DMIST: Cancer Detected at Higher Rate with Digital Images Than with Film in Trial Subset

Results of the recently published Digital Mammographic Imaging Screening Trail (DMIST) concluded that while there were similarities in diagnostic accuracy of film and digital mammography screening for the overall group of women studied, digital mammography screening detected 14% to 27% more cases of cancer in women under the age of 50, women with denser breasts, and pre- and perimenopausal women without an increase in false-positives than film mammography screening. DMIST investigators are now analyzing the cost-effectiveness per quality of life year saved using digital mammography screening.

“Just because a technology is more accurate—in our case with digital [mammography] finding more cancers in the subsets without causing an increase of false-positives—doesn’t mean it is cost-effective,” says Etta D. Pisano, MD, lead author of the DMIST Investigators Group and professor of radiology and biomedical engineering at the University of North Carolina Department of Radiology. “You have to do a calculation of the cost per year of life saved to really figure out if something is cost-effective. We know that [digital mammography] is more accurate, but we do not know yet that it is more cost-effective and we are trying to figure that out right now.”

Pisano says they expect to be done with the cost-effective analysis in the next couple of months.

While the results of this initial study—published online from The New England Journal of Medicine in September—bode well for the use of digital mammography in breast cancer screening, implementing this technology may take some time. Providers still must contend with the cost of implementing digital mammography, 1.5 to 4 times the cost of film mammography systems, the investigators note.

“I would expect more digital systems to be purchased,” Pisano says regarding the findings of the study. “I think the transition from film to digital is going to happen in the next 5 years or so.”

She reports that the cost analysis will investigate how much more payors will spend on reimbursement for digital screening mammography mainly because the equipment is more expensive than film systems.

“Our cost-effective analysis takes the point of view of the payors to see if the amount of money they are investing in year of life saved is an appropriate investment because [digital screening mammography] will cost more,” she says.

Aside from digital mammography’s ability to better detect cancer in certain women, the investigators noted additional benefits, “namely, easier access to images and computer assisted diagnosis; improved means of transmission, retrieval, and storage of images; and the use of a lower average dose of radiation….”

But it should be stressed, Pisano says, that women should still be getting screened, regardless of the technology being used.

“Screening mammography has been taking place with film for 35 years. It has been done well,” she says. “We know it helps reduce breast cancer mortality along with improved therapy. We need to encourage our patients, even if they can only get film, to continue to get screened. We certainly do not want women to skip screening.”

One of the things DMIST was able to accomplish was improving the sensitivity of breast cancer detection without a change in specificity, meaning fewer false-negatives were reported.

“We found cancers that would not have been found otherwise without any change in specificity,” Pisano says. “We had no change in the number of false-positives. That’s a really good test result.”

Radiology Extends Aid to Katrina Victims

In the wake of one of the country’s largest natural disasters, members of the radiology and radiation oncology communities are reaching out to help the victims of Hurricane Katrina get back on their feet.

Here is what some of the organizations and business have been doing to help the devastated region:

  • The American Society for Therapeutic Radiology and Oncology, Fairfax, Va, has been compiling a list of radiation therapy facilities around the country that are willing and able to treat patients undergoing radiation therapy treatments who have been evacuated from the region.
  • The American Healthcare Radiology Administrators, Sudbury, Mass, is helping the Federal Emergency Management Agency coordinate all aspects of radiology management. For information on who has donated radiology equipment and/or supplies, those who would like to donate, or those in need of equipment can e-mail [email protected].
  • ECRI, Plymouth Meeting, Pa, a nonprofit health services research agency, has launched a Web site for information regarding medical device-related disaster relief to benefit health care facilities affected by Hurricane Katrina. The Katrina Medical Technology Information Clearinghouse can be found at
  • Siemens, Malvern, Pa, has sent power generators to hospitals in Houston and Louisiana, telecommunications equipment to emergency centers, USFilter water treatment equipment, and heart monitors and imaging equipment to Houston hospitals, and is offering a 100% matching donation program for its 70,000 US employees. Monetary donations will be made to the American Red Cross Disaster Relief Fund.
  • Atsutoshi Nishida, CEO and president of Toshiba Corporation, Tokyo, announced his company would donate $1 million in cash and medical equipment to the Gulf Coast in support of relief efforts.

Radiologist Compensation Data from 2004

Radiation Oncology Radiology: Diagnostic Non-Invasive Radiology: Diagnostic Invasive
Compensation Compensation Compensation
a Mean a Mean a Mean
Overall $427,536 Overall $411,050 Overall $437,635
Collections for Professional Charges Collections for Professional Charges Collections for Professional Charges
Overall $646,365 Overall $731,084 Overall $677,327
Compensation to Collections Ratio Compensation to Collections Ratio Compensation to Collections Ratio
Overall .654 Overall .653 Overall .704
Total RUVs Total RUVs Total RUVs
Overall 12,247 Overall 14,549 Overall 14,597

According to the Medical Group Management Association (MGMA), Englewood, Colo, in its Physician Compensation and Production Survey: 2005 Report Based on 2004 Data, specialty physician compensation growth fell behind that of primary care physicians for the first time in 5 years: an 0.18% compensation increase for specialists compared to a 20.6% overall growth in compensation. The figures above show the mean compensation for overall (single specialty and multispecialty) radiologists who reported their 2004 information to the MGMA. Compensation for radiation oncology decreased in 2004 from $429,776 in 2003. Compared to last year’s results, compensation for both diagnostic-noninvasive and invasive radiology increased in 2004 from $401,148 and $434,289, respectively, in 2003.


