Decreasing equipment, setup time may ease implementation of CESM into clinical workflow

Many clinicians would agree that incorporating new imaging methods into a daily clinical workflow can be challenging. But making minimal changes may ease implementation and make a clinical practice with alternative diagnostic methods just as efficient as others.  

According to a study published online March 30 in the Journal of the American College of Radiology, contrast-enhanced spectral mammography (CESM) may be easier to implement into clinical workflow and as timely as diagnostic mammography, through decreasing equipment and patient setup times related to contrast administration. 

Compared with conventional digital mammography, CESM has an increased sensitivity for breast cancer detection. It also has similar sensitivity to breast MRI but costs less. Also, compared to MRI, it can be more easily implemented into routine practice workflows because the equipment needed can be added to existing mammographic units, according to the researchers.  

Despite its advantages, however, CESM has increased aggregate time due to equipment setup and IV-line placement, the researchers wrote, and may impact routine workflow in an active breast imaging practice.  

For their study, the researchers collected time metrics of 123 CESM exams performed on 121 patients between Dec. 18, 2014, to July 11, 2017. For comparison purposes, time metrics were also collected for digital diagnostic mammography (DM), contrast-enhanced CT (CTIV) and MRI exams (including equipment setup time, patient setup time, examination time, post examination time and total aggregate time) between Oct. 24, 2016 and March 5, 2017.  

Overall, 38 CESMs, 34 DMs, 25 breast MRIs and 44 CTIV exams were included in the study. Time metric results for CESMs compared to all other imaging modalities included the following:   

  • Pairwise comparisons of equipment setup times and patient setup times for CESM revealed that CESM was increased compared with DM and CTIV (P < .001 for all) and not significantly different from breast MRI (P = .24 and P = .19 for equipment setup time and patient setup time).   

  • Pairwise comparisons for examination time revealed that CESM was shorter compared with breast MRI (P < .001) and not significantly different from DM (P = .04).   

  • Pairwise comparisons for post examination time showed that CESM was not significantly different from DM (P = .02), breast MRI (P = .01) or CTIV (P = .62).   

  • Although the ANOVA comparison for post-examination time across all imaging modalities was <.001, this result is due to significant differences between breast MRI and DM and between MRI and CTIV.   

  • Aggregate time for CESM was shorter compared with breast MRI (P = .007) and greater compared with DM (P < .001).  

"Our study suggests that decreasing equipment and patient setup times related to contrast administration can reduce overall CESM time by 21 minutes, making it comparable with routine diagnostic mammography and thereby easier to implement," wrote lead author Jordana Phillips, MD, a radiologist at Beth Israel Deaconess Medical Center in Boston. 

Additionally, the researchers noted that understanding the differences between CTIV and CESM is important when making implementation into clinical workflow easier and bringing CESM more in line with diagnostic mammography. 

"Understanding the differences between CTIV and CESM is important to reduce equipment and patient setup times," Phillips et al. concluded. "Three notable differences were: the experience level of the technologist preparing for and administering the IV contrast, tandem versus sequential equipment and patient setup and the location of IV-line placement in relation to the mammography examination room."

[Editor's note: A previous version of this story misrepresented the initial study's findings. IT has been updated to properly reflect the researchers' work. We apologize for any confusion.]