Currently, in the span of a single year, some 70,000 individual breast studies, 9,000 entirely in electronic format, are interpreted by 10 of the 50 radiologists at the seven campuses of Florida Hospital, Orlando. With that much volume and the major process changeover of filmless operation, those radiologists need all the help that technology can deliver in order to read more efficiently. It is understandable that news of a digital mammography workstation now reaching the market (and capable of easing such burdens) has generated keen interest.

Sally Grady is director of imaging for Florida Hospital Celebration Health, the institution’s state-of-the-art satellite in the Disney planned community of Celebration, Fla. She says, “Productivity is the name of the game.” To that end, Florida Hospital and Florida Hospital Celebration Health have been evaluating the IMPAX MA3000 digital mammography workstation from Agfa. In 2004, the IMPAX MA3000 received US Food and Drug Administration clearance, and it is now beginning to find its way into mammography centers eager to streamline workflow, maximize their return on investment, and improve the delivery of patient care, according to Carrie Handley, global manager of women’s care at Agfa HealthCare, Greenville, SC. “For the more than 32 million US women who will receive a mammogram this year, the new workstation could mean improved access, faster results, and an improved patient care continuum,” she says.

The IMPAX MA3000 incorporates two side-by-side, ultrahigh-resolution, high-contrast, 5-megapixel monitors for soft-copy interpretation of breast images. The monitors are supported by a Dell Precision” Workstation 650 containing either an Intel® Pentium® 4 or Intel Celeron® processor and configured to run Microsoft® Windows” 2000 SP4 or Windows XP Professional SP1a (or higher). The central processing unit accommodates up to 3.07 gigabytes of random-access memory. Onboard storage consists of a 40-gigabyte hard drive, an enhanced integrated drive electronics CD drive, and a 1.44 MB floppy drive. This is not, however, a dedicated mini picture archiving and communications system (PACS), Handley clarifies.

Software features of the IMPAX MA3000 start with a generous palette of image-manipulation tools, including window/level, invert, zoom, magnify, annotation, and hanging protocols, along with reliable study-management tools such as prior-study handling, an active work list, and routing rules. To help increase throughput, reduce patient waiting time, and increase user satisfaction, the IMPAX MA3000 also comes with specialized diagnostic and work-flow-automation tools.

It is a vendor-neutral product, so the IMPAX MA3000 can be used in conjunction with whatever make and model of breast-imaging equipment a facility happens to possess. It can be used with any number of adjunctive modalities, including MRI, CT, ultrasound, and computed radiography. “This workstation fits right into a best-of-breed environment,” according to Pat Montgomery, Agfa’s US manager of women’s care.


Agfa set about developing the IMPAX MA3000 in order to further its corporate goal of providing a total solution for the company’s breast imaging customers. It did not have to look far for inspiration. “The IMPAX MA3000 solution embraces what Agfa is, in part, best known for: PACS functionality,” Handley says. “There was no new technological wizardry involved in creating this workstation. We did not reinvent the wheel. We simply applied our knowledge of, and strengths in, mammography and PACS.”

Agfa also listened to its customers for insights regarding what they needed in the way of workstation capabilities when moving from film-based to filmless operations. “We found that radiology departments preparing to make that transition have lots of concerns about how best to handle mammography in the digital realm,” Montgomery says. “They wonder what kind of archiving they will be able to do, whether they can interconnect with the hospital information system (HIS) and radiology information system (RIS), how prior and current studies will be handled, and whether it is also possible to look at ultrasounds and MRIs.” She adds, “They told us that they wished that someone with PACS expertise would get involved in digital mammography. After 15 years front and center in this arena, our name is pretty much synonymous with PACS, so we saw here an opportunity for a perfectly natural fit. We knew the mammography world; we knew the digital world. We felt that we could put both together, and we did.”

The company recognized, too, that mammography reading in an analog environment entailed a number of unique workflow processes that would have to be carried forward into the brave new world of digital mammography. The answer, Handley says, was simply to retool one process for the other. “We took current functionality and made it better for digital mammography,” she says.

