Breast Imaging Workflow: Optimum Efficiency & Beyond

Mammography providers face intense pressure. The transition to digital imaging systems continues to gain traction, solving some issues and generating new challenges. Hybrid workflow and IT disconnects, for example, plague some digital providers. In addition, many sites continue to see a backlog of patients waiting for studies. Plus, breast imagers are in short supply, and margins are razor-thin. Finally, sites need to plan ahead. “Certification and insurability will be linked to quality data,” predicts William Smith, MD, director of breast imaging at University of Kansas Medical Center in Kansas City. The one constant in breast imaging: centers need to squeeze every ounce of productivity out of their investments in imaging solutions, information systems and human resources.

Although there is no magic bullet, a proactive approach that considers all systems and processes in the long-term serves many sites well. This month, a pair of breast centers share their workflow challenges and solutions.

Beyond basics

University of Kansas Medical Center is perched on the leading edge of high- quality breast imaging. Between 2001 and 2008, the center’s detection rate of stage 0 and stage 1 lumpectomy cures skyrocketed from 22 percent to 77 percent. Still, Smith strives for constant improvement. “We need outstanding, immediate feedback on our performance as mammographers.” Earlier this year, the center deployed Mammography Reporting System’s MRS tracking and reporting software for breast-related care and now taps into the system for basic efficiency gains and sophisticated practice improvements.

MRS software provides immediate data on every radiologist’s callback rate and positive predictive value, helping the center pinpoint deviations and areas for improvement. For example, a positive predictive value under 10 percent likely indicates the radiologist calls too many patients for follow-up. Ready access to such data facilitates training and continuous quality improvement. What’s more, because the software automates data mining, a department manager is free for other duties. Instead of spending one day a week gathering data, she conducts QA, teaches technologists and focuses on practice improvement.

At the radiologist level, the software incorporates a template system to reduce reporting time to the bare minimum. The efficiency gains travel downstream to referring clinicians, too. Every report adheres to a standard structure, so the clinicians know exactly where to find key information. “We are literally on the same page,” share Smith.

The combination of increased efficiency and sophisticated data management fuels clinical and operational improvements. For example, if a clinic stops referring patients to the center, MRS demographic data detects the change, providing the information needed to proactively tackle the problem. Smith and his partners also access historical data through MRS to fine-tune each interpretation. Take for example the patient with previous invasive lobular cancer. MRS puts pathology data at the radiologist’s fingertips and informs interpretation for the patient’s specific history. Such capabilities create a best-of-both worlds environment that weds efficient interpretation with optimal patient care.
The long view

For the last several years, Tansy Breast Center in New Orleans, could not meet screening mammography needs. The center expected a conversion to digital in mid-2008 to provide the necessary capacity boost. The good news, says Breast Imaging Supervisor Deanna Nettles, is productivity and capacity increased after the conversion. On the flip side, demand increased as well, so the wait for a screening appointment still hovers in the two-month range.

Automation helps radiologists and technologists to stay on track. Tansy Breast Center uses MagView software for reporting and tracking. “Mammography [report] verbiage is narrow. MagView incorporates this verbiage to create an easy to use, point and click reporting solution,” explains Nettles. For example, the software allows radiologists to complete negative reports in three clicks, allowing them to focus on image review rather than reporting. The software also facilitates administrative workflow, automatically sending letters and reminders to physicians and patients. “With our volume, only a computer can track these tasks,” says Nettles.

Tansy Breast Center continues to tweak MagView for maximum gains. For example, the center plans to develop an interface to enable single sign-on between MagView and Agfa Healthcare Impax PACS. After a radiologist launches a study in PACS, MagView will display the same study to save two to three seconds per exam. Multiplying the time-savings 100 times through the course of every day could allow the practice to accommodate additional patients, says Nettles. Plus, the interface guarantees a match between images and reports to reduce workflow-busting errors.

The digital transition: key considerations

  • Digitizing prior mammograms requires a large amount of work upfront, but it improves radiologists’ workflow because it eliminates manual hanging and worklists and reduces eye fatigue associated from shifting from a computer screen to a viewbox. “Any sites that complete more than 50 studies a day should consider digitizing priors,” recommends Nettles.
  • Think ahead, says Nettles. Volume will increase with digital. Add 20 percent to analog volume and plan accordingly. Appropriate adjustments include adding techs or administrative staff.
  • Digital mammography will slow down radiologists’ reading speed. Consider a variety of investments from network infrastructure to ergonomic furniture to minimize the impact. A robust network minimizes radiologists’ wait time for images, while the right furniture helps physicians focus on image review.

Mammography software is an essential of the digital practice. It benefits workflow in multiple ways: by streamlining reporting, automating manual tasks and facilitating data collection and management. Plus, sites can mine software to spur subtle productivity and patient care gains and realize the promise of digital department.

Clinical Connections
Mammography software holds the key to workflow gains; however, utility does not stop with basic productivity measurements. By collaborating with software vendors, physicians can drive clinical improvements. Take for example the University of Kansas Medical Center in Kansas City, and Mammography Reporting Systems.

The center employs a neoadjuvant chemotherapy protocol for patients with locally advanced breast disease. The protocol challenges conventional wisdom. The traditional treatment is based on surgical removal of the lump; however, some cancer remains in the breast in about 50 percent of cases, says William Smith, MD, director of breast imaging. The neoadjuvant protocol leaves the mass in the breast and uses it as a measure to gauge the effectiveness of therapy. If the tumor shrinks, it indicates that the chemotherapy regimen is working. If it does not shrink, physicians can change treatment or refer the patient for surgery.

Neoadjuvant chemotherapy hinges on measurement accuracy. Smith and MRS aim to develop a way to dictate standardized tumor volume measurements to facilitate the center’s neoadjuvant therapy protocol. By partnering with the vendor to standardize evaluation, a smart protocol becomes smarter. Physicians can use standardized evidence to inform treatment decisions and offer patients the best possible care.