News Story

Studies Show Usefulness of Foam Breast Cushions for Mammography
UFE Effective for Postmenopausal Women
Lenox Hill?s New Workhorse
Running the Numbers
Image-Enhancement Technology Promising for Breast-Cancer Screening
Product Showcase

Studies Show Usefulness of Foam Breast Cushions for Mammography

Two new studies demonstrate the usefulness of foam breast cushions in mammography, citing their ability to help breast positioning. The first study demonstrates an improvement in tissue acquisition in mammograms on real patients, and the second shows an absence of negative effect on digital mammography image quality.

Part of a 211-patient tissue-acquisition study, the left mammogram was captured in 2004 without the MammoPad. In 2005, the right mammogram was repeated by the same technologist on the same patient using the MammoPad. An average of 0.6 cm additional tissue was acquired with training and use of the breast cushion in all four standard views in the mammogram study.

The first study—”Increasing Tissue Acquisition Through Positioning Training and Use of a Foam Breast Cushion for Mammography” by Tammy Coryell, RT(R)(M), of Mammography Impact Consultants (Springfield, Mo)—examined the effects of the foam breast cushion on 211 patients from 31 different facilities. New mammograms using a breast cushion were compared to recent mammograms in which a breast cushion was not used. Additionally, the mammography technologists studied training techniques to better position the breast, including using the breast cushion—in this case, the MammoPad from BioLucent Inc (Aliso Viejo, Calif). The evaluated images were standard four-view mammograms.

“Proper breast positioning is crucial for a good mammogram; yet, that positioning can be hard to obtain,” Coryell said. “This study demonstrates that the MammoPad, combined with positioning training, makes it possible to acquire more breast tissue and a more complete image.”

The second study—”Assessment of Image Quality and Dose When Using Breast Cushions During Full-Field Digital Mammography” by medical physicists Eric Berns, PhD, and R. Edward Hendrick, PhD, FACR, of the Lynn Sage Comprehensive Breast Center at Northwestern University’s Feinberg School of Medicine (Chicago)—assessed the effect of breast cushions on image quality. Berns and Hendrick used four full-field digital mammography units from GE Healthcare (Waukesha, Wis), Hologic Inc (Bedford, Mass), and Siemens Medical Solutions (Malvern, Pa), all of which are approved by the US Food and Drug Administration (FDA). Researchers evaluated the effect on digital mammograms of zero, one, and two cushions while imaging the full clinical range of compressed breast thickness.

“The foam pads had no clinically relevant effect on image quality or dose,” Berns said.

BioLucent President Jill Anderson is understandably pleased with the studies’ results. “We knew when we developed the MammoPad that image quality was pivotal, and so we designed the cushion not to interfere with a radiologist’s ability to interpret the image,” she said. “Nevertheless, it’s always helpful when several independent studies—along with the broad experience of radiologists and technologists—confirms your original intent and design.”

Copies of the Coryell study and the Berns/Hendrick study are available from the National Consortium of Breast Centers (NCBC).

—M. Said

Lenox Hill?s New Workhorse
Case Study: One hospital accelerates throughput with a pair of portable DR and several CR systems

by Dave Cater

With space at a premium and manpower resources precious, Gerard A. Durney, MBA, FAHRA, searched for ways to improve the radiology workflow and service levels at Lenox Hill Hospital, a 12-story, 652-bed acute-care teaching facility on Manhattan’s Upper East Side.

Portable radiography at Lenox Hill is a high-volume aspect of radiology and a service that is often provided to critically ill patients. “When we were using film/screen radiography, one of the rate-limiting steps was the image acquisition itself,” noted Durney, administrative director of radiology pathology, noninvasive cardiology, and central transport at Lenox Hill.

This portable DR unit from Canon, embedded in an AMX 4 from GE Healthcare, is used at the patient?s bedside at Lenox Hill Hospital.

Logjams could be found at every level of the imaging process. First was the arduous task of lugging as many as 20 to 30 3-pound plastic film cassettes up and down several floors to a darkroom. Then, there were the repetitive tasks of identifying and opening each cassette, pushing each sheet of film into a processor, reloading the film, and checking the quality. Only then could the film be returned to the critical-care units. If the image quality was unsatisfactory or if the patient moved, the entire process had to be repeated. The films also would remain in the critical-care units after delivery for some period of time, delaying interpretation by a radiologist.

“The time spent in terms of manpower was enormous,” said Durney, who has been with Lenox Hill since 2001.

But that all changed when Lenox Hill turned to a combination of portable digital radiography (DR) from Canon Medical Systems (Irvine, Calif) and computed radiography (CR) from FUJIFILM Medical Systems USA (Stamford, Conn). In September 2004, Lenox Hill spent $400,000 on a pair of Canon portable DR units embedded in an AMX 4 from GE Healthcare (Waukesha, Wis) and several Fuji CR systems. According to Durney, the portable DR units, along with the CR systems, have helped increase throughput and service levels by decreasing exam order to completion times an estimated 30%?50%.

