Buyers beware of digital mammography interoperability

Hot on the heels of favorable findings from the Digital Mammographic Imaging Screening Trial, digital mammography systems are in high demand on the RSNA exhibition floor. But buyers may have a rude awakening when they encounter problems with interoperability of systems from different vendors, according to a mammography task force.

A mammography task force warns of interoperability problems with digital mammography systems. Above, images of the same breast, acquired using three different mammography systems.

"We have had the honeymoon period with digital mammography and we are about to have the real work period. This will affect everyday radiologists-- not just academic geeks like us," said Dr. Etta Pisano, chief of breast imaging at the University of North Carolina in Chapel Hill, and lead investigator of the DMIST study.

"When rank-and-file radiologists put these systems into their practices, these problems will rear their ugly heads," said Pisano, speaking at a meeting held by the Integrating the Healthcare Enterprise (IHE) mammography working group.

The group gathered vendors, breast imaging specialists, and regulatory officials at a meeting Sunday to stress the urgent need for interoperability. Vendors must speed up their work on this issue to avoid major problems that will be exacerbated with mainstream use, speakers said.

Digital mammography received a boost from the favorable DMIST results. The number of units accredited by the FDA has risen by more than 70% in the last year, up from 722 in November 2004, to 885 in May 2005, and 1089 in November 2005. The number of accredited facilities with digital mammography units rose from 631 to 775 in the last year.

Image display varies greatly depending on the vendor. Consequently, it can be difficult and time-consuming to compare mammograms of the same patient if the images were taken on different systems, said Dr. Margarita Zuley, who represented the task force at the RSNA meeting. Prospective buyers are probably unaware of these potential problems and will discover them when they start to use the digital systems, said Zuley, a radiologist at Elizabeth Wende Breast Clinic in Rochester, NY.

"Patients move around and we are incredibly dependent on prior images. If prior images were taken on the equipment of a different vendor, we may not be able to read them," Zuley said. "With the number of machines [coming into use] and cross-platform incompatibilities, we will have lot of unhappy people at the RSNA next year," Zuley said.

The task force has drafted a list of issues that it feels must be addressed right away. This list will be published for comment early in 2006 and finalized by May. The task force wants industry to work on the draft list now, ahead of finalization, and to demonstrate progress on these issues to the radiology community at a meeting planned for April 2006 at Stanford University.

Digital mammography system vendors in the audience said they felt the timetable was too fast and some requested more time. Some also were reluctant to participate in a demonstration of systems to users in April, feeling that would pit vendors against each other unnecessarily. Also, some pointed out, at that time, vendors won't have a final product to show users.

The task force, however, says there is no time to waste given the escalating demand for digital mammography systems. If the pressure is on, one vendor might just discover a solution by early next year. Furthermore, the task force says it has the support of radiology organizations.

"We strongly support this [initiative], given the difficulty of connecting systems," said Priscilla Butler, senior director of the American College of Radiology's breast imaging accreditation program. "We encourage everyone to move forward as quickly as possible."