Digital Breast Tomosynthesis Necessary for Imaging Dense Breast Tissue

Digital Breast Tomosynthesis

The image on the left is a DBT image, and the image on the right is traditional 2D mammography.

Digital breast tomoysnthesis (DBT), or 3-D mammography, has often been referred to as being the key to advancement in breast imaging. With more and more states passing laws requiring that women be notified if they are classified as having dense breast tissue, DBT is proving to be beneficial in accurate detection—a JAMA study showed that using 3-D mammography resulted in a 15% reduction in recall rates and a 41% increase in the detection of potentially lethal cancers.

Dense breast tissue and the accompanying notifications to women who possess it has become a frequent conversation topic over the past couple years. As of now, 20 states have enacted laws that require medical professionals to notify women if their mammograms reveal them to have dense tissue. Organizations such as Are You Dense Advocacy are fighting the good fight trying to get more states on board with these notifications because of the major risk dense breast tissue presents— making it more difficult to detect cancer in a mammogram than normal tissue.

At the International Congress of Radiology (ICR) in September 2014, Dr. Marwa Adel from Misr University for Science and Technology and Cairo Scan in Egypt presented two cases:

  1. The first case, Dr. Adel and company compared breast cancer visibility in digital mammography with that of DBT. Cancer visibility was ranked higher for DBT than for digital mammography in 52% of cases and was equivalent in 49 cases (33.6%). When observing the group with higher breast tissue density, the cancers were rated more visible in 64.6% of the cases.
  2. In the second study, DBT also proved better than digital mammography in image quality of masses. DBT was rated as equivalent or superior to digital mammography in 96% of the total findings.

Dr. Adel and the other authors of the studies concluded that DBT is superior to digital mammography in diagnostic performance. Particularly when it comes to dense breast tissue, it is clear that the use of DBT is vital to providing improved diagnosis to patients.

There are important questions regarding financial, technical, product, and workflow issues related to DBT that should be answered before a facility installs a system. As women’s healthcare continues to evolve, more and more facilities are able to implement DBT machines and be in a position to provide the highest quality of care to their patients.

At RSNA 2014, Carestream will showcase enhancements to its DBT module including a DBT image map that indicates the location and orientation of the currently displayed slice in the breast, a slabbing tool that allows  adjust of the slab thickness , improved workflow settings and the display of DICOM-compliant 2D synthetic views, which are calculated from the 3D dataset.  For more information, you can visit us in South Hall at booth #4735.

UPDATE, NOVEMBER 10, 2014: According to an article published last week by Health Imaging, “the Centers for Medicare & Medicaid Services (CMS) established two new add-on codes that will go into effect Jan. 1, 2015, and extend additional payment when DBT is performed along with 2D digital mammography.”  You can click the link to get more details about the designated codes and payment amounts for DBT. CMS said it will also “revisit payment for DBT and 2D mammography for 2016 as part of a review under its misvalued codes initiative.”

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream Ron Muscosky, Worldwide Product Line Manager, Healthcare Information Solutions, Carestream 



Challenges of Stage 2 Meaningful Use Require More Allies

ONC, Meaningful Use, Stage 2

Click the picture to go to the website to learn more about Stage 2 meaningful use certification.

Stage 2 of Meaningful Use is a vital component to the initiative since it, as the U.S. government defines, “intends to increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information.”

As reported by Hospitals & Health Networks, only 140 hospitals have achieved Stage 2 of meaningful use. Throughout 2014, hospitals have been claiming that requirements such as this are more difficult to implement than originally thought. Assistance is needed in the form of decreased time for reporting periods or providers fear that they will face the severe penalties.

From the vendor side, to properly help providers, it is clear that we must be able to provide the answers to two key questions:

  • Can the technology be optimized with the existing solutions in place?
  • One of requirements for Stage 2 states that more than 5% of unique patients during the reporting period must use the hospital’s portal to view, download or transmit their health info to a third party. Since patients will be using the technology, is it intuitive and secure?

