What can radiologists do to improve their digital mammography reading skills?

This is an increasingly common question in the field of Women’s Health, as more facilities and radiologists make the transition to digital mammography. As anyone who has viewed film and digital mammograms can attest to, there are inherent differences in reading digital breast exams that make training and ongoing improvement paramount.

Despite the inherent clinical benefits of digital technology, digital mammography can slow down the reading process substantially. Magnifying, panning, zooming and scrolling through digital breast images, using various display protocols, can be quite an adjustment for even the most experienced film-based mammographer.

Fortunately, there are steps radiologists can take to improve their digital reading skills.

The first activity is to conduct a rigorous medical outcomes audit of the mammography practice. A required annual event in some countries, the audit serves as a retrospective evaluation of the appropriateness and accuracy of mammographic image interpretation. By analyzing true-positive, false-positive, false-negative and true-negative results, radiologists are able to establish a baseline of measurement that they can work to improve upon.

Radiologists can further improve their skills through self-assessment workshops—an increasingly popular tool offered at conferences around the world. These workshops provide a positive environment for radiologists to practice digital mammography reading and, quite often, measure themselves against their peers.

Participants read from a set of images that include both normal screening exams and screenings that contain confirmed pathology. The images will include different breast types (e.g., fatty, scattered fibroglandular, homogeneously dense and heterogeneously dense) and different types of lesions (e.g., microcalcifications, architectural distortions, masses and masses with calcifications)—all of varying sizes. In addition, most assessment workshops will time participants to help gauge reading productivity.

We’re sponsoring an upcoming self-assessment workshop at the European Congress of Radiology, featuring two highly-renowned mammography screening and pathology experts: Ulrich Bick, MD and Roland Holland, MD, PhD. The American College of Radiology, National Consortium of Breast Centers and Radlist.com are also excellent resources for information on digital mammography training courses and seminars.

Have other methods to improve digital reading skills? Any courses you recommend? Comment below or let us know of any other questions you’d like me to answer!

– Anne Richards, Clinical Development Manager, Women’s Health

Editor’s Note: “Ask Anne” is a new monthly installment in which we pose a mammography-focused question to Carestream Health Women’s Health Clinical Development Manager and all-around mammography expert, Anne Richards.

Cloud Computing promises a rainbow of benefits—how does it apply to healthcare?

Cloud computing holds enormous promise for healthcare facilities

For decades, healthcare providers have invested in implementing, maintaining and upgrading their own extensive technology infrastructures. Given this expense (and the headaches that go along with it), the industry is turning to “pay-as-you-go” service models that deliver on-demand data utilizing offsite data centers and web-based virtual environments.

This shift has many compelling benefits including eliminating overhead for system maintenance, upgrades, replacement and remote disaster recovery. It also simplifies data management and enables secure information sharing across multiple locations.

In addition to reducing global expenses and overhead, cloud computing holds tremendous promise for helping healthcare IT staffs manage and harness the explosive growth of medical imaging data. It gives immediate access to virtually unlimited resources, with a business model very similar to what most of us pay for utilities: you get charged only for what you use and are generally able to predict cost based on current/planned usage.

Healthcare facilities can therefore send both legacy and new clinical data to the cloud, benefiting from long-term preservation of their data, but also enabling controlled access to data from different stakeholders, such as clinicians or referring physicians.

But being able to entrust data to the cloud requires us to “healthcare-enable” it. Clinical data is not like most other data—it has specific requirements: security, confidentiality, availability to authorized users, traceability of access, reversibility of data and long-term preservation. A simple “public” cloud is not enough. 

This is where the “healthcare cloud” journey starts.

Come see us at HIMSS to see what we are doing to build the healthcare cloud, or tell us what you think.

–  Patrick Koch, Carestream Health

HIMSS presents opportunity to evaluate vendor-neutral archives

What's your biggest IT headache?

The DICOM standard has been around for what seems like forever. In retrospect, the implementation path most modality vendors chose is far from “standard.” Most vendors have inserted their own “tricks & treats” within the data. This “expansion” of the standard has sometimes provided unique vendor-specific capabilities. But when we attempt to integrate data from many sites to one logical archive, and access it intelligently, we are faced with a huge data migration effort.

Thankfully, new vendor-neutral archiving platforms finally promise to bridge this historic chasm and reduce the headache level for the IT organization. But don’t be fooled by all the hand waving: vendor-neutrality is a difficult achievement that requires careful planning and skilled execution.

HIMSS presents IT managers with the opportunity to evaluate data exchange methods required for true interoperability. Bi-directional dynamic tag morphing, for example, is essential… it facilitates interconnection of incompatible DICOM devices by allowing the archive to reference an internal library of PACS-specific tag addresses and attributes. This enables DICOM headers to be modified when transmitting DICOM image data acquired on one vendor’s PACS for widespread access by other users.

The morphing/parsing performed is typically different with each source and destination, and can start from simple search and replace rules up to complex nested translation-tables. In addition, the archive needs to support industry-standard integration methods such as XDS-I and DICOM, and enable easy data access from a single point through one global viewer.

For more details on vendor-neutral archiving, come see us at HIMSS booth # 6751. Additional reading on VNA concepts can be found in Michael’s Gray’s informative blog.

What’s your biggest health IT headache?

– Eran Galil, PACS/Archive Product Manager, Carestream Health

Gazing into the HIMSS10 crystal ball

What's in your HIMSS crystal ball?

