Streamlining Mammography -All In a Day: Screening, Results and a Biopsy Booking

Streamlining Mammography

All In a Day: Screening, Results and a Biopsy Booking

Professor Dr. Alexander Tschammler, Chief Physician of the Institute of Radiology, University of Wurzburg, credits the Hologic full-field digital mammography system with helping the facility achieve optimum efficacy and efficiency

Germany - In the world of breast imaging the goal is clear: to detect abnormalities early and notify patients as quickly as possible. At the Institute of Radiology, University of Wurzburg, Germany, the pieces are in place to routinely achieve both. In fact, the Institute of Radiology has evolved into a one-visit breast-imaging center where woman can undergo mammography, receive results and schedule a biopsy-all on the same day.

Prof. Dr. Alexander Tschammler credits the acquisition of a Hologic Selenia full- field digital mammography system and a Hologic MultiCare Platinum breast biopsy system with helping the facility achieve optimum efficacy and efficiency.

The larger field of view of the Selenia system is absolutely necessary. A third of our patients don't fit on an 18 x 24 device.

The Institute, which carries out 6,000 mammograms and 350 biopsies annually, began streamlining its process in 2003, with the installation of a Hologic MultiCare Platinum breast biopsy system. This was chosen for two key reasons, explained Professor Alexander Tschammler, chief physician in the Institute's breast imaging department: the patient is prone which minimizes movement, and the system facilitates biopsy from above, below or either side, enabling the breast to be reached from any angle. "I try to enter the breast from below," he added. "That way, if there's a scar, no one will see it."

The 24 x 29 cm field of view of the Selenia system, the largest available in the industry today, is absolutely necessary, Prof. Tshammler says. He estimates a third of his patients won't fit on an 18 x 24 cm device.

In 2004, the University opted to install a Hologic Selenia full-field digital mammography system, a choice made not only for consistency, but also because slot scanning system scan times were too long, and among the flat-panel equipment on offer, either the field of view was far smaller than the 24 x 29 cm field of view of the Hologic Selenia system, or the manufacturer did not have a mature system solution worth evaluating. "The larger field of view is absolutely necessary. A third of our patients don't fit on an 18 x 24 device," Prof. Tschammler said.

In addition to accommodating larger breasts and providing overall great images, the Selenia system is also compatible with the hospital's new PACS system-the entire state-of- the-art imaging/biopsy/image transmission capability went online early this year.

Because Germany does not yet allow digital screening, the Institute also purchased a conventional Hologic M-IV system to replace the analog mammography system used there for many years. The professor explained that the change in manufacturers was made because Hologic's analog and digital systems are very similar, making it easy for technologists to switch between either, and servicing by just one company proved more attractive-a Hologic support technician was within easy distance, ensuring speed if any changes to the system should be needed.

"Hologic's analog and digital systems are very similar, making it easy for technologists to switch between either"

In terms of digital versus analog image quality, contrast in digital is better for visualization of calcifications and architectural distortion also is more easily visualized, he pointed out. And radiation dose has been reduced by about 10% with the digital system, largely because the improved ability to manipulate digital images has reduced the need for magnification and other additional views. Another advantage is that digital images are produced far more quickly than film images and, if they request it, patients can be given their images on a CD.

Germany offers insufficient reimbursement to cover the additional costs involved in a full-field digital screening system. "When digital screening is reimbursed, and when the cost of systems comes down, its impact will really begin to be felt," the professor predicted. That is, conventional mammography systems will not be needed. "Image characteristics of digital mammography and biopsy systems are similar, so it's easy to go from digital mammography to digital biopsy. The future is digital."

This case study first appeared in Volume 14, the Jan/Feb 2005 issue of European Hospital.