Digital Mammography at Memorial Memorial Healthcare fast-tracks its transition to digital
AHRA Accredits 21 New CRAs
Program Apollo for Health Care Executives Provides Hands-On Learning in a Virtual Environment
The Country Hospital and the City Hospital: Rural sites keep pace with PACS, imaging modalities

Digital Mammography at Memorial Memorial Healthcare fast-tracks its transition to digital

In October, Memorial Healthcare System, Hollywood, Fla, made the inevitable switch from analog to digital mammography. The 14 mammography systems at four of Memorial’s hospitals and one cancer center were rapidly and systematically replaced with 13 Selenia digital devices from Hologic Inc, Bedford, Mass, completing Memorial’s transition to filmless, all-digital imaging networked to a single PACS. A short time frame for change creates a number of challenges, some of which can be addressed only through cooperation between administrators, radiologists, and IT staff. And careful planning must be paramount, says Sally Abrams, administrative director of imaging for the Women’s Imaging Center at Memorial.

“It exceeded my MasterCard limit,” Abrams jokes, “and my American Express. But we put together a financial proposal showing [how transitioning to digital mammography] could have a very positive return on investment.” Such factors as increased reimbursement and reduction in film, film processing costs, and staff, as well as a strong existing patient base, meant that Memorial could anticipate achieving ROI within 3 years. “And we were not going to be in a position where one of our hospitals offered analog mammography and another one offered digital,” Abrams says. “We try to standardize the level of care at all of our facilities.”

Mary Hayes, MD, medical director of the Women’s Imaging Center, agrees about the importance of a unilateral turnover. “We ensured that each hospital had digital mammography right away,” she explains. “So, we turned over those units so that at least one unit in each of our facilities was digital, and then we filled in the rest.”

Although Memorial was one of the last health systems in its region to go digital, Hayes emphasizes the necessity of proceeding with caution when considering a new technology. “I don’t think all facilities in the area have taken their whole systems digital, as we’re doing, because it is very costly,” she says. “Some of the other hospitals went digital early—it was an administrative decision for marketing. And when we radiologists reviewed the images, we were not yet satisfied with the image quality.”

Another factor was reading time. “There’s been some literature that shows it actually takes the radiologist longer, sometimes twice as long, to read the digital mammograms as compared to the analog films,” Hayes says, referring in part to a recent study in the American Journal of Roentgenology.1

So Memorial waited, biding its time while sitting on one of the only remaining all-analog networks in the market. “We waited for the high-end digital mammography,” Hayes explains. “The resolution with the Hologic product is 70 microns. [Another vendor] came out with 100 microns—the images could come up quickly and wouldn’t be a burden on IT memory, but the images were not satisfactory. So, we’ve gone down to the 70 micron level, and we have a nice balance between image resolution and IT memory.”

Hayes says the hidden cost of IT system strain can be just as daunting as the financial challenge of switching to digital. “If you’re talking about economics, you always have to mention IT and the cost of memory. It’s a hidden cost if your facility chooses to go digital. You’ll have to make some hard decisions about how you want to handle your prior comparison films, making sure you’re compliant with the ACR and MQSA guidelines, as well as making sure it’s user-friendly for the radiologists.”

But Abrams and Hayes knew for Memorial, which performs about 35,000 screening and 4,500 diagnostic mammograms each year, a carefully planned, organized, and integrated rapid turnover was the only option.


  1. Berns EA, Hendrick RE, Solari M, et al. Digital and screen-film mammography: comparison of image acquisition and interpretation times. AJR Am J Roentgenol. 2006;187:38–41. Available at: content/abstract/187/1/38. Accessed November 14, 2006.

AHRA Accredits 21 New CRAs

The American Healthcare Radiology Administrators (AHRA), Sudbury, Mass, has announced the results of the August 2006 Certified Radiology Administrator (CRA) examination. CRA status was awarded to 46.81%, or 21, of the radiology administrators who took the exam.

The CRA is the only accreditation program for radiology administrators; there are currently 550 CRAs nationwide. The examination consists of 185 questions broken down into three categories: 30% test knowledge, 40% evaluate problem-solving skills, and 30% test analysis. The domains evaluated by the exam include human resource management, asset resource management, fiscal management, operations management, and communications and information management.

