Buying smart in digital mammography means a lot more than finding the best imaging system. Be sure to factor in workflow changes for going from analog to digital, integration with PACS, an efficient scheme for the reading room that integrates prior analog films and investigate new multimodality mammography workstations, too.
As the Digital Mammographic Imaging Screening Trial (DMIST) winds down (and results are expected in the next few months), experts predict that the study will demonstrate that digital and analog yield fairly comparable clinical results. Nevertheless, interest in digital mammography systems remains fairly high, and it continues to gains converts in the breast imaging world. There are multiple reasons behind digital's appeal.
For starters, many sites report workflow, efficiency and throughput gains after transitioning to digital. Digital improves contrast resolution, which can translate into improved detection. It also offers a better assessment tool for women with dense breasts who may be at greater risk for breast cancer. And the immediate availability of results and ability to post-process the mammogram can reduce callbacks. Another plus? Digital mammography provides mammography a ticket into the PACS environment, which facilitates immediate image distribution and review across and beyond the enterprise. (Although a good hybrid reading plan is needed for smooth reviewing of prior studies.) Finally, digital will serve as the platform for upcoming, promising applications such as tomosynthesis and contrast-enhanced mammography.
"Digital mammography should be thought of as a beginning, not an end," recommends Elizabeth Rafferty, MD, associate director of breast imaging, Avon Comprehensive Breast Center at Massachusetts General Hospital in Boston.
Facilities eyeing digital mammography should consider some critical questions as they investigate the technology, including:
- What are the pros and cons of digital mammography?
- What are the options and challenges associated with bringing mammography into the PACS arena?
- How can the facility optimize the reading room for comparison of prior film mammograms to current digital mammograms?
- How can the site reconfigure workflow to capitalize on digital technology?
Weighing the pros and cons
The advantages of digital mammography fall into the areas of quality of care and efficiency. In many imaging centers, hospitals and women's clinics, mammograms represent the only patient images that can not be accessed on a workstation. The implementation of digital mammography brings sites closer to the anytime/anywhere distribution of mammograms.
Take for example, St. Vincent Breast Center of Indianapolis, Ind., which implemented three Fischer Imaging SenoScan full-field digital mammography systems when it moved to a new location in December 2003. Workflow and patient care across the enterprise are improved as the new digital systems allow oncologists to view and evaluate digital mammograms at their desks instead of tracking down films. Decisions can be made more quickly, which allows patients to receive treatment in a more timely manner, explains Julie Howerton, MSN, MBA, director of St. Vincent Breast Center.
Rafferty, who relies on a Hologic Selenia and a GE Healthcare Senographe to complete her site's digital workload, adds to the list. "There are no more lost films, radiologists can see images immediately, and we can send and discuss images in their original format," she says.
John Nelson, MD, medical director of Battlefield Imaging in Ringgold, Ga., says the ability to view images immediately on the Siemens Medical Solutions Mammomat Novation digital mammography system enables radiologists to screen mammograms for abnormalities that might have initiated a callback in the analog environment. Depending on the findings, the radiologist can magnify the image, apply a filtration algorithm or order additional views or an ultrasound study. As a result, Battlefield has experienced a 30 percent drop in callbacks since implementing digital.
Image quality also is improved with digital mammo. Laurent Levy, MD, radiologist with Institut de Radiologie de Paris in France, explains, "Our [GE Senographe] systems provide consistent, reproducible quality from one patient to another, from one view to another and over time. Contrast resolution is excellent as well." Nelson says the enhanced contrast resolution may translate into better detection. "Anecdotally, I've clearly identified lesions