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.


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:


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.


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.

ACR on the CNBSS Mammography Study: “Deeply Flawed and Widely Discredited”

Clinical Development Manager, Women’s Healthcare, Carestream

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

A disturbing study about the effectiveness of mammography was released to the public on February 11 in the British Journal of Medicine. The New York Times wrote about the study, providing such summaries as:

“… the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: One in five cancers found with mammography and treated was not a threat to the woman’s health and did not need treatment such as chemotherapy, surgery or radiation.” – New York Times, February 12, 2014

The goal behind this study was for researchers to determine if there is any advantage to discover breast cancers that were too small to feel. The study claimed that there is no advantage, but the American College of Radiology (ACR) came to the rescue to debunk this claim.

The ACR came right out to call the study “deeply flawed and widely discredited” and backed up its words. Citing reviews from experts, the ACR learned that the trial used second-hand mammography machines, which were not the most up-to-date at the time the study was conducted. The ACR went on to say:

“The images were compromised by ‘scatter’ which makes the images cloudy and cancers harder to see since they did not employ grids for much of the trial. Grids remove the scatter and make it easier to see cancers. Also, technologists were not taught proper positioning. As such, many women were not properly positioned in the machines, resulting in missed cancers. And the CNBSS radiologists had no specific training in mammographic interpretation.” – American College of Radiology, February 12, 2014

Additionally, the ACR brought about claims that the CNBSS violated the rules of conducting a randomized, controlled trial (RCT). This was because each woman who participated in the study had a clinical breast examination by a trained nurse so that they knew which women had lumps and which women indications of more advanced cancer. For a RCT to be valid, the women assigned to the screening group or the control group must be random, and this was certainly not the case.

One issue with the wording in the news articles that covered the CNBSS study is that they are including mammography exams into the same category as treatment. But these are two different areas. Mammography and the advancements made in the field are leading to earlier detection of breast cancer. Patients are then referred to their physicians who then determine the diagnosis best course for treatment.

Along with the ACR, the mammography medical community made sure its voice was heard after large news outlets began picking up the story. On the radiology trade publication site AuntMinnie, Dr. László Tabár and Tony Hsiu-Hsi Chen, DDS, PhD, wrote an op-ed about the CNBSS study and how the medical field has been dismissing it for years, citing it as being “a failure from the beginning.”

They go on to say that even the World Health Organization’s International Agency for Research on Cancer (IARC) workshop excluded the study in 2002 because the study was not population based and “the Canadian trials could not evaluate the independent impact of mammography because of the confounding effect of physical examination.” At the end of their letter, Drs. Tabár and Chen quote Dr. Norman Boyd, who had this to say about the CNBSS study 21 years ago in Radiology (1993, Vol. 189:3, pp. 661-663):

“Taken at face value, the results of the [CNBSS] argue for abandoning mammographic screening as a population-based means of controlling death rates from breast cancer. We believe such a conclusion to be unjustified and unsupported by the findings of the [CNBSS] … [and] the results of these trials should not be used to change the prevailing scientific view of the potential benefits of screening with mammography.”

Those of us that have been involved in mammography since the 70s have seen enormous advances in the understanding of what is needed to ensure early detection and the effectiveness of mammography. The industry has helped to improve the image quality since the Canadian study with advances in analog film, improvements in x-ray units and of course the introduction of digital mammography and digital breast tomosynthesis.  There have also been great advancements in the training of technologist that perform and the radiologists that interpret mammography.

Early detection remains a must if we wish to continue to improve the survival rate of breast cancer. To dismiss the value of mammograms is to turn a blind eye toward a disease that is predicted to be diagnosed in 232,670 new cases in 2014 in the United States alone (source: American Cancer Society). It is the second leading cause of cancer death in women and dismissing exams that can lead to earlier detection is putting more women at risk.

In the video below, Dr. Tabár provides more details about the flaws behind the the CNBSS study.


Digital Breast Tomosynthesis Brings Benefits to Patient Exams

Digital Breast Tomosynthesis (DBT) provides higher quality mammography images and is becoming more vital to breast exams. At RSNA we spoke with Dr. Harmindar Gill, Medical Director of Premiere Women’s Radiology in Bonita Springs, Florida, about the benefits of DBT and what patients get out of having it as part of their exam. Being the first office in Southwest Florida to offer DBT as part of breast exams, Dr. Gill noticed a decrease in patients’ recall rates and found that it’s easier to spot small lesions that go unnoticed by traditional mammography exams.  The video below provides more insight on Dr. Gill’s practice and DBT discussion at RSNA.