The AHRA also announced the date for the spring test, which will be administered in computer-based format on March 3, 2007, at 125 CompUSA Testing Centers in 34 states. Applications for the examination are due January 29, 2007, and will evaluate candidates based on a point system measuring education, experience, and credentials. Seven points are required to take the exam.

The cost of the examination is $300, plus a $50 application fee. To maintain the credential, CRAs must submit 36 continuing education credits and pay a $150 renewal fee every 3 years. To learn more or apply, visit

Program Apollo for Health Care Executives Provides Hands-On Learning in a Virtual Environment

Most health care executives are not given a 5-year trial period during which to learn the terrain of the market. There is no opportunity to make harmless mistakes and learn from them; training occurs in real time, sink or swim, and the inevitable errors in judgment are indelible. Now, a program offered by the Lally School of Management and Technology at Rensselaer Polytechnic Institute, Troy, NY, offers hands-on education through a 3-1/2-day workshop, during which health care executives simulate the kind of business environment they face in the real world over a 5-year horizon.

“Participants are thrown into the roles of running fictitious, or virtual, health care service delivery organizations,” explains Lally School Dean David Gautschi. At the outset of the program, students are divided into small groups, with each group representing a different health care provider within the simulated market. “We talk about competition, physician relations, managing people, technology, and public policy, but then we always throw them back into the laboratory where we say, ‘Go figure out what the issues are for your virtual companies.'”

As quickly as participants can make decisions for their simulated health care systems, results are generated by the computerized “Strategy Laboratory” system developed by management education expert Darius Sabavala of Janus Enterprise International LLC, New Providence, NJ. Gautschi explains, “Participants make decisions, they get results, they have to understand and interpret results, and then they figure out what to do. It gets progressively more complex, because a lot of the information that comes back is generated by decisions that they’re making. Participants also have the issue of competition, collaboration, or avoidance with the other players in the system.”

Graduate Jen Lethco agrees. “I think the most interesting piece was how [the faculty] approached simulation,” she says. “They actually create the environment of competition.” The former radiologic technologist’s career has led her into a finance and project management role; she is now the director of materials management at Community Care Physicians PC, Latham, NY. Lethco participated in Program Apollo as a health care-focused supplement to her Executive MBA.

David Gautschi
Jal Salbvala

Lethco signed up for Program Apollo along with Community Care CFO Richard J. Scanu and Community Care CTO Sumeet Murarka; and Sabavala and Gautschi were sure to put the three of them on a team for the simulation. “Community Care is very technology-driven,” Lethco explains. “Our physicians always want to have the latest and greatest technology: RIS, PACS, EMR, and all the imaging equipment. We found through the program that you have a certain amount of cash to invest in certain areas. But you can effectively invest in technology and medical systems only to the degree that it satisfies the customers: physicians and patients. Otherwise, you will overinvest and waste cash resources.”

That is exactly the kind of educational experience that the Lally School hopes to create for health care executives. “The question was, how do you bring decision-makers in the health care services delivery arena up to the point where they feel confident about making choices?” Gautschi asks. “Technology, competition, physician relations? They couldn’t understand how to think through the various trade-offs of making a choice to adopt or move ahead on one technology front.”

Program Apollo is held five times a year, lasts for 3 1/2 days, and is worth 24 CME credits. The full price is $4,995; however, both merit- and need-based scholarships are available on a limited basis. To learn more, visit the Lally School online at

Cat Vasko is associate editor of  Axis Imaging News. For more information, contact .

The Country Hospital and the City Hospital: Rural sites keep pace with PACS, imaging modalities

Most people connect top-of-the-line health care with massive hospitals in urban environments, assuming a smaller facility would not be capable of providing the same level of technological prowess and medical savvy.

“You have that stigma, but nowadays, that is really not the case. Many times, the smaller, rural hospitals are more on the cutting edge than the bigger hospitals,” says Michael S. Dunlap, director of radiology at Navapache Regional Medical Center (NRMC), Show Low, Ariz. “Our philosophy is that no one should have to leave this area for treatment that they can get here.”

Without question, NRMC, a private, not-for-profit organization, is sitting on the cutting edge. Though small—it has 66 licensed beds—the facility boasts digital imaging in all modalities except mammography, which will be in place within the next 2 years.

NRMC responds to the health care needs of more than 40,000 permanent and seasonal residents living in a 3,000-square-mile mountain area. Covering such an expanse virtually requires the facility make use of technology, such as providing its physicians with remote access to a Fusion PACS from Merge eMed.

