Providing the Latest Technology with Limited Resources

As a private, not-for-profit healthcare provider, Prairie du Chien Memorial Hospital in rural Prairie du Chien, Wisconsin, is all too familiar with the challenges of providing the latest technology with limited resources. When the time came to replace the hospital's aging analog mammography system, they knew they wanted to upgrade to digital technology.

They were not alone. The National Electrical Manufacturers Association, a leading industry trade group, reports that 97 percent of the mammography systems sold in the U.S. in 2008 were digital. According to the FDA, nearly half of the 8,786 certified MQSA sites in the U.S. have purchased at least one digital mammography system. The only question was which modality would Prairie du Chien pick to enter the digital mammography age -computed radiography (CR) or digital radiography (DR)?

Big Enough to Help, Small Enough to Care

Prairie du Chien Memorial Hospital takes pride in its ability to introduce new avenues of medical care to the community despite its rural setting. It was one of the first rural hospitals in Wisconsin to utilize in-house CT imaging and the first in the entire state to offer a hospice program. Yet the hospital must regularly remind the community of its commitment to cutting edge technology.

Prairie du Chien Memorial Hospital is one of the nearly 1,300 certified Critical Access Hospitals (CAH) in the United States. CAHs are rural acute care hospitals that receive cost-based reimbursement from Medicare, intended to improve financial performance and ensure access to critical care for rural communities. As a CAH, Prairie du Chien's biggest challenge is making the patients they serve in critical situations realize that the hospital has the technology and staff to provide their routine care as well.

According to Kelly Mundt, director of diagnostic imaging services, large medical centers that have clinics in the town of Prairie du Chien are the hospital's biggest competitors for providing routine diagnostic care.

"It's a big challenge to keep people coming to us for services other than emergency or critical care," Mundt says. "They don't realize how current our technology is and what we can actually provide them. We do a lot of publicity to remind the community about the state-of-the-art services and technology we have available."

The hospital's motto - "Big enough to help. Small enough to care." - shows what sets Prairie du Chien apart from the larger medical centers, Mundt says. They are able to offer the best of both worlds: the cutting edge technology of urban centers with the personal touch of a small community hospital.

Digital Mammography: CR vs. DR?

Because of Prairie du Chien's commitment to keep its technology current, when it came time to upgrade the hospital's mammography equipment, everyone agreed digital was the way to go. The only question was: CR mammography or DR mammography?

CR mammography appeared to offer a number of advantages, including lower up-front equipment costs and a similarity to analog mammography that could help ease the transition to digital. But on closer inspection, Mundt began to realize that the benefits of DR mammography might be worth the added initial investment.

The Hologic Selenia digital mammography system came highly recommended from the hospital's radiology group, which already had a demo with the equipment and completed a trial period with the workstation. The hospital staff also had an impressive demo at St. Luke's Hospital, a large medical center in Iowa, where they observed the workflow benefits and witnessed the ease and capabilities of the digital workstation. The Selenia system's direct capture technology eliminates the need for a processor, resulting in an almost instantaneous acquisition of images. This prevents technologists from having to leave patients during the exam and allows them to perform repeat views immediately, without repositioning the patient.

The hospital estimated that the improved productivity of DR mammography would reduce exam times by 8-10 minutes per patient. The lack of a processor would also simplify the technologists' jobs by not requiring them to maintain an additional piece of equipment.

The ability to retrofit their current x-ray machines for CR mammography provided no benefit to the hospital. With analog equipment that was nearly eight years old, Prairie du Chien wanted to purchase a new x-ray mammography machine anyway. So when Hologic presented the opportunity to purchase a Hologic Selenia digital mammography system at a price that was "very competitive" to CR mammography, Mundt says DR mammography became the clear choice.

Going Digital with the Hologic Selenia System

In June 2008, Prairie du Chien traded its old film-screen equipment for a Hologic Selenia digital mammography system, becoming the first site in the area spanning southwestern Wisconsin and northeastern Iowa to offer digital mammography.

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The increased productivity of digital mammography enabled the hospital to accommodate more patients, while the new technology attracted two new groups of women: older women who had avoided mammograms in the past and younger women with dense breasts.

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"It was impressive to see the whole thing in action," Mundt said. "We saw how Selenia mammography could work for us."

In particular, they were impressed with the easy-to-use Hologic workstation, which they knew would further streamline the workflow and help the staff quickly adapt to the new technology.

Aside from the technology, Hologic helped Prairie du Chien by providing invaluable information regarding how DR mammography could benefit a small rural hospital. That information, Mundt says, helped demonstrate the value of DR over CR to the hospital administration.

"While some people looked at us as a just small rural hospital and immediately concluded that CR was the only way we could afford digital, Hologic knew what we wanted," Mundt says. "They worked with us and really showed us why we should go the extra mile for our patients and staff."

Going Digital Increased the Hospital's Patient Base

Within six months, the hospital experienced a 25-30% increase in patient volume. The increased productivity of digital mammography enabled them to accommodate more patients, while the new technology attracted two new groups of women: older women who had avoided mammograms in the past and younger women with dense breasts.

"One of the reasons we wanted digital mammography was that it would allow us to offer the service to younger women," Mundt said. "Before, these women had to travel to other facilities to get a digital exam, sometimes as far as two hours away. We wanted to be able to help this younger population."

As with its other technologies, Prairie du Chien wanted to be sure it spread the word about digital mammography to the community, particularly since all of the larger clinics in town had yet to adopt the new technology. With the help of Hologic, the hospital launched a PR campaign that included fliers, ads and even a spot on cable television.

All of this appeared to be effective, as many women mentioned the advertising as how they learned about digital mammography at Prairie du Chien. Mundt says patients appreciate the shorter exam time, and they're grateful the hospital was able to bring the state-of-the-art technology so close to home.

The hospital staff is equally thrilled with the new technology.

"The technologists love digital. They're so happy we were able to bring it on board," he said. "They say it's so much better for the patient, and the exam goes much more smoothly."