No doubt that many of you reading this post have already seen the volumes of articles and posting on the efficacy of digital breast tomosynthesis (DBT). Entire learning tracks were dedicated to this topic at the recent Radiological Society of North America (RSNA) conference, European Congress of Radiology (ECR) and other congresses around the world. DBT is a fairly new technology that can provide physicians with an additional tool in the fight against breast cancer. Whether you are already convinced of the benefits of (DBT) or still sitting on the fence, DBT is coming, and image size and workflow are at the forefront of the conversation.
Image size – Implementation considerations
Unlike standard full field digital mammography, DBT multiplies the number of images per view and typically provides 50-100 slices per view depending on breast size. An average, uncompressed tomosynthesis image averages 450 MB in size – larger than a typical CT of the chest, abdomen and pelvis. In the United States, DBT images must be stored in the original format as lossy compression is not permitted. This makes the implementation, transmission and storage of 3D DICOM breast tomosynthesis objects (BTO) something that organizations need to plan for in a different way than preparing for the addition of a new CT or MR.
Workflow – Break the cycle of ‘back and forth’
Did you know that radiologists estimate that using workstations dedicated to a single modality can waste up to 28 minutes per day?  Or that variability in the tools and options available among workstations can add up to 18 minutes per day? 3 Reading DBT on a stand-alone workstation – as opposed to using tools integrated with the PACS – can impact productivity, causing radiologists to move back and forth between a PACS workstation, a modality workstation, and back to a PACS to see images from other modalities or historical reports for a patient.
As important as productivity and diagnostic confidence is to a radiologist, access to these images by clinicians and other specialists is important to the overall patient care process. Implementing a viewer, either web-based or zero footprint, can give referring physicians and specialists access to the current and prior images as well as other breast imaging studies. This may help to enhance patient care and improve clinician satisfaction with the services you provide.
Storing DBT images in your PACS enables radiologists to pull multiple prior exams over different time periods without the need to retrieve them from an archive and reload them on to the workstation (again, more toggling between systems). It also enables access to images from other modalities. Having tools in the PACS that support the reading and analysis of 3D breast tomosynthesis can help to improve radiologist productivity and confidence in the diagnosis.
DBT – Ask yourself these questions
If you’re considering DBT, and as I said – it’s coming – ask yourself and your current vendor these questions:
- Is your current PACS system able to store breast tomosynthesis objects in the DICOM standard format? If not, do you need to upgrade?
- Are your workstations ready? Is the software approved for reading DBT? Will the hardware need to be upgraded to support processing of these large images?
- Does your breast imaging software support the reading of multi-modality images? Can this be set up as part of the hanging protocol to help improve productivity?
- Will your network support the transmission of DBT images?
No doubt you’ll continue to see more discussions around DBT, at GE we’ll be hosting several webinars on the topic – if you’d like join, the first will be with Imaging Technology News on April 23rd – Universal Viewer with Breast Imaging Part I: Enhance Workflow. You can register for this webinar on Imaging Technology News.
 Radiologists’ Burden of Inefficiency Using Conventional Imaging Workstations, Dr. Bruce Hillman, Journal of the American College of Radiology. November 20132- Source: Radiologist Compensation Report 2012, Medscape