They started seeing patients in May 2002 on Mother's Day
weekend, yet after barely 5 months of operation, the $3.5 million
Providence Everett Comprehensive Breast Center at Providence
Everett Medical Center in Washington State, with its cutting-edge
technology, is on its way to reaching its goals. According to Dr.
Nancy Neubauer, the Center's Imaging Director, "The overriding aim
of the Center is to become the area's centralized location to
streamline quality breast care for the community, working in
clinical parallel with the referring physicians and patients." The
goal of the Center is to embody a comprehensive approach, she
explains, working with breast surgeons, radiation oncologists,
medical oncologists, pathologists, and all the myriad people who
take care of women with breast cancer.
The Center now employs 25 full-time and part-time personnel,
including 8 technologists. According to Dr. Neubauer, the Center's
long-range goal is to see 90 patients a day. She says that she and
the Center's Medical Director, surgical oncologist Dr. Thomas
Smith, expect the Center to become a hub for breast cancer
caregivers and patients. "We will be offering high-quality
screening, diagnostic, and minimally invasive procedures onsite and
providing continuity and comprehensive care with other referring
physicians," she explains.
They now have four state-of-the-art Instrumentarium Diamond
Mammography Units (Instrumentarium Imaging, Milwaukee, WI), a
Mammo- Reader™ CAD (icad, Intelligent Computer-Aided Detection
system, Boca Raton, FL), two ultrasounds, and two stereotactic
units. One of the stereotactic units is a prone stereotactic table
(Fischer Imaging, Denver, CO); the other is an upright Diamond
Unit, which is an accessory kit to the Diamond Mammography Unit.
One of the Diamond units (which will be operational by the end of
the year) also offers three-dimensional breast imaging using TACT
(Tuned Aperture Computed Tomography). The Center is planning a wide
range of professional, wellness, and support services, including
breast self-exam instruction, nutrition counseling, genetic
counseling, second-opinion and peer survivor programs, a resource
library, and educational programs for newly diagnosed women and
their families.
The development of this busy modern center was not without some
challenges along the way, says Dr. Neubauer. She acknowledges that
although they are moving toward their goals, they are not quite
there yet. Operational and technical problems still occur from time
to time.
Despite these hurdles, the staff at the Center is in agreement
that their vendor, Instrumentarium Imaging, has provided excellent
service. The Manager of the Center, Claire Neal, says, "I like
Instrumentarium because they are on top of their equipment. Not
only are they here very quickly when we call, but they anticipate
our needs, and come back here with their upgrades and updates."
Lead technologist Teresa Murphy agrees, "Their support service has
been outstanding." In fact, she adds that many of the suggestions
the Center's staff made at the initial presentation were
implemented into the newest model of Diamond machines. (The
original Diamond was approved only in 2000.)
The Diamond Mammography Units
The Center houses four Diamond Mammography Units that it
purchased from Instrumentarium Imaging. The new Diamond SP-cathode
tube construction has a better gaussian intensity distribution on
the focal spot, which is designed to make the finest details
visible, especially with the small focus. Don Blomstrom, Vice
President of Mammography at Instrumentarium, proudly announced that
the Diamond Mammography Unit was selected as the best new product
at the Radiological Society of North America meeting in 2000.
Connie Sheran, a medical imaging technologist at Providence who
was involved in the purchase of the equipment, says that the
product selection team "decided to purchase the Diamonds because of
the quality of the image and ease of use." Adding to this, she says
that they believed that this equipment "would take them into the
future."
ECS (Easy Compression System)
One of the unique features of the Diamond is its Easy
Compression System (ECS), which is designed to minimize discomfort.
Any woman who has had a mammogram knows how uncomfortable it can be
when the paddle presses down on the breast, squeezing and pinching
skin in order to compress a woman's conically shaped breast into a
rectangular shape for clear imaging. The ECS, on the other hand, is
designed to minimize this discomfort through its bi-directional
compression system. According to technologist Murphy, in the ECS,
unlike traditional mammogram units, the movement comes from the
bottom as well as the top. She says, "In the old way, you place the
breast on the bucky [the portion of the machine that holds the film
in place]; you then get the paddle as close to the chest wall as
you can, sliding it down the chest to get the pectoral muscle in
view. In doing this, the technologist may potentially tug down on
the skin, which can be painful. With the Diamond unit, the breast
is captured on the bucky, and the unit's Easy Compression System
raises the breast up from the bottom, which is the mobile aspect of
the breast." Ms. Murphy explains that although the patient still
feels the technologist compressing the breast, there is often less
discomfort because the skin is not pulled down along the chest by
the paddle. Moreover, she adds that the technologist may include
more of the pectoral muscle, which can optimize the image. She also
notes that the Diamond has rounded the corners of the bucky, which
is potentially more patient friendly.
