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’s Teleradiology White Paper and What it Means for the Industry

The ACR white paper about best practices in teleradiology that was published in 2013 has been a popular discussion topic over the past several months. David Willcutts, CEO of ONRAD, a radiology services provider based in California that offers flexible, custom radiology service solutions that can include teleradiology, on-site coverage, subspecialty reports and turnkey quality assurance programs, spoke with us about the teleradiology white paper and what he sees as being the most important points.

Willcutts explained that the focus is on important issues related to radiology as a whole, and that these are not exactly unique to teleradiology. A company such as ONRAD has trained radiologists on staff, and it is vital for them to maintain and manage items such as having the right licensure, efficient around time, complying regulations, etc. He stated that as the radiology industry evolves, the two monickers are going to blend and the only way to support clients is to focus on being the best radiologists possible.

In the end, it is all about one core issue – how do radiologists best take care of the patients? The interview with Willcutts can be viewed in its entirety below.

Why User Groups Are Necessary for Technology End-Users

By Jim Travitz, Senior Imaging Analyst, Trinity Health, Holy Cross Hospital, and President, Carestream VIBE User Group

When becoming an end-user of a particular piece of technology, one way to ensure you are able to get the most out of that technology is to join a user group, if the company has set one up. By joining a user group, customers are essentially creating a line of communication between not only themselves and the company, but with like-minded customers like themselves as well—and that is where some of the most important benefits exist.

Collaboration is the name of the game when it comes to user groups. The ultimate goal is for customers to discuss issues and solutions among each other, allowing the company to chime in when necessary. As an example, I am currently the president of Carestream’s VIBE User Group for its HCIS products, and am currently corralling more Carestream customers to join the group because of the benefits it offers. In addition to learning about the latest PACS, RIS, and other HCIS updates, there are several other initiatives in the works for VIBE:

How-to guides for users: We want users to have knowledge and informational materials available at their fingertips when joining the group. This is made possible by creating channels for users to reach out to one another, as well as Carestream delivering on providing the information we need to learn about its technologies.

Bring clarity to the user group:  As a group, we have the ability to decide what are the most important ideas/issues that need to be addressed. Collaborating to decide this is able to give Carestream a better idea on how to develop its products so it can meet our needs. Being from diverse organizations, we are going to have different needs we want addressed, so it becomes up to the group to deliberate on what the most universal needs are that can be focused on.

Sharing content: The best source of content in a user group tends to be the users themselves. Coming across an article or research, and then sharing it with the group is one of the best resources available. The best user groups are those that are the most educated and participate often, so by sharing content, users are contributing to improving the education of the group.

Education from Carestream about new features: If users are to experience the benefits from Carestream’s technologies, then education will be needed on its part to educate users about new features. Be it in the form of webinars, demo videos, or downloadable guides, education about these features is a must, and one the company is looking forward to providing.

Regarding the future of VIBE, I am currently working to fill a couple positions in the user group. I am looking for a PACS Knowledge Manager and a RIS Knowledge Manager. These two positions will be tasked with organizing all of the content that is shared among the PACS and RIS sections of the group, and ensuring that this information is accessible for all members.

Additionally, I recently attended RSNA in December and was able to talk with other members of VIBE about what they are looking from joining the group. The two biggest needs users are looking for from the group are consistent user collaboration and webinars from current VIBE members. With these features being put into place, it is our plan than as VIBE evolves, so will the members of the group. That will be the most beneficial end-game for all of those involved.

If you are a Carestream HCIS user and are interested in joining the VIBE user group, you can click the link to sign up.

Below is an interview I conducted at RSNA about VIBE, what changes are currently taking place in the user group, and what improvements users can expect in the future.

Van Damme vs. Bones: The Epic Splits

Heidi McIntosh, Marketing Manager, X-ray Solutions, Carestream

Heidi McIntosh, Marketing Manager, X-ray Solutions, Carestream

If you haven’t seen the Jean-Claude Van Damme Epic Split video by now, allow us to introduce you. Back in November, Volvo released a video featuring Van Damme atop two reversing trucks to demonstrate Volvo Dynamic Steering. The stunt was performed in one take and went viral quickly. What’s equally impressive is that the video racked up over 64 million views in just over a month. It’s kind of something you have to see to believe.

 

We thought it’d be fun to demonstrate the precision and directional stability of our DRX-Revolution mobile X-ray system in a similar manner, but on a much smaller scale. Our video features “Bones” performing an epic split between two reversing DRX-Revolutions. Without the fully automatic collapsible column, mobility wouldn’t be such a breeze. Check out our version below and let us know what you think!

 

The Benefits of Upgrading to DR Technology

Radiology and technology go hand in hand. Each year the advances we see at RSNA confirm that innovations are what keep radiology as a premier medical specialty. Regularly upgrading these technologies help to enhance patient care, throughput, diagnostic accuracy and personal confidence among the physician’s when diagnosing a patient. Dr. Shrinivas Desai, Director of Radiology at Jaslok Hospital in India, spoke with us at RSNA about his hospital upgrading its DR technologies and the many benefits that come from doing so. To him, it’s all about enhancing patient care and making a positive impact on the services rendered to them. Hear more about what Dr. Desai had to say in the video below.

