The Women’s Health center at the Baptist Memorial Hospital for Women (Memphis, Tenn) always has prided itself on providing patients with the latest breast-cancer detection technology. The Center owns the distinction of being the seventh facility in America?not to mention currently one of only two centers in the Mid-South?to offer full-field digital mammography. It is worthy to note that the Center was using this technology a full 4 years before the area’s competing mammography centers followed suit.

So when the latest in breast-cancer detection technology recently was introduced, it came as no surprise that the Center was at the forefront of interest, installation, and eventual use. Many breast cancers are so minute in nature that even the finest digital mammography units are often hard-pressed to pinpoint underlying problems. What was needed was a keener set of eyes?a second, more discriminating look, if you will. The Women’s Health Center found its answer in Second Look from iCAD Inc (Nashua, NH).

“Part of the issue is that, unlike CT or MR, you are looking for things that are really almost microscopic; you are looking for things that are exceedingly small,” says Lynn Gayden, MD, medical director of the Women’s Health Center. “So the whole world of digital had to be different from [traditional] mammography. It had to be different from ultrasound, MR, or CT.”

A Closer Look

Second Look is a new computer-aided detection (CAD) system that helps radiologists detect smaller cancers in a more timely fashion. Second Look provides a computerized second review of both screening and diagnostic mammograms. This “second,” or closer, look allows radiologists to recognize subtle changes in breast tissue that could either indicate the presence of cancer or necessitate a more thorough examination.

The new technology is particularly beneficial to special-needs patients who have pre-existing conditions that would make cancer detection more difficult.

“Undoubtedly, there is a subset of patients in which digital is very helpful,” Gayden explains. “In particular, patients with implants, patients who have had radiation, patients who are pregnant and have breast cancer, or patients who are young?they all benefit dramatically from the digital technology.”

Noting a multitude of published studies heralding the CAD’s effect on early cancer detection, Gayden says that “it is comforting” to have a second set of “eyes.” “I know that when you’re sitting down to read a board of screens, it is good to have that second check to be sure there is nothing you overlooked,” she says. “CAD does improve your detection of early cancer and, obviously, that’s what we’re doing; that’s the name of the game.”

The Second Look system from iCAD has been a welcome addition to the Women's Health Center at the Baptist Memorial Hospital for Women, both by the Center's staff as well as patients.
The Second Look system from iCAD has been a welcome addition to the Women’s Health Center at the Baptist Memorial Hospital for Women, both by the Center’s staff as well as patients.

Making a Choice

Gayden oversees a staff of five full-time radiologists who work at the main office in Memphis. The Women’s Health Center also has a mobile van that caters to underserved areas around Memphis and offers an extremely popular retail-based mammography center at a Macy’s department store at the city’s Oak Court Mall.

She explains that the process from discussing the Center’s CAD options to deciding on the Second Look system took only a few weeks. Choosing iCAD over other suitors was determined by which system was least likely to impact the patient experience.

“It seemed that iCAD’s system had a better, faster throughput that would impact our patient flow the least,” Gayden notes. “Turnaround time for patients and the amount of time spent in the Center is pretty critical. We always keep a close watch on patient satisfaction. Also, Second Look was a little more streamlined in getting the film screen through the digitizer and into the physician’s office.

“We actually had done initial studies with R2 [Technology Inc (Sunnyvale, Calif)] on the digital unit, some of the company’s older prototypes,” she continues. “So when we looked at adding CAD to our diagnostic center and our screening center, we went through RSNA and chatted with vendors. We thought iCAD would be better in terms of throughput. We were interested in having the ability to get a paper printout. Those were predominantly the factors that allowed us to choose iCAD.”

Gayden adds that once the decision was made to go with iCAD, implementation was fairly simple. Because of those initial studies performed by the Center’s staff, they “were accustomed to using the CAD function,” explains Gayden, who notes that iCAD was there for the Women’s Health Center every step of the way. “We had never digitized the analog film screen, so there were some issues as far as personnel being trained and changing the workflow pattern a bit.”

The only unanticipated drawback to the new technology was a prolonged wait time. Gayden says that incorporating the Second Look system adds about 15 minutes to a patient’s visit. The increase is attributed, in part, to the time it takes to print film and run it through the system.

“I don’t think we anticipated what the impact would be on throughput,” she admits. “From the time a patient signs in until the time she leaves, that’s something we track as far as our quality improvement. Most of our diagnostic patients coming in have multiple studies?they have mammograms, ultrasounds, and other procedures; they often go back and have repeat mammograms. We are very sensitive to how long the visit takes. Anything that adds time to the patient’s visit is something we try to minimize.”

Despite the additional 15 minutes, on average, needed for office visits, the benefits of CAD far outweigh the time patients spend at the Center. Gayden points to the potential for earlier detection of microscopic cancers, along with greater patient peace of mind, as two reasons why the Women’s Health Center is pleased with their choice.

Growing the Data

Suggesting that major breakthroughs in breast-cancer detection are just around the corner, Gayden notes that digital mammography will continue to be a luxury for many imaging centers. The cost of making the change from traditional mammography can be too prohibitive. But for those centers fortunate enough to be using CAD technology, early detection has become not only easier, but also more reliable.

“I think everything has changed for the better,” she maintains. “Both the database and the sensitivity of the CAD have improved so dramatically. I think clearly, as improvements continue to be made, the pickup rate will improve more and more as well.”

A constantly changing and improving database will only lead to better detection down the road, Gayden insists. “If something is detected by the physician but not detected by the [Second Look system], it falls within the criterion that we submit to iCAD,” she adds. “The company will go back and evaluate those cases. The more cases iCAD has in its database, the more sensitive and specific the test will become.”

Pleased Patients

Gayden, a 1992 graduate of Baylor College of Medicine (Houston), reports that many new and current patients ask if the Women’s Health Center is equipped with CAD technology.

Gayden notes that prior to an appointment, the Center sends letters to all patients detailing the visit, explaining the recommended procedure, and noting that CAD will be implemented. Patients are given the option of opting out of the CAD procedure, as it carries an extra cost. “It is rare that they opt out,” she says, “but it does occasionally happen.”

A more common occurrence is that patients want to make sure their exams are read with CAD technology.

“We consult with patients both during and after the visit,” Gayden says, “and they commonly ask, ?Did I have that CAD thing?’ The information that is now available in the lay press is educating patients and making them aware of [CAD’s] existence.

“People are realizing the significant health risk breast cancer is,” she continues. “When I started, women were very uneducated, as were the physicians. But today, patients are requesting more information, and the news media is happy to give it to them. Everybody has either had [breast cancer], or knows a friend or family member who’s had it. It’s every woman’s worst fear, so they’ve become very educated generally about breast cancer. It’s a big change.”

Dave Cater is a contributing writer for Medical Imaging.