Bringing digital mammography technology to outlying areas

Last year, the mobile digital mammography van operated by Woman's Hospital in Baton Rouge, LA performed 5,000 mammograms. Without that service, three quarters of the women currently being screened by the service would go without mammograms. That's the estimate given by Woman's Hospital's Director of Imaging Services, Cynthia Rabalais, RT, who coordinates the mobile program.

While Woman's mobile mammography program has been serving Baton Rouge and the surrounding parishes since 1996, the digital incarnation of the program began making the rounds a decade later. In 2005 the hospital committed to changing their three campus and satellite screening sites to digital, but converting the mobile program required a little extra ingenuity and a lot of foresight.

"We just took the bull by the horns and decided that we weren't willing to stop serving the 5,000 women that depended on us," Cynthia recalled. "It took us about a year to plan, to work with the coach manufacturer and with Hologic and no one had a whole lot of experience about all of that."

Location, Location, Location

The switch to digital presented a few challenges to the mobile van crew's established routine. In years past, the crew would drive a small van to a remote site, take the analog equipment out of the van, and set it up in the building that would host the screening. With digital, there was no such portability. "We did our due diligence about that and visited some coach manufacturers. The only place at that time that was doing mobile digital was in Seattle at Swedish Hospital. I did a site visit there," Cynthia said.

After the coach design was established, Cynthia tackled the logistics of delivering a much larger unit to the screening sites. "We were in some very small places, like a community health clinic that had a total of 8 parking slots. Well, you bring this big thing in and you need 10 parking spots to set up. So we had to re-analyze where the coach would go.

"We also had to establish where we could have a mobile connection because we are registering the patients onboard and wanted to take advantage of the advantages of being digital, that we could not do in an analog world." After about two weeks of working out routines and transmission issues, the link between the mobile unit and the hospital's PACS worked effortlessly. The van's technologist and driver work in tandem to register patients and order tests. Once the image is acquired on the van's SeleniaT, R2 Image Checker is overlaid on the image and saved on a laptop containing the hospital's PACS software. "When we get back home we put the laptop into the hospital's network and all those images are dumped into the PACS and we're ready to read," she concluded.

Sometimes the smallest issues pose the biggest concerns. "For me, the greatest challenge has been learning how to operate the coach. Driving it - it's like having a teenager; every time they leave I tell them '"don't speed, don't go over too many bumps, don't scratch it, don't dent it.'" Cynthia said with a laugh.

Reaching Out Over Land

Because most of the small hospitals and community clinics in the rural areas surrounding Baton Rouge do not offer mammography services, the Woman's Hospital mobile van program reaches populations in desperate need of screening. "We typically try to stay within a 60 mile radius simply because we've learned that it is hard for patients beyond that point to come back should they need further evaluation," she noted. "If you get out of that 60 miles it's taking the patient out of her home."

In the aftermath of Hurricane Katrina, Cynthia stretched that 60-mile limit to assist the staff at the Louisiana State University Healthcare system. "They didn't have any mammography ability at all, so we worked with them for almost a year until they got reestablished with their own equipment," she said. "We served about 1,400 patients for them."

In addition to working with clinics and small hospitals, the van visits health units in federally-qualified community centers and the Louisiana Correctional Institute for Women, as well as churches and schools. "We typically do about 10 or more schools when we are in the area. Teachers in these facilities know that we'll come once a year so they don't have to take off a day's work."

Working With Wellness Programs

Employers in and around Louisiana's state capital depend on the Woman's mobile program to augment their wellness programs. Dow Chemical, Blue Cross Blue Shield of Louisiana, Novartis and E-Tel are just a few of the heavy hitters calling on the service. "Actually my job is a little easier these days as there are many already well-developed wellness programs in major employers, so this is just a way to bring mammography to the mix," said Cynthia. "Everybody loves it. When I go there, and once we're there a year, we always get invited because women say 'I didn't have to take off work a half day to get a 15 minute test done. It was here at work and I did it on my noon hour.'"

It should come as no surprise that once a company approves a mobile screening day, the Woman's mobile mammography van and crew are always invited back.

Getting the Word Out

Ten years of operating a mobile analog program provided Cynthia and her staff with an established base of service sites to grow from. Woman's hospital also partners with a local cancer treatment facility to augment their clinical offerings. "They do a lot of advertising, and they also have a coach that provides like clinical things: breast exams, skin screens, prostate screens. When they're on the breast end of things usually both our coaches are there," Cynthia explained.

Newspaper advertising helps fund screening for the underinsured population, as does a grant from the Louisiana Breast and Cervical Health Program.

The mobile program is so well known in the area that there are often more calls than Cynthia and her crew of a driver, two technologists and one receptionist can handle. Typically, the van is running five days a week and two Saturdays each month. "My schedule is 90% booked until the end of the year. When we do have some openings they are far and few between."