Breast CAD Comes of Age

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Over the last several years, mammography CAD systems have matured and gained acceptance among radiologists, payors and patients as a standard of care. Today vendors are finding new ways to demonstrate the value of CAD. Breast CAD vendors have always touted CAD solutions as to a way to improve breast cancer detection with improvements in the range of 20 to 25 percent. The latest technology extends the reach of breast CAD - aiming to initiate sites transitioning to digital with efficiency gains and simplified storage solutions.

Breast MRI CAD looms larger as well. In addition to the two dedicated MRI CAD solutions on the market, iCAD markets its 500M viewing solution. The 500M performs CAD on both the breast MRI study and film-based mammogram and displays both on the same viewer. Efficiency is, once again, the name of the game as reading breast MRIs can be a time-consuming undertaking. CAD provides an answer by reducing the time it takes to read a breast MRI from up to several hours to five to 15 to 20 minutes.

CAD & FFDM: THE PERFECT MARRIAGE

Straub Clinic and Hospital (Honolulu, Hawaii) is part of the Hawaii Pacific Health Network, a four-hospital system with an ambitious plan to implement PACS, digital mammography and 3D CT technology. Robert Lipman, MD, staff radiologist, says CAD is a key part of the transition to PACS and digital mammography. Straub Clinic and Hospital installed R2's DigitalNow last summer to pave the way for PACS and digital mammography. "The ability to transfer from film to digital to PACS is the No. 1 reason why we implemented CAD," Lipman says. With DigitalNow, Straub Clinic and Hospital transfers film mammograms to its DigitalNow digitizer to a Fujifilm Synapse PACS. The hospital system also has installed a Hologic Selenia digital mammography system at one hospital and plans to install another three digital mammography systems by the middle of 2005.

Lipman explains the benefits of the hospital's approach. "There are obvious benefits, like discussing findings on a mammogram without needing the physical film. And radiologists and surgeons can talk about the same image without being in the same place. What we didn't realize before we installed DigitalNow are the benefits for procedure planning. When a surgeon is planning a biopsy, he no longer needs to locate the film, which is a real time and workflow savings."

There are other 'surprise' benefits to digitized mammograms, says Lipman. For example, a digitized mammogram can be magnified and enhanced when it is projected in a conference room during a tumor board meeting, providing radiologists and clinicians in all parts of the room a clear view of the case.

Lipman adds another simple, but valuable, plus to the list of CAD benefits. "With every CAD product, the radiologist can be sure he or she is reading and dictating the right mammogram. Techs can put the case on the wrong panel number, and the radiologist can dictate the wrong patient." With CAD, however, if the CAD findings don't match the images, the radiologist knows he or she is looking at the wrong film.

There are cost benefits as well. "The insurance companies are indirectly paying us to digitize films and store mammograms in PACS [by reimbursing for CAD]," Lipman explains. To gain this benefit, sites must retain the initial digitized mammography images; some sites scan twice - once for CAD and once for PACS, which is an inexpensive and overly complicated process. Instead of disposing of the digitized CAD images, Lipman recommends that sites hold them for storage in PACS.

The final benefit with CAD is the computer markings - alerting radiologists to potential lesions. Even with the detection, storage and efficiency gains with CAD, Lipman looks forward to future improvements. "The next great leap in CAD will be the ability to compare mammograms to prior images. I have that advantage; CAD doesn't. I know if a lumpy spot has existed for 10 years and isn't a cause for concern."

CAD & COMPREHENSIVE BREAST IMAGING

Catholic Medical Center (Manchester, N.H.) plans to open a new comprehensive breast center offering both digital mammography and breast MRI next month. iCAD's MammoReader and CAD software is serving as the backbone for the endeavor. The hospital deployed CAD about 18 months ago. Michael Cloutier, manager of technical services, says the technology helps radiologists identify positive findings more quickly and with less clutter than without CAD. But these benefits just scratch the