What issues must be addressed before mammography can be linked to PACS?

August 20, 2003

Moving mammography to a PACS is not a simple task and vendors may not have all of the answers for you. PACS experts relate their experiences, along with tips and advice, on making the transition.*Dr. Frits Barneveld BinkhuysenRadiologist, Hospital

Moving mammography to a PACS is not a simple task and vendors may not have all of the answers for you. PACS experts relate their experiences, along with tips and advice, on making the transition.

?Dr. Frits Barneveld Binkhuysen
Radiologist, Hospital Eemland
Amersfoort, the Netherlands

A U.S. FDA-approved digital mammography system is an option. You can also choose a digital radiography (DR) or computed radiography (CR) alternative. You have to be extra careful with CR because next to the acquisition device you also need cassettes, a reader, and viewing screens as part of the digital chain. Here the problems start. When you want to fulfill the minimum requirements for performing digital mammography, the parts of the chain must fit perfectly, and this is not always the case in daily practice. In some hospitals, mammographic images have shown less quality compared with images from a screening program, but it was realized only after hundreds of patients. You can help yourself if you think twice.

?Dr. Keith Foord
Consultant radiologist
Conquest Hospital, Hastings, U.K.

CR mammography (CRM) using special digital luminescent plate readers and image processing algorithms is already in regular use in the U.K. See the work of Dr. Geoff Parkin from Leeds. Direct digital mammographic (DDM) units remain very expensive but are coming into early clinical use.

CRM and DDM images can be stored in PACS archives, particularly now that high-volume archiving solutions are possible with storage area networks (SANs). In centers that do large amounts of mammograhy, partitioning CRM/DDM SANs may be advisable.

Soft-copy interpretation of both CRM and DDM images will require very high definition/high contrast 5-megapixel monitors. Viewing of the large data volume CRM and DDM images should be simple if there is a gigabit/sec network connection to a high-specification special workstation used to report mammography.

?Dr. Raimund Vogl
Imaging information manager
Innsbruck Hospital, Austria

At our hospital, mammography was the last imaging modality to be connected to PACS in 1999, mainly because usable and certified products for digital mammography had not previously been available. To have a completely digital workflow in all subspecialties was of great importance to our radiologists. Initially, we had problems storing the new DICOM mammography image formats in our PACS, but they were quickly resolved.

From the very start, a special mammography reporting workstation from the vendor of the imaging equipment with special display functions (screen layout) and display quality control was installed. Since this workstation hardly supports any DICOM image standards other than mammography, reporting of associated ultrasound and MR examinations cannot be performed on the same station; the radiologist has to bring up those examinations on a standard PACS workstation. This special workstation can access the central PACS archive only via DICOM query/retrieve, which is less convenient than the on-demand protocol of the regular PACS workstations. There is potential for workflow improvements.

?Dr. Erik Ranschaert
Radiologist, Jeroen Bosch Ziekenhuis, locatie Carolus
's-Hertogenbosch, the Netherlands

Including mammography in a PACS is an ongoing problem, and few vendors know the answer. We started with 1K monitors and used a CR system with high-resolution (100 microns/pixel) cassettes to generate mammograms. But comparison with conventional films showed that some microcalcifications were invisible on CR. We then switched to a CR reader with a 50-microns/pixel resolution and invested in a dedicated diagnostic workstation for mammography with 5K monitors. The quality of our mammograms is now as good as or even better than conventional mammography. But our PACS vendor did not suggest that we purchase a dedicated mammography workstation. We had to find this out for ourselves.

?Prof. Walter Hruby
Chair of radiology
Danube Hospital, Vienna

The main prerequisite for the introduction of digital mammography is that all components of your PACS are prepared for the increased demands. The network has to be fast, the monitors must have the highest possible resolution, and the archive must be able to cope with even more data. Digital mammography can help to reduce radiation exposure, eliminate retakes and lost films, give faster access to image information, and increase departmental efficiency. As in DR, the duel between phosphor plate technology and digital detector technology should be won by the latter in the long run.