patients in just two rooms, but we are pretty close to that." Mammograms are done every 15 minutes from 7 a.m. to 7 p.m., Monday through Thursday.

Radiologists read images on a Hologic SecurViewDX workstation. Images come up in hanging protocol in a continuous flow, and the radiologist marks them as read when done interpreting. "At first it took more time because everything looks different and there are more tools. But now they can read faster than they could with film," Johnson says. They are constantly reminded of the difference now that they are digital thanks to the worklist. Radiologists read all their screenings in one session and all their diagnostic exams in another. "It's easier for them when broken down into smaller sessions," he says.

Once a mammogram is finished, it is sent to CAD, the soft-copy workstation, and PACS. "The radiologists never have to pull from PACS, so there's no delay in retrieval." If the physician makes annotations, he or she can click a button, and they are automatically sent back to PACS as an overlay.

Switching to digital was a big transition, Johnson says. "The workflow was totally different, but Hologic offered training and provided resources." She highly recommends taking advantage of vendor training. And, "if you're going to [install] anything digital, trace out your workflow before it actually happens. Play out a mock workflow, and talk with your vendor about that. Let them meet the needs of your workflow."

Scheduling, scheduling, scheduling

The hardest part of maintaining a good workflow is scheduling, says Andrew Gitschlag, administrative director of Knoxville Comprehensive Breast Center in Knoxville, Tenn. And although digital mammography offers many benefits, it takes longer to read digital images, says Kamilia F. Kozlowski, MD, medical director. "You have to be careful how you schedule screenings and diagnostic mammograms," she says. "You can end up with a backflow rate of clinicians, and you can't speed that up. Seeing the patient has not been expedited in any way."

The center uses Hologic's mammography image management solutions (MIMS) mini-PACS and PACS 1, a PACS software that was tailored to the center's needs, says Gitschlag. Kozlowski is in the process of linking disparate systems to eliminate double entry of patient data. "Integration has been good on some of the vendors, but for some of the others, it's a little harder because of the proprietary nature of their products."

Two coordinators help drive the workflow. One follows the patients, the other follows the doctor, Gitschlag explains. The coordinators make sure the doctors are reading the patient who has been waiting the longest, let patients know how long they will wait to see the doctor, and work with technologists so that the radiologist knows the best angle and approach for a study.

Enhanced and improved productivity

Closely managing mammography reports was a priority at the Breast Center at Southern Ohio Medical Center in Portsmouth that installed Mammography Reporting System's MRS reporting system for exam results reporting for all breast-related procedures and letter generation.

As established patients enter the center, the office staff prints a history sheet, and the technologist checks the information with them, explains supervisor Robin Dixon. After a screening mammogram, the radiologist can use one of several templates to create a report right in MRS. Radiologists can mark the studies as read and they are archived to PACS. Coming soon will be