“Tomosynthesis” a Key Area of Focus at RSNA 2013

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

Among the many trends and buzzwords floating around RSNA 2013, one of the key areas that seems to be popping up everywhere is “tomosynthesis,” which is 3D imaging using X-Ray technology. With enhancements being made to DT technologies, as well as numerous laws being written related to breast density, tomosynthesis is sure to be an important topic in the medical imaging community for a long time to come. Yesterday, Carestream presented “Stationary Chest Tomosynthesis System using Distributed CNT X-ray Source Array,” with the University of North Carolina School of Medicine. The results of this study showed the feasibility of a stationary chest tomosynthesis system. This has the ability to improve image quality and enhance detection of small lung nodules and other chest pathology.

In addition to our presentation, multiple sessions have focused on the benefits of tomosythesis. Two in particular that caught our attention were focused about digital breast tomosynthesis (DBT) and its superiority to conventional mammography in breast cancer detection, and a session focused on how tomosynthesis is more beneficial in detecting lung cancer. The former looked to expand upon the usual benefits of using DBT, which are reduced recall rates, improved diagnostic accuracy, and improved cancer detection. From there, Pragya A. Dang, M.D., of Massachusetts General Hospital, Boston, lookedCARESTREAM-Vue-Mammo-Workstation at the data her team collected after using DBT for more than two years. Dr. Dang looked at the cancers in the study using both DBT and conventional mammography. Radiologists then looked at the visibility and morphology of the studied cancers with both tomosynthesis and conventional mammography. The findings showed that the degree of visibility vastly improved using tomosythnesis. An additional benefit that Dr. Dang pointed out was that a higher percentage of the cancers were more definitively characterized as masses compared to asymmetries when using tomosynthesis for diagnosis. In her conlcusion, Dr. Dang presented that when compared to conventional radiology, tomosynthesis allows for increased cancer detectability upon screening because of its improved visibility and the precise morphology of cancers allow for a better lesion diagnostics in initial imaging.

James T. Dobbins III, Ph.D., associate professor of radiology at Duke University,  used dual-energy imaging and also looking at a broader range of expertise among radiologists when analyzing lung nodules. Dr. Dobbins saw that tomosynthesis had a threefold improvement in sensitivity, which is consistent with studies done in the past. He concluded that tomosynthesis is much better than conventional radiology when it comes to detecting lung nodules, and offered three options tomosynthesis implementation strategies:

  1. Using it as a problem-solving tool for suspicious findings on radiography
  2. Using it as alternative to CT for tracking changes in nodules over time, though Dr. Dobbins did state that additional studies on this would need to be conducted to validate this option
  3. Implementing it as a lower dose, lower cost model for lung cancer screening

From these studies, it is clear that we have only seen the beginning of DT and DBT. Study after study are showing the benefits of this technology, and as future studies are conducted, it becomes much more likely that we will start seeing wide-spread usage of tomoysnthesis for more accurate and efficienct diagnoses.

The Finnish Way: Mammography Screening Saves Lives

Jussi Perkio

Jussi Perkiö, Director, Service Development and Medical Technology, PhD, Hospital Physicist, Suomen Terveystalo Ltd.

The goal of mammography screening is to reduce breast cancer mortality rates by detecting the cancer early enough for efficient treatment to be possible. In Finland, the mortality rates are one of the lowest in the world. One of the reasons is the efficient nationwide screening program.

Finland was the first country in the world to begin a nationwide mammography screening program governed by law in 1987. Beginning with 50-59 y.o. women, the target group was extended to 50-69 y.o. women in 2007. Finland has a high participation rate; almost 90% of the target group undergoes the screening study. Of all the participating women, approx. 3% is recalled to second imaging study and approx. 0.5% is diagnosed with breast cancer and directed to the treatment pathway. Annually, approximately 50 deaths due to breast cancer are prevented by the screening program.

The organizing and funding of mammography screening is the responsibility of more than 300 municipalities. The municipalities typically outsource the screening program as the program is demanding to put up and maintain and not cost-effective to run with low volume of participants. As a result, over 80% of all the nation’s mammography screenings are performed by one operative, a private healthcare service provider, Terveystalo, which has managed to standardize the screening process and obtain large enough volume to maintain very high quality – both clinical and operational quality as well as experienced quality – with low cost.

One of the key points in the process is the utilization of digital technology to allow the primary screening images to be read by specialist radiologists anywhere. This not only promotes equality by putting all the women to be screened in equal position regardless of their location, but also ensures that the specialist radiologists get to screen enough mammograms to maintain high quality in their expertise.

