Diagnostic Reading #25: Five Must Read Articles from the Past Week

Carestream LogoIt’s Friday, which means it is time for a new edition of Diagnostic Reading. This week’s articles include a study on radiology and patient care, the benefit of clinical decision support, breast cancer screening recommendations, the importance of telemedicine and an update about the future of Medicare without SGR.

1) ARRS: Patient Consults Improve Care, Raise Radiology Profile – AuntMinnie

A study presented at the annual American Roentgen Ray Society meeting in Toronto revealed that patients value the ability to meet with a radiologist to discuss diagnostic images. The study found that patients that met with a radiologist were likely to want to review exam results with a radiologist again. Furthermore, connecting with patients adds to the value of care provided by radiologists.

2) Clinical Decision Support can Cut Inappropriate Imaging – AuntMinnie

According to a report in Tuesday’s edition of Annals of Internal Medicine, clinical decision-support (CDS) can have a beneficial effect on imaging appropriateness. Hard-stop features could cut inappropriate imaging even more. These features disallow imaging procedures without the approval of another person, if the software considers the study to be inappropriate.

3) Speak Now About USPSTF Breast Cancer Screening Recommendations – Diagnostic Imaging

The United States Preventive Services Task Force has released recommendations for mammography. These recommendations discuss the issues of breast density and aging as some of the risk factors for breast cancer. USPSTF is asking for public comments on these recommendations until May 18, 2015.

4) Telemedicine a High 2015 Priority for Healthcare Executives – FierceHealthIT

A survey of 233 healthcare professionals conducted by REACH Health has indicated that telemedicine has taken a position of precedence among healthcare executives. About 60 percent of respondents considered telemedicine to be a high priority this year. These professionals see telemedicine as an important way to improve care. The author notes that patients are interested in telemedicine and aware of its benefits.

5) The SGR is history. Now what? – Health Imaging

With legislation to repeal SGR last week, it is time to look towards the future of healthcare. This article explains what the SGR repeal means and how it will affect healthcare legislation. The author discusses the importance of the new value-based healthcare model that will be put into place called the Merit-Based Incentive Payment System.

 

 

Diagnostic Reading #20: Five Must Read Articles from the Past Week

Carestream logoIt’s Friday, which means it’s time for a new edition of Diagnostic Reading! This week’s reading includes the benefits of big data, the effectiveness of early imaging, pediatric radiology, an update on healthcare legislation, and an article about the importance of mammography technicians to women’s health. Have a great weekend!

1) The Benefits of Data-Driven Healthcare– Hospital Impact
This article addresses the issue of data analysis. The author makes a point to say that though data is important, simply collecting the data is useless. Evidence-based reports are noted as the most effective way to improve healthcare. If data can be used to determine which departments are underperforming, then the issue can be repaired.

2) JAMA: Early Imaging Questionable for Older Adults with Back Pain– Aunt Minnie
Researchers from the University of Washington found that early imaging for back pain in adults older than 65 years old has no significant clinical value. This study, which was recorded in the Journal of the American Medical Association, emphasized that though there are no benefits for patients, early imaging procedures add to healthcare costs. Also read: Adults at Low Risk of Heart Disease Shouldn’t Get Screening

3) Building Trust in Pediatric Imaging– Diagnostic Imaging
When working with pediatricians, it is important for radiologists to gain rapport. This trust comes from more than just accurate readings. Radiologists also need to exhibit interest in the patient and commitment to reducing radiation dose. This article looks more deeply into the relationships between radiologists and pediatricians and gives insight on how to build trust.

4) Washington Debrief: Interoperability Bill Would Penalize Non-Compliant Vendors– Healthcare Informatics
This article discusses new pieces of healthcare legislation that have been introduced. First, EHR providers and vendors will be required to be interoperable by 2018. Second, this article talks about data security. Legislators are making progress towards securing patient records and notifying patients in the event of a data breach. Lastly, lawmakers have been working to fix the current Medicare system in order to improve the physician reimbursement.

5) NCoBC: Mammography Techs Play Crucial Role in Women’s Health– Aunt Minnie
Mammography is one of the most rapidly growing segments of health imaging. This article discusses the importance of the technologist. Patient-technologist interactions have become more intensive and the technologist has taken on greater responsibility when it comes to education. The author lays out guidelines for mammography technologists to thrive in the new scene.