With health IT’s own version of “March Madness” fast approaching, we are considering information management trends that we expect to dominate HIMSS10 discussion. Certainly building an efficient EMR infrastructure and enhancements in data/image archiving are always hot topics, and we expect this year to be no different.

Here’s a sneak peak of the capabilities we expect people to be talking about—and evaluating—at this year’s conference.

  • Achieving vendor-neutral archiving. Consultants have urged healthcare providers to carefully evaluate archiving solutions to find those that enable interoperability with multiple vendors through the use of standard interactions and dynamic tag morphing capabilities. Prior to purchasing an archiving solution, healthcare IT staffs need to understand the specific implementation of every data exchange method to ensure that the archive can deliver true vendor neutrality.
  • Building an EMR infrastructure. Most healthcare organizations want to implement some form of EMR that expedites access to patient records while complying with all ARRA rules. Clinical data repositories are taking an important role in the “meaningful use” adherence. Its cost-effective to implement a solid infrastructure repository that collects data from many different departments and sites, and then serves the whole EMR through a single secured access point.
  • Streamlined IT management and enhanced data security. Overworked IT staffs need tools that expedite enterprise-wide data management, as well as new techniques to ensure the highest possible levels of data security.

If you are a seasoned health information guru and find these predictions too basic—not to worry! We’ll be drilling down on each of these trends in the coming days. Or for more details, see http://it.carestreamhealth.com.

What’s in your HIMSS crystal ball?

– Eran Galil, PACS/Archive Product Manager, Carestream Health

HIMSS Poll: What’s your toughest clinical data management challenge?

The Everything Rad team is getting excited for the HIMSS10 conference and will be rolling out a bevy of health IT discussion content throughout the coming weeks.

To kick things off, we are conducting a fun “twtpoll” (Twitter poll) asking,

What’s your toughest clinical data management challenge?

Answer now!

We will be randomly picking two entrants to win an iPod Shuffle—live at HIMSS10 in Atlanta!

Global Radiology Snapshot: Arab Health 2010


Carestream Health's Rudy Van de Walle and Mirna Bassil (the author) welcoming Sheikh M. Al Maktoum

According to the Arab Health website, the Arab Health Exhibition & Congress is, by far, the largest healthcare exhibition in the Middle East, and the second largest in the world. I have personally attended this conference for many years now, and it continues to grow by leaps and bounds.

Due to the economic crisis, which had important repercussions in Dubai, this year’s Arab Health visitors were expecting lower activity at the show. They were surprised to see instead that four additional halls were built and filled with exhibitors!

Attendees this year were abuzz about the number and quality of this year’s “conferences” (accredited educational offerings and tracks), which were under the auspices of The Cleveland Clinic Foundation Center for Continuing Education and Institute for International Research Middle East,” which granted CME credits.

Another hot topic was the opening of the show by His Highness The Emir Sheikh Mohammed bin Rashid Al Maktoum, ruler of Dubai, in person. Our Carestream team was honored by His Highness’ visit to our booth. 

In our now five-year tradition of introducing new DR technology at Arab Health, we introduced our new DRX-Evolution—which (if we may say) was also a big hit with show attendees. This was the first public showing of the DRX-Evolution in the Middle East, with DR adoption continuing to grow steadily across the region. Visitors from across the Middle East, Pakistan, Iran, North Africa, India and other countries were well represented, with a noticeable increase this year in the number of decision makers and VIPs actively seeking new imaging technology.

All is all, Arab Health is on the rise—a positive sign for our industry and our customers.

If you attended Arab Health, what did you think? What did we miss?

– Mirna Bassil, Emerging Markets, Carestream Health

Arab Health attendees at the Carestream booth

“New PACS For You?”

Key considerations when looking for a new PACS

With many healthcare facilities turning their attention to replacing or upgrading older systems, and HIMSS 2010 less than a month away, we thought it would be useful to pinpoint a few important elements to consider when buying a new PACS.

What are you looking for in your next PACS?

  1. Advanced onboard 3D processing – The strong growth in the number of exams and images has created the need for volumetric tools such as 3D and automatic volumetric comparison capabilities between current and prior studies built in to the workstation that enhance radiologist efficiency. Most third-party integrations are very limited: they do not allow 3D to be part of the hanging protocols and do not share memory for the image data, thus reducing the number of images the user can work with. It’s wise to look for a PACS platform that incorporates advanced 3D applications into its workstation to ensure maximum efficiency and productivity—without compromising performance or ease of use.
  2. Ease of integration with other imaging/information management systems – PACS platforms need to extend communication out of radiology to other non-DICOM modalities and applications and support data archival from these “other” products. Modern PACS today should go beyond the basics of DICOM and HL7 and enable communication with third-party applications through use of XDS, API interface and other integration mechanisms. The PACS viewing capabilities should also support viewing of images as well as a variety of patient data types at the clinical workstation.
  3. Full cross-site reading functionality across multiple sites – Unfortunately, many independent local PACS systems often hamper data sharing, global worklist sharing and in particular global workflow in a multi-site environment. Many suppliers are taking steps to enable these and provide efficient solutions across multiple sites. Features to look for include real-time synchronization of the data between the sites, secured and fast ad-hoc access to data from any location through a single access point and global workflow capabilities without data migration.

 Not surprisingly, these are capabilities that our customers have reported as “must-have” and which we’ve built into our new PACS offering.

” …so what are you looking for in your next PACS?”

 – Neville Skudowitz, PACS Product Line Manager, Carestream Health 

Editor’s Note: This post was updated on Monday, Feb. 8