Digital mammography ready for prime time

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Is digital mammography ready for prime time? That was the question presenter J. Anthony Siebert, PhD, University of California (Davis) outlined last week in a session at the Healthcare Information Management and Systems Society meeting in Dallas.

The session took a close look at the pros and cons of digital, with Siebert predicting that the Digital Mammographic Imaging Screening Trial (DMIST) will show that digital and analog yield fairly comparable clinical results with digital adding value in other areas. That is, digital can overcome film limitations and increase efficiency, improve image quality and enable mammography PACS and CAD. The ability to deploy digital telemammography screening is a significant plus, Siebert said. Digital systems also support advanced applications such as digital tomosynthesis, dual-energy subtraction and breast CT.
   
On the downside, Siebert pointed to the high acquisition costs of digital, its somewhat lengthy learning curve, storage issues related to study sizes of up to 200 megabytes and the difficulties of operating in a hybrid soft- and hard-copy environment. Soft-copy displays are a concern as well as hanging protocols and workstations must be optimized and streamlined for digital mammography reading.
   
Ultimately, Siebert indicated that digital mammography is ready for prime time on a site-by-site basis. Sites in the market should complete a thorough technical evaluation and business and clinical plans prior to making the decision to deploy digital mammography. Key variables in the decision-making process include enterprise buy-in among radiologists, techs, IT staff, physicists and administration. On the technical side, mammography PACS and dedicated workstations are mandatory. Finally, the facility needs to understand quality control issues and government requirements.