Evolution in Care: Mammography

For more than 50 years, PrimeImaging has been pioneering imaging services in the tri-state area of Tennessee, Georgia, and Alabama. The innovative group is often the first to offer emerging technologies that positively impact patients and physicians in the community, including the area’s first full-body CT scanner and first all-digital outpatient imaging center.

In 2006, the practice expanded its women’s imaging services by installing full-field digital mammography (FFDM) at its new PrimeImaging Gunbarrel Road center, complementing digital mammography offerings at several of its other sites. During the process, we had to address the need to view patients’ prior film studies as part of the reading workflow, an important but often-overlooked issue. For PrimeImaging, a large portion of its prior studies were coming from other facilities that were not performing digital exams. We turned to VIDAR Systems Corporation for its film digitizing expertise, experience designing efficiency into the digital mammography workflow, and exceptional customer service. The center acquired VIDAR’s CAD PRO® Advantage digitizer with ClinicalExpress® software to streamline the integration of mammography priors, maximizing the benefits of FFDM. 

Benefits & Challenges of Digital Mammography

James Busch, M.D., Director of Informatics, said there were several reasons to expand the offerings of digital mammography. “Digital mammography provides many benefits, including improved patient care, enhanced patient and staff satisfaction, improved productivity, and reduced costs,” he said. “Utilizing cutting-edge imaging technologies also is a prerequisite for recruiting talented radiologists and establishing hospital partnerships.” 

Significant workflow issues, however, arise from the need to review and compare current digital studies with prior analog films. Mammographers have limited time for reading exams, and the need to move from a digital workstation to lightbox and back is cumbersome and time-consuming. This creates a less-than-ideal clinical environment that may adversely impact diagnostic accuracy. There also are important cost and resource considerations, such as the staff time needed to retrieve and hang films.

“Analog priors diminish the benefits of digital imaging,” Dr. Busch said. “Digitizing prior studies eliminates the need for cumbersome, distracting ‘dual reading’ environments. Facilities should address this critical workflow issue in the planning stages so they can maximize digital workflow from day one.” 

Establishing a Digital Mammography Facility

The practice learned firsthand the value of planning mammography workflow when opening the new digital imaging center. According to lead mammographer Amy Caldwell, when PrimeImaging opened the facility, it did not have a film digitizer on site for 18 months. As a result, the workflow was complicated. 

Radiologists read digital studies on a workstation and then went to the mammography room to view prior analog studies on a lightbox. Caldwell said this significantly interrupted reading workflow. Dr. Busch said it also was distracting for radiologists, and the significant difference in the luminance and illuminance of a lightbox versus a monitor makes comparing mammograms difficult, negatively impacting quality. 

To resolve this problem, prior studies were couriered to one of the practice’s other imaging centers for digitizing and then sent electronically to DRC for review, resulting in at least a one-day delay in reading studies. DRC’s solution was the acquisition of a VIDAR CAD PRO Advantage digitizer and ClinicalExpress software. 

Integrating Mammography Priors

TThe CAD PRO Advantage meets the highest standards of quality and reliability to quickly digitize film-based prior studies. The ClinicalExpress software, with its dedicated user interface for digitizing and transporting mammography priors, uses the DICOM MG standard to identify the specific view contained on each film. Prior film-based studies are correctly displayed on mammography workstations alongside current digital studies, increasing efficiency and productivity. 

“Workflow efficiencies increased two to three times when comparing side-by-side current and prior-year digital studies,” Dr. Busch said. “The automated hanging protocols and labeling for various types of studies and radiologist preferences further enhance the reading workflow, eliminating the outdated task of manually sorting and hanging images."

Caldwell agreed that workflow is improved with the VIDAR digitizer and is pleased with the impact it has had on daily operations. “The CAD PRO Advantage made our workflow much smoother and more efficient,” she said. “I would tell anyone looking to switch to digital mammography that a digitizer with the right capabilities is a critical requirement.” 

Quality Considerations

According to Dr. Busch, the image quality of the CAD PRO AAdvantageeasily meets the needs of radiologists for reviewing mammography priors. The image quality of the digitizer was confirmed in a 2007 comparative study conducted at the Johns Hopkins Medical Institutions and published in the Journal of Digital Imaging. Results showed no statistically significant differences between the interpretations of film mammography examinations and softcopy exams digitized by the CAD PRO Advantage

“The quality of the digitized images works very well for comparing current and prior mammograms,” Dr. Busch said. “Film digitizing is not a reimbursable procedure, so choosing an affordable digitizer that provides high-quality images and workflow efficiencies is key. I have used more expensive digitizers, and VIDAR’s CAD PRO Advantage provides similar image quality. Therefore, there is no reason to go with a more expensive solution.”

Dr. Busch said that imaging facilities and their patients stand to reap many benefits from the transition to FFDM, but workflow considerations are critical. Analog priors don’t have to be an obstacle as long as facilities plan for digitizing prior studies in order to maximize the benefits of digital mammography for patients, staff, and the center’s bottom line. For PrimeImaging, VIDAR’s CAD PRO Advantage digitizer and ClinicalExpress software are key pieces of a successful digital mammography solution.