A wave of tomosynthesis adoption is coming, and practices looking to incorporate the modality must make sure their PACS doesn’t limit their viewing or workflow, according to a vendor town hall discussion at the Society for Imaging Informatics in Medicine (SIIM) 2015 annual meeting in National Harbor, Md.

There are three big factors that are going to drive tomosynthesis adoption, explained Steve Deaton, vice president at Viztek, speaking before the crowd gathered in the exhibit hall:

1. Additional reimbursement established by Medicare with the newly assigned billing codes for 2015.
2. The introduction of competitors in in the tomosynthesis market. “Now that there are multiple vendors there’s going to be more competition, and prices will drop on these devices, so we expect a lot more deployment in facilities,” said Deaton.
3. Radiologists are becoming more familiar with the technology and how to read tomosynthesis studies efficiently.

While physicians are becoming more comfortable with the modality, reading workstations may be holding some practices back by not supporting workflow. Over the last decade, mammography went from being siloed on dedicated workstations to being brought into the main system where it could be read alongside all other modalities. With tomosynthesis, history is repeating itself at some practices.

“We’re seeing that tomo is forcing a lot of people to come back to the typical of 10 years ago where you’re faced with a workstation where you can read all other studies and then you have still a tomo-only workstation,” said Deaton.

That doesn’t have to be the way, however, and practices should expect PACS vendors to support all modalities. Deaton also highlighted two other features that practices should expect: zero-footprint viewing and server side rendering.

Just like any website you want to navigate to can be viewed on any browser, the expectation in healthcare should be zero-footprint viewers that offer full functionality regardless of the operating system or age of computer. There should be no installation or plug-ins required.

Server side rendering helps deal with the huge sizes of tomosynthesis studies, which can run 1-2GB. Typical PACS viewers download the full DICOM dataset, using pre-fetching and auto-routing to drive studies to workstations. With server side rendering, however, there is no need to worry about pre-fetching studies and as much as two-thirds of network traffic can be eliminated because data sits on the server.

A few years ago, the conversation was about storing tomosynthesis images, said Deaton. Now, the conversation has shifted to streamlining display and reading.

“Server side rendering can be the solution to almost eliminate the concerns with these [breast tomosynthesis object] studies,” he said.