At the Heart of Breast Imaging: Keeping Workflow Moving
Diligence and planning the ins and outs of breast imaging workflow—from image acquisition, to patient flow, to tracking and monitoring exams—are paramount to the success of the digital transition, along with healthcare IT tools and techniques to ensure the delivery of quality patient care.
A strong IT backbone
“In breast imaging, quality of care is always the first consideration, but this must be delivered in an environment that is efficient and had rapid throughput,” says Gary Levine, MD, director of breast imaging at the Hoag Breast Care Center in Newport Beach, Calif. With an annual imaging volume of approximately 60,000 studies, the center offers diagnostic and screening mammography services.
The first step to increasing efficiency is having qualified technical staff acquire the images. Hiring proficient technologists with many years of experience in multiple technologies can help keep things moving with minimal interruption in workflow. For example, at Hoag, most diagnostic technologists perform ultrasound as well as mammography exams, so that if additional imaging is required, the patient is imaged by the same technologist. This results in two efficiencies—no loss of information between staff as a patient is moved and better efficiency and flow of patient care throughout the department.
Hoag also recognizes the advantages of having all modalities at one site. “You don’t want to have to move patients between offices since information can be lost and patients are inconvenienced,” he adds.
Just as important, if not more, is a strong IT backbone to support the variety of imaging modalities and technologies in use. At Hoag, the Magview mammography reporting and distribution system is “the heart of the department because all of our reports are available in the system,” Levine adds. Approximately 98 percent of reports are template-generated reports through Magview, which enables faster throughput. Radiologists can dictate, use check-off sheets or create reports directly using the AutoScribe feature, which lets them enter findings directly at the workstation/viewstation. Reports can be ready before the patient leaves and auto-faxed to the referring physician’s office.
The center can automatically track and follow-up on patients, ensuring that no patient falls through the cracks. For mammography, perhaps more than any other modality in radiology, tracking patients is extremely important, especially in light of an abnormal finding which requires follow up. In a manual system, the potential for human error is present—but in a digital environment all of the manual processes are seemingly replaced. When the patient has an exam, she or he is automatically entered into Magview, which tracks when the patient is scheduled for the next study and alerts the provider when those patients are due for follow up.
Levine stresses the importance of planning and site visits to organizations utilizing digital mammography, and design a workflow up front that best suits their needs. “It is vital to have an IT backbone to support a digital mammography environment, and facilities must consider this in their transition plan,” he says.
A ‘central nervous system’ workflow
While a strong healthcare IT backbone is critical to the success of streamlining workflow in a breast imaging environment, keeping the interactions and communications open between staff is also key. To tackle this challenge, it is helpful to design how you want the work to flow before the transition is complete. “We really have no issues anymore in workflow because of the way we set it up when making the transition to digital,” according to Donna Pletcha, MD, director of breast imaging at University Hospitals in Cleveland. In going digital in 2006, the hospital designed a new workflow across four sites, making sure that all the modalities and technologies could talk to each other by choosing a third-party PACS workstation for mammography into which digital mammography, breast MR, CT and ultrasound images are fed.
The staff designated one technologist who leaves the floor everyday, either for the full day or half day, to work at a Sectra IDS5 mqa/mx.net workstation with a Sectra Enterprise Edition PACS. The workflow coordinator receives all studies from the various modalities, checks hanging protocols, makes any final adjustments and sends them off to the radiologist for reading on a Sectra IDS5/mx.net softcopy diagnostic workstation. The two workstations share a network connection, allowing radiologists and technologists to communicate via text message and annotate markings on images.
This allows the radiologist to focus on the diagnosis, while the workstation handles all the logistics. Radiology images are displayed according to individual preferences. Radiologists look at a worklist, select a patient, review the study and communicate with the workflow coordinator to explain what needs to happen next with the patient. The coordinator then communicates this information back the technologist performing the exam. “They don’t interrupt us, we don’t interrupt the techs—they just keep imaging the patients,” Pletcha notes. “We have this central nervous system in which one person knows the picture of the day, who anyone could go to for answers—that is the key to making things run smoothly throughout the day.”
One feature of the Sectra workstation for radiologists that helps keep work moving throughout the center is the keyboard work pad, which offers shortcut buttons for the user to speed through cases. Users can customize the shortcuts and assign buttons on the pad to correlate with different functions, specific to individual user sign-ons.
“My sign on and shortcuts can be different than my colleagues, allowing for a personalized, user-friendly workstation to help us work faster,” Pletcha says.
Using the work pad, users can bring up previous images, as well as blow them up to true to size, as different modality manufacturers have different spatial resolutions. “For example, GE Healthcare has 100 micron per pixel size, Hologic is 70 microns.In order to view the image at true size, you have shortcuts for each to change the spatial resolution,” she notes. Shortcuts also help with image inversion to better look at mass density or micro calcifications, or to just leaf through an exam.
With a well-planned workflow design in place that helps images and patients flow throughout the department, quicker and more efficiently, patients at University are waiting less and techs are imaging more with minimal interruptions. “It allows us to be more efficient with the diagnostics, to be able to do more, more efficiently,” she concludes.