Comprehensive Solution, Patient-Focused Care
High Marks for New Markers

Comprehensive Solution, Patient-Focused Care

At Regional Medical Imaging (RMI), an ACR-accredited Breast Imaging Center of Excellence that includes five facilities located in the Flint, Mich, area, we?re focused on providing excellent patient care to women at one of the most vulnerable times in their lives.

Here?s why: Picture a 40-year-old woman with a full-time job and two young children. Receiving a breast cancer diagnosis is going to be a traumatic experience?so, I like to do what I can to walk her through what I see when I perform my interpretation. Through my years of walking women through this, I?ve discovered that it makes them feel more empowered about the next stage, which is about getting them on the path to wellness.

In order to provide women with this level of patient care, in the past, RMI had one mammographer at each of our five sites, which was inefficient. But, because we didn?t have the technology to connect our five sites, it was the only way we could provide these services to women in our area.

Randy Hicks, MD, MBA

Back then, each of these mammographers was reading approximately 12 analog studies a day, which was very inefficient and expensive. As we began to look at a digital mammography solution, we estimated a need for an investment of approximately $450,000 per site for digital equipment and mammography workstations. Multiply that by five sites and you?re talking about $2,250,000 for the entire organization.

Looking at this issue from a business perspective, we knew that we couldn?t compete in our market as an independent imaging center with that kind of overhead. Given that, we began talking to AMICAS, our PACS vendor, about the need for a PACS solution for the mammography segment of our business.

As a result of those conversations, we began working on the development of the mammography solution in 2008. Over the ensuing 18 months, RMI became the proving grounds for the product as AMICAS? developers worked day-to-day with our team to come up with a product that would not only replace the need for dedicated mammography workstations but would allow for the entire patient record to be reviewed inside one system.

Our mammographers and others at RMI worked closely with AMICAS to develop a solution that allows our practice to manage patients efficiently and with safeguards to protect the patient from getting ?lost in the system.? Using AMICAS? customizable worklists and image annotation, RMI now directs ?call backs? seamlessly. Mammographers communicate with the RMI team through these worklists and ?voice clips? to direct messages to the patient and instruct technologists on the types of additional images needed when the patient returns.

Complicated cases with multiple modalities such as MRI, ultrasound, and BSGI can now be reviewed together with the digital mammogram, which provides for a more comprehensive reporting of the findings. Having this comprehensive view of the findings helps the patient and her physician during a decision-making process that can be very difficult for breast cancer patients.

Today, because AMICAS PACS provides full mammography capabilities as a part of its solution, our practice has saved $500,000?and we know that?s because we have eliminated the need for independent workstations and can consolidate workflow for our mammographers. For example, two full-time dedicated mammographers can now interpret all mammography performed at RMI?no matter where the study was performed.

These savings have allowed us to reinvest in additional equipment for breast imaging, including a new, updated MRI breast coil and a BSGI camera, both of which have significantly improved our ability to care for our patients. Dedicated mammographers can continue to deliver on our commitment to care for our patients and help them with questions that inevitably arise during the diagnostic workup.

Our practice has realized additional savings as a direct result of our centralized medical records and improved patient flow. What that means for RMI is we can review a patient?s images from any of the facilities and direct patient care on the spot. Therefore, patients can be imaged at a site that?s convenient to them, while still receiving the same high-quality care from the dedicated RMI team.

As happens in business, as a result of our changed workflow, we had an unexpected added cost in that we needed to upgrade our data pipeline because of the large volume of data created by the digital mammographic images. But that investment in bandwidth was essential, since expanded bandwidth is the ?glue? that keeps our operation humming at maximum possible efficiency. Overall, this single PACS solution has been a net positive for our practice, given the significant improvement in our cost structure and our delivery of patient care.

Let?s return to my 40-year-old patient and her journey through our practice. For the sake of this example, let?s say that this mother of two is in for a routine screening mammogram. If, during the procedure, the technologist sees an abnormality, she can simply have the case reviewed in real time by one of the dedicated mammographers.

The images can then be annotated along with a voice clip embedded in the PACS viewer that instructs the technologist on any further imaging requirements. At which point, the case is put into the ?add views? worklist, which is monitored by one of our technologists, who then reviews the instructions on the voice clip and annotated images and proceeds with converting the case into a diagnostic study.

