Technology innovation -- at what price?

Hospitals that archive digital mammograms in their PACS must plan for network modifications to handle the transfer of very large data sets and prepare for significantly increased archival storage requirements.

The Sansum-Santa Barbara Medical Foundation Clinic in Southern California made the conversion to filmless mammography in 2003. The data size for a digital mammogram is 45 MB. The 18,000 procedures performed annually at the facility may be stored only with lossless compression.

In a scientific paper presented at the 2004 RSNA meeting, researchers from the clinic stated that use of an 8:1 compression ratio for archival storage after interpretation would not compromise image integrity for further analysis and diagnostic review. Transfer of diagnostic-quality mammographic images within the PACS is unwieldily. A compressed image with a voice clip is created for Web server access and use by referring physicians.

The benefits of filmless mammography have been mixed. Room use productivity has increased by 250%. Two digital mammo suites replaced five analog suites.

Image quality has improved significantly. The number of patient callbacks have been reduced. Referring physicians are very satisfied with having immediate digital access to reports and reference images.

There has been a huge negative impact on the radiologists, however. Their productivity has dropped by half. This is attributed to the dedicated mammography workstation's user interface, which the presenters stated needed to be made more intuitive and easier to use.

The 10-minute time slot allocated for RSNA paper presentations is a challenge to presenters, but it can be maddening to attendees, as it was with this presentation. This session begs for follow-up. Digital workstation design has historically been a technology adoption inhibitor. The appeal of the graphical user interface of a diagnostic workstation is a major decision factor in PACS selection. The proliferation of digital mammography equipment is obvious to anyone who walks through either hall of the technical exhibitions. Information on what needs to be changed must be published in order to educate the medical device industry.

Of interest to this consultant is how the radiologists and their diagnostic imaging department have dealt with a 50% productivity reduction in reading mammograms. What is the financial cost? What is the impact on overall workflow? Would it not be more prudent from both a workflow and opportunity cost perspective to print film and read the traditional way? Does productivity increase over time? Did the radiologists revolt?

The bell sounded. Next paper presentation. Lots of questions for post-RSNA follow-up.

Ms. Keen is a PACS consultant with i.t. Communications. She can be reached at itcommckeen@earthlink.net.