Q&A: The implications of digital mammography on workflow, prior image comparison

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In addition to the positive implications of digital mammography for diagnosing and treating breast cancer, the technology has the potential to improve radiology workflow and can assist physicians in comparing old and new images via PACS integration.

Health Imaging News sat down with Thomas J. Nardozzi, president of Array Corporation USA, to discuss the evolution of breast cancer screening technology and how reading of mammography images has changed as a result. Array Corporation is a developer of digital image processing and photometric measurements products. The company’s MammoPro is a tabletop film digitizer especially built for mammography images.

In brief, lay out the line of technological developments in breast imaging.


It’s important to acknowledge the importance of early film screening systems that replaced tube side mammography and xerography. As time went on, film manufacturers were able to develop faster films and more efficient screens to help reduce dose, while improving the image quality. Equipment manufacturers found better ways with which to produce their equipment for utilization of compression techniques and dose reduction to reduce dose, leading up to advances we are now seeing in CAD. All of these things led us to where we are with full field digital mammography taking shape, and the FDA and ACR [American College of Radiology] saying “yes, this is the next logical step.” Now the cost and efficacy of these systems have really improved to the point that benefits patients and the practice of radiology. In the span of 20 years, we’ve seen tremendous strides forward. That’s not a long time in the history of medicine to see such great advances.

What effect will the FDA’s approval of digital mammography have on image comparisons?


I think there will be significant impact. If you look at the work process, this is the natural next step. In imaging departments — in hospitals, imaging centers, or other venues — mammography has been set to the side and has not necessarily been a fully active participant in the PACS. Well, here it is. Now the radiologists can be far more productive by taking greater advantage of the PACS to go about their work. Logically, what winds up happening is that we eliminate radiologists getting away from their high-resolution displays to view mammograms on light boxes for the purpose of comparing priors with digitally acquired images, resulting in a more productive workflow that lends itself to the promise of PACS.

What should be considered when shifting to digital mammography from film?


The grand arbiter of deciding whether digital is acceptable or not all revolves around, in my estimation, very few criteria. At the top of that list are image quality and its impact relative to dose to the patient. Essentially, consider delivery of the quality of the exam and its result. If digital is able to compete with and equal or eclipse film screen and deliver the results to the radiologist without going through any additional obstacles, then it passes the test.

What are some additional benefits gained from storing digital mammography images in PACS?


audioClick here to listen to Thomas J. Nardozzi’s response.

What other developments does the future hold for mammography?


The science will continue to evolve, of course. We get to this plateau and we think “wow, look what we’re doing now.” The things that we’re doing that help people are just phenomenal. Well, the good news is that people are not resting on what they have just accomplished, and they will keep pushing for better technologies and better methods with which to diagnose, treat, and exercise good patient care.