Newton-Wellesley Hospital transitions to a totally digital environment

The over-riding philosophy guiding the entire approach to patient care for the Women's Imaging Center of Newton-Wellesley Hospital is the need to create a comprehensive medical environment where a woman can receive all of the services she needs in one location and in one day. "It means," says Dr. Alan Semine, Chief of Breast Imaging, "providing the best technology possible, and the most qualified clinical staff.all the while, keeping the patients perspective in mind, so that whatever needs to be addressed can be addressed during the same visit."

For Newton-Wellesley, located in the suburbs of Boston, this comprehensive approach allows patients to receive any necessary follow-up procedures quickly. "If a woman comes in for a mammogram, and we find she needs additional views, an ultrasound, or a biopsy, we'll do it during the same visit," says Dr. Semine. "The time frame in which a diagnosis is rendered makes a big difference to the patient."

Making the Digital Transition

As part of this on-going commitment to providing the best care possible, the staff of the Women's Imaging Center knew they had to make the transition from a traditional analog work environment to providing digital mammography. In fact, one of the reasons Dr. Semine came to the Imaging Center was because Newton-Wellesley Hospital understood the value of digital imaging, and was committed to moving into the digital world. "All of radiology is becoming digital," Dr. Semine says, "and it is important that mammography departments also benefit from the potential of the digital environment."

Dr. Semine knew that if they were going to make the transition, and make it work for the patient, it was going to take time to integrate the new systems into the existing workflow. "We didn't want to change the way we approached patient care," says Dr. Semine. "Going digital before we had the proper processes in place was a serious concern."

Hologic was very receptive when we suggested early on in our digital mammography journey that we would need some type of electronic communication between the radiologist and the mammographer obtaining additional views. Because of this the Hologic technologist workstation was developed. Newton-Wellesley Hospital has opted to install technologist workstations in each exam room as well as one in the mammography work area. This allows the mammographer who is taking additional views to review the images in the exam room - similar to bringing analog images that have been circled into the exam room for review.

Making the Leap with Hologic

Because digital mammography was, at the time, an emerging technology, the transition of the Imaging Center from analog to totally digital was
a deliberate process. "Digital was not quite ready for prime time," Dr. Semine stated. After months
of research, including site visits, and meetings with technology vendors and medical professionals, the decision was made to move ahead with the purchase of the Hologic Selenia digital mammography technology. "We were confident that we would go with Hologic," Dr. Semine says, "because the image quality is really the best on the market."

"We looked at all the vendors, and what they could bring to our patients here," says Rich Guarino, Director of Radiology at Newton-Wellesley Hospital. "We bought the Selenia system based on image quality, and how that quality improves patient care."

In fact, the Center was so impressed with the quality of the digital images from the Selenia that it committed to the purchase of the first unit on the contingency that the Hologic Selenia Technology received approval from the FDA. "We definitely made a leap of faith with Hologic," Guarino says.

"Our workflow has improved as a direct result of the Selenia technology," says Deborah Lockhart, Operations Manager of Women's Imaging. "We're no longer printing images or burning CD's, we're increasing the efficiency within the department."

Deborah Lockhart went on to note that the goal of Newton-Wellesley Hospital is to provide superior patient care using cutting edge technology. "We have accomplished this with the Hologic Selenia system. Another NWH top priority is to reduce our patient's anxiety in a friendly and helpful manner. Selenia technology has helped us achieve this goal as well. Each mammographer has the ability to view her patient's images without leaving the exam room, taking additional images if necessary, reducing patient wait time and unnecessary anxiety."

Advantages of Digital Images

According to Dr. Semine, the digital images from the Selenia system are far superior to analog film systems. "The most important aspect of the digital image is that it can be manipulated by the radiologist," says Dr. Semine. "You're able to interact with it much more effectively, and bring out features that you never could with analog."

The radiologists of the Women's Imaging Center, in association with Hologic, recently completed a study in the use of complementary imaging software to enhance still further the detail in the images generated by the Selenia FFDM system. "Providing physicians with the technology to see more detail with better clarity is quite valuable," Dr. Semine says. "Improving the display of visual information inherent in digital mammograms can ultimately help physicians detect breast cancers more effectively."

The Women's Imaging Center has found that the digital environment allows for a seamless integration of their Hologic R2 Computer Aided Detection (CAD) software, improving the image interpretation workflow for their radiologists. "I worked with CAD since it first became available," Dr. Semine says. "Once it's been incorporated into the workflow, it proves to be valuable and makes even more of a difference in the digital environment."

Working Through the Growing Pains

The transition from analog to digital mammography for Newton-Wellesley Hospital was a gradual journey. Deborah Lockhart said "We knew that the Hologic Selenia system was the answer, the image quality is superb and the unit itself is user friendly. How this transition would impact our department and how we were to work through this transition was the question. The goal was to make this transition from the analog to digital environment as smooth as possible. "

"The Hologic team has been extremely helpful and supportive through this transition. I could not have asked for a better company to work with - they are a great team: willing to help and listen to ideas and suggestions."

With the implementation of any new technology, a certain amount of growing pains are expected, and the first Selenia system installed in the Center was no exception. What made all the difference is that Hologic understood this and worked closely with the doctors, administrators and technologists at the Center to improve the new technology, and integrate their suggestions into subsequent updates.

One improvement was the need for better communication between the radiologist and the imaging technologist at the acquisition station. "We worked closely with Hologic to validate the concept of a technologist workstation and demonstrate the improvement in workflow," Dr. Semine says.

The Hologic technologist workstations allowed the Selenia technology to imitate, in a way, the analog environment. "We can now circle areas in the breast on the digital image that we would like the technologist to provide additional views of," Dr. Semine says, "and push it right back to the technologist's work station. This has improved the efficiency of the digital environment."

Patient Care

According to Cheryl Cain, Breast Imaging Facilitator, the Selenia technology would not be as impressive if it did not improve the delivery of care to the patients. "We want to be hi-tech and on the cutting edge of technology, the Selenia has enabled us to do that," Cain says. "But it's all for patient care. Doing the best for the patient is the bottom line."

With digital mammography, the technologists have the ability to see right away if the image taken is satisfactory or not. "You have the ability to review the image almost immediately and assess it for positioning, motion and overall exposure," Cain says. She also points out that because the technologist never needs to leave the patient alone in order to process films, she has found that the patients feel more at ease. Reducing their anxiety makes the entire experience of having a mammogram better for the patient and the technologist.

Digital detectors have a much wider dynamic range and are more tolerant of exposure variations reducing the number of retakes compared to screen-film. "The patient can be more confident that the images will be satisfactory, and not need to be repeated because of exposure factors," Dr. Semine noted.