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Digital mammography: Easing the transition for radiologists

Radiology Administrator's Compliance and Reimbursement Insider, March 1, 2005

Many organizations have made the leap and purchased full-field digital mammography equipment, and many more are contemplating doing the same. Although the new digital systems are touted as a means to reduce operating expenses and improve efficiency, the initial transition to digital can be burdensome for radiologists who must use both film and digital images until all images are digitized.

Switching from one medium to the other can lead to physical strain and extended read times, and it has the potential to increase the likelihood of errors.

Although digital equipment could eventually speed up the interpretation process for radiologists, the transition period may tack on an extra 15 minutes to what would currently be an hour-long session, says Shirley M. Long, RTR, CBI. Radiologists need time to become familiar with this modality; a learning curve is an unavoidable part of this process. Although there is no way to alleviate all the issues related to the transition from film to digital, there are ways to ease the process, says Long.

Focus on ergonomics

The first step is to ensure that your radiologists'workstations are as comfortable as possible, Long says. "Make sure the station is efficiently laid out," says Long. Also ensure that

  • radiologists don't have to get up from their chairs when switching from the film-viewing station to the digital monitor. Provide a chair with wheels to allow the radiologists to move back and forth quickly and efficiently.

  • the film viewer and monitor are adjusted to the same height so radiologists don't have to move their heads up and down when switching between modalities.

  • whoever mounts the films organizes them the same way as the digital images so radiologists aren't hunting to match images for patients. This also helps minimize errors and needless confusion during the interpretation process.

  • paperwork and needed tools are readily accessible at the workstation. The atmosphere in the room is also important, says Long, citing the following as important items to be aware of:

  • Low-level ambient lighting is critical for visual acuity.

  • Keep the room cool and dry to prevent drowsiness; good air circulation is also important.

  • Strive to minimize noise and interruptions in the reading area. "Probably a lot of people will smile at this thought, because it's not always possible," says Long. "But working toward this goal will create the most ideal setting for interpretation."

  • Encourage your radiologists to take brief breaks to reduce eyestrain and fatigue.

Working out a solution

Keep in mind that when radiologists work between two different modalities it can raise the potential for error. There are a number of innovative plans that organizations have adopted to make the transition easier, says Long.

For example, some organizations have decided to digitize prior film images during the transition period. This is certainly not ideal, she says, because detail is lost in the digitization process and image detail is key in mammography.

Some might argue that using the digital modality is the clearest way to view mammography images. In addition, the older film images can be examined if the digitized version isn't adequate, but Long still thinks this is something that organizations should avoid.

Long also knows of a handful of organizations that print out all digital mammography images so they can be examined on film viewers along with the prior film study. She says this is an ineffective idea-one she hopes few organizations will adopt.

This protocol defeats the purpose of going digital, Long says. Again, the printing process results in reduced image quality, and therefore the potential for error arises. "It's going backwards," she says. "It's like buying a Cadillac, stepping out of it, and going back into the Volkswagen."

Also, radiologists will undoubtedly want to view the digital study on high-resolution computer monitors at some point in the process, which defeats the purpose.

Printing digital images is also a large expense, involving both the purchase of a high-quality printer and the ongoing cost of printing materials, says Long.

These dollars might be better spent on a computer aided detection (CAD) system. Although CAD systems are not foolproof, they can provide a safety net of sorts, catching errors that might otherwise slip through the system. This is particularly beneficial and comforting during the initial transition, when the potential for error is a concern.

Learning new tools

Because digital equipment offers radiologists the opportunity to use a host of new tools when examining images, it may also initially prove to be more time-consuming. Radiologists have more power with digital imaging to manipulate images, such as zooming in on problem areas and enlarging, reducing, and lightening dark spots, says Long. But although these tools will eventually be a boon, they may initially be a bane for those unfamiliar with how to use them efficiently. Radiologists need to experiment with the imagemanipulation features of the equipment.

"Going digital is definitely something that will be more time-consuming initially until radiologists develop a comfort level with their new equipment," says Long. Some may attempt to use all the digital tools on every image, but this practice is highly unlikely in the long run, she says. Once their confidence level is raised, they will begin to read the images more quickly. Eventually radiologists' interpretation will settle back into a standard pattern and efficiency level, but at first it is important for them to determine which tools are most helpful with different breast and tissue types.

Insider source:

Shirley Long, RTR, CBI, Mammography Consulting Service Ltd., Alberta, Canada.  

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