Diagnostic Reading #7: 10 Most Popular Blog Posts from the Second Half of 2014

CARESTREAM Touch Ultrasound System - 1Carestream has worked hard to provide content of value throughout 2014. We have used our blog to deliver information about Carestream technology, address major industry trends, and inform readers about the medical imaging and IT fields. In this edition of Diagnostic Reading, we look at our most read blog posts since July. The topics include, the recent unveiling of our newest technology, industry infographics, image quality, digital 3D mammography, and dose reduction.

1) A LOOK AT THE NEW CARESTREAM TOUCH ULTRASOUND SYSTEM

Carestream unveiled its newest technology in Chicago at RSNA 2014. The CARESTREAM Touch Ultrasound System officially moved the company into the ultrasound market. This post contains information about the new technology, including images that explain its features and capabilities.

2) INFOGRAPHIC: THE EVOLUTION OF RADIOLOGY REPORTING

This infographic follows radiology reporting throughout history. It covers traditional hand written reports, transcribed reports, and voice recognition. Pros and cons of these types of report are listed. Ultimately, the evolution brings us to multimedia reporting and highlights its benefits.

3) UNCOMPROMISED QUALITY: BONE SUPPRESSION AND CHEST X-RAY IMAGES

Since being FDA approved earlier this year, radiologists are 58% more confident in their ability to read chest x-rays with bone suppression software. Since the software produces 2-D images rather than 3-D images, it also reduces the typical dose for patients receiving chest x-rays.

4) DREAM JOB: APPLICATIONS ENGINEER, DIGITAL MEDICAL SOLUTIONS

This Q & A with Marty Pesce asks questions about his experiences as an applications engineer for Carestream. The interview discusses the nature of a job as a radiologic technologist. Pesce also had the opportunity to answer questions about his personal experiences in the radiology field.

5) IMPLEMENTING EFFECTIVE WAYS TO REDUCE AND TRACK RADIATION DOSE FOR X-RAY EXAMS

El Camino Hospital in Mountain View, California, has taken measures to dramatically track and decrease patient dose. The hospital attributes this success to their transition from CR to DR technology. It claims that better imaging software leads to less repeated imaging.

6) DIGITAL BREAST TOMOSYNTHESIS NECESSARY FOR IMAGING DENSE BREAST TISSUE

This post emphasizes the importance of Digital Breast Tomosynthesis (DBT), or 3-D mammography for women with dense breast tissue. Numerous studies are noted by the author, including a JAMA study that found that by using DBT, there was a 41% increase in the detection of possibly lethal cancers.

7) RADIOLOGY’S RESPONSE TO HEALTHCARE CONSOLIDATION – STEP ONE: THE GLOBAL WORKLIST

With hospital mergers becoming prevalent, this post suggests that interoperability will continue to be a challenge. The adoption of software such as CARESTREAM Vue Connect could ease the transition. Combining data allows for both institutions to access their own information, as well as having access to new patient information.

8) THE ROLE OF A FULLY INTEGRATED RIS-PACS: DREAM OR REALITY?

Seventy-eight percent of office based physicians use some sort of electronic health record system (EHR). This post addresses the possibility of  radiologists and physicians working together using RIS and PACS to document patient records. There are inevitable challenges, but ideally this could mean “one patient, one record.”

9) RADIOLOGY AND MACRO HEALTHCARE TRENDS PART II: COST

In a time when Americans find it difficult to afford medical bills, radiologists must be conscientious about cost. Inappropriate imaging exams and lack of quality drive up costs, this post discusses how imaging appropriateness and effective reading of images can reduce costs in the field of radiology. Additionally, the post addresses other ways that health IT can help lower imaging costs.

10) THE THREE-PHASE PROCESS TO IMPLEMENT A PACS-DRIVEN TELERADIOLOGY SERVICE

Innovative Radiology adopted CARESTREAM Vue Motion. Since the implementation, efficiency has been higher. Additionally, Vue Motion connected Innovative Radiology with more than 40 sites in early 2014.

Diagnostic Reading #3: Five Must-Read Articles from the Past Week

 

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.

This week’s Diagnostic Readings include updates on meaningful use, analysis of telemedicine growth, tips about dose management and more. Check out our weekly series, “Diagnostic Reading,” for news and updates in healthcare IT and radiology.

1) Survey Indicates Telemedicine Adoption Growth among Healthcare Executives

This post presents the results of a survey taken by 57 healthcare executives. The findings explore the extent to which health care systems are adopting telemedicine and electronic health records (EHR). The author explores the the channels of telemedicine that are the most popular among this sample group.

