Digital Mammography & Beyond

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In November 2006, Fujifilm Medical Systems introduced its Synapse version 3.2 PACS with additional digital mammography capabilities that include reader-specific preferences to be set.

Breast imaging is in the midst of a perfect storm. Digital mammography is well-established and still growing fast. About 3,000 facilities now have digital technology, according to the FDA. And the Digital Mammographic Image Screening Trial (DMIST) results that two years ago demonstrated digital’s superiority for pre- and peri-menopausal women and patients with dense breasts are fueling digital sales. FDA approval for CR mammography is further feeding the fire by bringing the digital price tag into range for more sites, particularly lower volume facilities.

But the breast imaging resurgence transcends mammography. Breast MRI is making further inroads into clinical practice, and digital tomosynthesis seems to be right around the corner. New additions to the breast imaging arsenal provide radiologists with tools to help pinpoint breast cancers at earlier and more treatable stages and accurately evaluate the extent of disease to best steer treatment.

This month, Health Imaging & IT visits with state-of-the-art breast imaging sites across the nation to learn about the clinical and operational issues associated with various solutions.

Digital mammo proves itself

When digital mammography first hit the market earlier this decade, most sites eyed the technology cautiously. But over the last two years, that initial wariness has been transformed into enthusiasm. Digital is the wave of the future—from clinical and workflow perspectives. It is the platform for next-generation applications such as breast tomosynthesis. Plus it boosts efficiency, and the recent FDA approval of a CR option puts the digital price tag within reach of most mammography sites. And more systems are pending approval.

Seattle Cancer Care Alliance in Washington is a digital pioneer; the center opened in 2001 as a digital mammography site outfitted with GE Healthcare Senographe DS systems. The advantages of digital are significant, says Connie Lehman, MD, director of radiology. It offers superior image quality, faster image acquisition and fewer retakes.

Still, digital mammography can be a somewhat challenging transition, particularly for radiologists accustomed to rapidly reviewing large stacks of analog mammograms. “It can take more time to review digital images, especially at first, but there are ways to drop interpretation time,” Lehman says. For example, a radiology assistant can be added to help radiologists with digital and film image management. The goal, says Lehman, is to make radiologists as efficient as possible, which means minimizing the time they spend managing and manipulating images.

On the technologist side, Seattle Cancer Care Alliance organizes the digital mammography worklist to coordinate comparison films and information and minimize extraneous movement by radiologists. Image sorting and ordering are automated, which brings digital workflow closer to the analog ideal with the clinical advantage of additional information.

Some of the major beneficiaries of early adopters’ efforts are later adopters like Metro Imaging in St. Louis, Mo. The five-site practice began, deploying Siemens Medical Solutions Mammomat Novation DR in November 2006. “We planned on staging a full implementation over one year, but after the first installation we saw reimbursement increase with CAD and digital mammography, and decided to accelerate the deployment,” says COO Deanne Blume. The practice replaced all of its analog systems with five digital systems in just more than six months, and reaped benefits beyond the reimbursement increases.

Exam times have dropped; in fact, the more rapid digital throughput made it possible for one facility to replace two analog systems with a single digital unit. But what about radiologist productivity? “We were a little apprehensive because we were told it would be slower,” says Blume. Most radiologists have adjusted well with only a slight increase in interpretation time and the added benefit of improved image quality. Digital mammography also helps facilitate Metro Imaging’s commitment to patient care. “We treat most patients as diagnostic patients with radiologists reviewing and sharing results with patients before they leave,” explains Blume.

The advantages of digital mammography run the gamut from improved efficiency to enhanced patient care.