For both of the questions, I feel confident that Carestream would be able to answer, “Yes.” Our Vue RIS platform recently achieved Stage 2 certification, making it one of the first RIS platforms to achieve both Stage 1 and Stage 2 certifications. This means that those facilities using the system can exchange patient medical records and clinical documents with other certified EHR providers.

Beyond just being having an integrated solution, working with your clinical departments can enable capturing specific clinical data required: i.e. smoking cessation, BMI etc. In the case of the University of Virginia, the organization shared that radiology helped meaningful use attestation because it was able to capture the data that would not otherwise be captured.

With the Stage 2 certification, Vue RIS includes the following capabilities: family health history, the transfer and sharing of health information, and online patient access to information and communication. Additionally, the RIS platform can also be coupled with the MyVue patient portal to allow for patients to view their exam results, view and reschedule appointments, and also share the exam results with their primary care physicians.

Stage 2 of meaningful use has been deemed so vital to the future of healthcare because it is the first stage that involves the patients becoming ingrained in the process. As the patients become more in tune with their own health, we must make sure that we not only provide them with the tools to take action, but also the guidance and education on how best to use them, as well as the benefits these tools provide.

What have been your biggest challenges when working to achieve Stage 2 meaningful use? What have you been doing to combat these challenges, and what successes have resulted?

Cristine Kao, Healthcare IT, CarestreamCristine Kao is the global marketing manager, Healthcare IT, for Carestream.




NHS Ayrshire and Arran Works to Improve Radiation Dose with Radimetrics

NHS Ayrshire and Arran serves 400,000 people at 10 hospitals across East, North, and South Ayrshire in Scotland. Two years ago, the organization worked to integrate Bayer HealthCare’s Radimetrics with its Carestream Vue PACS. The integration was completed in weeks, and the facility immediately found how well the two work together.

With Radimetrics, NHS Ayrshire and Arran became able to track radiation dose and room utilization as a way to collect data and act swiftly if issues are to arise. The big questions that the facility can now answer include, “Are we minimizing radiation dose for our patients?” and “Are we making the best use of our resources?”

As the video above explains, the organization was able to bring protocols together, standardize them, and oversee the management of dose. With this newfound efficiency, NHS Ayrshire and Arran can now easily spot discrepancies in the data, and seamlessly update patient information.

As volume of exams and complexity exams goes up, the organization needs to justify its decisions. As an example, it can view dashboards to determine room utilization, which allows for specific acquisition on how a room is being used, with Radimetrics, that information is now at their fingertips.

Radiology’s Response to Healthcare Consolidation – Step One: The Global Worklist

Enterprise Image Access

Click the image to learn more about Vue Connect and download a presentation about enterprise image access.

If you’re like me, your day starts with a scan of healthcare headlines that are packed with merger, acquisition and partnership news.  This month Becker’s Hospital Review reported that – in my backyard – Jameson Health will join UPMC. Elsewhere, Advocate and NorthShore are merging to create a new 16-hospital system.  In the Seattle, eight hospitals, 163 clinics, 24 ancillary provider locations and 2,875 primary and specialty physicians from CHI Franciscan Health, Virginia Mason and others have formed a new health network — Puget Sound High-Value Network.

This climate of change in the healthcare system shows no sign of slowing. Booz & Company predicts that 1,000 of the nation’s roughly 5,000 hospitals could seek out mergers in the next five to seven years.

These new care systems and models bring with them large interoperability challenges.  Take this survey of 62 accountable care organizations that found 100 percent of respondents have difficulty achieving interoperability with disparate partners.

I see this often in radiology departments faced with change. Here are five immediate interoperability questions that departments will face:

  • How will we index images from multiple sites and vendors?
  • Can we synchronize patient data in real time from multiple sites?
  • How will we manage metadata discrepancies and accommodate IHE profiles?
  • Is there a way to provide a common interface and tools for reading and reporting without migrating?
  • What’s the best way to allow the referring community to view all patient data regardless of originating site?

