Health Imaging & IT - August 2008 - (Page 21)

Ultrasound Meets Next-generation Imaging Demands Kansas University Breast Cancer Prevention Center in Westwood, Kansas, exemplifies the state-ofthe-art breast cancer facility. The new center is equipped with digital mammography, breast MRI and four Philips Healthcare iU22 ultrasound systems. The center not only serves a large high-risk population, but also employs neoadjuvant therapy. The therapeutic model poses unique imaging demands as it requires ongoing monitoring of changes in tumor volume. Ultrasound is ideally suited to neoadjuvant [ Philips iu22 ultrasound system is among the arsenal of breast technologies at kansas model, says William Smith, MD, university breast cancer Prevention center in Westwood, kan., that also include digital director of breast imaging. mammography and breast Mri. ] Neoadjuvant therapy bypasses the traditional excisional biopsy. Instead, the patient undergoes a needle biopsy. The tissue is examined for markers before the team determines the therapeutic approach. Smith explains the rational for the approach. “If we remove the tumor and lymph nodes, we also lose the gauge to measure the success of therapy. Leaving the mass within the breast provides a metric to visually determine whether or not the first line treatment is working.” There is a hitch. Neoadjuvant therapy requires improved breast cancer imaging. “Traditional imaging and measurement tools are not acceptable for neoadjuvant therapy. Imaging must provide precise data about tumor volume on a regular and ongoing basis,” states Smith. Ultrasound is an ideal platform because it’s economical, convenient, pain-free and lacks radiation. In 2007, Smith challenged Philips to tweak the iU22 to meet neoadjuvant needs. The imaging challenge is two-fold as the solution needs to precisely measure tumor volume and differentiate scar tissue from active cancer. Philips’ answer, its 3D volumetric space application, measures vascular density and may be the earliest way to determine therapeutic success. The system meets other breast cancer imaging demands as well, says Smith. “Every day we are challenged to increase patient throughput and maintain or improve quality.” The reality of patient throughput prohibits radiologists from interrogating masses when the patient is in the room. At Kansas University Medical Center, Philips’ iU22 image clips are saved to PACS, so the radiologist and sonographer can review the files thoroughly after data acquisition. On the quality front, it’s critical for the sonographer to spend as much as time as possible looking for cancer rather than typing data during the initial study. Philips iU22 incorporates a one button prompt protocol to lead the sonographer through the breast and locate the probe. “It saves about 180 keystrokes per scan and results in greater consistency,” sums Smith. While ultrasound plays a central role in the neoadjuvant model, applications could expand to include greater roles in high-risk screening in the future. (See “On the Horizon,” page 23.) system with a shareware keyboard expander that allows users to create templates for additional categories like left lumpectomy. The investment in robust workflow analysis reaps dividends. “Radiologists at breast imaging practices that put all of the pieces together can focus on their primary job of image analysis, provide state-of-the-art care, regain their time and stay profitable,” asserts Schroeder. less paper, less staff, more profits When Women’s Diagnostic Center in Louisville, Ky., deployed digital mammography in April 2007, the practice boosted MagView mammography tracking and reporting software with RadView for demographics, billing and appointment control. The new software automates CPT and ICD9 code creation. “We’ve become so much more efficient,” says Practice Manager Cris Vittitoe. The practice increased its daily patient volume from 60 to 70 to 80 to 90 after deploying digital mammography and RadView. Plus, as patient volume increased, Women’s Diagnostic Center trimmed its staff. Front-office staff went from seven to five, mammography techs from eight to seven and transcriptionists from two to 1.5 FTEs. Women’s Diagnostic Center continues to tap into MagView’s capabilities to improve its practice. For example, earlier this year Vittitoe customized the software to barcode encounter forms and eliminate paper encounter forms to accelerate the move to a paperless practice. Other pieces of the paperless puzzle include six Motion Computing C5 Tablet computers, which will be deployed later in 2008. Patients will input demographic data upon arrival at the center. “Data will flow into MagView to eliminate one more piece of paper and another job,” explains Vittitoe. Streamlining the digital/analog hybrid environment Any practice that transitioned to digital mammography can attest to the pain of a hybrid environment. Radiologists are forced to work in a dual configuration, reviewing current digital studies and comparing them to analog images. The hybrid reading room is cluttered with workstations and alternators. Not only is the arrangement inconvenient and inefficient, it also impacts the recall rate as hybrid comparisons can be challenging. The Radiology Imaging Center at Mount Sinai Hospital in New York City, eased its recent transition to digital mammography with the iCAD Inc. TotalLook MammoAdvantage digitizer. “The digitizer streamlines the analog-to-digital comparison process, and it saves time,” says Laurie Margolies, MD, assistant professor of radiology. A dedicated clerk digitizes two years of analog priors for all digital cases, relieving radiologists of the burden of searching through paper files and hanging films. 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Health Imaging & IT - August 2008 Table of Contents On the Web The Enterprise News Update Cover Story: 2008 Top 25 Connected Healthcare Facilities Interpreting the Spectrum: Breast Imaging & IT Options Abound Optimizing Breast MRI Reading Technology Outlook Managing Technology Reader's Resource People & Technology

Health Imaging & IT - August 2008

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