Fine-Tuning Breast Imaging Workflow

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  Michael Trambert, MD
  Michael Trambert, MD—lead radiologist for PACS Reengineering at the Cottage Health System, and the Sansum Clinic in Santa Barbara, Calif.—reads mammography images on an integrated PACS from DR Systems.

2007 could mark the year that mammography turned the corner in terms of achieving efficient breast imaging workflow. More sites are purchasing or planning for digital mammography solutions. Positive clinical study results such as the Digital Mammographic Image Screening Trial (DMIST), new CR-based options, a sharp rise in the number of full-field digital mammography placed and FDA approval of PACS workstations for digital review all fuel interest in digital systems.

Still, digital breast imaging is challenging. There aren’t enough radiologists specialized in mammography; margins are razor thin; transitioning to digital is a challenging process fraught with complex decision such as:

  • Whether or not to digitize prior films
  • Which workstation—a PACS, third-party or single vendor—should be deployed for image review
  • How to develop user-friendly image review processes and reading room configurations

“Transitioning to digital mammography can be painful. Everything changes: image acquisition and review, communication and storage,” says Debra Mitchell, MD, managing partner of Breast Imaging of Oklahoma. This month, Health Imaging & IT visits some digital pioneers to ferret out the secrets to breast imaging workflow success.

PACS pluses

The Sansum Clinic in Santa Barbara, Calif., is a digital mammography pioneer. Its mammography department deployed digital mammography in 2003, replacing five analog rooms with two digital systems. “We decided to convert to digital 100 percent,” says Michael Trambert, MD, lead radiologist for PACS reengineering at the Sansum Clinic and the Cottage Health System. “If the resources are available, complete conversion simplifies the transition, resulting in a clean cutover date to a single digital database, rather than partial conversion that requires two databases: digital and film-based for current exams,” asserts Trambert.

The site did digitize prior analog mammograms, which can eliminate the workflow muddle of maintaining both film and digital archives and the time-consuming process of pulling, hanging and re-filing films. Although some radiologists express hesitation about the image quality of digitized images, Trambert says a good workstation facilitates effective viewing and comparison. The Sansum Clinic uses a simple process for digitization, pulling prior studies for digitization the night before a patient’s scheduled visit. The decision not only enhances radiologists’ workflow, says Trambert, but also improves clinical care as referring physicians can view prior films on the web, including the digitized prior film-based exams, via the clinic’s DR Systems PACS. Current exams have a conclusive voice-clip report attached to the exam at the time of radiologist interpretation, providing immediate results availability for the referring physicians, anywhere anytime over the web.

Sansum Clinic decided to archive digital mammograms and voice-clip reports on PACS from the date of conversion and make exams and immediate voice-clip results available to referring physicians via the web, to allow 100 percent filmless transition to digital mammography. “PACS brings an efficiency benefit to breast surgeons and makes it easier for them to reengineer their workflow. Their front office staff doesn’t need to call us for images or search for films.” Instead, images and reports are available online immediately after the radiologist completes the interpretation.

Over the last two years, the practice has added a third digital mammography system and hopes to transition to PACS review. Trambert has bypassed the third-party workstation for the last 20 months and uses the PACS workstation for mammography interpretation. In the next three to six months, he hopes all of the practice’s remaining eight mammographers will follow suit and convert to PACS review, simplifying workflow and adding efficiency to the system. According to Trambert, PACS review is more efficient than the vendor workstation review. “It used to take about two minutes to read a screening mammogram on the film-based mammoviewer. Now, I’m as fast or slightly faster on the PACS workstation,” Trambert says. In contrast, it took Trambert about three minutes to complete image review on the dedicated digital mammography workstation.

Image review is just one