Transitioning from film to digital mammography can give you a competitive edge.

Tyler Harris

A conversation gaining increased attention in radiology circles is whether to eliminate ?traditional? mammography, meaning conventional film, chemicals, processors, folders, filing, etc, in favor of transitioning to a 100% digital mammography PACS environment. While changes to the ?typical? way of doing things can cause temporary challenges, evaluating the cost savings and efficiency improvements that can be gained makes a strong business case for making the shift.

In any business, it is prudent to evaluate and weigh both sides of a decision to ensure that it is clinically and financially advantageous when compared to leaving things status quo. When I am on-site at clinics and women?s centers, I hear most often that the issues of concern are image quality and cost.

Image Quality

Those considering transitioning to digital mammography often ask: Is the image quality of digital comparable to that of film?

Because resolution and degradation are of utmost concern when dealing with microcalcifications and other pathology and etiology, there are FDA-approved standards that must be met for monitors and software to ensure high-quality, accurate images.

In side-by-side comparisons of film and digital images, the image quality of digital studies has proven to be as good as or even better than that of film. In its study, ?Digital vs Film Mammography in the Digital Mammographic Imaging Screening Trial,?, the National Cancer Institute reported that women who will gain the greatest advantages from screenings completed with a digital system include those under 50, those with very dense breast tissue, and perimenopausal women.

Further advantages provided by digital mammography include eliminating artifacts and providing better visualization of the skin, retromammillary region, nipple, and dense parenchymal areas. Contrast has also been shown to be much better with digital compared to film for fatty tissue and high-density areas. When combined with the tools and features offered in digital systems, including advanced hanging protocols, advanced workflow for reading, step-by-step walk-through, CAD markers, and overreads, a digital system provides the added benefit of making reading more efficient, which helps deliver a higher standard of patient care.

An additional benefit to patients is that digital mammography uses less radiation than film mammography.

It does need to be noted that the number of false positives has been shown to increase slightly with a digital system. The believed cause for this result is the enhanced level of digital clarity compared to film.

Another consideration is that only a limited number of vendors have CR mammography approval. It is important when a facility is considering a system to identify a vendor that has obtained this approval from the FDA.

Cost and ROI

Often, a facility has made a major capital investment in film processing equipment and is therefore hesitant to go digital. However, mammography PACS can offer a cost advantage.

After factoring in the expenses for purchasing, processing, maintaining, and storing film, there is only a small margin of cost recovery per patient. Price sensitivity is impacting the industry and causing providers to look for ways to cut costs and increase margins per exam.

When comparing the costs of film to digital, it is simple to show in real bottom line savings how a digital system can save money. It is not just eliminating the film costs, it is also saving time for FTEs by eliminating QC for film chemistry, film quality, and modalities. Even with the low reimbursement for mammography, typically, most facilities that have installed mammography PACS realize ROI in less than a year and in many cases in as little as 6 months.

In addition to the tangible cost savings, digital systems also offer space saving benefits. Archiving mammography studies with a digital system is much more convenient and saves a tremendous amount of space compared to traditional film. Digital images are stored on a server archive, making them easily accessible for repeat analysis, running additional reports, or sharing studies online.

Electronic file storage can also improve productivity. Typically, studies can be retrieved in less than 30 seconds. This is a tremendous time saver compared to physically locating jackets in a storage room, and then pulling and hanging films.

Overall, the tangible cost savings and intangible space savings to be gained clearly demonstrate the advantages to going digital. The question then shouldn?t be ?if? the shift from film to digital should be made, but ?when.? The sooner the better is proving to be the best business case for facilities that want to gain a competitive edge.

Tyler Harris is vice president, clinical solutions at NovaRad Corporation. In this position, he leverages his years of clinical in-hospital experience to help hospitals, clinics, and imaging centers improve workflow procedures, productivity, and patient care.