Many I talk to worry that the radiology department will not get the funding needed to make a PACS replacement or archiving consolidation project a priority. A complex, forklift migration is time intensive and could be delayed for other system needs.

To respond to change out of the gate and bring immediate value, I counsel my clients to look for solutions that allow them to leverage their existing investments first.

I recommend that step one should be to federate multiple repositories into an intelligent worklist.

By cross indexing multiple databases without replacing existing infrastructure you can enable enterprise wide reading, but keep local autonomy.

This global worklist acts as the “brain” of the new enterprise helping to bring teams together with a common interface and set of tools that allows all people, at all locations to work as if they were just down the hall from each other.

Addressing the worklist first with an intelligent workflow layer like Vue Connect and allowing local sites to keep some local autonomy at the start of a merger, acquisition or affiliation could help drive collaboration and partnership for future changes.  The global worklist can also help ease future transitions such as maintaining the enterprise’s workflow during a VNA deployment and connecting additional PACS systems as the network grows.

Are you planning for change and more interoperability demands now? What alternatives to “ripping and replacing” your PACS are you evaluating?

Interested in learning more about the first step in “Enterprise Image Access in a Climate of Change?” You can download a SlideShare presentation or contact us to learn more about Vue Connect here.

Daniel Hixenbaugh, HCIS, CarestreamDaniel Hixenbaugh is an account executive in the Mid-Atlantic for Carestream.



The Role of a Fully Integrated RIS-PACS: Dream or Reality?

RIS_PACS Integration

The evolution of PACS makes it so radiologists are looking for more dynamic systems.

The EHR is playing an increasing role in the management of patients. In the U.S., according to a recent NHCS Data Brief, 78% of office-based physicians use some kind of EHR. Far from being just a collection of patient medical information in different storage systems, we need the ability to integrate all the information and to have it readily available, thus avoiding redundant tests and appointments. We also need to be able to manage sensitive data as well as to transmit it to health care decision-maker. It must be a dynamic system, constantly achieving more ambitious goals. However this vision is far from being shared by all the players, considering that even some national authorities view it simply as a data repository (or, to put it in bureaucratic jargon, “a set of digital data and documents relating to health and social health generated by present and past clinical events, relating to the patient”).

These goals can be fairly easily met either within homogeneous populations, or within a health system, which is allowed to set the rules of the game and to enforce them. However, this is an extremely complex task in all those environments where different systems are allowed to coexist and no rules are set/enforced to reach the ultimate goal of “one patient-one record.”

The end-solution to this goal lies probably, at least for the near future, in the vendor neutral archive (VNA). However even in its definition, VNA is a compromise solution: a medical imaging technology in which images and documents (potentially any file of clinical relevance) are stored in a standard format with a standard interface, making them accessible in a vendor-neutral manner by other systems. It can be considered an evolution of the original RIS-PACS concept, where no longer are radiology and nuclear medicine the sole players, but on the contrary, all the medical and surgical specialties are involved, as long as they are capable of providing images or documents to be managed within the same archive.

This makes the contribution of a fully integrated RIS-PACS of paramount importance. We should no longer rely solely on the principles of improved productivity, more efficient staffing, optimization of the financial management of the department we are running, and the backbone of the RIS as we have been used to consider it. Instead we should try to put under the same enterprise-wide umbrella all the images and documents which could fit in the system, with positive outcome in the patients’ management. I believe that the key word to this approach to the digital world in health management should be “share”—overcoming the still too common fear to make data accessible not only to the patients but also to “competitors” in the health business. Far from being just a tiny dot within the digital world, the fully integrated RIS-PACS should be a cornerstone not only to the VNA, but also to the EHR.

