NovaRad Adds NovaMG Breast Imaging Viewer
Digital Mammography Increases Diagnostic Certainty
FDA Clears Cerner Mammography Workstation

NovaRad Adds NovaMG Breast Imaging Viewer

American Forks, Utah-based NovaRad has received the Food and Drug Administration’s 510(k) clearance for a new Integrating the Healthcare Enterprise (IHE) compliant breast viewer. The viewer will combine the tool set of NovaPACS with customizable mammographic reading and hanging protocol sequences and feature ?one-click? reading workflow, multimodality viewing, and iCad and R2 structured reports, all with an economical price point.

Tyler Harris, director of implementation at NovaRad, said, ?The first rendition is going to have what 90% of every radiologist who reads mammography is going to need. It’s not going to have all of the bells and whistles that a big dedicated system will have, but it will be able to do what most mammographers need to do all of the time.? The cost will vary based on the customer’s need for hardware, such as monitors, and whether they have an existing NovaRad Enterprise Viewing license.

NovaRad’s new breast imaging viewer features a ?one click? system that allows radiologists to systematically run through hanging protocols with one key.

Harris added that future updates will offer the remaining 10% of features. ?We always add features, so eventually it’s going to have every bell and whistle and have some unique aspects down the road. But I think the fact that they can get it at a low price point and that it’s Web based is a great advantage, because radiologists often have one station somewhere in the hospital that they have to walk to, and they can never read it from home.?

The features of the first edition of NovaMG will include direct receipt of digital mammographic images from the modality, while prefetching from the PACS archive is initiated with a DICOM modality worklist. The viewer provides all pixels viewing for searching all image pixels, and incorporates Tabar’s systematic viewing masks to enhance perception of subtle radiographic abnormalities.

In addition, all annotations and additions to image information, such as Grayscale Softcopy Presentation State (GSPS), queried and retrieved images, and structured reports, are stored in the PACS upon completion of interpretation. NovaMG automatically populates the diagnostic findings to a mammography reporting system and facilitates worklist synchronization for recall-report exporting from either the RIS or mammography reporting system.

?Input from radiologists helped us to create this new viewer,? said Paul Shumway, vice president of NovaRad, in the NovaMG press release. ?We learned there remained a need to further improve efficiency and with this viewer delivered unique ?one click’ reading workflow setup that simplifies the process from opening a study to generating a report.?

The ?one click? system will enable individual radiologists to systematically run through hanging protocols with one key, including changing views, window levels, as well as positioning.

Harris also noted that the viewer will not be a stand-alone product, but designed exclusively for NovaRad products. ?The interfacing [with other vendors] is so time-consuming. We don’t like to do it, and the client doesn’t like to do it. So we designed NovaMG to be part of NovaPACS. You don’t have to integrate with a third-party system, and you don’t have to run with another viewer.?

Now that NovaMG has received 510(k) clearance, Harris said that the viewer should be available to end users by the end of 2009, if not before the November conference of the Radiological Society of North America (RSNA.)

?Tor Valenza

Digital Mammography Increases Diagnostic Certainty

Mammography is among the last frontiers of the digital imaging revolution. Because of its lower reimbursement rate?often resulting in a billing deficit?many radiology departments and imaging centers do not see the economic advantages of converting from film to digital.

But there might be a compelling reason not to wait to make the switch. A recent study published in the American Journal of Roentgenology makes the case that digital mammography resulted in better cancer detection. Lead authors Fred S. Vernacchia, MD, and Zachary G. Pena, MD, who both practice at the San Luis Diagnostic Center in San Luis Obispo, Calif, found that over a 4-year period, during which time they converted to digital mammography, detection rates almost doubled from 4.1/1,000 to 7.9/1,000.

The San Luis Obispo study included four separate retrospective audits carried out in a community-based radiology practice. Over the last 3 years of the study, cancer diagnosis rates varied from 7.9/1,000 to 5.1/1,000 to 6.9/1,000. Significantly, the number of patients involved in the retrospective survey was about 3,000 more each subsequent year from the last year that the practice used film mammography. However, the authors found that the recall rates increase significantly throughout the study?particularly during the second audit. It was 10.2% during the first year that the practice used digital mammography compared to 6.1% for the last year that it used film mammography.

