iaea human health series publications - SEDIM

To allow full utilization of the digital environment in mammography, especially in a breast screeningenvironment, both a PACS and an integrated RIS or HIS are required. To maximize efficiency, this integrationshould preferably be seamless to facilitate well planned workflow customized to the facility’s needs. There must besynchronization between the RIS and the workstation viewer software to ensure that the patient record and theimages on-screen match. In the case of screening, this will then require that the RIS be customized to allowrecording of multiple mammography reports, double-blind reading, a third radiologist or consensus opinion and adetermination of the final ‘outcome’ of the reading. Other advantages of the fully integrated RIS include easyaccess to current patient clinical or referral information with little opportunity for information loss, and easy accessto past reports and clinical information. Useful ‘other’ information (e.g. biopsy reports) can also be scanned into theRIS for increased accessibility.The use of IHE compliant DICOM data in a PACS environment readily allows analysis of facility qualityindicators, such as the time taken for procedures, the time to reporting and actual reporting times, and this has apositive effect on facility quality improvement.5.5. TRAINING AND TRANSITION CONSIDERATIONS5.5.1. Special training requirementsWhile image reading with digital mammography is not substantially different from that with screen filmsystems, the process for image review is. Therefore, radiologist training is required in the use of workstation toolsand the RIS/PACS. Both radiologist and radiographer training in the use of vendor specific RIS/PACS features,‘new’ digital workflow processes, display protocols and use of software tools is essential. It has been estimated thatit might take up to 90 days for radiologists to adjust to the new reading environment, which may necessitate changesto patient scheduling during this period. Radiographers may initially find the transition to digital equipmentchallenging, especially if they are not accustomed to using computers. It is important that they adjust to workingwith the equipment features, rather than trying to work in the same way they did with screen film. In addition, theymust be careful not to repeat images unnecessarily as a result of the increased speed and convenience of DX.5.5.2. Planning for transition from screen film to digital mammographyThe transition phase from screen film to digital mammography requires:(1) Extensive planning, particularly for changes relating to workflow and display protocols. In some cases,hospitals and radiology practices have engaged specialized teams for long periods prior to the introduction ofdigital imaging and the PACS, and have included external professionals such as an architect in the transitionpreparation team.(2) A close working arrangement with the suppliers of equipment, to ensure that where there are options ininstallation configuration the equipment is set up in the way that best suits the facility’s needs.(3) Time for the radiologist to become familiar with the workstation, software tools, display protocols and RIS use.(4) Provisions for making comparisons between current digital mammograms and prior mammogram images. Astrategy is needed to manage this, and three possibilities should be considered:— Scanning of prior non-digital images into the PACS and display of these images in routine protocols tominimize the use of light boxes for analogue film viewing. While this is the most desirable from aworkflow and clinical perspective, the cost can be prohibitive. Apart from the cost of a high quality filmscanner, labour costs for the scanning must be fully considered. It should be noted that the film digitizationprocess demands high standards and that training is required for staff. In some cases, this scanning mightbe outsourced.— Scanning of comparison images on an as needed basis. This has the effect of extending the film scanningover a period of as long as 10 years. However, there is the advantage of the cost being spread out over thattime, allowing the transition to be manageable.— Maintaining the analogue (screen film) images, which are mounted on a viewbox or multiviewer. This isslow and awkward, and viewboxes need to be mounted carefully to avoid reflected light falling on the28