A Revolution in Waiting: Digital Radiography Plows the Path for Going Digital in Mammography

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Faced with shrinking budgets, staff shortages, aging equipment, the higher cost of switching to newer technologies such as DR and CR, growing workloads, limited space, increasingly high patient and referring clinician expectations, the radiology administrator has a daunting task. Digital radiography and digital mammography have been touted as systems than can revolutionize how medical imaging is done - but have the benefits of these technologies proven to be true?

This article looks at the experiences at Dartmouth-Hitchcock Medical Center (DHMC) in Lebanon, N.H. Dartmouth-Hitchcock, which has a tradition of providing its patients and referring clinicians with the latest advances in cost-effective imaging technology, has thought long and hard, and decided to invest in the digital revolution.


As part of its long-term strategy to invest in the future, Dartmouth-Hitchcock Medical Center made the conversion to digital imaging in the general radiographic department with the purchase of six digital radiography and four computed radiography units in 2003. This purchase was made as part of the center's long-range migration to a picture archiving and communications system (PACS) and a comprehensive electronic medical record system.

For radiology, the path to the future is clear; screen film-based imaging is going the way of wet processing. The much talked about but slow to take off digital revolution is starting to impact radiology in the same way it has the consumer camera market - particularly in the general radiography department. Why limit yourself to film when digital imaging offers increased speed, high quality, improved staff productivity, low consumable costs and convenience?

The first digital radiography systems were introduced in the U.S. in 1998. Two years later, the first digital mammography systems were cleared for sale. Digital mammography followed digital radiography because there were major technical challenges in going digital in women's imaging and the benefits of a digital image capture system in mammography are different than they are in digital radiography.

For most of the last dozen years, there was only one choice for going filmless - computed radiography. Now there are more than a dozen different options for going digital in the general radiography department and a growing number of alternatives for going digital in women's imaging.

Early indications at DHMC are that DR and CR have lived up to their reputation of providing 30 to 40 percent gains in technologist productivity, increased imaging room capacity, while providing long-term cost savings.


Justifying digital radiography purchases with increased productivity and lower overall cost arguments is possible for the general radiography department, particularly if you include costs that are more difficult to measure - such as improved patient care and increased productivity of the radiologist and referring clinician. However, making a productivity argument for moving to digital mammography is more difficult.

The high cost of entering the digital imaging arena - three to four times the cost of an analog system - makes many hospital administrators put off the decision to go digital. Hospital administrators, conditioned to examining their department finances quarter by quarter and expecting a quick return on investment (ROI) for their major acquisitions, quickly realize that DR/CR and PACS will not provide ROI payback solely by eliminating film costs and staff reductions in the film library. The economic decision to go digital requires a longer time horizon.

Granted, savings will be achieved with the elimination of film and low paid film library staff, but that generally is not enough to pay for the move to digital imaging. This is where many hospital executives halt the move to digital imaging and PACS - the payback isn't there.

The real payback is in productivity increases for the highly paid staff - the technologists, radiologists and referring clinicians. These productivity increases, coupled with enhanced productivity of the imaging equipment and space, although difficult to quantify, are huge. While reaping the gains of these productivity increases, the real benefit becomes clear: improved patient care.

Some referring clinicians at DHMC were astonished at how the PACS increased their productivity, job satisfaction and ability to treat their patients. Most of the referring clinicians at DHMC now have the ability