Implementing Digital Mammography with a Positive Impact on Workflow

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When it comes to beating breast cancer, everyone agrees: the best way to combat the disease is with early diagnosis via routine mammography. There is also agreement that the quality of the mammography image must always be a primary consideration and that digital mammography is becoming an increasing popular method of choice worldwide.

Radiologists and administrators today have an ever-expanding wish list of features they are looking for in a digital mammography system, including a comprehensive reporting structure, increased flexibility and ease of use, and a workflow that maximizes the efficiency of the department as well as the level of patient care.

Converting a large, busy mammography department to digital, however, requires a considerable investment in planning by many diverse functions: radiology managers and radiologists, facilities managers, interior designers, technologists, PACS administrators, IT network and storage specialists, clerical supervisors, and others. As was recently proven at Woman's Hospital in Baton Rouge, LA, with sufficient attention to detail and a specific concentration on workflow efficiency, while the migration to a digital environment can be challenging, it can result in improved workflow efficiency.

A close relationship with a vendor capable of understanding the digital imaging world is critical. "The Agfa sales and support team met frequently with our Information Systems and Radiology personnel in order to configure a site-specific solution for our digital environment," reports Dr. James Ruiz, a radiologist at the 40-year-old facility, which was one of the first women's specialty hospitals in the United States. "The most challenging aspect of the project was satisfying the needs of a busy breast center that has more than 45,000 visits a year." This step-by-step methodology was planned in anticipation of the installation of seven digital mammography units, one of which will be housed in a mobile coach (see sidebar).

"Choosing the right diagnostic workstation was a critical component of the overall project because the interface that radiologists use has to be intuitive and high speed, and must also provide the highest resolution possible," adds Dr. Ruiz.

There are basically two options when evaluating mammography workstations: a multimodality system that allows viewing of all types of imaging studies, or a modality-specific station. After testing the functionality of available modality-specific workstations, it was decided that the multimodality approach would be the most efficient solution possible for Woman's Hospital .

"First, it was the value of digital mammography over analog mammography that made the biggest difference to us, and then it became the value of a multimodality workstation that proved to be just as big a gain," Dr. Ruiz says. "With the multimodality workstation, the patient's complete set of imaging exams are available to review together, allowing us to make faster and more accurate diagnoses-some-times even while the patient is in the exam room. That's an enormous comfort to them."

Furthermore, radiologists no longer have to move from station to station through the department to view multiple exam types. "Many of our patients have multiple examinations that I'll need to review along with their mammogram- CT, MRI, ultrasound. Without a multi-modality workstation, I would review the mammogram on a dedicated workstation and to review the other exam, I'd need to have an additional workstation in the reporting room or might even need to walk down the hall to another station. The multimodality workstation makes life a lot easier and gives me the confidence to know that I'm providing quality patient care" says Dr. Ruiz. "Even if I'm here late at night with much work still to be done, I can take care of reviewing all modalities from a single chair in the mammography room, where I spend most of my time anyway."

A single workstation eliminates the space problem that modality-specific workstations present. Many additional expenses for furniture, lighting, electrical, and ventilation required by two different workstations are also eliminated.

Woman's Hospital made the decision to use Agfa's IMPAX MA3000, a multimodality diagnostic workstation for digital mammography built on the IMPAX platform with dual 5 mega-pixel flat-panel monitors. Color images can be viewed on a 21-inch NEC flat-panel monitor. "This system functions well with our permanent storage, which essentially consists of all exams residing on spindle cache. The configuration makes retrieval of studies nearly instantaneous," Dr. Ruiz adds.

Selecting IMPAX completed an enterprise-wide installation at Woman's Hospital that streamlines maintenance and prevents software/hard-ware conflicts that might otherwise arise in a multivendor situation. "The IMPAX workstation had been easy to master and there was no desire to learn an entirely new interface that would come with a modality-specific workstation. Our conversion was complex, but only because we were determined to pay strict attention to all the details," says Cynthia Rabalais, director of imaging services. "Our entire department, in addition to the IT group and technical experts from Agfa, spent several months planning it. The results speak for themselves. Paul Kirk of our IT department, along with his team and our Agfa family, provided a goldmine of knowledge and commitment to getting everything properly designed and con-nected-both within Radiology and within the HIS. They really were cutting edge in their approach."

"We have found that the MA3000 is remarkably flexible for mammography display," Rabalais says. "There are six radiologists in the department and each one has his own set of favorite tools and hanging protocols." Hanging protocols cover virtually any configuration that might be desired and can accommodate prior digital or digitized film studies. The available tools allow for the manipulation of images and studies. Some radiologists prefer to use the mouse to access tools while others choose to program the keyboard to perform many functions. In addition to standard tools, the workstation can be programmed with any number of macros to further expand workstation functionality. The workstation can also retrieve reports from HIS and can be linked to voice recognition systems.

For patients having a work-up for an abnormality, the workstation allows the radiologist to view the screening exam, additional views, ultrasound, and MRI exams at a single workstation. Radiologists can view studies in progress and annotate the images that need additional views. The annotation tool contains a modality-specific database with a drop-down menu with which the user can store favorite additional views of the mammography exam. While logged onto Agfa's web tool, technologists viewing these annotations do not have to leave the patient.

Medical professionals have acknowledged that digital images are at least equivalent to film-based images for identifying breast abnormalities, including cancer. 1 The objective of the multi-modality workstation is to allow radiologists to maximize attention devoted to image interpretation while minimizing the effort required to manage a busy workload With the added benefits offered by a multi-modality workstation like the IMPAX MA3000, image enhancement is easier than it was before, fewer keystrokes and less mouse handling are required, and there is far greater simplification and customization of image management, interpretation, reporting and storage. In essence, it's all about the workflow.

Indeed, workflow has been an operative phrase for diagnostic efficiency for many years now-but with the multimodality, single workstation option, it is taking on an entirely new meaning. It is, in effect, becoming synonymous with quality patient care.

Mobile Mammography

Although Woman's Hospital performs more than 45,000 breast exams each year using the latest digital technology, the radiology staff will readily admit that it's not enough. That's because, as in most cities and large municipalities, there are always thousands, and in some cases hundreds of thousands, of women for whom travel to the hospital is difficult, or who are simply unaware of the need for regular mammography exams.

But Baton Rouge's premier healthcare facility is known to rise to every challenge, and their mobile mammography coach is inspiring proof of that. Woman's mobile coach makes mammography accesible to more women in southern-central Louisiana than ever before. Images are transmitted digitally to the hospital for interpretation, leading to effective, timely diagnosis for women needing on-site follow-up. The coach travels to neighborhoods, churches, schools, community centers and any other location where women's services are needed.

This important initiative is bringing modern digital technology to dozens of communities in and around Baton Rouge. It is anticipated that more than 20,000 women each year will be examined. In short, many lives will be saved by a simple mobile visit.

Contact Information

Agfa Healthcare Pat Montgomery, Sr. Marketing Manager, Woman's Care 864-421-1600 infosales@agfa.com www.agfa.com/healthcare

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Implementing Digital Mammography with a Positive Impact on Workflow.  Appl Radiol. 

October 12, 2006



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