Digital mammography, both with digital radiography (DR) and computed radiography (CR) technology, provides many benefits over traditional film-based mammography; however, implementing these technologies successfully requires thoughtful planning and preparation. According to Bonnie Rush, president of San Diego-based Breast Imaging Associates, there is no longer a question of when digital mammography will be a viable alternative to film.
"Digital is the way of the future," Rush said during a presentation at the 2006 American Healthcare Radiology Administrators (AHRA) conference in Las Vegas.
Rush cited several advantages to digital mammography -- among them the capability to manipulate images, the elimination of film and its chemical-based processors, a much higher detective quantum efficiency (DQE) and broad dynamic range, and the possibility of greater patient throughput.
As with any emergent technology, some technical challenges still need to be addressed. These include interpretation issues for radiologists, diagnostic display station capabilities, and lack of an Integrating the Healthcare Enterprise (IHE) profile (although one is under development).
Simply plugging in a digital mammography unit and realizing its benefits is an unrealistic expectation. First and foremost, a healthcare facility or imaging center contemplating the transition to digital must have a PACS. That PACS should also be mounted on a robust physical infrastructure and possess strong archiving capabilities. A terabyte of image data per machine, per year, is not unusual, according to Rush.
Because of the size of digital mammography images, and the greater patient throughput available with the modalities, network bandwidth can be compromised. For this reason, Rush advocates involving a department's information technology (IT) group from the inception of a digital mammography initiative.
Cost benefit
As U.S. radiology administrators know, the margins in mammography are slim at best. Getting a favorable return on investment (ROI) for crossing into the digital mammography domain may be impossible at current price points for full-field digital mammography (FFDM) or even CR mammography for some practices.
An administrator should define the initial capital outlay for either CR or FFDM; include the recurring annual costs such as maintenance, service, and software; research reimbursement from each of its payors; and determine an acceptable timeframe for ROI, Rush advised.
Volume matters a great deal in the financial practicability of these modalities. For example, the Breast Center at Houston Northwest Medical Center in Texas that cares for 25,000 patients annually. The high volume of patients allowed for the facility to achieve a three-year ROI on its FFDM units, she said.
The addition of computer-aided detection (CAD) software can swing the numbers in favor of digital acquisition, if CAD is reimbursed by a practice's payor mix. Rush cited a case of a 6,500 annual patient volume at another facility that was able to capture a three-year ROI on its FFDM equipment by combining CAD with its exams.
Other financial considerations include a decrease in film costs, an increase in productivity if workflow is configured correctly for the digital environment, a decrease in full-time equivalent (FTE) technologists, a reduction in repeats and recalls, and an increase in patient and referring physician satisfaction, according to Rush.
Even if the economics don't work for a practice to implement digital mammography right now, chances are that as more devices receive U.S. Food and Drug Administration approval, equipment acquisition costs will decrease.
"In the future, as in all technologies, we will see prices going down," Rush said. "So you need to really look at your facility and what works for it."
By Jonathan S. Batchelor
AuntMinnie.com staff writer
October 23, 2006
Related Reading
New study analyzes digital mammography's workflow impact, August 10, 2006
New workflow, personnel needed for adopting digital mammography, August 10, 2006
Take care when coding for digital mammography and CAD, July 13, 2006
Fuji CR mammo approval offers new option for breast imaging, July 11, 2006
Digital mammography: Can your facility afford to make the leap? May 11, 2006
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