In fact, as long as we shall not be able to integrate within one single framework all data concerning all patients, whatever the source (private, public, national, trans-national as it happens in the European Union), the talk about a real EHR will sound just as a simple exercise in debate. Unfortunately, these same doubts are shared by other thinkers, such as Gary Drevitch in his short editorial, “Will we ever have universal electronic health records?” published last year in

Dr. Ivo Bergamo- Andreis is Chairman, Department of Radiology/Diagnostic Imaging at Legnano City Hospital, Legnano, ItalyDr. Ivo Bergamo- Andreis is Chairman, Department of Radiology/Diagnostic Imaging at Legnano City Hospital, Legnano, Italy, and is a member of Carestream’s Medical Advisory Board



White Paper: Does Image Quality Matter?

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

The answer to the title question may not be what you think it is. It depends critically on clear definitions of numerous technological and human factors that influence the image during its journey along the imaging chain.

The white paper covers several key topics along this journey

  • The three different “flavors” of image quality—objective, subjective, and performance-based—and their interrelationships
  • Where image quality is created and/or destroyed in the radiographic image chain
  • The role of medical image processing in determining image quality of a displayed image
  • The quantitative characterization of reader error in radiology

The white paper is embedded below and can be downloaded when visiting this page. You can also view a recording of a webinar I hosted that sought to answer the same question.

Image quality is a tool. It can be used, for example, to trade-off against dose, or to improve diagnostic confidence. But, it must be balanced against the natural limitations of the human observer at the end of the imaging chain. Higher image quality does not necessarily produce better performance. So, while high image quality is a desirable goal, it should not become a goal in itself.

Radiology and Macro Healthcare Trends Part I: Access to Care

Access ti healthcare via mobile devices

Mobile devices are important technologies that are improving access to healthcare for patients.

Access to quality care is a popular trend that shows no sign of fading. The Affordable Healthcare Act, the millions still unable to obtain quality care and rapid changes in healthcare technology lead to heated discussions.

For high-quality care to be accessible, facilities must be able to provide the services that meet the population’s need and expectations. Rationing, the integration of radiology and the use of teleradiology in the delivery continuum all have an impact on access.


With the rise in self-rationing and changes in insurer-rationing, imaging’s role is more important than ever.  Imaging is a key data input to the evaluation of patients’ needs and, ultimately, treatment.  Radiologists need a voice in the process and find ways to be included in communication with physicians.

This is where the Integration in the delivery continuum comes into play.

For radiologists to have a more present, active role in diagnoses and treatment facilities must ensure that they are included.

New technology is working to address this while helping to put patients more in direct communication with their healthcare providers. For example, online patient portals have proven to be effective by health facilities that use them, and radiology is becoming integrated into the information accessible via these patient portals.

Patient portals that include radiologic information significant potential to:

  • Provide patients with a more holistic view of their medical histories, thereby meeting expectations in access to personal healthcare information, and
  • Integrate radiology into the delivery continuum by including the images and analyses within the rest of the patients’ histories.


This technology facilitates the delivery of images from one location to another.  This includes the transmission, reception and then review of the images.  When done right, teleradiology is a key aspect of access as it can speed the diagnostic process and support better patient communication.

Teleradiology, in particular, is one trend that can be seen across the globe.  It has transformed healthcare delivery through a cost-effective and flexible online platform.  Success stories on the implementation of teleradiology in India, Australia and Europe are easy to find.  In fact, Carestream, in March of this  year, highlighted ESR’s report on best practices in teleradiology and Aunt Minnie reported on how Russia views teleradiology as a bridge-builder in healthcare.

What do you think? Are you seeing radiology become an integrated, vital component of healthcare delivery? If not, what are the major roadblocks stand in its way?

In part two of this series, we will focus the costs of healthcare, and how radiology can change cost for the better.

Carestream CMONorman Yung is the CMO for Carestream. His series about macro trends in healthcare will be published in three parts throughout 2014. Parts II and III being published in October and November.



