Netherlands group rolls out mobile digital mammography pilot

Population-based breast screening programs face an uphill battle in remote communities. Patients, technologists, prior exam results, new images, and qualified reporters must all meet at the right place at the right time. Organizers of a Dutch mammography screening service hope to solve this workflow problem with a combination of mobile digital imaging and PACS.

The BBNN (Breast Cancer Screening Organization) is one of nine government-funded regional groups responsible for implementing the Netherland's national breast cancer screening program. Free mammography screening is offered to all women aged 50 to 75 years old every two years.

The BBNN has served women living the northern part of the country using conventional mammography units in eight mobile and fixed vans. Beginning in September, however, it will send out an additional mobile van equipped with digital mammography, distributing the soft-copy images to readers via a centralized PACS.

The pilot is being touted as the first such mobile digital mammography service in Europe.

The digital solution matches existing film-based workflow as closely as possible, according to Iskander Accaoui, global digital radiography manager for Agfa, the company charged with realizing BBNN's vision. All hard-copy mammograms acquired by BBNN staff are currently transported to one of three reporting units to be read by two independent experts.

Under the digital regime, technologists will store breast images in DICOM format on a removable hard disk. This disk will be taken to a nearby reporting unit and images uploaded onto a central PACS server. Radiologists at any of the three reporting sites will then have access to the mammograms.

"In one sense, this is a very conservative solution, because we have only changed one parameter, which is to go digital," Accaoui said. "We have to demonstrate that this is going to lead to better overall workflow, efficacy, and patient safety. If it is proven we are guaranteeing quality, then they may look at changing other steps in the workflow."

Use of digital mammography plus PACS could free up radiologists from attending centralized reporting stations, Accaoui said. Double-reading requirements could then be fulfilled more efficiently.

"Long-term, we expect to be able to dispatch images to the locations where these independent viewers are already based. This way they will not have to travel, and they will have more time to review the images, which will benefit patients," he said.

The BBNN has yet to decide whether to digitize prior mammograms. Priors are sent automatically from centralized archives to screening points, so technologists can match compression and positioning as near as possible. Once all patients have been scanned digitally, this will cease to be an issue.

"Scanning mammography images is not a very fast process, and conventional films might still be sent as an interim measure. They are evaluating what is best in terms of efficiency," Accaoui said.