2) Enterprise Imaging—Walking the tightrope: Optimizing radiation dose management 

Since the 1980s, the annual per-capita radiation dose from medical exposure has risen from 0.53 mSv to 3.1 mSv. This article from the November edition of Applied Radiology explores the challenges and solutions of moderating dose. The author discusses how the balance of radiation dose management can be optimized.

3) AMA Urges CMS to Drop Meaningful Use Penalties

This article addresses the existing meaningful use criteria and the difficulties that some medical centers may encounter. This piece discusses that reasons outside of a physician’s control may be the reason for their lack of interoperability. Due to these difficulties, the American Medical Association has asked the Centers for Medicare & Medicaid Services to “suspend all penalties to physicians and healthcare facilities for failure to meet meaningful use criteria.”

4)  It’s Time for Radiology to Take Peer Review Seriously

This post discusses the importance of knowing your diagnostic accuracy rate in radiography. The author writes about comparing accuracy rates to bench marks and national standards. These ideas could lead to more accurate readings and more industry-wide credibility.

5) To Improve Mammography Reading Accuracy, Follow Through with Workups

This article discusses the correlation between reading high volumes of mammography readings and accuracy rates. The study conducted at the Group Health Research Institute in Seattle found that radiologists with higher numbers of annual workups had higher screening sensitivity and cancer-detection.

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 

 

 

JAMA Study Showcases the Benefits of 3-D Mammography

Anne Richards, Clinical Development Manager, Women’s Healthcare, Carestream

Anne Richards, Clinical Development Manager, Women’s Healthcare, Carestream

The case for the importance and relevance of mammograms has had its battles in 2014. The CNBSS announcement sought to prove that mammograms do not result in better detection and essentially, do not save lives. Those working in women’s health were up in arms about this study, claiming it as being dangerous and working to discredit it. With an announcement made yesterday by the Journal of the American Medical Association, the pro-mammogram field has secured a victory.

3-D mammography, known in the medical field as breast tomosynthesis, was the focus of a study released on June 24, 2014 in JAMA. The results of the 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. These results are certainly positive, especially as millions of women will be having the mammograms and/or digital breast tomosynthesis this year.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

The benefits of tomosynthesis do not come without issues. First off, the machines are expensive upfront costs for facilities. The New York Times article about the study estimated the tomosynthesis machines to cost about $500,000—almost double the cost of digital mammography machines. Reimbursement is an issue in some facilities—both in terms of the technology and from insurance companies since tomosynthesis exams are new to women’s health initiatives.

Second, the images captured by 3-D mammography machines create bigger volumes of data since the file size of a 3-D image is exponentially larger than a 2-D one. This creates the need for more storage space, resulting in higher IT costs for the facility.

Third, 3-D mammography images are creating a bottle-neck in terms of efficiency in reading and analyzing the exams. There is more substance to study and analyze in a tomosynthesis exam, so initially it takes longer for the radiologist to read and report the exam. Workstations with dedicated tools for tomosynthesis are helping to reduce this reading time.

Even with these three issues, the benefits that 3-D mammography provides to the patients outweighs each one. Providing quality care to the patient should always be the number-one priority for medical professionals. If it takes more expensive equipment, then the facility should make the investment because the benefits has the potential to save lives. Giving that up to save money and time is not worth the risk.

The Breast Density Notification Train is A-Rollin’

Sean P. Reilly

Sean P. Reilly, Publisher, Imaging Technology News and Diagnostic and Interventional Cardiology

What started with a chug and a whisper is growing in both momentum and volume. Can you hear that whistle blowing?

For years, mammography has been the breast cancer screening standard of care for women over 40 and, to its credit, has saved countless lives by detecting breast cancer early enough to provide life-saving treatment. Despite recent controversial studies that challenge the value of annual screening, or screening of women under 50, mammography has been, and will likely continue to be, the gold standard for breast cancer screening for years to come.

There is, however, a growing population of women, healthcare providers, and legislators who passionately believe mammography screening may not be the ideal solution for all women — particularly for those with dense breast tissue, where cancer is more difficult to detect.. Cancer is being missed and these women are paying a high, and sometimes the ultimate, price.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

 

The good news is there are several imaging modalities available today that may more effectively detect early-stage breast cancer in dense-breasted women, including magnetic resonance imaging (MRI), ultrasound or automated breast ultrasound (ABUS), molecular breast imaging (MBI) and breast tomosynthesis, to name a few. The bad news is, with these promising technologies come challenges, not the least of which is increased cost. Providers have been slow to adopt these modalities for initial (or adjunct) screening due to the upstart cost of obtaining the equipment, workflow, staffing and training issues, lack of reimbursement and other challenges. So women with dense breasts, or women with a history of breast cancer, are instructed to continue with annual mammograms—just like forty something-year-old women with no family history of breast cancer.