Access, Cost and Quality: Macro Trends in Healthcare

Technological evolution, government legislation and industry regulations continually change the ability of our industry to provide the best, most affordable care to patients.

Today’s patient expectations are that they will get high quality care, be able to choose from health care providers and get care at a reasonable price.  In addition to reasonable healthcare costs, patients also expect that there will be transparency so that they are fully aware of their investment.

TrendsThe expectations do not, however, match the reality of healthcare today.   In the radiology sector, however, there are a number of things happening that address these expectations in a positive way.  In a 3-part blog series, we will take a look at what’s being done and how important radiology’s role plays in today’s changing healthcare landscape.

Blog #1 will focus on access. Access goes well beyond seeing practitioners that are in your neighborhood.  It includes accessing your own healthcare data.  How patient data is captured and shared is becoming more integrated into the healthcare process and, therefore, working to address access concerns.

Blog #2 will focus on cost. At a time when 23% of U.S. adults either had problems paying medical bills or were unable to pay them, cost is top of mind for patients and practitioners.  Imaging costs now vary widely and, money spent on imaging has correlated to a reduction in hospital stays. Data show that radiology is very important to streamlining healthcare costs.

Finally, blog #3 will focus on quality. New regulations, controlled costs for facilities and patients, and technological innovations have given healthcare providers the ability to more easily provide patients a high-quality level of care. Particularly in radiology, we see significant advances in the products and software that support the capture and delivery of images.

Use our sign up box to receive the blog posts in your inbox or come back tomorrow for Part I of this series when we will look at how radiology’s role improves access to healthcare.

Carestream CMONorman Yung is the CMO for Carestream. His series about macro trends in healthcare will be published in three parts throughout the rest of 2014. Part I will be posted tomorrow, with Part II and III being published in October and November.

Two Heads are Better than One in Radiology Informatics

While attending this year’s NYMIIS conference in New York City—an annual radiology informatics gathering hosted by Dr. David Hirschorn that has easily become a must see event—I was awed by the refreshing insight displayed by the distinguished lineup of presenters.

Each of the speakers discussed realistic and achievable opportunities to harness the power of healthcare IT systems to increase access to care, lower costs, shorten wait times and improve the delivery of care—all while highlighting that it cannot be done alone. Dr. Kathy Andriole of Brigham and Women’s Hospital summed it up in near perfect form in her presentation on improving decision support through innovative use of information technologies by saying that partnering with a vendor is more “than just doing business, it is about how to make optimal use of resources.”

Dr. Eliot Siegel, Baltimore VA

Dr. Eliot Siegel, Baltimore VA, giving his talk at Nymiis 2014 titled, “How Big Data is Changing the Practice of Radiology.”

Upon hearing that simple yet exacting description of what it really means for technology companies and care providers to truly work together, I was reminded of the phrase “What we’ve got here is failure to communicate” from the 1967 film Cool Hand Luke, spoken by Paul Newman in the role of Luke Jackson. Far too often we have all heard the words “partner” and “partnership” tossed about like rice at a young couple’s wedding. These terms are often taken to mean: “We’ll sell you something at a discounted price and you guys send us our check on time and let’s keep in touch…” A true partnership formed around a common cause and committed to the success of both parties is much deeper and significantly more valuable than such a simplistic treatment implies.

Having a reliable and trusted technology partner that will guide your organization on what is often a complex, multi-year journey to improve the management of medical imaging and information is a critically important relationship. A true technology partner will invest the time necessary to understand the unique needs and challenges faced by IT staffs, radiology managers, physicians and other decision-makers and can be counted on to make the right decisions. This enables the partner to put their knowledge and expertise to work to develop the right healthcare IT systems for your organization, using a well-structured implementation plan that optimizes precious resources while making things better for both the medical staff and their patients.

Healthcare IT innovations have made dramatic improvements in the practice of radiology and have heightened the value that radiology professionals provide to referring physicians and specialists that lead to a better experience for patients. But there is still much more to be done. Do you have the right partner for the journey?

