The Low-down on Digital Mammography Displays

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Choice is a new addition to digital mammography displays and workstations with the recent addition of third-party, high-resolution monitors and PACS. But buyer beware when it comes to DICOM compatibility issues between acquisition devices and displays. A good QA plan also is key, along with making sure your reading room is digital mammo-friendly. Here are some tried-and-true tips to getting it right.

Until recently, digital mammography system buyers had little choice in display systems; each mammography vendor selected a display for use with its acquisition device and reading station and submitted a soup-to-nuts package to the FDA for approval. That meant each workstation and display worked with just one vendor's system. But those days are history.

"The market is changing rapidly and giving buyers more choice in the display systems used to view digital mammograms," explains Margarita Zuley, MD, radiologist with Elizabeth Wende Breast Clinic (Rochester, N.Y.).

The changes have been spurred by recent FDA approvals for third-party PACS and high-resolution displays for presentation of digital mammography images. Consequently, digital mammography is becoming more of an a la carte purchase with sites able to customize a solution by selecting a preferred or best-of-breed acquisition device, soft-copy review stations and PACS workstations.

The buyers' market that began last year as digital mammo displays started gaining FDA clearance brings a few challenges. For starters, DICOM incompatibilities between digital mammography acquisition devices and displays still exist and can cause subtle image degradation. Vendors could remedy remaining DICOM issues by this summer, industry watchers say. Nevertheless, a thorough test drive pairing potential acquisition systems with displays is warranted, says Zuley. After installation, sites need to implement processes and solutions to maintain high image quality. This includes implementing a QA program and fine-tuning the reading room environment for digital image review.

Other changes are in the works, too. Flat-panel displays for digital mammography are right around the corner. This affects current sites eyeing the replacement market and new installs that need to prep for the brave new world of flat-panels.

Buying power

Whether an imaging facility buys an entire digital mammography system or purchases individual components, image quality of the display should serve as the basis of the final product evaluation, says Capt. Jerry Thomas, radiological physicist with Bethesda Naval Hospital (Bethesda, Md.). Maria Kallerghi, PhD, program leader, digital medical imaging at Moffitt Cancer Center (Tampa, Fla.), adds, "Right now, it's not as much a matter of CRTs vs. flat-panels. Image equality is the most important factor."

Radiologists should evaluate various displays and determine how each shows calcifications and masses. Other evaluation factors include the user interface, which can enhance or detract from a display. A busy, bright interface can make reading more difficult. Radiologists should analyze soft-copy hanging protocols and ensure that they support workflow.

Buyers brave enough to customize a solution can overcome DICOM incompatibilities by conducting a side-by-side comparison of images on the vendor's mammography workstation to images on the soft-copy review station, looking for minor degradations, Zuley says.

Nikunj Patel, MD, director of high-tech imaging at Scripps Clinic (La Jolla, Calif.), adds a few more criteria to the pot. Buyers must make sure that a display has adequate resolution to support digital mammography. Palette is the next consideration, with more bits translating into more shades of gray per pixel. Then, Patel says, the decision can be based on a consensus of personal preferences among radiologists. This includes items like anti-reflective glass, blue or gray tinted screens and self-calibration software. It is important to stick with a single display system for digital mammography across a site, as a hodge-podge approach can affect consistency among reads, Patel concludes.

Another digital mammography display purchase issue is the service contract. Buyers need to understand each party's responsibility if a monitor fails. Moffitt Cancer Center placed an upgrade clause in its digital mammography service contract; when the mammography vendor integrates flat-panels, the Center will receive flat-panel upgrades on its workstations.

The QA question

While image quality and