With the introduction of the first FDA-approved, full-field digital mammography systems, clinicians and their patients can now take advantage of the most sophisticated technology available for the detection of breast cancer. Digital mammography has been shown to offer a variety of advantages over conventional analog-based film mammography: superb image quality, increased patient throughput, fewer recalls and retakes, and, in many cases, increased reimbursement from Medicare and third-party payers.
With the introduction of the first FDA-approved, full-field
digital mammography systems, clinicians and their patients can now
take advantage of the most sophisticated technology available for
the detection of breast cancer. Digital mammography has been shown
to offer a variety of advantages over conventional analog-based
film mammography: superb image quality, increased patient
throughput, fewer recalls and retakes, and, in many cases,
increased reimbursement from Medicare and third-party payers. It
also eliminates the problem of lost films and allows both
clinicians and patients to be assured that the machines being used
to detect even the smallest breast cancers are built on the most
advanced technology available.
As digital mammography systems have become commercially
available, many practices across the country have begun switching
from analog to digital systems for their mammography studies. One
such practice is the Sitron-Hammel Radiology Group of Bethpage, NY,
which performs approximately 12,000 digital mammograms a year.
"We have always tried to be cutting edge in technology at our
facility," said Jay D. Hammel, MD, Managing Partner for
Sitron-Hammel. "The preliminary data suggested that digital has
some improvement over analog mammography for the detection of
breast cancer. We also liked the idea that it cut back on the need
for some additional views, especially spot magnification views. We
now clearly see calcifications and, in particular,
microcalcifications, better. The ability to manipulate the data in
the same fashion as any other digital modality is also important;
we believe that that improved cancer detection in digital
Debra S. Mitchell, MD is Managing Partner at Breast Imaging of
Oklahoma (Edmond, OK), an all-digital mammography program. "As we
look toward the future," noted Dr. Mitchell, "I think that we will
see a continued increase in the use of digital mammography. We
didn't see any reason to go back to analog; we decided to go
digital and have had no second thoughts."
As with any imaging modality, image quality is of paramount
importance, and digital mammography has repeatedly been shown to be
as good as, if not better than, analog imaging.
"There's a learning curve if you're used to analog. I personally
believe that the image quality is equivalent, if not better,"
Mitchell said. "As an example, the U.S. Food and Drug
Administration and the American College of Radiology require that
we image phantoms to maintain consistent image quality. On the
phantoms, you look for little tiny dots and specks. With analog,
you don't always see all the imperfections on the phantom. With
digital, we always see every single imperfection every time."
"I think people are beginning to realize that image quality is
clearly better with digital mammography as opposed to analog
mammograms, which, in turn, allows us to feel more confident of our
diagnosis," agreed Hammel.
Digital mammography has also been shown to increase the number
of patients who can be imaged in a given time, thereby increasing
the volume of patients that an imaging center can serve.
"There is no question," noted Hammel. "We are quicker doing
digital mammography than we were with analog. Once our technicians
got over the short learning curve, they clearly are happier doing
digital mammograms. We can easily do 6 patients in an hour, where
previously that was a stretch for us."
"I have absolutely no doubt that one digital machine can do the
equivalent of two to two-and-a-half analog machines," agreed
Mitchell. "Digital mammography is quicker for the patient and
quicker for the technologist. I think it's improving for the
radiologist, but throughput is
In light of the manpower shortage in radiology in general and in
mammography in particular, this increase in efficiency takes on
added importance. "Digital mammography provides the option for more
people to have access to the expertise," explained Mitchell.
"Because you can transmit the images with no degradation in image
quality, the system becomes 'virtual.' You can concentrate all of
your most expensive equipment and your expertise at one location.
Yet, patients can go some place convenient to have their screening,
with all images interpreted at the same high level of expertise. It
doesn't matter anymore whether your mammography machine is 10 feet
away, 10 miles away, or clear around the Earth."
Improving the bottom line
Breast imaging centers also face the challenge of extremely low
levels of reimbursement for screening mammography. In 2003, the
Medicare reimbursement for screening mammography with plain film at
free-standing clinics was $82.77. When performed with digital
equipment, the reimbursement jumps to $132.06.
"Although the cost for the machine is significantly more
expensive than the analog machine," explained Hammel, "most
insurance companies are reimbursing more money for digital
mammography. We are surely doing as good as, or maybe a little
better, financially with the digital mammography than we were with
Mitchell called the financial impact a mixed bag. "It costs
more," she said. "The equipment, the storage, the PACS, the
workstation, the gantry, the mammographic machine itself all cost
more, but you can see more patients on it. So there is a trade-off.
There are also some payers who pay more for digital mammography. So
for each practice, it's a unique combination of their payer mix and
Making the move to digital
Once a radiology practice determines that the benefits of
digital mammog-raphy are right for them, the question becomes which
system to chose. For both the Sitron-Hammel Radiology Group and
Breast Imaging of Oklahoma the answer was the GE Senographe (GE
Medical Systems, Waukesha, WI).
"We felt that there were features of the GE machine that we
liked better than others," said Hammel. "It was important to us
that they have a service track record. In our industry, as
important as the quality of the machine when you get it is how fast
do you get back up once your machine has been down. GE has always
been superb to our office in that respect."
For Mitchell, the advanced applications of the GE system were
key. "All the other digital mammography vendors are newer," she
explained. "GE is obviously further along in their advanced
applications, including Premium View. I think their mammography
machine itself is more user friendly for the technologist, it's
more automated. I think their radiologist workstation is also more
The GE Senographe 2000D
Since its introduction more than 3 years ago, more than a
million women in more than 32 countries have undergone digital
mammography with the GE Senographe.
This digital system features the company's Revolution flat-panel
digital detector. The intuitive operator console automates many
steps, increasing user productivity. In addition, the digital
detector's small pixels automatically identify the densest part of
the breast for phototiming. The system then identifies and
automatically marks all other parameters.
The included Review Workstation consists of two dedicated
high-resolution monitors and an operator keypad. Archiving and
networking capabilities allow the radiologist to review virtually
any stored image.
The GE Review Workstation also has available a new tool designed
to increase diagnostic confidence by optimizing contrast and
providing more detailed information. Premium View, as the
"one-click" feature is called, increases productivity by allowing
the user to optimize the image contrast in a single window, thereby
deleting the need for additional steps such as windowing. In
addition, this optional feature automatically improves
visualization in dense areas of the breast while maintaining
peripheral contrast at the chest wall and skin line.
The addition of the computer-aided detection (CAD) module
provides an added layer of diagnostic confidence for women
undergoing screening mammography and for the radiologist reading
The Senographe 2000D includes a seamlessly integrated
all-digital CAD module. With the push of one button, the system
reviews the image and displays the image with regions of interest
highlighted, serving as a second set of eyes to support and enhance
the radiologist's clinical judgment.
"The literature reports a 10% to 20% increase in breast cancer
detection rate linked to having a mammographer read a mammogram
with a CAD module," noted Hammel. "The combination of doing a
digital mammography with a CAD has really helped us in terms of
recruiting patients. As well, we feel that we are giving our
patients the best possible mammographic care."
"As for the GE digital mammography with the Premium View and
CAD," agreed Mitchell, "I think there's nothing superior in
mammography right now. I think we all sleep well at night thinking
that we are providing our patients with the absolute best
technology for mammography."