The Move to Digital Mammography

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Siemens syngo MammoReport digital reading workstationBusy radiology practices that seek to offer digital mammography services must engage in strategic planning to provide an optimal infrastructure to manage the huge image data files produced by these systems, as well as the newly defined workflow.

Digital mammography systems are powerful, and the workstation design is geared towards improving efficiency while providing high-resolution images on 5 megapixel (5MP) monitors mandated by the FDA. Digital mammography is being implemented in facilities of all sizes, ranging from academic medical centers to community hospitals to imaging centers. Health Imaging & IT visited with several that are defining the process.

Outpatient imaging center

Raleigh Radiology Associates is a busy multi-center outpatient practice that replaced four screen-film scanners with two Hologic Selenia digital mammography systems, while maintaining the same 80 patient-a-day load in their digital office.

What is the ultimate benefit? Improved patient care, says Donald G. Detweiler, MD, president of this group in Raleigh, N.C. He describes image clarity, resolution and quality that provides additional information to guide their diagnostic activities that is far superior to screen-film technology.

Although it may take slightly longer to read the images, Detweiler says the advantages of digital mammography so far outweigh any disadvantages and improved patient care drives their appreciation of this technology.

The Hologic SecurViewDX workstation includes R2 Technology ImageChecker computer aided detection (CAD) which permits individual user configuration for hanging protocols and workflow customization.  Detweiler explains that when these systems were first installed, the applications technician suggested a specific hanging protocol to view each case in full resolution mode. Although he tinkered with another approach, he laughingly admits he found himself returning to the original configuration because it was most thorough.

Some of the features offered on the SecurView DX include a digital magnifying glass that permits visualization of image detail at increased resolution to examine fine details, “intelligent” roaming that automatically moves from one quadrant of a breast image to another while passing over any quadrants where no breast tissue is present.

The workstations are configured as dual 5 megapixel (MP) monitors with 1,024 true shades of gray to allow full contrast resolution. Detweiler says he seldom needs to change the contrast and the magnification functionality has proven quite valuable.

University health center

Alberto Goldszal, PhD, director of radiology informatics for the University of Pennsylvania Health System in Philadelphia explains that they are in the midst of revamping their infrastructure to accommodate full entry into digital mammography. Currently they have two GE Healthcare Senographe systems, but in 2008 when they move into a new Center for Advanced Medicine, they will install an additional seven digital mammography systems. 

He considers that part of the significant investment in storage and display infrastructure will be avoided by leveraging their GE Centricity PACS for archiving and image management. Once the latest version of Centricity 2.1 is in place, which was scheduled for last month, they should have all of the support they need for storage, networking and interpreting digital mammograms built into the PACS.

Considering that the data set for one mammography exam can be between 20 and 60 megabytes, the storage requirements increase exponentially. Because they store data sets from advanced modalities including CT and MR, careful structuring of the archive and network is essential. 

“From an archiving basis in this institution, we generate 12 to 15 terabytes (TB) of digital imaging data per year,” Goldszal relates. “That number is bound to increase once digital mammography is fully functional.”

Beginning last month, they started using an integrated approach managing images from all modalities on their GE PACS with RA 1000 workstations that offer 5MP monitors. The upgraded PACS features a mammography module that permits image manipulation and management. “The GE proposal is that you do not need to invest in a separate workstation, much like we have today, but digital mammograms can be pushed to a regular PACS workstation as long as it has the appropriate display hardware,” Goldszal says. This functionality enables display of prior mammography scans, as well as other modalities