Telemammography: implementation issues

Teleradiology with uncompressed digital mammograms: clinical assessment

PURPOSE

The purpose of our study was to demonstrate the feasibility of sending uncompressed digital mammograms in a teleradiologic setting without loss of information by comparing image quality, lesion detection, and BI-RADS assessment.

MATERIALS AND METHODS

CDMAM phantoms were sent bidirectionally to two hospitals via the network. For the clinical aspect of the study, 200 patients were selected based on the BI-RAD system: 50% BI-RADS I and II; and 50% BI-RADS IV and V. Two hundred digital mammograms (800 views) were sent to two different institutions via a teleradiology network. Three readers evaluated those 200 mammography studies at institution 1 where the images originated, and in the two other institutions (institutions 2 and 3) where the images were sent. The readers assessed image quality, lesion detection, and BI-RADS classification.

RESULTS

Automatic readout showed that CDMAM image quality was identical before and after transmission. The image quality of the 200 studies (total 600 mammograms) was rated as very good or good in 90-97% before and after transmission. Depending on the institution and the reader, only 2.5-9.5% of all studies were rated as poor. The congruence of the readers with respect to the final BI-RADS assessment ranged from 90% and 91% at institution 1 vs. institution 2, and from 86% to 92% at institution 1 vs. institution 3. The agreement was even higher for conformity of content (BI-RADS I or II and BI-RADS IV or V). Reader agreement in the three different institutions with regard to the detection of masses and calcifications, as well as BI-RADS classification, was very good (κ: 0.775-0.884). Results for interreader agreement were similar.

CONCLUSION

Uncompressed digital mammograms can be transmitted to different institutions with different workstations, without loss of information. The transmission process does not significantly influence image quality, lesion detection, or BI-RADS rating.

A multisite telemammography system for remote management of screening mammography: an assessment of technical, operational, and clinical issues

OBJECTIVE

This paper describes a high-quality, multisite telemammography system to enable "almost real-time" remote patient management while the patient remains in the clinic. One goal is to reduce the number of women who would physically need to return to the clinic for additional imaging procedures (termed "recall") to supplement "routine" imaging of screening mammography.

MATERIALS AND METHODS

Mammography films from current and prior (when available) examinations are digitized at three remote sites and transmitted along with other pertinent information across low-level communication systems to the central site. Images are automatically cropped, wavelet compressed, and encrypted prior to transmission to the central site. At the central site, radiologists review and rate examinations on a high-resolution workstation that displays the images, computer-assisted detection results, and the technologist's communication. Intersite communication is provided instantly via a messaging "chat" window.

RESULTS

The technologists recommended additional procedures at 2.7 times the actual clinical recall rate for the same cases. Using the telemammography system during a series of "off-line" clinically simulated studies, radiologists recommended additional procedures at 1.3 times the actual clinical recall rate. Percent agreement and kappa between the study and actual clinical interpretations were 66.1% and 0.315, respectively. For every physical recall potentially avoided using the telemammography system, approximately one presumed "unnecessary" imaging procedure was recommended.

CONCLUSION

Remote patient management can reduce the number of women recalled by as much as 50% without performing an unreasonable number of presumed "unnecessary" procedures.

Computer aided diagnosis for breast masses detection on a telemammography system

A Computer-Aided Diagnosis (CAD) scheme for breast masses detection has been developed and integrated as a part of a telemammography system. This work derives from the close cooperation between the Laboratory for Radiologic Image Research of the University of Santiago de Compostela (Spain) and the company Intelsis Sistemas Inteligentes (Santiago de Compostela, Spain). This cooperation has been supported by funds from different projects, mainly from the European Union, the Spanish Health Administration, and the Galician Public Health's Service. As a result, a first prototype is ready to begin a demonstration project.

A high resolution workstation prototype for diagnosis of digital mammograms

The development of a total digital high resolution mammography display system must meet a number of requirements that remain a challenge nowadays, most probably because of the special nature of breast imaging. In this paper, we discuss our particular approach to address some problems concerning the complexity of soft-copy diagnosis in digital mammography, such as image quality and user interface evaluation. Based on the experience obtained in the previous implementation of a medical image browser, a more ambitious project is being developed at the Department of Radiology of the University of Santiago de Compostela (Spain) in collaboration with the Department of Medical Informatics of INTELSIS, an emerging software company in our country. This new system will provide complete support to display, store and analyze mammographic studies in digital format.

Communication between older patients and their physicians

This article provides an overview of communication between older patients and their physicians. The authors discuss distinctive features of geriatric medical visits and empirical investigations of communication between physicians and older patients in real life clinical encounters highlighting the content, interactional processes, and outcomes of care. They also discuss strategies for improving communication between physicians and older patients using new and innovative technologies. The authors conclude that healing in its broadest sense can occur only through a humanistic approach to geriatric care.