Wireless DR Lightens the Load

There’s a new mobile digital mammography coach designed to reach underserved, rural women. And women are jumping aboard.

Gundersen Lutheran Medical Center is located in La Crosse, Wis, in the county of La Crosse. One of 72 counties in Wisconsin, La Crosse County occupies 452.8 square miles and, in 2000, was home to 107,210 people. Gundersen Lutheran Health System provide services to not only this population, but also to 18 additional surrounding counties, into Minnesota and Iowa as well as Wisconsin.

Distance, combined with area industry and rural setting, therefore presents a challenge for much of the population in seeking medical services. Many find they do not have easy access nor can they get the time needed away from work. Routine examinations and regular screenings are neither routine nor regular.

Gundersen Lutheran’s mobile digital mammography coach features a waiting and reception area, two changing rooms, an examination room, and a rear galley.

Gayle S. Jago, ARRT(R) (M), clinical manager of program development for the Norma J. Vinger Center for Breast Care within Gundersen Lutheran Medical Center, estimates the area mammogram compliance rate at 60%. “We have many fairly rural areas,” she said.

These women are underserved: routine examinations and regular screenings can save lives. “We know we can decrease the cost in caring for women with breast cancer if we find it at an early stage,” Jago said, referring both to financial and personal outcomes. So Gundersen Lutheran decided to “mobilize” its efforts.

Traveling Coach
Gundersen turned to Oshkosh Specialty Vehicles (OSV), an Oshkosh Corp company in Harvey, Ill, for the 40-foot mobile digital mammography vehicle that will travel the health system’s service area. The vehicle features a waiting and reception area, two changing rooms, an examination room, and a rear galley area for the staff.

The examination room was designed for the GE Senographe Essential Digital Mammography System, which was installed by OSV with assistance from engineers from GE Healthcare, Waukesha, Wis. The equipment was tested and calibrated prior to delivery.

The device features the largest field of view on the market, according to GE, which permits image capture of a diverse patient population, some within a single exposure. The examination suite is large enough to allow the operator to easily position the patient for the exam.

Gundersen Lutheran opted not to utilize the GE reading workstation but rather to mix and match vendors. The result was a customized solution that took some effort to put together. “We are the hub for many different organizations, and so we wanted the vendor’s name on each piece of equipment not to matter. It took some work, but everything works together, is appropriate and efficient,” Jago said.

Gundersen Lutheran hired one mammography technologist and a driver. “It’s a 40-foot coach and needs a dedicated CDL driver,” Jago said. He also handles the reception work. Images are brought into the main campus via telecommunications and are read by the organization’s breast imaging radiologists.

“We are handling it the same as a fixed-site clinic, but the location changes every day,” Jago said. Because much of Gundersen Lutheran’s service area rests on the banks of the Mississippi River, connectivity has presented some challenges, but the telecommunications issues have been discovered that fit the project’s budget.

Mobile Mammograms
The vehicle debuted in September at the third annual Gundersen Lutheran Medical Foundation Steppin’ Out In Pink walk for breast cancer research and awareness. In October, the mobile digital mammography unit made its first outreach effort, traveling to Ashley Furniture Industries Inc in Arcadia, Wis.

Originally scheduled for a 3-day stop, the event was expanded to 4 days before the coach even arrived. About 120 women registered for exams. Ashley has already begun planning another screening event.

“The patients are grateful. They are used to traveling about an hour and 15 minutes to us for this service, and to have it in the parking lot where they work is very nice,” Jago said. She estimates about half of the women participating in the event were not getting their recommended annual mammogram.

The effort has therefore already been a success. The mission is to screen more women, and Jago expects that within 3 years the mobile unit will be completely booked.

Whether it will earn money is unknown, in part because revenue generation is not a goal of the program. Rather, the digital mammography coach was intended to bring screening services to underserved women. The vehicle was funded in part by the federal government with a $236,000 appropriation secured by Rep Bruce Braley (D-Iowa).

Women whose mammograms are abnormal will need to have their work-ups completed at a diagnostic breast imaging center. Gunderson Lutheran is working with regional hospitals to form partnerships that will give these women the opportunity to have their care close to home. Gundersen Lutheran has made a commitment to deliver care to any woman diagnosed with breast cancer on the coach regardless of her ability to pay. “It’s a big step, but it needed to be taken,” Jago said.

Although this will be associated with costs, the organization does ultimately expect to save money. “If one in eight women develop breast cancer, the downstream cost could be significant for our organization. We are trying to reduce the cost by catching it early,” Jago said, adding, “We’re trying to do the right thing more than worry about the right dollars.”

—Renee DiIulio