While providers and payers grapple with the possibilities and challenges of personalized breast screening for women (as this interview with Gary Levine, M.D., president, National Consortium of Breast Centers, demonstrates), there is a movement under way to inform women with dense breast tissue of their increased risk factors and screening options. Breast density advocates like Nancy Cappello, Ph.D., founder of Are You Dense, Inc., and JoAnn Pushkin, co-founder of D.E.N.S.E., have led the charge by increasing awareness in women who have, in turn, captured the attention of healthcare providers and lawmakers. Slowly but surely, it seems to be working. To date, 17 states (CT, TX, VA, NY, CA, HI, MD, TN, AL, NV, OR, NC, PA, NJ, AZ, MN, RI) have enacted mandatory density inform laws, six additional states (DE, KY, MA, MI, OH, and SC) have legislation pending and, in time, others will likely follow. Federal legislation is also in play. At the moment, over 50 percent of American women now live in states requiring some level of notification. The train has left the station and is gaining speed.

I’d sure hate to be the governor of the final state to sign off on breast density inform legislation—wouldn’t you?

ABOUT THE AUTHOR

Sean Reilly is healthcare brands group publisher (Imaging Technology News and Diagnostic and Interventional Cardiology) at Scranton Gillette Communications.

How to make emotional connections with patients through image sharing

Belimar Velazquez, MBA, Director of Marketing and Inside Sales, United States & Canada, Carestream

Belimar Velazquez, MBA, Director of Marketing and Inside Sales, United States & Canada, Carestream

Healthcare providers work every day to deliver the best quality of care and the best experience to their patients. In many cases, a provider’s compassionate care creates a special bond and once this connection is created, patient satisfaction and loyalty is established.

However, in some cases, as is the case for radiology professionals, this emotional connection is a little harder to establish.  Consider the “invisible radiologist”:

  • 80 % of radiologists don’t meet their patients
  • 50 % of adults surveyed don’t know that radiologists interpret x-rays
  • Focus group participants were split as to “whether a radiologist is a licensed physician or a technician”

Yet, images – the very medium that defines the radiology role – presents a unique opportunity to establish connections. Think about the rampant proliferation of image sharing online:

Image sharing apps like Pinterest, Instagram and Snapchat all have one purpose in common to connect and elicit an emotional reaction through images (and words).  Imaging professionals are at the right place and the right time to help the enterprise establish an emotional connection with their patients through image sharing.

And guess what?  Patients want to see their radiology images and they want to share them.  We partnered with IDR Medical to conduct a survey of 1000 patients across the US with various backgrounds and found that patients place great value on the ability to share images online:

  • 61 % want to share their medical images with family members and friends
  • 88 % want to share with other physicians
  • Only 4 % would not share their own images

A recent Diagnostic Imaging meme portrayed just this fact.

042514_meme-ogram

While the meme was supposed to be funny, a quick search on Instagram shows this image sharing is happening now for mammograms, ultrasounds and x-rays:

Ultrasound Mammogram X-Ray
3,645 photos tagged 5,736 photos tagged 1,571 photos tagged

*Source Webstagram Search  – various hastags indicating images in each category, i.e. xraypictures, ultrasoundpic, mammogramscan

How do you put images into the hands of your patients to build this emotional connection?

The radiology community can turn to secure applications that allow patients and radiologists to share images.   These applications, usually compatible with the EHR/EMR, allow radiologists to establish communication with the patient and “tell a story” through both, images and words.  Here’s how it works:

[youtube https://www.youtube.com/watch?v=7zC84TNpIxw&w=560&h=315]

Building an emotional connection through image sharing can bring radiologists out of the dark and directly influence patient satisfaction. Our patient attitudes study found that:

  • 79 % of patients would return to a practice that offers online image access
  • 77 % would refer family and friends to a practice that offers online image access

What do you think? Can online image sharing play a more role in fostering direct connections with patients? 