“With the portable DR, all you have to do is capture the image, store it in the CPU of the DR system, plug it into the hospital network, download your images, and you’re done,” Durney said. “You don’t have to be carrying all of those cassettes around with you.”

“With the portable DR, all you have to do is capture the image, store it in the CPU of the DR system, plug it into the hospital network, download your images, and you?re done. You don?t have to be carrying all of those cassettes around with you.”?Gerard A. Durney,Lenox Hill Hospital

In combination with Lenox Hill’s picture archiving and communications system (PACS)—a Synapse system from Fuji, which went live in July 2005—the CR/DR systems made life easier for clinicians by making the image ubiquitous across the Lenox Hill enterprise. “It saved our clinicians enormous amounts of time searching for images, as they did in the film/screen days, and concomitantly decreased the radiology report turnaround time,” Durney said.

Workflow efficiencies in radiography amount to considerable savings when one considers that Lenox Hill averages 30,000 portable radiographs per year. The roving portable DR units are used throughout the hospital—from open-heart surgery cases to surgical and medical intensive-care-unit patients to orthopedics. Lenox Hill also has a fixed DR unit from Canon in the orthopedic outpatient center, which performs more than 20,000 procedures per year during normal business hours.

“You can take the portable DR units anywhere, and you don’t have to worry about where the CR reader is. They truly are remarkable,” Durney said.

Another reason that is pushing Lenox Hill in the direction of portable DR systems is that the facility plans to have its wireless network upgraded and, by the end of the year or early 2007, to have enough bandwidth to handle the transmission of image files. According to Durney, the plan is to use modality worklists, which will be delivered to the portable DR systems wirelessly from the radiology information system (RIS). At the present time, technologists are required to plug the DR systems into network ports to receive orders by modality worklists and transmit images back to the PACS.

“In the near future,” Durney explained, “our technologists will leave the department in the morning with the portable DR systems, perform the portables on the worklist as exams are ordered and as the worklist is wirelessly updated, and then send the images to the PACS via the wireless network.”

Despite its portability, image quality remains the same as a fixed DR.

“If I take an x-ray of my foot with a fixed DR system as well as a portable DR system, the image quality is identical,” Durney said. “Technically speaking, pixel-to-pixel image quality, spatial resolution, contrast resolution, or any other image test you choose, there’s no difference between the two.

He added, though, that when conducting a portable radiograph, by its very nature—whether it is on film, DR, or CR—there will be limitations. However, these limitations rest with the patient’s condition and physical limitations of performing a portable exam, not with the technology.

In the past, a frequent complaint from Lenox Hill surgeons, intensivists, and other clinicians was the lack of timeliness of image availability.

“Before we implemented the CR/DR systems and PACS, one of my biggest sources of complaints came from open-heart surgeons, who said they were not getting their images when they made their morning rounds,” Durney said. “When an open-heart surgeon begins rounding on his patients at 6 am, it’s very important for him or her to see his or her patient’s chest x-rays. But because of the labor intensity involved in getting these things done, we very often didn’t make it on time.”

Now, complaints about an antiquated system have been replaced by a protocol that benefits surgeons, technologists, and, most of all, patients. “Since we implemented the portable DR, the complaints have gone away,” Durney reported. “It makes the open-heart surgeon’s job easier in this respect, and it benefits the patients. And in the end, that’s what we’re here for.”

Image-Enhancement Technology Promising for Breast-Cancer Screening

Radiologists at Newton-Wellesley Hospital (Newton, Mass) have released findings from a breast-cancer research study designed to evaluate the use of Advanced Image Enhancement Inc’s (AIE of Providence, RI) software for examining regions of interest (ROI) with the Lorad Selenia digital mammography system from Hologic Inc (Bedford, Mass). Leveraging advanced technology for locating and detecting undersea mines, AIE tailored the approach for breast-cancer image enhancement.

AIE Enhancement for Digital Mammography

The study reports that the AIE software allowed radiologists to reach an opinion with more confidence in 20%?70% of the cases studied, depending on the radiologist. When asked to rate AIE technology on the software’s ability to improve the conspicuity and detail of calcifications, the radiologist participating in the study rated the software superior in 88% of the cases studied.

The researchers compared the ROI of a magnified Selenia image with the corresponding magnified ROI of an AIE-enhanced Selenia image for both views (one cranial-caudal and one mediolateral-oblique) of the breast for 50 women with suspicious abnormalities.

The study was funded by Aid for Cancer Research (Boston) and Hologic, the latter of which is partnering with AIE to develop the algorithms for the digital-mammography market. According to Georgia Hitzke, VP of clinical and product management at Hologic, the software has been cleared by the FDA for use on the company’s Soft-Copy Workstation in a small window that can be turned on and off; therefore, it is not a permanent change to the image.

A Hologic spokesperson said it is the hope of AIE to have the functionality incorporated on Hologic’s SecurView workstation.

—M. Said