Shifting to Digital Mammography System-Wide
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.