Q&A: Digital Breast Tomosynthesis

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream

Digital breast tomosynthesis (DBT) is becoming increasingly popular in healthcare, but there are still many uncertainties surrounding it. Below are common questions healthcare organizations are asking about DBT and it is my goal to provide as thorough and accurate of answers as possible to demonstrate this technology’s value.

1.   What is DBT and how does it differ from/compare to traditional mammograms?      

DBT is a mammography procedure that uses low dose X-rays to create a three-dimensional image of the breast. Also referred to as ‘3D mammography’, the tomosynthesis scanner partially rotates around the breast and takes about 10 to 15 images from many different angles. As with traditional mammograms, the breast is compressed during the exam. The radiologist can then view the breast tissue in narrow slices, similarly to CT scan images.

 2. What benefits does DBT provide to physicians and patients?

With two-dimensional mammography, overlapping tissue can mask suspicious areas. Since thin layers of breast tissue are viewed with DBT, the overlap is removed and abnormalities are much easier to recognize. Studies have shown improved tissue identification, improved tumor visualization, and a lower recall rate for additional testing. Because of this, digital breast tomosynthesis has the potential to improve on the accuracy of mammography.

DBT

3. What are the challenges health facilities face when implementing DBT?

Financial:  Cost is a challenge due to the lack of reimbursement.  As patients become more aware of the benefits that DBT can bring, they’re asking for it.  Even with the lack of reimbursement, many facilities are adding DBT to prevent a loss of patients to other facilities offering this technology, and/or to provide better patient care.

Technical: Technical challenges include the size and format of DBT data.  DBT images can be very large, several times the size of conventional mammograms, so the transfer and storage of this data can be challenging.  Additionally, some acquisition device vendors have been generating data in a proprietary format (due to the lack of a DICOM standard format in the past), and in some cases still storing data in a proprietary format.  This presents challenges for healthcare facilities looking to standardize their data or use a mixture of vendor products.

Product:  As healthcare facilities add DBT to their breast imaging procedures, many are finding that their existing storage and viewing solutions do not yet support this technology.  This presents the facilities with the challenge of how they are going to store and view this data.

Workflow: DBT creates more data than a a conventional mammogram, increasing the time to read a case.  Just like when digital mammography was first introduced, users are experiencing a learning curve with reading the images with the use of workstations and the tools they provide.   In addition, some workstation vendors have very limited, if any, tools to optimize the reading of DBT exams, which magnifies the challenge.

4. How do providers overcome these challenges?

Financial:  Some facilities are absorbing the costs by marketing the value of  DBT and bringing in more patients.  Others are charging the customer an extra fee to help offset the costs.

Technical:  The data size challenge is overcome by careful planning of the network infrastructure and storage requirements.  Acquisition device manufacturers are recommending a 1Gbps network to accommodate the image transfers, so facilities are either planning for this when building new or upgrading their existing infrastructure.  We have found that in addition to adequate network bandwidth, the use of lossless compression and intelligent routing/pre-fetching of data are extremely important to efficiently move such large amounts of data around transparently to the user.  This is especially true when reading is performed across multiple facilities and/or remotely.

Regarding the data format, DICOM now supports a new SOP Class that specifies how such data can be transmitted in a standardized format for interoperability between various vendors’ equipment.  Most acquisition device vendors have adopted this standard, but existing proprietary data, and in some cases newly acquired data, still remain in proprietary formats.  To address this issue, some acquisition device vendors are offering a service where the proprietary data can be converted to DICOM standardized data.  This needs to be planned for ahead of any implementation of DICOM compliant equipment, since the conversion process can take some time to complete.

Product:  Facilities that add DBT and find their existing solutions don’t support this technology are faced with either waiting for their existing solution to support this technology or purchasing another product that will provide such capabilities.  Due to the importance of DBT, many facilities are choosing to replace or adjunct their existing solution with a product that supports this technology.

Workflow: We believe the learning curve radiologists are experiencing with the DBT technology will decrease over time, just as it did with digital mammography when it was first available.

The tools provided by an equipment vendor can also significantly decrease the time to read a DBT exam.  It is important that a facility chooses a product with the appropriate tools to optimize their workflow.  This includes not only the basic tools that automatically scale and position both 2D and 3D images, but also advanced tools that can help localize pathology and allow one to quickly navigate both current and prior studies.  With conventional mammography, digital breast tomosynthesis, synthetic 2D mammography, and other mammography procedures being generated (e.g. breast US, breast MRI, etc.), workstations with hanging protocols that can support and display all of these in an efficient manner become extremely important as well.