As for the digital imaging technology, it does not necessarily mean FFDM. While it is highly likely that FFDM will be the method of choice in the future, Terveystalo currently uses CR technology for the most part due to its flexibility, cost-effectiveness, and high-enough image quality. Due to advances in detector screen development, the image quality vs. dose levels have met Finnish requirements. Also, tomosynthesis, an inherently FFDM application, is so far not included in the screening process. To meet national requirements, Terveystalo has a technical quality assurance protocol in place, routinely measuring and documenting the whole imaging chain.

From the information technology point-of-view, the backbone of the common nationwide process is a fast and secure nationwide information system. Although screening data cannot be mixed with patient data, the systems, e.g. PACS, can serve both groups simultaneously.

The other key points for the efficient screening process are the high level of standardization and continuous improvement. Apart from the service provider, the process has three important stakeholders:

  • Municipalities: appreciate clear contract models, see-through pricing, and reliable and on-demand reporting
  • Women to be screened: value flexibility in the scheduling of the imaging study, comfortable and competent imaging study, and clear results without delay
  • The national authority responsible for planning and evaluating national cancer screening programs: expect to get the data concerning invitations and findings to further evaluate the statistics, develop the screening program and guiding also political decision-making in the field.

The screening process has to be designed to provide all these and be flexible enough to allow municipality- and consumer-dependent modifications.

Based on experiences in Finland, an efficient mammography screening process is not easy to set up and maintain. However, by combining reliable technology with both medical and process expertise, the results are excellent.

Sizing Things Up

Marianne Matthews, Editor, Imaging Economics

Marianne Matthews, Editor, Imaging Economics

Guest post by Marianne Matthews, editor of Imaging Economics.

I had to chuckle recently when Jockey rolled out its new bra sizing system. Everyone from fashionistas to morning talk show hosts seemed obsessed with the news. It even garnered coverage (pardon the pun) on the front page of The New York Times. While some called the new bra sizing system important, others deemed it unnecessary and even downright confusing.

When it comes to their breasts, American women have a lot more important things to think about. And some of it—like understanding the real implications of breast density—can be as confusing as going from a 34B to a 7-36.

Although 10 states have now enacted breast density notification laws, the issue remains controversial. Proponents say it’s a no-brainer. They point to studies that show that increased breast density correlates with increased breast cancer risk. Experts say those with extremely dense breast tissue have twice the risk of breast cancer compared to those with average breast density. Moreover, dense breast tissue makes it hard to spot cancer on a mammogram.

So why not just enact legislation that mandates informing women of their density?

Well, there are a lot of reasons not to. Some of those opposed say the science is not perfect, density studies are misleading, and density alone is not necessarily a major cancer risk. Others fear the notification legislation will lead to too many tests and unnecessary biopsies. Still others object on principle to the government legislating medical care.

To be honest, I’ve had trouble sizing up the issue myself. Originally, I was all for notification legislation. Then, when I had a mammogram a few months ago, I talked to my radiologist. Turns out, she’s adamantly opposed to the density notification because she believes it will lead to “panic” among women. She’s not the only expert who feels density notification will only confuse women further, perhaps make them think they have cancer, or mistrust mammography altogether. She’s got a point. (There is a great deal of confusion among the highly educated women I know about breast density.)

So, I’ve gone round and round on the issue and come full circle. On balance, I think it’s a good thing. At this point, I see at least three simple reasons to support density notification laws.

First, in today’s society, patients are expected to be their own advocates—and doctors have pretty much made that the case. Doctors spend very little time in office visits actually communicating with patients. We’re expected to arrive prepared with our list of complaints and questions—and cover them all in less than 10 minutes. We’re expected to know our numbers. In some cases, we’re even forced to follow up on test results because all too often the physician’s office doesn’t bother to call with results. So, since we’re expected to be sophisticated patients—which takes some of the burden off of doctors—we need to be informed about our own bodies. That’s as good a reason as any to let women know if they have dense breasts.

Second, there is no turning back. Advocacy organizations are succeeding on Capitol Hill. In addition to the 10 states that already have density notification laws on the books, several more state legislatures have introduced legislation in 2013. What’s more, Federal legislation is under way. My point: You can’t put the genie back in the bottle.

Finally, as a radiologist, if you come out against density notification, you’re probably shooting yourself in the foot. Though I remain loyal to my breast imager, my guess is most women would not find her views all that favorable. In short, it’s politically incorrect for a women’s imaging provider to oppose the density movement.

So, you might as well use the density issue as an opportunity to educate your patients. Talk to her; get closer to her; show her radiology’s value. You can either be viewed as a foe or join the fight. That’s about the size of it.

Dragon Boat Racing Offers Breast Cancer Survivors a New Way to Get Fit While Building Comradery

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Breast cancer survivors have joined together in an activity that focuses on support, wellness and competition as way to recover from breast cancer. The diagnosis of breast cancer has brought survivors from around the world together in the unique paddling sport of dragon boating.