Patient Portals Enable Immediate, Secure Access to Medical Images

Cobalt Imaging Center is a medical charity that provides state of the art imaging for a large population in Southwest England. The facility recently adopted Carestream’s MyVue patient portal to enable patients’ immediate, secure access to their medical images via the web. Peter Sharp and Roisin Dobbins-Stacey of Cobalt Imaging spoke with us at RSNA and emphasized the need for a patient portal over CDs–their current means of sharing patient images—which are costly and timely.

Patients want access to their images now and a patient portal allows them instant access at their fingertips to share with whoever they want whether it’s the referring physician, or friends and family. The facility will slowly roll out MyVue and get patients adapted to a timely, functional, and secure way of sharing medical images.

Hear more about the benefits a patient portal brings to patients and imaging facilities in the video below.

Vue PACS Enables Image Sharing Among 11 UK Trusts

The Cheshire and Merseyside NHS Consortium covers 11 trusts in the UK and chose Carestream to be their new PACS supplier after their existing contracts for PACS and RIS systems, delivered through the National Program for Information Technology (NPfIT), expired. When selecting a new provider, the consortium was aiming to get the most cost effective and feature-rich system to meet their needs. One feature that came equipped with their chosen system was the advanced features of CT reconstruction. Taking steps to be cost effective has allowed Cheshire and Merseyside to pay 40 percent less than their previous national contract.

Cheshire and Merseyside is unusual in that there are multiple trusts in a small geographic area with a number of specialist hospitals. Royal Liverpool University Hospital is one hospital in the trust and for them it has been a challenge between patients moving around to hospitals and keeping images with the patient. The PACS system makes it easy for images to be acquired at one site and reported at another, a high priority for the trusts. When reporting, radiologists have access to previous studies where they can report right then and there, which is a big advantage. Roughly 1.5 to 2 million exams are conducted each year across the consortium and the more studies that are done, the faster the amount of data being transferred increases. Royal Liverpool has greatly decreased their amount of data transfers from about 250 studies per week to around 180 and is looking forward to that number dropping even further than 100 studies per week. This provides lead image transfer teams with more resources to do other things instead of importing such a large amount of studies.

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.

Medical Tourism Initiative Enables Nigerian Hospital to Deliver Quality Medical Care

Delta State University and Teaching Hospital is a 300-bed facility in Nigeria that is actively developing a center of medical tourism to deliver local quality medical services at standards comparable to international guidelines. The objective is to ultimately reduce the number of Nigerians traveling out of the country to seek medical care abroad. The Delta Hospital focuses on special areas such as radiology, minimal access surgeries, orthopedic services, and offers specialized treatments for patients with chronic kidney diseases, which occupies a severe percentage of Nigerians who seek medical care abroad. Kidney transplants will begin to take place in January of next year.

Rendering this level of service requires a well established radiology department. They are one of the first hospitals in Nigeria to acquire a 64-slice Computed Tomography (CT) scanner. The facility is also equipped with a Digital Radiography (DR) department, digital mammography unit, and ultrasound services to aid patient care. Dr. Abraham Inikori, consultant radiologist and director of clinical services and training, Delta State University and Teaching Hospital, further explains the organization’s medical tourism initiative.

Detailed and Precise Measurement with Lesion Management

Larry Ray

Larry Ray, CTO R+I Volume Image Processing, Carestream Health

Precise lesion measurement is important for reliable evaluation of metastatic disease and faster assessment of the patient response to cancer treatment. For radiologists and oncologists, simple quantitative comparisons of historical exams – especially those imported from disparate PACS or modalities – have been a challenge in a traditional PACS, causing many to turn to costly dedicated workstations. Lesion Management is an embedded application tool in our Vue PACS that provides native oncology follow-up capabilities. The precision of the tool can help provide physicians with clearer and more detailed imaging exam results in less time, enhancing their productivity and efficiency to make a diagnosis.

There are several reasons oncology follow-ups are one of the most time consuming and challenging tasks for radiologists:

  • Relevant priors may not have been acquired by the same modality, thus making it difficult to compare as most PACS cannot correlate with different exam types
  • Identification, localization and measurements of lesions are often manual, time consuming and inconsistent
  • Often times lesion management and tracking is performed on a separate workstation or application, without integration to PACS

The lesion tool reduces the need for visual measurement by providing semi-automatic tracking and segmentation of lesions, which can help provide a faster and more consistent means of determining the size and estimating the overall volume of the lesion. The result has the potential to provide a better gauge of disease progression. Typically, when a radiologist first gets a case they mark the lesion and report on it before the data is stored. At a follow-up visit a second set of images with added lesions is read, often by a different radiologist. The lesion management software matches between the two reports and immediately generates a spreadsheet of the patient’s information. The data can be viewed and evaluated on a single exam basis, or a per lesion basis for comparison purposes.

 

When a patient is diagnosed with cancer it’s really a team effort between them and their care providers to choose the best possible treatment plan. Today, we have access to information almost immediately; questions get responses pretty quickly; we have better tools to fight these diseases. The lesion application is one of those tools. It allows for clearer, more meaningful communication and collaboration between radiologists, oncologists and referring physicians which is a vital step in providing the patient with the best care possible.

Editor’s Note:  The Lesion Management application, created by Larry Ray, Edward Gindele & Rick Simon, was a finalists for the Digital Rochester Great Awards in the Optic, Photonics and Imaging Technology category.

Learn more about Carestream’s Lesion Management application: