Telemammography Revives Rural Hospitals

By Arlene Sussman, MD

Arlene Sussman, MD

Imagine this scenario: A patient detects a lump in her breast and schedules a mammogram with her local facility to determine its status. If the lump is solid as opposed to fluid-filled, further imaging (eg, breast ultrasound) or surgery may be needed. In an urban setting, a subspecialty radiologist on staff evaluates those diagnostic images and coordinates any additional images, if needed, with the mammography technologist. The radiologist may then direct the technologist about additional magnified views. The entire process could take as little as 24 to 48 hours. A rural patient may have a very different experience.

In many rural hospitals, a patient would also obtain their mammogram from their local facility, but could then endure an extended wait while the images are mailed or couriered to the closest state-licensed radiologist who specializes in reading diagnostic mammography. If the images are not clear enough or different angles or tests need to be performed, the radiologist would send physically marked-up original films back to the hospital, again via postal mail or courier. The patient would then schedule yet another imaging appointment, repeating the time-consuming manual process.

But even those limited local services face an uncertain future. When radiology departments stop providing breast imaging services, patients are left with no alternative but to travel hours to another imaging center or hospital. As the patient’s anxiety, fear, and frustration mount, her satisfaction with the local facility will likely decline.

An Ongoing Challenge

With the exponential growth of teleradiology over the past decade, why is mammography—especially diagnostic mammography—such a challenge to deliver to many rural communities?

First, the number of skilled mammographers is declining as radiologists choose less litigious and more profitable subspecialties, or choose to remain generalists. Second, the rural areas are challenged to recruit even general radiologists to their hospitals, let alone subspecialists, due to smaller study volumes and less-than-desirable locations. Third, until recently, critical technology had not yet evolved to meet the demands of telemammography in the areas of secure digital communications; fast transmission and display of large diagnostic image files; and remote access to image data regardless of time, location, or IT infrastructure.

Technology to the Rescue

Physicians receive real-time notification of patient results on mobile devices.

Thanks to the latest advancements in cloud-based technology, the barriers faced by rural areas can now be overcome. vRad’s well-established radiology platform allows mammography technologists to immediately transmit large digital diagnostic images to radiologists, regardless of geographic location or IT infrastructure. It also enables radiology practices and their clients to have real-time communication with subspecialists, further enabling the fully integrated alignment and interdisciplinary collaboration that improve quality.

Before producing a final report, the radiologist compares the current images to any priors, which have also been seamlessly transmitted via the telemammography platform. Before leaving the local hospital, many patients have been fully informed as to the radiologist’s conclusions and recommendations. If the image analysis takes longer than the allotted office visit, the secure cloud-based imaging technology allows patients to access their results as soon as they are available. Typically within 24 to 48 hours, the patient receives an e-mail, directing her to log into a secure portal through which she can access her results. For those patients without Web access, they can review their results through an on-site hospital kiosk.

Into the Clouds

The benefits of next-generation telemammography also extend to compliance with health care regulations and reform mandates. Rural hospitals have long struggled to store patient radiology images for the required 10 years with their limited IT staff and budget. With the ability to maintain long-term archives through the cloud-based imaging platforms, small health care organizations are now freed from capital investments, maintenance, and disaster recovery concerns.

The 24/7 Web-based access to diagnostic images also opens up new possibilities for authorized providers to view these images whenever and wherever needed along the patient care continuum. For example, the patient care team for a woman undergoing breast cancer treatment may be comprised of her internist, OB/GYN, radiologist, and surgeon, all of whom may be spread across disparate health care networks and geographies.

The next-generation telemammography platform also facilitates the monitoring of image reading accuracy by multiple radiologists, a growing state requirement. The measurement of performance quality is also one of the building blocks of meaningful use and could be included in future pay for performance criteria.