ParkBack
Technologist Murphy is also impressed with Diamond's ParkBack
tubehead feature, which allows the operator to move the X-ray tube
out of the way when positioning the patient. "When we angle the
machine, the tubehead is able to slide backward, enabling the
technologist to visualize and manipulate the patient's positioning,
without compromising the technologist's back." Ms. Murphy also
likes the flexibility of the face shield on the Diamond. If
necessary for challenging positioning, it can be removed from the
top while the patient remains under compression, as opposed to
having to release the compression and reposition the patient.
TACT (Tuned Aperture Computed Tomography)
This exclusive Instrumentarium technology reconstructs a
three-dimensional image from a series of two-dimensional images
taken with a digital receptor, allowing the radiologist to see
objects within the dense part of the breast or areas obscured by
superimposed structures. By using the automatic movement of the
Diamond tubehead, the breast is imaged from different angles in
ways not possible before, as a three-dimensional image or as
layers, much as with a CT scan.
Ms. Murphy explains, "Mammography is still predominantly a
film-based modality. Two-dimensional digital imaging produces the
same results as two-dimensional film imaging; it is simply a
different medium. Digital mammography is still in the trial stages
and has not been proven to provide a better image than traditional
film-based systems."
"For our traditional screening and diagnostic mammography, we
are still film-based. TACT, on the other hand, is a
three-dimensional digital image displayed on a monitor that can be
manipulated to view the breast image from various angles with a
computer-generated image. The advantage of the three-dimensional
digital imaging is that it can differentiate a suspicious density
as overlapping dense tissue rather than a solid mass. We can then
produce various angled hard-copy film images for further
evaluation. Essentially, we are producing a digital image and then
photocopying it onto a piece of plastic that resembles a film
mammogram."
MammoReader™ icad System
Providence Everett Comprehensive Breast Center also has two icad
(Intelligent Computer-Aided Detection) MammoReaders (distributed
exclusively by Instrumentarium), which are utilized for all
screening mammography.
A film-based mammogram is fed into the MammoReader, which
displays a digitized image on a monitor for the radiologist to
view. The MammoReader identifies suspicious areas automatically and
landmarks them, indicating potential abnormalities. Radiologists
first read the film mammogram, then compare their findings to the
icad MammoReader's findings. The software is designed to analyze
the image and highlight areas that contain features associated with
breast disease. Currently the Center is using the MammoReader only
for screening, not as a diagnostic tool, although it has recently
been approved for diagnostic use.
Working as a partnership to develop the Center
The development of the center and choice of equipment was
determined by a team of physicians, technical personnel, key
administrative representatives, and breast-cancer survivors. The
vision for the Center is to partner with equipment vendors to
provide outstanding professional service to the community utilizing
the latest breast imaging technology.
"We wanted to have a solid foundation that would support our
desire to utilize digital mammography as it becomes the standard of
care for women's breast health," explains Ms. Neal. "Our vision was
to partner with a company that was investing its efforts in
research and development of digital imaging. Instrumentarium
provided the opportunity in two ways. First, all four machines
produce standard film mammograms. One of the units can be used as a
two-dimensional digital stereotactic device, as well as
three-dimensional digital imaging (TACT). Second, all machines are
upgradeable to digital imaging, so we will not need to purchase new
units to move completely into digital mammography."
Today, Providence Everett is rapidly progressing toward
completely fulfilling its vision of a unique breast imaging
facility committed to providing integrated patient care and meeting
the needs of the community. Through its ongoing partnerships with
equipment vendors, physicians, Breast Center staff, patients, and
the community, Dr. Neubauer hopes the Center will truly become
"comprehensive."