“It has allowed us to provide better service to our physicians, because they can use the Web to review studies on their patients,” Dunlap says. “The ER physician here can consult with a physician in Phoenix or Flagstaff, and they can be looking at the same images at the same time.”

Dunlap believes staying up-to-date with this type of technology is a pressing issue for smaller facilities. Before the advent of teleradiology, isolated locations were forced to deliver films over long distances.

That same level of convenience has been brought into the hospital as well. NRMC has four reading stations in radiology and one in the emergency department (ED), as well as a viewing station in the ICU. A second viewing station is mounted to a cart and shuttled between operating suites. “I also have set up viewing stations at each of the nurses’ stations, so the doctors can access patient studies right there,” Dunlap explains.

When transporting patients to larger hospitals, clinicians send along a CD that includes diagnostic-quality images of all completed studies. The CDs include an image viewer that launches automatically on any user’s system.

In the City

Despite its remote location, NRMC is clearly keeping pace with its larger, metropolitan-based counterparts. One such hospital, John C. Lincoln (JCL), often receives patients from NRMC when the level of care required demands a transfer.

Serving the almost 3.5 million residents in the Phoenix-metro area, the JCL Health Network consists of two not-for-profit community hospitals—one in North Mountain and the other in Deer Valley—as well as three outpatient imaging centers.

The North Mountain location features 262 beds and has a 24-hour Level I trauma center and ED. In Deer Valley, a 35-bed ED recently was added to the 169-bed hospital. Like NRMC, all of JCL’s imaging systems are digital with the exception of mammography, which is expected to be online in early to mid 2008.

At this time, JCL’s hospitals are operating on separate PACS solutions from different vendors. (Deer Valley uses Synapse from FUJIFILM Medical Systems USA, and North Mountain uses a combination of DirectView PACS from Kodak’s Health Group, and iSite PACS from Philips Medical Systems.) A push is under way to unify the imaging systems at JCL’s multiple locations. Early next year, the hospitals and outpatient centers will merge to a single PACS: Synapse from Fuji. When searching for the ideal PACS, JCL focused on obtaining a software solution.

“We really wanted a system that was software only and allowed our IT department to maintain the hardware,” says Judy Tucker, clinical director of medical imaging and the cardiac catheterization laboratory at JCL’s Deer Valley location.

The new, fused system will include an advanced backup architecture. Each location will serve as a mirrored archive for the others. North Mountain’s archive will be stored at Deer Valley and vice versa. There will be a redundancy of all files, eliminating the risk of losing electronic patient files. Files from the outpatient centers will be included as well.

As with all health care organizations, security is the biggest obstacle to be cleared before online access to the PACS is widely available. Also, security across the Internet presents a host of difficulties, all of which must be remedied prior to launching any teleradiology programs.

Once the integrated PACS is in place, JCL will be able to provide its physician network with remote access to view images directly from the PACS. Until then, JCL’s referring physicians can access patient information via the hospital’s online portal.

“Physicians can access the portal to look at the whole patient file,” says Steven Hardin, administrative director of diagnostic services at the JCL North Mountain location. “They locate the patient and are able to access all different departments in one place.”

Keeping Up With the Joneses

Now more than ever, patients are active participants in their health care, and their awareness of the available technology is increasing. “We have to be on the cutting edge to compete with the larger hospitals. If smaller hospitals are behind in technology, patients will bypass them and go where the technology is best,” Dunlap says. “Although larger hospitals have more competition than we do in rural areas, they are in a race to keep up with what other hospitals are doing in their area. That affects which areas they are growing and what new equipment will be added.”

Despite all obstacles, both JCL and NRMC are looking eagerly toward the future. Currently, NRMC is preparing for its new 64-slice CT scanner from GE Healthcare, expected to be available for patient use in January. Once the scanner is up and running, the facility will introduce a preventive cardiac scoring program that community members can access online.

In the next year, the hospital also is opening its five-story patient tower project that will expand the ICU and medical/surgical unit. The building is expected to be ready for occupancy in August 2007, with the remodel of the existing facility expected to be complete the following spring.

After putting the finishing touches on its PACS integration project, JCL also is looking to install 64-slice CTs in its outpatient imaging centers.

Dana Hinesly is a contributing writer for  Axis Imaging News. For more information, contact .