The September print issue erroneously identified two of the three cover subjects, both on the cover and on pages 15 and 16 of the story “The Imaging Center Entrepreneurs.” The cover caption should have read: From left: Ken Bishop, Open System Imaging, Palm Desert, Calif; Frank Kyle, Outpatient Imaging Affiliates LLC, Nashville, Tenn; and Joseph Paul, Cypress Partners LLC, Palm Beach Gardens, Fla.

Also, Rebecca J. Engstrom is IS Lead Business Analyst for the Enterprise Medical Imaging, Allina Hospitals & Clinics, not the CIO as stated in the print article “The Migratory Patterns of PACS” in the August issue.

Industry News

LDR Spine, Austin, Tex, has received 501(k) clearance from the FDA to market its MC+® and ROI fusion spine products…Philips Medical Systems, Andover, Mass, has released its “Digital Radiography: An Administrator’s Guide” to help radiology administrators through the process of changing to digital radiography. Additionally, KLAS Enterprises has ranked Philips as the best overall cardiology PACS vendor in its Cardiology PACS Study published in June 2005. It also ranked Philips’ Xcelera cardiology PACS first or joint first in 10 categories…In the ambulatory and imaging center PACS specialty category, the KLAS Top 20: 2005 Mid-Year Report Card named Dynamic Imaging, Allendale, NJ, No. 1 for its IntegradWeb PACS…GE Healthcare, Waukesha, Wis, announced a worldwide distribution/sales representation agreement with InSightec Image Guided Treatment Ltd, Dallas, for the sales and marketing of ExAblate® 2000, an MRI-guided focused ultrasound system designed to noninvasively treat uterine fibroids. Also, the FDA has cleared the company’s Innova CT technology for its Innova digital fluoroscopic imaging systems. The company also announced signing a collaboration agreement with Daiichi Pharmaceutical Co, Tokyo, for the research and development of non-nuclear contrast media…Methodist Health System, Dallas, and US Oncology, Houston, are forming a joint venture to manage cancer radiation services at two sites in Dallas: the Methodist Dallas Medical Center, and a Texas Oncology-run cancer center…Analogic Corp, Peabody, Mass, has formed ANEXA Financial Services Inc to provide financial options for customers who want to buy digital imaging equipment from ANEXA Corp…Mitsubishi Electric Corp, Tokyo, will combine its MD211GS2P and MD211GS3P medical displays with the Matrox RAD PCI and RAD PCIe display controller boards by Matrox Graphics Inc, Montreal…Imaging Dynamics Co Ltd, Calgary, Alberta, Canada, has signed an OEM agreement with Summit Industries Inc, Chicago, for its Xaminer™ DR detector and software technology…SourceOne Healthcare Technologies Inc, Mentor, Ohio, and iCAD Inc, Nashua, NH, have signed an extended 2-year agreement for national distribution…Quest International Inc, Irvine, Calif, has signed an agreement with SYNNEX Corporation, Fremont, Calif, allowing SYNNEX to distribute its Totoku Medical Display Monitors.


Brad Levin

Dynamic Imaging, Allendale, NJ, has hired Brad Levin as the company’s new vice president of marketing…Merge Technologies Inc, Milwaukee, announced that Abe Schwartz has stepped down from the company’s board of directors to begin a new health care technology investment fund. The company also announced that Ram Ramkumar has been appointed to the board to fill Schwartz’s seat…CoActiv Medical, Ridgefield, Conn, appointed Robert Damiani as Northeast regional sales manager of the EXAM-PACS® division…peerVue LLC, Burlington, Vt, has appointed Sandeep Bhat to focus on sales of peerVue’s digital teaching file product line, and Richard Smillie to assist in developing strategic relationships and sales support…Milton Silva-Craig has been elected to the board of directors of Neurognostics Inc, Milwaukee…The American Healthcare Radiology Administrators, Sudbury, Mass, announced that 69% of the 13 radiology administrators who took the Certified Radiology Administrator (CRA) examination in August received a passing score, and may be recognized by the credential after their name. They are: Leslee K. Arthur, CRA, Newark, Ohio; Gregory A. Fields, CRA, West Burlington, Iowa; Peter C. McCormack, CRA, Temple, Tex; Steven P. Metcalfe, CRA, Grand Forks, ND; Adrian Riggs, CRA, Roseville, Calif; Verlon E. Salley, CRA, Cincinnati; Daniel L. Whitt, CRA, Riverdale, Ga; Cindy Winter, CRA, Wappingers Falls, NY; and Ruth A. Woosley, CRA, Dayton, Ohio.