April 4, 2013 Leave a comment
The challenges with digital breast tomosynthesis are well explained in this article on AuntMinnie, and very real. At Carestream, we have been working with digital breast tomosynthesis data from various vendors to provide solutions for these very same issues. Although there are many different aspects to consider when adding digital breast tomosynthesis, I’ll explain some of the solutions we’ve found and hope others find them to be useful.
Since digital breast tomosynthesis is relatively new, we are finding that the level of support each vendor provides varies significantly. We decided to embrace digital breast tomosynthesis from the start since we believe it will have a place among the various different technologies used to detect breast cancer. Other technologies will continue to evolve to the point where each will have a place as well. The clinical benefits of digital breast tomosynthesis are still being debated by some, but it has rapidly gained supporters in the Radiologist community.
While support continues to grow, two main barriers that exist include reimbursement and dosage. Reimbursement will definitely help encourage widespread acceptance from a business perspective. And, with the various acquisition device vendors working on synthetic 2D images, it appears the dosage barrier can be overcome as well. This may open the door for digitial breast tomosynthesis to be used on a regular basis in the screening environment.
Regarding the storage of the digital breast tomosynthesis data objects, we have found that in addition to the use of lossless compression, adequate network bandwidth and intelligent routing/pre-fetching of data are vital to efficiently move such a large amount of data transparently to the user. This is especially true when reading such procedures across multiple facilities and/or remotely. We are recommending that internal networks support 1 Gigabit, as some of the acquisition device vendors have done..
As mentioned in the AuntMinnie article, earlier digital breast tomosynthesis data may have been stored using a proprietary format. Our current understanding is that the conversion process being provided can be scheduled during the evening or weekend, so there is little or no impact during normal business hours. Although this conversion process can appear to be a daunting task at first, it is important for a site to maintain data that follows the DICOM standard moving forward for interoperability. Otherwise, the task becomes much larger at a later time. The same will be true for synthetic 2D images in the near future.
Another challenge outlined in the article is the additional time needed to read digital breast tomosynthesis images. Similar to when digital mammography was first introduced, users experienced a learning curve not only with reading the images, but also with using the workstations and the tools that they provided. We believe the same is true with digital breast tomosynthesis, where the reading time will decrease as both of these improve. Focusing on the tools provided by workstation vendors, we have found that a key aspect to optimize the reading time is not only through basic tools that automatically scale and position both 2D and 3D images, but also advanced tools that can help localize pathology and allow the user to quickly navigate current and priors studies. It is not enough to just stack a series of tomosynthesis slices and allow the user to scroll through them at will. With traditional 2D mammography, digital breast tomosynthesis, synthetic 2D mammography, and other mammography procedures (e.g. breast US, breast MRI, etc.) being generated, workstations with hanging protocols that can support and display all of these in an efficient manner become extremely important.
As the IHE Mammography Image integration profile is expanded to include digital breast tomosynthesis, our expectation is that the interoperability issues experienced early on will at some point be resolved by most vendors.
The video below shares more information about digital breast tomosynthesis and Carestream’s capabilities in that area.