Meanwhile, the vendor-neutral, multimodality aspects of the IMPAX MA3000 permit institutions to benefit from any legacy systems that they might own. “An enterprise that has been investing capital, over the years, in systems for patient scheduling or reporting will discover, with the IMPAX MA3000, that it is unnecessary to reinvest in order to connect digital mammography to the rest of the facility,” Montgomery says.

The new workstation also introduces potential cost savings where storage is concerned. “The IMPAX MA3000 allows you to continue using whatever archival scheme is already in place,” Handley says. “Since this is not a dedicated mini-PACS, you are not forced to go out and buy dedicated archival volume. That, of course, runs counter to the trend in mammography, which has seen vendor-specific mini-PACS as the solution. We feel that such an approach defeats the whole ambition to have true accessibility to image and report data.”

Handley explains that accessibility and functionality are key, in light of the way that facilities previously offering only mammograms have lately been evolving into comprehensive breast centers. “Patients still come in for a mammogram as before, but now they can also have a breast ultrasound done right away,” she says. “For a radiologist to have access to both the initial screening examination plus one or more adjunct imaging examinations at a single workstation is going to shorten the care continuum significantly.”


Florida Hospital is evaluating the IMPAX MA3000 for its own breast centers. FFDM is currently deployed only at Celebration Health, but Grady plans to install one of the multimodality workstations at the system’s primary mammography center as well. Florida Hospital is a huge enterprise that had, in 2003, the highest admissions volume in the United States, in addition to generating the largest number of services billed to the Medicare program, according to Grady. It is poised to become even bigger over the next 4 years. “Consultants looking at population-growth trends determined that between now and 2008, the central Florida market will need 1,200 new beds to keep pace,” Grady says. “Based on those projections, we concluded that we would have to provide a commensurate share of the needed beds. At present, our main campus is up to almost 900 beds, with plans in the works to add 300 more. Here at Celebration Health, we are slated to go from 100 beds to 225.”

The hospital’s most far-reaching technology investment, by far, has been PACS. “Enterprise PACS spans the main campus and our six outlying sites, including Celebration Health,” Grady says. “It was a major undertaking. We completed it about a year ago, and it allowed us to transition to a fully digital operation across the board.”

In the midst of all this, Florida Hospital consolidated its 14 women’s centers down to 5. “We assured the public that we were not going to reduce the number of mammograms we would be performing, but that we would just be bringing together the radiologists who have mammography expertise,” Grady says.

The consolidation at Florida Hospital is in keeping with events across the central Florida market. “Many facilities here have entirely stopped doing mammography,” Grady says. “Either that, or they do not do diagnostics, or will not do a follow-up mammogram unless the screening mammogram was performed at their site. As a result of all this, there are very long backlogs for women to obtain mammography services in most places.” This is not the case at the Florida Hospital centers, where the backlog is shorter than that of the community standard. Grady says, “Two of our five consolidated centers offer screening and diagnostic services jointly. One of those sites is brand new, and that is where the bulk of those studies and interventions occur; Celebration Health is the other.”

Grady indicates that interest in the IMPAX MA3000 solution resulted from the staff’s familiarity, and satisfaction, with Agfa’s PACS reading station. “Choosing the IMPAX MA3000 would allow the radiologists to avoid a long, steep learning curve, as might be the case were they to use another brand of mammography workstation,” she says. “When radiologists switch from film-screen to digital mammography, they typically feel that it is going to take them longer to read. If the workstation does not have the tools that they need, then it will, indeed, take them longer. That is one of the difficult issues that we have faced: that it has been taking them longer to read digital mammography. With the number of women in our market waiting to have mammography done, I need my radiologists to be as productive as possible.”