Taken one step further, the cloud-based data exchange and archival technology gives hospitals the tools to identify trends in diagnostic mammography data, which can be transmitted to the National Cancer Registry to assist with overall research, as well as to support the broader goal of evidence-based medicine. In addition, individual hospitals can use the de-identified patient data to direct their proactive educational and wellness outreach efforts, resulting in improvements in overall community health.

vRad Results is expanding to include breast imaging in 2012.


A win-win scenario for all, rural hospitals can now offer expertise in diagnostic mammography through this efficient telemammography workflow model that facilitates high volume, fast turnarounds, and demonstrated quality outcomes, while transforming this subspecialty into a profitable and sustainable service.

As for radiologists, they can now outsource potentially risky image readings to those mammographers who only do diagnostic mammography readings, increasing the reading accuracy while freeing up staff radiologists to more effectively handle the remainder of their workloads. The option to outsource via telemammography is also a tremendous benefit in covering for vacations or holiday shifts when radiologists or subspecialty radiologists are less available.

Rural patients may be the biggest beneficiaries of telemammography. They gain instant access to top diagnostic mammography experts, all under the umbrella of their local provider. In addition to the increased quality of care, rural patients benefit from 24- to 48-hour turnarounds—a far cry from the anxiety-filled week of waiting that accompanied the physical transmission of diagnostic images. This timely, high-quality care empowers patients with the knowledge and guidance that are priceless in the path toward healing.

Urban Efficiencies, Too

The benefits of telemammography solutions are not limited to rural areas. Many large hospitals and health systems have multiple PACS across various locations, requiring an integrative technology to streamline the many imaging workflows. The Web-based platforms also deliver 24/7 patient data access to authorized providers from any Web-enabled device, further improving staff productivity and decision-making at the point of care.

Moreover, telemammography provides a much-needed relief valve for subspecialty radiologist staff with overloaded imaging worklists. By outsourcing excess or lesser-desired imaging reads, radiologists can then review other mammograms, sonograms, and interventional procedures. By efficiently handling the imaging overflow, radiologists can provide faster turnarounds per patient while increasing patient volume—good news for patient access and the hospitals’ bottom lines.

Mobile apps facilitate physician-to-physician collaboration.

Future of Telemammography

The latest innovations in telemammography have successfully broken through the geographic and operational barriers that once isolated rural hospitals. Now the underserved locales can benefit from the same subspecialty radiologist expertise available to any urban hospital with timely, accurate imaging reads that set the stage for high-quality, collaborative patient care.

However, telemammography supports more than just current analysis and diagnosis of patient health. The technology enables hospitals to easily collate and analyze patients’ health history, genes indicating higher risk (eg, BRCA gene), and other data points to deliver highly accurate risk predications and suggested preventive actions. By transforming the data into actionable health care strategies, hospitals can best meet mandated clinical outcome documentation needs, while greatly contributing to long-term patient health and wellness.

Furthermore, the ability to weave real-time video technologies such as Skype into telemammography functionality delivers benefits that reach beyond the aforementioned time and workflow efficiencies. The synergies experienced by patient care team members reviewing images in real time during joint Skype calls will continue to expand as integrated care delivery models cross national borders.

Additionally, such videoconferencing will allow doctors or specialists to speak directly with the patient, removing geographic barriers that, in the past, prevented underserved patients from experiencing the doctor-patient connection that is vital to overall treatment success.

Why is this personal connection so important to telemammography? Simply put, while the science of technology supplies the critical data exchange, it is the doctor who delivers the human touch to health care.

Arlene Sussman, MD, is currently Director of Breast Imaging at vRad. She previously was Director of the Department of Radiology for Memorial Sloan-Kettering Cancer Center Suffolk Division and Director of Women’s Imaging at Winthrop University Hospital.

The Grand Prize Goes to Oconee Medical Center

J.J. Thomas, mammography supervisor at Oconee Medical Center, with the facility?s new MAMMOMAT nspiration.