However, a study at the University of Pittsburgh Medical Center (UPMC) points the way to a solution for decreasing recall. UPMC researchers found that the use of breast tomosynthesis and full-field digital mammography resulted in a 30% decrease in the recall rate for cancer-free women, study coauthor Jules H. Sumkin, MD, told Science Daily. He added that recall rates are problematic because of the high costs involved for the radiology centers and the emotional toll it takes on patients.

He credits digital breast tomosynthesis?which has yet to receive US Food and Drug Administration approval?as the reason for the decrease in recall rates. The authors of the San Luis Obispo study also credit digital mammography as the reason for their better diagnosis rates.

Better diagnosis is only part of the reason that digital mammography increasingly is making sense in today’s radiology departments and centers. Its higher reimbursement rate means that, if marketed and scheduled correctly, digital mammography can be a profit center instead of a loss-leader.

The federal government’s goal to have all health records in a digital format may eventually force radiology practices to transition to digital mammography. Doing so ahead of the curve to benefit from better diagnostic outcomes and reimbursement could save headaches for clinicians, patients, and administrators alike. There is significant room for growth in the digital mammography market. Vernacchia and Pena told the Reuters news service that about 70% of US screening facilities are still using film mammography.

?C.A. Wolski

FDA Clears Cerner Mammography Workstation

Kansas City, Mo-based Cerner Corporation has received 510(k) premarket clearance from the FDA for its ProVision Workstation?Mammography. The integrated system offers seamless viewing of both mammography and general radiology images at the same workstation. Radiologists no longer need to switch viewers but can see all imaging modalities and patient data in one spot, including mammography, MR, CT, PET, ultrasound, x-ray, x-ray angiography, and the electronic health record (EHR).

Workflow is more efficient, information access is more expansive, and analysis is easier?all advantages for radiologists whose workloads are increasing. The American Cancer Society notes that the number of women age 40 and above who have had a mammogram in the past 2 years more than doubled between 1987 and 2000. Even so, approximately half of eligible women do not get screened, indicating the demand could continue to increase.

A new integrated system from Cerner offers seamless viewing of both mammography and general radiology images at the same workstation.

?Efficiency is taking on an even greater importance as the demand increases for radiologists to interpret the ever-growing numbers and types of imaging studies,? said John Hansen, Cerner vice president of imaging solutions, in a release.

Features and Functionality

The Cerner ProVision Workstation?Mammography permits users to view mammograms alongside related studies, such as MR, PET, and ultrasound. The system automatically recognizes the image type and matches its parameters, for instance using posterior justification on mammograms.

Using the workstation, physicians can easily move through specified views of the breast, hide or show CAD structured reports, and customize the layout, presentation, and viewing order of images. Roaming user profiles attach radiologists’ viewing preferences and authorizations at log-in.

Additional tools with a positive impact on efficiency include user programmable keyboards that facilitate one-button access to shortcuts and protocol steps. Toggle capabilities enable physicians to bounce between an image and its 2x-magnification and between magnified quadrant and original views. An edge enhancement filter and multiplanar reconstruction improve viewing as well.

Diagnosis and analysis are aided by manipulation and markup capabilities standard to Cerner ProVision systems. For instance, ?Magnify Glass? magnifies a specific portion of an image and can be configured to mirror between two or more viewports; three mask options (monocular, vertical, horizontal) can also be configured to mirror the active viewport. Both functions are intended to reduce movement between viewports and streamline workflow.

By replacing the traditional dedicated workstation with an integrated model, Cerner aims to maximize individual and departmental radiology performance. ?With the FDA 510(k) clearance for Cerner ProVision Workstation?Mammography solution, we can provide radiologists with a comprehensive mammography solution designed to help them view mammography images more efficiently and effectively,? Hansen said.

The system runs on standard PCs and is now available in the United States with a wide range of multimonitor and ultrahigh-resolution configurations.

?Renee Diiulio