3D digital breast imaging puts new spring in the step of established Ohio practice

Fourteen years ago, radiologist Dean R. Ball, DO, founded a breast imaging practice to meet the needs of the underserved communities in and surrounding Youngstown, Ohio. Today, the practice Ball founded, Tiffany Breast Care Center, employs 16 mammography staffers, up from five in 2004. Although the practice has grown significantly, Ball is committed to reading the X-ray images for each of his patients—which is upwards of 15,000 annually.  

The numbers speak volumes—literally. At the main office, Sandi Bruff, practice administrator and a mammography technologist, reports an increase in volume of around 350 patients over the past six months. The upsurge is all the more impressive considering what prompted the growth spurt: Tiffany Breast Care Center’s decision to replace, at the start of that period, two computed radiography (CR) rooms with one room dedicated to digital mammography.

Then again, Tiffany Breast Care Center didn’t merely go from CR (and analog) to digital radiography (DR) six months ago. Instead, Ball’s team introduced the practice’s first 3D imaging capabilities. The upgrade came in the form of a Fujifilm ASPIRE Cristalle digital mammography system with digital breast tomosynthesis (DBT). The equipment is now handling all diagnostic exams the practice performs and, in fact, all exams—screening as well as diagnostic—at the main office. 

Crystal-clear images, easily acquired 

Tiffany Breast Care’s embrace of 3D DBT has an interesting side story all its own. Ball’s interest in the technology took off when patient inquiries about it went from occasional to frequent. Many said they’d heard about the superiority of 3D from their friends on social media. 

Little by little, the word-of-mouth demand “got so great that I started to feel the fear of falling behind,” Ball says. “My awareness of the competition led me to start thinking I needed to purchase a 3D machine. Heading into the future, having better technology made sense.”

So it was that, last year, Ball and Bruff went DBT shopping. They looked at offerings from several highly regarded vendors in the space, prioritizing two essential aspects—ease of use for the techs and image quality for Ball, who does all image interpretation for the practice. 

Secondary considerations that registered as highly desirable included Fujifilm’s patented Comfort Paddle together with the ASPIRE Cristalle’s hexagonal image-capture technology and advanced image processing techniques, which automatically optimize contrast to help minimize radiation dose.  

The tilting Comfort Paddle technology alone has generated considerable buzz among mammography patients comparing notes, Bruff says. 

“Pretty much every patient says the compression is so much more comfortable than their last mammogram,” she says. “One patient said she’s definitely going to have her sister come here.”

“We tell them to go tell all their friends and family,” Ball adds. “And they do.”

Summing up their impressions six months into their work with the ASPIRE Cristalle, Ball and Bruff don’t equivocate. 

“The image quality is excellent, the technology is very easy to use, and the patients really like the speed as well as the comfort,” Ball says. “They like that they can get in and out in just a few minutes. On top of all that, the pricing was very fair. In fact, for all we got, I thought Fujifilm’s pricing was very good.” 

A clinical cinch 

Drilling down into the very reason for mammography’s existence, Ball takes up the question of how well ASPIRE Cristalle has been doing at catching cancers. 

“There have been a couple of instances in which I may not have seen a lesion or a cancer with analog or CR, or maybe I wouldn’t have made the diagnosis as quickly and as confidently as I was able to with the 3D,” he says. “We’ve had a couple of patients with small, spiculated areas that were easier to pick up with the 3D.”

He describes a patient who had microcalcifications, which can be a sign of breast cancer. “These areas of interest were very subtle, and I might have blown by them if not for the detailed 3D images,” Ball says. “We’ll see when she comes back in. We’ll probably get another view and biopsy the tissue.”

Ball points out that, for patients with dense breast tissue, the superiority of 3D over 2D is “a no-brainer. The cancers that hide from 2D can’t hide from 3D, with its greater detail and views for the radiologist from all the angles.”

One good technology deserves another 

Looking ahead, Ball and Bruff expect to see increased revenues from 3D billings. They plan to leverage the resulting stronger financial position to make Tiffany Breast Care even stronger technologically. A second ASPIRE Cristalle is likely, they report, and a new PACS is already on the way. 

“We’re soon to get a new PACS because of the amount of data there is in each 3D image,” Ball says. “It turns out 3D has kind of been a fulcrum for me. It’s pushing me to get up to speed with other technologies.” 

Bruff circles back to the ASPIRE Cristalle’s ease of use and how that facet serves to make the technologists more confident in learning new technologies. 

“This machine has a lot of time-saving menu options that are easy to learn,” she says. “We can do one click rather than four clicks for all the different views, and the one-touch button automatically advances the machine to go to the next view. This makes the procedure even quicker. We can start positioning the patient while the machine is setting itself up for the next view. All our techs like that feature.”

Ball is clearly satisfied he made the right move in 2004 when he decided to focus most of his radiological attention on breast imaging. 

And he says having installed one of the first ASPIRE Cristalles in Ohio “makes me more confident as a radiologist,” he says. “I’m confident that I’m providing the best diagnostic capabilities and the best technology people in this area can get.” 

“That’s really what we’re all about,” Ball says. “That’s why we have so many patients coming back, including the few who have had breast cancer. To see the smiles on their faces, and to hear them telling us we did a great job—and to receive the hugs we occasionally get—it’s just really gratifying.”