PACS integration showcases digital advantage

Digital mammography integrated with PACS has numerous advantages over screen-film mammography when it comes to image storage, transmission, archiving, and consultation, according to a study conducted at Cottage Health System in Santa Barbara, CA. But those benefits come at a cost in time and productivity.

The study, based on a survey of radiologists using digital mammography and PACS at the health system, evaluated radiologist productivity, perceived image quality, and exam and report availability to referring physicians and breast surgeons.

The health system includes two campuses. A Web-based PACS links all digital modalities. Exams and results are accessed via the general PACS server with connectivity to 180 clinic physicians using personal computers, as well as 100 offsite community physicians. Three hospitals, part of the larger Santa Barbara Medical Foundation Health System, also have access to the server.

Digital mammography was installed and integrated with a DR Systems PACS in June 2003, said Dr. Michael Trambert, a staff radiologist at Cottage. The health system performs about 18,000 mammograms annually. All exams were read and archived as soft copy from the first day of installation.

Radiologists surveyed perceived that the combined digital mammography and PACS led to expedited patient care, due to the ease and availability of exams, Trambert said. The system also received high marks for enabling better communications with referring physicians and breast surgeons about exam results and the need for follow-up.

Acceptance of the system by breast surgeons also ranked high, Trambert said. Typically, reports and exams are available on the Web server within a minute or two of dictation.

Users also lauded the image quality of digital mammography, which improved over 17 months' experience with it, he said.

"Over the last four months, we rarely windowed, leveled, or touched an image in regards to presentation state," he said.

The PACS' voice annotation feature, used to recap or highlight findings, proved popular not only with radiologists but also with referring physicians, he said.

"This is extremely powerful. Surgeons have immediate availability to images and results," he said. "But what is absolutely key is that the radiologist's value-added is stamped on the study as they read it."

The big negative in the study was radiologist productivity, which was halved with digital mammography compared with screen-film.

For the study, images were interpreted on the Fischer digital mammography workstation, then reported or annotated with voice clips using the PACS workstation. The PACS vendor received FDA approval in August that allows diagnostic reads on its workstations. Transitioning to a single integrated system for image interpretation and reporting should solve productivity issues, Trambert said.

"The workstation interface needs to improve, and that is what is slowing it down," he said. "I look forward to interpreting digital mammograms on our general PACS."