iaea human health series publications - SEDIM

monitors. This option increases the report time for a study and has negative impacts on the radiologist’sconcentration and efficiency, with the possibility of reducing reporting accuracy.(5) Consideration of environmental issues to address the heat and light generated by the computers and monitors.(6) Consideration of ergonomic improvements of the reporting environment to avoid eye strain and problemswith the wrist and shoulders. This includes an analysis of the number of monitors needed to view patientinformation as well as the increasing number of images from other digital modalities.5.6. COST CONSIDERATIONS5.6.1. Procurement and maintenance costsWhile the cost and disposal of chemicals for film processing are eliminated with digital mammography, thecost of acquiring and servicing a dedicated digital mammography system is several times that of a screen filmsystem. The cost of the high resolution monitors used for interpretation is also greater than that of mammographyviewboxes and multiviewers. It is, however, less costly to convert to CR systems, as the existing mammographysystems can be utilized and both large and small cassettes are available. Nevertheless, DX has been found to be lesscostly than screen film mammography over the longer term [44].In addition to the initial and ongoing costs of X ray equipment, procurement and maintenance of a PACS willbe required for the efficient use of digital mammography. In this case, the total costs of computer software andhardware, a high speed local network, as required, and a wider area network need to be considered. However, thisis less of an issue in a facility that is already, or will be, performing other digital imaging.During the transition phase from screen film to digital mammography, capital and labour costs of filmdigitization may be incurred, including the purchase cost of a high quality film digitizer.5.6.2. Improving efficiency and accuracy of practiceDigital technology facilitates telemammography, with improved service to under-resourced areas. Digitalsystems can be installed on a bus that travels to remote areas, and the digital images produced can be seenimmediately by the radiographer so that an image with positioning problems can be repeated before the patientleaves the bus. These screening images may then be sent over a high speed communications network to a site wherea radiologist specializing in mammography can review and report the examinations, with a faster turnaround timeand less waiting and anxiety for the patient. The images can be sent across the street, across town, or to a regionalor national centre to the radiologist, who no longer needs to travel to the remote site to report, or to wait until theimages are delivered.There is improved efficiency for radiographers, who no longer have to process films. However, CR typedigital mammography systems still require handling and processing of cassettes in dedicated readers, and thereforethe associated risk of musculoskeletal strain is not eliminated. In addition, care must be taken not to decreaseappointment time unduly for DX, otherwise the risk of repetitive strain injury will increase and the client’sexperience of the examination may be compromised. Mammography guided procedures such as pre-operative wirelocalizations and galactograms can be done more quickly when there is no longer a need for films or cassettes to beprocessed. This decreases both the time that a breast is in compression during the localization procedure and thetime a radiologist spends on the procedure.29