In early January, Siemens launched the “Who Inspires You?” contest, soliciting videos from radiology centers and departments around the country. Facilities were invited to nominate up to three clinical staff members who regularly inspire colleagues and/or patients in the battle against breast cancer and to tell their story with a homemade video production. The response was impressive with more than 100 videos pouring in. The National Consortium of Breast Centers (NCoBC) conducted the judging.

The winner of the contest is Oconee Medical Center, a small community-based hospital in Seneca, SC. The facility will receive—appropriately enough—a brand-new Siemens MAMMOMAT Inspiration digital mammography system.

Oconee’s winning entry, “It’s All About the Patient,” highlights its mammography supervisor, J.J. Thomas. In the video, Thomas’ coworkers and patients described how she inspired them every day with her intense focus on patient care—not only medical exams, including mammograms, biopsies, and surgeries, but also their emotional well-being during what is often a very difficult time for them.

Interestingly, the medical center was still film-based at the time it submitted its video. “J.J. Thomas embodies the spirit of the ‘Who Inspires You?’ contest with her unwavering commitment to delivering exceptional, personal care to her patients. We are thrilled that her work is being recognized and that we are the winner of a new MAMMOMAT Inspiration digital mammography system,” said Blake Poleynard, MD, OMC, radiologist at Oconee Medical Center.

While Oconee Medical Center captured the grand prize, Siemens rewarded other facilities as well. Five runners-up received $10,000 each toward the purchase of a new Inspiration. The runners-up were Moberly Radiology and Imaging, Moberly, Mo; Rush Memorial Hospital, Rushville, Ind; Cobre Valley Regional Medical Center, Globe, Ariz; Lincoln Hospital, Davenport, Wash; and Sitka Community Hospital, Sitka, Alaska.

—C.A. Wolski

Better Detection of Tumors in Dense Breasts

Women with dense breasts are more susceptible to developing cancer with up to 35% of tumors going undetected. But because of a new agreement between Matakina International, Limited of New Zealand and PenRad Technologies Inc, mammographers will now be able to more easily identify suspected tumors in women with dense breasts.

PenRad recently signed a letter of intent with Matakina to allow it to display its Volpara breast imaging software on PenRad’s Mammography Information System (MIS).

The FDA-cleared Volpara is a reliable and cost-effective tool to automatically generate objective volumetric breast density values from digital screening mammograms. The software assists radiologists by providing objective, automatic, and robust measurement of volumetric breast tissue density and is currently available for Hologic and GE digital mammography systems with validation of integration with other systems under way.

The PenRad MIS is ideal for use with Volpara because it improves mammography efficiency and standardization while offering faster turnaround time for exams. According to the company, by automating tasks and eliminating duplication, secondary data input, and transcription, the system enhances the patient care workflow, including interpretation, reporting, tracking, and management. The payoff is increased productivity and cost savings of up to 25%.

—C.A. Wolski

NovaMG breast imaging viewer from Novarad.

Upgrade Alert: NovaMG Viewer

In January, Novarad released the latest upgrade to its NovaMG breast imaging viewer. The product combines the tool set of a PACS with customizable mammographic reading and hanging protocol sequences. FDA 510(k) cleared and IHE compliant, it supports multimodality viewing and iCad and R2 structured reports.

The viewer enables direct receipt of digital mammographic images from the modality while pre-fetching from the PACS archive is initiated via DICOM modality worklist. Latest enhancements to the NovaMG include:

  • Expanded logging support for the IHE “Audit Trail and Node Authentication” (ATNA) profile.
  • Line measurement associated with “shape” markups. In this scenario, the measurement number can be interpreted as the size of the finding that is “circled” by the ellipse or rectangle. This size is used on the screening report and can also be used within an integrated reporting system.

Offered as an option to Novarad’s existing radiologist view stations, the viewer provides all pixels viewing that allows for searching of all image pixels and incorporates Tab?r’s systematic viewing masks to enhance perception of subtle radiographic abnormalities. 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.

—Marianne Matthews