Breast Imaging Workstations: Why Multimodality Is a Must

Twitter icon
Facebook icon
LinkedIn icon
e-mail icon
Google icon
The Merge Mammo workstation features the ability to simultaneously display mammography, MRI and/or ultrasound studies for viewing or manipulation at one workstation. Displayed on the left monitor is a mammogram showing a solid mass on the left breast and on the right monitor an ultrasound of the same mass.

Breast imaging workstations are a whole new breed of animal these days. Becoming extinct are the single-vendor workstation solutions in favor of more flexible multimodality, multi-vendor workstations that allow radiologists to efficiently read digital mammography, ultrasound, breast MRI, and CT images in one place as well as read remotely to cover a variety of imaging sites.

In the early days of digital mammography, image review options were very limited. Digital pioneers paired the digital acquisition unit with the mammography vendor’s workstation. This approach does work, but in a fair share of cases, it may not be ideal. The digital mammography vendor often differs from the PACS vendor, which means the facility needs to develop interfaces between the workstation and PACS. In addition, RIS/PACS workstation integration may be an issue.

Some sites have found the cost of vendor workstations hard to swallow. In other cases, the site is a hybrid environment with an array of acquisition units. It can be difficult or impossible to read one vendor’s mammogram on a second vendor’s workstation, which creates workflow and logistics challenges. And finally, breast imaging is a multimodality specialty; in many cases, radiologists need to review ultrasound, MRI and mammography studies to provide a complete diagnosis. And reading efficiency is a must these days.

The past several years, however, have delivered a new breed of options. In addition to vendor workstations, digital mammography facilities can install third-party or PACS review stations approved for digital mammography interpretation. This option brings a number of advantages. For starters, the systems are built to handle multi-vendor, multimodality images, which delivers workflow and efficiency improvements as radiologists can use a single workstation as their primary review station for digital mammograms and multimodality studies. The approach also facilitates remote reading, a key consideration for multi-site operations. Third-party systems also can deliver economic benefits. The initial cost of the breast imaging workstation may be lower, and the site may be able to trim the total number of workstations because the breast review station can be used to read multiple types of images—not just mammograms.

The open model

Digital mammography can be a challenging transition. Early adopters, like Doshi Diagnostic in New York City, encountered several roadblocks. One of the challenges, says Lyle Backenroth, CIO of the 48-site imaging center group, was the limitations posed by vendor workstations. The practice, which started deploying digital mammography in 2003, is a mixed acquisition environment that uses digital mammography systems from two different vendors. The hitch is reading one vendor’s study on the second vendor’s workstation. In some cases, radiologists had to move between two workstations to review a single case, complicating workflow and reducing efficiency.

Four years ago, the practice began looking for new workstations and decided to deploy Carestream Health Kodak Carestream Mammography Workstations, eventually equipping its centers with 35 mammography workstations for its 45 radiologists. “This model provides flexibility. Our digital acquisition units produce different file sizes and use different DICOM tags. The Carestream workstation can interact with mammograms from both vendors,” says Backenroth. The practice developed a variety of hanging protocols to address the array of studies and priors. That is, there is a protocol for each possible permutation of current study and prior exam. “It took some effort on the part of the IT and PACS teams, but it cuts down on the total number of workstations and saves workflow steps because radiologists don’t need to move between workstations to interpret multi-vendor patient exams. The Carestream workstation lets them concentrate on reading.” What’s more, the new system allows radiologists to share digital images with colleagues for consultation.

In addition, the workstation is a multimodality solution, so radiologists can rely on the same workstation for all types of work, from digital mammography, to CT, breast MRI