Digital mammography: CR and tomo could change game

Full-field digital mammography was built on solid-state technology. The first such machines, introduced eight years ago, were based on flat-panel detectors, a tradition that continued until the commercial introduction of computed radiography a few years ago. These CR-based products work with the generators, x-ray tubes, and stands now being used in film mammography. The addition of high-resolution phosphor-based plates and a plate reader are all that any current mammography facility needs to go digital. But there are issues.

• Throughput, throughput, throughput. Ask users of flatpanel FFDM about the advantages of their systems, and one is sure to be increased productivity. More patients can be examined because the images are acquired and displayed in moments. CR can't do that.

• A question of price. CR systems don't cost anywhere near as much as flat-panel FFDM systems. The reason is as plain as the film in the machines now used at these sites to perform mammography. The question might then come down to workload, if not for one thing.

• The fear of obsolescence. CR plates cannot perform tomosynthesis. Only digital flat panels can gather the volumetric data needed for the 3D analyses that developers of tomo products are preparing to deliver. The key question here is when this obsolescence will occur. Commercial products capable of tomosynthesis may be months or even years away. None is yet on the U.S. market. Even when they do become available, thirdparty payers will likely demand evidence of these machines' clinical value before reimbursing for their use. And that could add months or years more.

-By Greg Freiherr