Paddling in colorful dragon boats offers an active, health-giving, life-affirming option for breast cancer survivors. Dragon boat racing is a relatively new but rapidly growing international activity. A dragon boat is a long, colorful wooden or fiberglass boat adorned with a dragon head at the front and tail at the back — with room for about 20 paddlers and a drummer. Teams of cancer survivors and their supporters paddle in harmony to the beat of a drum. The sport of dragon boating provides the benefit of vigorous exercise and may help prevent or relieve the symptoms of lymphedema — a common side effect from the effects of breast surgery or radiation.

I recently had the opportunity to coach a group of breast cancer survivors from the Dragonheart Vermont club that plans to send a crew to the U.S. National Championship in September. These contestants will compete to win a chance to represent the U.S. at the 2014 Club Crew World Championships in Ravenna, Italy. The championship has a division for breast cancer survivors and it’s estimated that there are about hundreds of dragon boat breast cancer teams around the world.

Cancer research and treatment has made dramatic strides in the last 10 years. Thousands of activities publicize the ability for survivors to recover from this previously debilitating disease and live normal, active lives. However more research is needed, which is why we all need to support additional research to develop new detection methods and treatments for all forms of cancer.

Please visit the International Breast Cancer Paddlers Commission if you would like to get involved with a local team. The rewards are many!

We would like to hear comments from readers who have participated in these types of events. When did you first hear about dragon boat races and what benefits have you received from being on a dragon boat team?

Dragon Boat Team

Dragon Boat Team

Solutions to Making Digital Breast Tomosynthesis Widely Accepted in Mammography Imaging

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream

The challenges with digital breast tomosynthesis are well explained in this article on AuntMinnie, and very real. At Carestream, we have been working with digital breast tomosynthesis data from various vendors to provide solutions for these very same issues.  Although there are many different aspects to consider when adding digital breast tomosynthesis, I’ll explain some of the solutions we’ve found and hope others find them to be useful.

Since digital breast tomosynthesis is relatively new, we are finding that the level of support each vendor provides varies significantly.  We decided to embrace digital breast tomosynthesis from the start since we believe it will have a place among the various different technologies used to detect breast cancer.  Other technologies will continue to evolve to the point where each will have a place as well.  The clinical benefits of digital breast tomosynthesis are still being debated by some, but it has rapidly gained supporters in the Radiologist community.

While support continues to grow,  two main barriers that exist include reimbursement and dosage.  Reimbursement will definitely help encourage widespread acceptance from a business perspective. And, with the various acquisition device vendors working on synthetic 2D images, it appears the dosage barrier can be overcome as well.  This may open the door for digitial breast tomosynthesis to be used on a regular basis in the screening environment.

Regarding the storage of the digital breast tomosynthesis data objects, we have found that in addition to the use of lossless compression, adequate network bandwidth and intelligent routing/pre-fetching of data are vital to efficiently move such a large amount of data transparently to the user.  This is especially true when reading such procedures across multiple facilities and/or remotely. We are recommending that internal networks support 1 Gigabit, as some of the acquisition device vendors have done..

As mentioned in the AuntMinnie article, earlier digital breast tomosynthesis data may have been stored using a proprietary format. Our current understanding is that the conversion process being provided can be scheduled during the evening or weekend, so there is little or no impact during normal business hours. Although this conversion process can appear to be a daunting task at first, it is important for a site to maintain data that follows the DICOM standard moving forward for interoperability.  Otherwise, the task becomes much larger at a later time.  The same will be true for synthetic 2D images in the near future.

Another challenge outlined in the article is the additional time needed to read digital breast tomosynthesis images.  Similar to when digital mammography was first introduced, users experienced a learning curve not only with reading the images, but also with using the workstations and the tools that they provided.  We believe the same is true with digital breast tomosynthesis, where the reading time will decrease as both of these improve.  Focusing on the tools provided by workstation vendors, we have found that a key aspect to optimize the reading time is not only through basic tools that automatically scale and position both 2D and 3D images, but also advanced tools that can help localize pathology and allow the user to quickly navigate current and priors studies.  It is not enough to just stack a series of tomosynthesis slices and allow the user to scroll through them at will.  With traditional 2D mammography, digital breast tomosynthesis, synthetic 2D mammography, and other mammography procedures (e.g. breast US, breast MRI, etc.) being generated, workstations with hanging protocols that can support and display all of these in an efficient manner become extremely important.

As the IHE Mammography Image integration profile is expanded to include digital breast tomosynthesis, our expectation is that the interoperability issues experienced early on will at some point be resolved by most vendors.

The video below shares more information about digital breast tomosynthesis and Carestream’s capabilities in that area.