The Memorial Healthcare System Experience

Choosing the right technological fit requires research, patience, and timing. For the radiologists in South Florida's Memorial Healthcare System (MHS), having a team dedicated to pursuing the right technology at the right time made all the difference in a smooth switch to digital mammography.

"We've been interested in the switch to digital since its inception," says Mary K. Hayes, M.D., medical director of Women's Imaging at Memorial Regional Hospital in Hollywood, Florida. That interest drove Dr. Hayes and the team at MHS to spearhead their own internal trials of digital mammography before committing to the technology - or to a vendor.

Internal Trial Confirmed the DMIST Results

The public, non-profit healthcare system's equipment trials paralleled the Digital Mammographic Imaging Screening Trial (DMIST), sponsored by the National Cancer Institute. "At the same time that the DMIST trial was ongoing we conducted our own internal trial parallel to the DMIST trial using the same endpoints," Dr. Hayes said. "We screened 1,000 patients in our facility using Hologic equipment."

The results of the MHS trials became a significant catalyst for the MHS changeover. "We were satisfied that digital mammography was at least as good as film-screen mammography. It's been proven that through the DMIST trial of 50,000 women as well as through our own experience at MHS that digital mammography is more sensitive than screen-film mammography for certain subsets of women: those women that are premenopausal and women with dense breasts," Dr. Hayes noted.

As they investigated the available digital systems, the MHS team brought their own phantom to the vendor sites to add another layer of certainty to their equipment evaluation process. "We went to multiple sites and viewed both soft and hard copy images using our phantoms so we could do an apples-to-apples comparison," said Jeanne Brotzky, RT (R) (M), manager of Memorial Regional Women's Imaging Center.

Workflow Efficiency Was a Critical Consideration

For a healthcare system comprised of four hospitals and an outpatient clinic that together serve over 35,000 individuals annually, workflow efficiency was also a critical consideration. Again, the team took a hands-on approach to measuring performance. "We did a lot of things as far as timing the images," Brotzky added. "We looked at how long it took for images to appear and the time it took for the image to reach the radiologist's workstation" One team member held a stopwatch as Brotzky watched the acquisition station and radiologist's workstations.

The move to digital required an across the board commitment to making the most efficient choices, system-wide. "We see over 650 new patients with breast cancer each year out of a screening population of about 35,000; the vast majority of the cancers we identify are early stage. With that volume and priority of excellent patient care we need a highly efficient system. That's our goal. We need excellent images, but we need a high efficiency model to view and assess those images," said Dr. Hayes.

Their digital mammography trial model compared current digital mammograms with hard copy mammograms taken in the same year, compared to hard copy prior films. Dr. Hayes and her team concluded that the model, while moderately efficient, was not going to satisfy their needs in the total digital environment.

Hologic SecurView Workstations Were Chosen for Their Intuitive Design and Aid to Workflow

In addition to eliminating traditional view boxes from their operational procedures, MHS integrated their hospital PACS system and their radiology information system into the Hologic SecurViewTM diagnostic workstation to maximize workflow efficiency. As a result, Dr. Hayes noted, "We have ongoing synchronized case management, both comparing digital to digital." Utilizing a straightforward barcoding system enables the radiologists to synchronize patient histories and prior imaging for rapid, accurate comparison.

"I can compare any type of imaging on the same patient, whether it's an MRI, ultrasound, nuclear medicine bone scan, chest x-ray or a chest CT. If there's anything I have a question about, I have the whole patient imaging history - images and reports - available on our PACS workstation, which is synchronized with our SecurView workstation."

Their current system affords radiologists three opportunities to compare prior images - on the hospital PACS, hard copy, and disk. "These comparison images can sometimes help in making the earliest diagnosis of breast cancer, and can also help in avoiding unnecessary biopsies when certain mammographic findings have been stable over many years," Dr. Hayes said. "The opportunity to have consistent comparison images is very important to patient care so it's a win-win for patients and radiologists."

The SecurView's intuitive design made screening more comfortable for the radiologists and technologists as well. "Typically, the radiologists don't need to look away from the workstation monitors; we simply look at the computer monitor showing the images and our finger just hits one 'hot button' on the smart keypad to move forward in the case," Dr. Hayes explained. This user-friendly design, which incorporates the R2 ImageCheckerTM CAD, adds an element of convenience to routine tasks.

"Screening mammography involves a lot of standard reporting, so you can hold the Dictaphone in one hand or write a note with one hand and move through the case with your other hand."

Training is an important aspect in any equipment acquisition, particularly in one as comprehensive as the MHS project. "The training process so far has gone exceptionally well," according to Brotzky. In fact, the transition to Choplogic's filmless environment for technologists across the spectrum of experience has been easy. "One of my senior technologists, who is not computer savvy, learned the system and she loved it. She had no problems with the training, she felt very comfortable. Hologic did a phenomenal job training the radiologists and technologists," said Brotzky.

Choosing a vendor that could fill the system's service and support needs was vital to the success of the transition, and Hologic has stepped up to meet those challenges. "We've had Hologic equipment in the healthcare system for more than a decade, utilizing both their M-IV units as well as their stereotactic biopsy table," she added. "Throughout this time, Hologic has always provided quality imaging combined with excellent service, which is an integral part of the decision-making for any significant equipment purchase."

The fifth and newest hospital in the Memorial Healthcare System, Memorial Hospital Miramar, used the Selenia digital mammography in their breast center, when it opened in March 2005. The MHS Mobile Mammography Van, which screened over 2,380 patients last year, is scheduled for an update this winter and will feature Selenia technology. By December, the four hospitals and one outpatient clinic of MHS will have 13 Selenia units in use: Memorial Regional Hospital, Memorial Hospital West, Memorial Hospital Miramar, Memorial Hospital Pembroke, and Esther L. Grossman Women's Health and Resource Center.

From Dr. Hayes' perspective, Hologic digital imaging serves MHS and their patient population by providing not just the best imaging quality and performance today, but by providing robust, stable platforms for emerging technology.

"All the building blocks for future development of new technologies, whether it's digital tomosynthesis or fusion imaging, will be harnessed on this current existing digital imaging technology," she affirmed. "It serves the patient well not only today, but for the future as well."