Interpreting the Spectrum: Breast Imaging & IT Options Abound

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  The hybrid reading room model at Eastern Radiologists’ Breast Imaging Center in Greenville, N.C., keeps radiologists focused on image interpretation to maximize productivity.

While digital mammography has monopolized the breast imaging limelight over the last 18 months, a host of other breast cancer imaging and IT options have quietly performed. Although no single technology meets all needs, each holds a critical place in the spectrum. In addition, all have upped the ante, delivering essential imaging and workflow improvements to enable better patient care, higher profit margins and greater efficiency. Consider:

  • Breast imaging practices tap into mammography reporting software to hyper-charge workflow and eliminate paper.
  • Improved MRI technologies fine-tune resolution and scanning time for great flexibility and earlier detection.

Lower cost options like breast-specific gamma imaging and ultrasound are proving their merit, adding to the array of choices and carving new niches like ongoing therapeutic monitoring.

As the breast cancer imaging evolution marches forward, Health Imaging & IT offers a guide to the 21st century breast imaging practice.

Meeting the efficiency challenge

“Breast imaging facilities are being squeezed on all ends: manpower shortages, reimbursement cuts and increasing technology costs,” says Bruce Schroeder, MD, director of Eastern Radiologists Breast Imaging Center in Greenville, N.C. Practices must meet dual challenges to survive and turn a profit: operate at a highly efficient level and provide high-quality patient care. Eastern Radiologists examines every aspect of workflow in its ongoing quest to squeeze every ounce of productivity from its practice.

The practice’s analysis begins with the basics. Breast imaging interpretation workflow consists of three components on the radiologist’s part: patient selection, image analysis and reporting. Attending to selection and reporting can generate a hefty payoff, says Schroeder. For example, Eastern Radiologists uses CCOW (Clinical Context Object Workgroup) to link its Mammography Reporting System (MRS) mammography tracking and reporting software to its GE Healthcare Seno Advantage mammography workstation. The HL7 protocol allows for automatic synchronization between the reporting system and the image viewing software. “It’s twice as fast because the radiologist doesn’t have to pick through the worklist,” says Schroeder. Instead, the physician inputs the patient’s barcode into MRS and CCOW opens the appropriate mammogram or ultrasound study for viewing. “This is a differentiating technology. If I spend 15 to 20 seconds finding a patient in the worklist, it translates into one-third of the time it takes to read a mammogram,” calculates Schroeder. The practice tested a similar syncing progress to pull analog mammograms to the alternator and hopes to fully implement the concept later this year.

Another example of the practice’s “every 10 seconds counts” credo is its rich use of MRS’ template system. Normal studies can be completed with single or double letter codes. The practice enhanced the system with a shareware keyboard expander that allows users to create templates for additional categories like left lumpectomy. The investment in robust workflow analysis reaps dividends. “Radiologists at breast imaging practices that put all of the pieces together can focus on their primary job of image analysis, provide state-of-the-art care, regain their time and stay profitable,” asserts Schroeder.

On the Horizon
The breast cancer imaging horizon is bright. Several new technologies under development promise to add to the breast imaging arsenal. Options under development include:
  • Whole-breast ultrasound. Although American College of Radiology Imaging Network (ACRIN) 6666 trial tied screening ultrasound to a relatively high callback rate and low positive predictive value, SonoCine believes screening ultrasound will be feasible. The company’s investigational technology separates data acquisition and review. The system interfaces with conventional ultrasound systems, adding computer guidance of the probe and custom review software to allow radiologists to adjust images for speed, size, brightness and contrast. Early data show a favorable callback rate and positive predictive value. On the economic front, it is expected that ultrasound could be more cost-effective than breast MRI for high-risk screening.
  • Molecular breast imaging (MBI, also known as sestamibi or