If the technologist didn?t notice anything out of the ordinary and the study goes through as a screening to the radiologist, the process is similar once the abnormality is discovered by the reviewing mammographer. Again, annotations and a voice clip would be made by the mammographer, but this time the patient would be moved to the ?call back? worklist, which is monitored by the RMI scheduling team and someone on that team would proceed with setting up the patient to return for the diagnostic workup.

Once the lesion in question is totally worked up (which may include ultrasound), all images can be reviewed in one setting. The patient?s physician is then consulted, and, in most cases, the mammographer proceeds to spend time with the patient reviewing images and preparing her for image-guided biopsy, which is usually performed within 24 hours.

After the biopsy is performed and cancer is confirmed, the patient often has additional preoperative workup that can include breast MRI, BSGI, CT scans, bone scans, and even PET/CT.

The beauty of the PACS system is that when all of these studies are ready for interpretation, the whole patient record is available, including biopsy images, pathology reports, mammograms, ultrasound, and BSGI and/or MRI?and that means that the patient and her physician can have a comprehensive understanding of the malignancy quickly, efficiently, and accurately.

The end result: We save everyone time, money, and anxiety?all while providing excellent care to that 40-year-old mother of two.

?Randy Hicks, MD, MBA

Randy Hicks, MD, MBA, is cofounder of Regional Medical Imaging. He obtained his MBA after joining RMI to enable him to direct the company to better serve his patients and the community.

High Marks for New Markers

Knowing that radiologists often rely on mammography technologists to highlight areas of clinical interest on the breast, Baltimore-based IZI Medical Products recently began distributing two new lines of flat mammography markers. Both markers are manufactured in the United States and sold worldwide under the name of Mammography Indicator? Markers.

Radiolucent markers from IZI Medical Products are available in triangles, dots, line, and circles.

Available in radiolucent and radiopaque varieties, the markers indicate areas such as masses, scar tissue, and moles in diagnostic mammograms. Unlike typical round BBs and wires, IZI officials say the flat technology in Mammography Indicator Markers prevents indentation of the patient?s skin that can create confusion. Company executives also tout the ability of the markers to eliminate pesky artifacts that often appear on scans due to lesser quality marking technology. The result is fewer rescans.

Customers are giving the new markers high marks. ?The most important benefit is ?stickability??the product does not come off after additional positioning,? said IZI customer Pattie W. Barnes, RT (R) (M) (BB), at Saint Joseph Candler: Breast Care Center-Telfair Pavilion, Savannah, Ga. ?And due to bulk purchasing, this product is significantly more cost-effective. I am impressed with this product. It maintains itself with additional imaging, and also is very visible on mammography.?

Helen Shafer, CEO of IZI Medical Products, says customers can expect large cost savings, in addition to solid performance. ?Our Mammography Indicator Markers are of the highest quality for producing clear results, yet we are able to offer end users competitive pricing for small and large orders alike,? said Shafer. ?On average, our customers are seeing up to a 50% savings when purchasing our markers at a bulk rate. The new lines of markers will make a big difference to our distribution network, to facilities performing the mammograms, and to patients who are counting on the most accurate results from their mammograms.?

The product is available in pink radiolucent ink and radiopaque black ink. The radiolucent pink ink allows the markers to appear radiolucent on a scan, and the marker will not hide underlying pathology. Radiolucent markers are available in: circles (12 mm); dots (1.5 mm, 2.0 mm, 2.5 mm); line (2.5 mm, 1.5 mm, 0.8 mm); and triangles (10 mm). The radiopaque markers are lead free, nontoxic, and available in: crosses (3.17 mm); dots (3.17 mm); and lines (3.3 mm).

IZI Medical Products is a longtime manufacturer of medical device accessories used in image-guided surgery (IGS), radiology, and radiation therapy procedures. Prior to the Indicator Markers, the company developed the first multimodal imaging marker?now a venerable reference technology used by physicians during IGS. ?The markers give radiologists who evaluate scans a way to easily identify the area of concern,? said Shafer. ?The result is a faster and more accurate diagnosis.

?Greg Thompson