What is your organization doing to harness the benefits that new information technologies can provide? How have you benefited from a successful supplier partnership?

Robert SalmonRobert Salmon, APR,  is director of corporate communications for Carestream, and attended the NYMIIS 2014 event in New York City on September 18, 2014.



[eBook] The Three-Phase Process to Implement a PACS-Driven Teleradiology Service

A PACS-driven workflow has proven to be beneficial in offering teleradiology services, while still allowing referrers to use the HIS/RIS they prefer.

The story of Innovative Radiology is a common one experienced in the diagnostic imaging sector. The organization was experiencing an increasingly busy workload serving over 40 Houston-based hospitals, physicians’ offices, clinics, and imaging centers, which totaled about 300,000 procedures per year.

For about 10 years, Innovative Radiology was linked electronically to referring physicians through a single RIS to create multiple registration centers. Physicians had to manually register patients in the RIS and workflow was guided by it since the images and patient information went right to the radiologist. This was arduous and required an immense amount of coordination and system integration. On a given day, thousands of images would be sent to the organization from dozens of different systems. Since reporting was not integrated, the radiologists would have to log on to the RIS, select the study, then log on to the PACS to read the cases.

It was the adoption of Meaningful Use that forced Innovative Radiology to move away from its RIS and look for a PACS-driven system. By accomplishing this, the organization now has options—a referrer can still communicate with Innovative Radiology with its HIS/RIS, but it is no longer mandatory.

On-site or cloud-based teleradiology can provide effective patient care.

An on-site or cloud-based teleradiology system can connect radiologists to reports, images, and patient history to provide efficient and effective care.

To implement the PACS-driven teleradiology system and services, Innovative Radiology needed to partner with Carestream to go through a three-phase transition process, which is outlined in the eBook, “Increased Capabilities: Do More with Vue for Teleradiology”:

Transition Phase #1: Innovative Radiology’s use of teleradiology began August 4, 2013. Phase 1 lasted two weeks during which two radiologists at Innovative Radiology were connected with two low-volume sites. About 40 studies from up to seven referring physicians were read daily. All involved digital radiography (DR). Report request order entries were created at Houston Medical Imaging (HMI) using Carestream’s Vue Motion. Report distribution was by fax. There was no email distribution and neither billing nor interface with the Houston healthcare information exchange (HIE) was possible.

Transition Phase #2: Continuing for two weeks, there was a leap forward in both study volume and sophistication. About 25 studies, including DR, PET, CT and ultrasound, were interpreted daily by three radiologists at Innovative Radiology. Studies were referred by 16 physicians from a single site, Oncology Consultants. Report request order entries using Vue Motion were created at the client site. Emails notified referring physicians that results were available via fax and Vue Motion. Billing and HIE HL7 interfaces were established.

Transition Phase #3: During this phase, the network was expanded to include about 30 client sites, including HMI and other large imaging centers. Within one week, 14 radiologists at Innovative Radiology were filing between 300 and 400 DR, PET, CT, ultrasound, MRI and nuclear medicine reports. Any of up to 2,000 physicians were referring studies for interpretation.

Today, Innovative Radiology uses a teleradiology solution that allows for an increase in study volume, workflow, and overall productivity. In early 2014, more than 40 sites were connected to Innovative Radiology via the teleradiology offering from Carestream.

For more information about Innovative Radiology’s story, and Carestream’s Vue for Teleradiology service, you can download this eBook, “Increased Capabilities: Do More with Vue for Teleradiology.”

What do you think about teleradiology? How is it improving care for the patients while also benefiting the providers that offer it? Did you experience roadblocks when implementing a teleradiology service? If so, what were they and how did you overcome them?

Kiran Krishnamurthy, Worldwide Product Line Manager, HCIS, CarestreamKiran Krishnamurthy is the Worldwide Product Line Manager for Carestream’s HCIS business.