According to Karen McInerney, manager of Swedish Breast Care Center and Women's Diagnostic Imaging Center, the advantages of going digital were inherent with mammography. "The real advantage of digital," McInerney said, "has always been in the process and the ease of storage, retrieval, moving data."

“Mary M. Kelly, MD, director of medical imaging, Comprehensive Breast Center at Swedish Medical Center/Providence Campus, added that total digital mammography was not far off. "The accuracy of digital imaging is very compelling - for image manipulation, storage, retrieval and filmless archiving "

The Clear Technology

As McInerney and Kelly began their research into finding the best digital technologies available, one particular system stood out for them: Hologic's Selenia FFDM System.

Both McInerney and Dr. Kelly discovered that several of their key technological requirements were met by the Selenia FFDM System. "We had to make sure the manufacturer had a good track record with mammography equipment in general," Dr. Kelly stated. Swedish Medical Center already had 14 Hologic film-screen mammography systems in four different centers, with proven reliability for consistent, high-quality mammograms. "Hologic had the clinical quality that we had always come to depend on," McInerney added.

Another important factor in their consideration was the technology's abilities to image large breasts with one image. McInerney explained, "As we looked at our patient population, we realized that gets to be a real issue." Having to use multiple images for one breast is inefficient and costly, with the potential for inaccuracies. "Trying to read the images on the back end was like looking at a jigsaw puzzle," she added. The Selenia FFDM System design allows for single imaging, no matter the breast size.

Although these factors were very important to Swedish Medical Center, there was a key technology that both McInerney and Dr. Kelly knew could only be provided by Hologic: direct digital technology with an amorphous selenium detector (aSe). "We liked that [aSe] had been used in other areas of imaging besides mammography and was a proven technology," Dr. Kelly said.

"The first digitals were indirect systems," she continued. "With indirect technology, X-rays are turned to light, which is then turned into an electrical signal. This indirect routing of the information increases the chances for loss of information and the potential of disruption."

"We looked at another system before Selenia was approved," said McInerney, "and we just felt the technology was not ready for prime time."

Partners For Success

What made Swedish Medical Center's decision final was that Hologic was willing to partner with them on the Selenia FFDM System  "There is a difference between buying equipment from a company and having a company willing to partner with us to make FFDM work in our system." McInerney stated. "They were willing to help us do creative and different things, especially with our mobile program." Dr. Kelly agreed, "We found the Hologic staff to be extremely helpful and supportive. Not just technically supportive, but in a philanthropic way, too. Especially in our efforts to improve mammography screening outreach to underserved women in Washington."

Access Saves Lives

One of the greatest contributions FFDM can make is improving access to quality mammography throughout rural America. Dr. Kelly referenced a study conducted by the Pugent Sound affiliate of the Susan G. Komen Foundation, which found that women who lived more than 30 miles from the major north-south freeway in Washington state, I-5, had very limited access to mammography screening. Swedish Medical has had a long history of providing mobile mammograms to women in out-lying areas. However, film-based systems were very labor intensive and fraught with problems, according to Dr. Kelly. "The beauty with digital mammography, of course, is we don't need an on-board processor," she said. McInerney added that existing regulations and requirements for mammography film processing compounded the difficulty of mobile environments. "The way to get around all this was with digital." In addition, analog technology, even with the best technologist, would often require repeat imaging. With digital, the tech can view in real-time the image to verify that a quality mammogram was taken.

Dr. Kelly and McInerney believe the greatest potential of mobile FFDM will be digital satellite mammography. A distributed satellite-based model for screening mammographies, with images transmitted by satellite to a central breast radiology center for skilled interpretation, will begin to relieve the shortage of quality technicians and breast radiologists, providing quality care to a greater percentage of women across America. "Even for small facilities," McInerney said, "it makes sense to put in at least one digital unit."

Although the mobile unit of Swedish Medical Center has yet to implement this, Dr. Kelly believes it is the path it will take. "We think it has a lot of potential for helping women get access to state-of-the-art mammography, read by expert radiologists," Dr. Kelly explained.

Positive Impact of FFDM

As with most digital modalities, the promise of FFDM goes beyond extending leading-edge technology to remote areas. It also fulfills the vision to improve clinical effectiveness and efficiency, which leads to a healthier bottom line for the woman care center. Dr. Kelly said that even though it may take her longer to read a digital mammogram than a film-based mammogram, the trade-off is well worth it. "Efficiency is not the most important issue here, accuracy is." Dr. Kelly stressed. FFDM gives her more tools to do her job with greater confidence.  "Digital allows panning, zooming, and magnifying the image. There isn't anything more you can do with analog - what you see is what you get."

Since the installation of the Selenia FFDM System in Swedish Medical Center's four facilities, McInerney has seen higher efficiency of her staff, which has had a direct impact on patient throughput and volume. Moreover, the reduction of handling, searching and storing of mammography film has meant more time to focus on the most important task - quality patient care.