5. What are the key points you hope attendees will take away from your panel discussion at SIIM? 

Although there are a number of challenges with implementing DBT, solutions exist for each challenge and that will only improve in time as the technology matures.  It is also important for attendees to plan their environment and product selections, knowing what challenges have been faced by others and how they have been resolved.

 Editor’s Note: Ron will be participating in a panel session on “Problems and Solutions in Breast Tomosynthesis” during SIIM 2014. The session will be held on Thursday, May 15 from 12-1 pm in Exhibit Hall B – Innovation Theater.

Studies Have Proved the Benefits of Digital Breast Tomosynthesis: Now How Do We Change Referral Habits?

Dr. Harmindar Gill, Medical Director, Premier Women’s Radiology (Bonita Springs, Fla.)

Dr. Harmindar Gill, Medical Director, Premier Women’s Radiology (Bonita Springs, Fla.)

As a female radiologist, I have created a practice dedicated to women’s imaging that includes digital breast tomosynthesis (DBT), breast and body ultrasound, whole body bone density screening and other services. I also read breast MR images that are captured at another facility.

According to the American Cancer Society, 1 in 8 women will develop breast cancer during her lifetime—just over a decade ago the rate was 1 in 11 women. Genetics cannot account for this increase since 85 percent of breast cancer victims have no family history of the disease. There are a variety of factors that may be contributing to increased risk, including estrogen in our foods, post-menopausal hormone therapy and childbearing later in life. The good news is that the ACS reports death rates from breast cancer in the U.S. have dropped 34% since 1990.

I am an avid proponent of DBT because I believe it can assist in the effort to further reduce deaths from breast cancer. In my personal experience, I have found small lesions that I did not detect on other breast imaging exams and it also decreased the need to recall patients for additional testing. The ability for DBT to increase cancer detection rates and decrease recall rates has now been well documented through studies conducted across the country. In 2013 breast tomosynthesis captured attention and acceptance throughout the radiology community, as illustrated by the dozens of scientific presentations and poster sessions focused on DBT at RSNA 2013.

One RSNA 2013 presentation reported results from a study in which every patient since October 2011 was screened for breast cancer using DBT at Hospital of the University of Pennsylvania (HUP) in Philadelphia. The study’s lead author was Emily F. Conant, M.D., chief of breast imaging at HUP. Dr. Conant and five colleagues compared imaging results from 15,633 women who underwent DBT at HUP beginning in 2011 to those of 10,753 patients imaged with digital mammography the prior year. Six radiologists trained in DBT interpretation reviewed the images. The researchers found that compared to digital mammography:

  • Average recall rate using DBT decreased from 10.40 percent to 8.78 percent
  • Overall cancer detection rate increased from 3.51 to 5.25 (per 1,000 patients)
  • Overall positive predictive value for the group—the proportion of positive screening mammograms from which cancer was diagnosed—increased from 4.1 percent to 6.0 percent with DBT.

A prominent earlier study published in the June 2013 issue of the American Journal of Roentgenology documented the benefits of DBT by Dr. Stephen L. Rose and his colleagues at TOPS Comprehensive Breast Center of Houston, Texas. This study compared recall rates, biopsy rates, and cancer detection rates for six radiologists who interpreted 13,856 screening mammography studies without tomosynthesis and 9,499 studies with tomosynthesis.

For the group as a whole, the use of tomosynthesis resulted in:

  • Increase in invasive cancer detection rate from 2.8 to 4.3 per 1,000 screening examinations
  • Increased cancer detection rates from 4.0 to 5.4 per 1,000 screenings
  • A reduction in recall rates from 8.7% to 5.5%
  • Reduction in biopsy rates from 15.2 to 13.5 per 1,000 screenings.

As a result of my personal experience and the scientific studies now available, I advocate use of DBT for all screening mammograms—especially for patients with dense breasts, patients with BRCA gene mutation and those who have been previously diagnosed with breast cancer—because its three-dimensional imaging offers significantly enhanced visualization of breast tissue.

Now that we recognize the advantages offered by DBT, the challenge is to make tomosynthesis a mainstream screening protocol. It’s not enough for radiologists to recognize the value of tomosynthesis—physicians and gynecologists need to be educated about the benefits of this technology since these doctors account for a majority of the referrals for annual screenings and follow up exams.

Hear more about Dr. Gill’s practice and the importance of DBT below from RSNA 2013.