In Grady’s view, among the most important attributes that a digital mammography workstation can possess are highly flexible hanging protocols. Further, those protocols should be definable for, and by, each radiologist. “We want a workstation that allows the radiologist to log on and automatically use his or her own particular set of hanging protocols,” she says. “From an administrative point of view, I want a workstation that allows the individual radiologist to define a set of hanging protocols easily, so that I am not having to call in an applications specialist every time a new radiologist joins us, or whenever one of the radiologists already on the team decides to change hanging protocols.”

Those are characteristics of the IMPAX MA3000, Montgomery points out, adding that it also allows side-by-side comparison of prior studies to current study images, plus image magnification of suspicious areas, interactive contrast manipulation to help highlight suspicious areas such as microcalcifications, gray-scale inversion to aid in assessing suspicious areas of the image, and various calipers to quantify clinical information from the imaging study.

Grady says that her mammography radiologists have been delighted by the way that the IMPAX MA3000 allows access to images from every digital modality. “That is a big plus,” she notes, “because it lets them bring in adjunctive ultrasounds and MRIs of the breast that might also have been done. They can look at those images paired at a single workstation. They do not have to look at a mammography workstation and then get up and walk over to a PACS workstation to look at the adjunctive modality’s images.”

Montgomery says that the IMPAX MA3000’s multimodality method of viewing all relevant images increases workflow efficiency and shortens the time elapsed before the patient receives care. “This aspect of multimodality viewing enhances the physicians’ ability to provide long-term follow-up for diagnosis and treatment,” she says.

The IMPAX MA3000 brings to bear several highly useful image-navigation tools. They minimize the amount of mouse clicking necessary to accomplish tasks. Grady says, “What fascinates me is that radiologists will count the number of clicks that they are obliged to make in order to get anything done. They will complain to me that it took 12 clicks to go from A to B when they know, or at least feel, that it should only have taken four clicks. They become upset about that because they recognize that every extra click costs them time that they could be putting to good use doing something else.”

Handley believes that the IMPAX MA3000 represents the taming of the click factor. “A woman’s prior-year examination needs to be very easily accessible, and by that I mean accessible without multiple clicks or multiple click-and-drags motions,” she says. “The IMPAX MA3000 enables radiologists to progress very rapidly through the multitudinous images in the queue, and to do so in a very systematic and consistent manner.”

Efficiency is abetted in other ways, too. With the IMPAX MA3000, relevant prior examinations can be prefetched from the PACS archive and sent automatically to the review station. Data and images from the facility’s HIS and RIS can also be displayed simultaneously. “From the information-technology perspective alone, there is much to like about the IMPAX MA3000,” Montgomery says. “For starters, because it is from the Agfa PACS environment, it is a known entity. The connectivity with third-party reporting applications found in our PACS reading station is likewise built into the IMPAX MA3000.”

She continues, “The security required by the Health Insurance Portability and Accountability Act (HIPAA) is taken well into account. Agfa is in the forefront, with its IMPAX systems, in providing that security. When customers install this digital mammography workstation, they are assured that Agfa has the expertise to ensure that patient data are protected and that they will meet all HIPAA requirements.”

Beyond pure operational efficiencies, Agfa has also sought to foster radiologist productivity by paying attention to the ergonomics of its IMPAX MA3000. “It is a physically comfortable system to work with,” Grady says. “Ergonomics are very important to us. We are trying to reduce our radiologists’ risk of sustaining repetitive motion injuries. They are vulnerable to those because they have a lot of wrist and finger activity, as a result of rolling a trackball all day. Consequently, workstation design has to be such that tasks can be completed with just the touch of a single button or a single mouse click.” Grady continues, “At Florida Hospital this year, our mammography radiologists will do a phenomenal amount of work. In addition to making their time as productive as possible, we must also make sure that they are as physically comfortable as possible. A comfortable workstation, for us, is one that is designed to be operated far more intuitively than ever before.”

That is precisely the concept at the heart of the Agfa IMPAX MA3000. “With this product,” Handley says, “we are offering the most optimized environment imaginable.”

Rich Smith is a contributing writer for Decisions in Axis Imaging News.