Case study - Mammography practice converting to digital
After reviewing studies comparing digital and analog mammography, a mammography radiologist decided it was time to convert to digital. He was concerned, however, about the cost of conversion and his reading efficiency after converting to digital.
Challenge
He reviewed all available mammography workstations to determine which one would make his reading time most efficient. He found all of them (other than Connect Imaging) required multiple button clicks or key strokes to emulate his prior film-viewing protocols. In addition, he required the ability to read his mammography studies remotely, often from a mobile van, a requirement that could not be met by most PACS companies. Finally, he required the conversion process, including digitizing of three years prior studies for each patient, to be accomplished with his existing staff.
Solution
At the time the only mammography workstations available were dedicated to reading digital mammograms and could not be used to read CT's or x-rays also. Thus, a radiologist reading both mammography and other modalities had to move from one workstation to another for each task. The software designers at Connect Imaging designed additional features into the existing ViewBox diagnostic workstation to make it an IHE compliant mammography workstation whenever a mammography study was loaded, while still maintaining its full capability for reading CT, CR, US, MR, XA, or other modalities when those studies were loaded.
In addition to the addition of an IHE compliant viewer to ViewBox, enhancements were made to other modules to make the process of digitizing prior films and reviewing the digitized films for proper labeling as efficient as possible:
- The SureScan film digitizer module was enhanced to automatically apply laterality and view labels to standard screening studies. The software also allowed white areas of the digitized films to be blackened for easier reading by the radiologist.
- The QA Manager module was enhanced to allow fast QC review of digitized studies for proper labeling. This module allowed clerical personnel to perform the relatively time-consuming task of actually digitizing the prior studies, while mammographers could quickly review the digitized studies.
- A Mammographer Workstation module was created with the same functionality as the radiologist's Mammo ViewBox diagnostic workstation, but with significantly lower cost because it ran on lower resolution monitors. This module allowed the mammographer to review prior studies, as well as images from current studies before the study is completed and sent to the FileRoom PACS archive.
To respond to the need to remotely read his mammography studies, the DICOM Forward module was enhanced to be more efficient in transferring studies over a satellite connection. Images were batched together and sent over a single association, reducing the normal 'chatty' nature of a DICOM connection, and a DICOM TLS connection was used for secure transfer over an open connection to the satellite.
Benefits
The result was a PACS that met the radiologist's initial requirements. The existing receptionist was trained to digitize prior studies for patients, while the mammographer performed quality control review of the digitized studies with QA Manager. No additional personnel were required after the conversion to digital.
The most surprising result of the transition was that the radiolgist discovered that he became more efficient reading the digital mammograpms than he had been reading film mammograms. He found he could hang or view digitized mammograms in ways that were not practically available with an analog film viewer. More importantly, he found the quality of care to his patients improved as a result of the conversion. For a copy of the published article, click on the magazine article page--> |
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