Modern breast image
The doctors Nader M. Amirfallah and Bernd Knoben run a modern radiology practice at two locations in Dortmund. The diagnostics focus in the Franziskanerstrase is: conventional radiography, computer tomography and nuclear medicine. There are a health insurance approved public magnetic resonance tomography and a digital mammography screening centre in the Stadtkrone Ost area. X-ray film is a thing of the past in both parts of the practice. The radiologists make all X-ray images, mammography, body and extremities, with a film storage system and evaluate them on high resolution monitors.
A prerequisite for the conversion from conventional X-ray technology to computed radiography for Dr. Nader Amirfallah was a system which is suitable not only for radiography but also for mammography.
The time was ripe for him in 2005. Different manufacturers provided EUREF-compliant computed radiography systems (European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services) which included all features for participation in the national mammography screening program.
A further feature which he required from the digital recording system was networking capability.
The new system should be added to an existing multi-site RIS-PACS infrastructure (Radiology Information System, Picture Archiving and Communication System).
Film storage mammography EUREF compliant
Dr. Nader Amirfallah describes the selection process as “The high performance, the low space requirement, the EUREF compliance and the networking capability quickly brought the Konica Minolta system to the front”.
He evaluated technical specifications and quotations for different systems from several manufacturers jointly with his colleagues before they decided first on a Regius system in the main practice and shortly afterwards for another one in the practice in the Stadtkrone Ost area, with the mammography screening centre.
Both practices are networked via a dedicated line. The readers send the images from Visus to a PACS. A central database ensures that all patient data and images are available at any time at both locations.
Dr. Amirfallah says “The Konica Minolta readers in combination with the Visus PACS are a very pleasant combination”. After all interfaces were identified and defined, the data exchange between the three systems from different manufacturers ? RIS, PACS and digital X-ray ? functioned smoothly.
In the meantime, the radiologists are spending significantly more time in front of the computer than with the conventional way of working. There are numerous tools available to them today for image processing on the Visus Jive X evaluation console.
The possibilities of infinitely magnifying image sections, changing brightness and contrast saved many a patient a repeat X-ray and thus higher exposure. Thus, the mammography with the digital CR system from Konica Minolta corresponds with the core ideas of the screening program: Finding as many so-called T1NO tumors (small tumors without metastasis) as possible with as little exposure as necessary.
Dr. Bernd Knoben is in contact with the screening program reference centre of the Munster university clinic every working day. His assistants input their quality measured values using the World Wide Web and receive approval online for every individual screening date. So a closely-meshed quality control is unique to date.
If we had known how simple and pleasant the work process with a computed radiography system is, we would have decided on it much earlier”. Dr. Nader Amirfallah
Image processing avoids repeat X-rays
“We are achieving a significantly higher assessment in the vicinity of the thoracic wall using image processing. Today we can evaluate recordings which we had to also print earlier” is how Dr. Amirfallah describes the benefits of the digital technology.
The radiologist and his colleagues perform approx. 4,000 to 5,000 mammographies per year.
With the Regius system from Konica Minolta, the examination process is significantly more efficient and more pleasant than previously.
In doing so, both dual slot readers are operating a long way below their performance limit.
“Both the Regius systems could cope with a significantly higher patient throughput, they are second to none for performance and fit almost everywhere due to the low space requirement” says Dr. Amirfallah about the configuration of the systems.
The assistant sends the X-ray order with all patient data directly from reception to the operating console of the CR system. There are no longer any scribers or order notes in both the Dortmund radiology practices.
The system was installed in only one day and the X-ray assistants mastered the new technology in less than half a day.
The doctors planned two weeks of parallel operation and a gradual conversion. Yet, they did not switch on the developing machine at all for the first time on only the second day.
An application specialist from Konica Minolta ? an experienced X-ray assistant herself ? supported the team in the practice with adjustment of the system parameters and showed how to use the Regius system.
The X-ray assistants said “The really simple operation of the system using the touch screen interface and the intuitive menu guidance made our work a lot easier”. The time from exposure of the cassette to the finished image is shortened enormously by the use of digital recording systems.
The doctors and assistants have more time again for the patients.
An intuitive user interface combined with simple menu guidance and touch screen monitor make the work of the X-ray assistant much easier.
The patient data are read in at reception from the insurance card and sent directly with the X-ray order to the operating console of the examination machine.
Access at any time also via UMTS
In Dortmund there are four digital screening units which are networked not only with the reference centre but also with each other. One of the greatest benefits of digital radiography for Dr. Amirfallah is the availability of all photographs at any time.
It often happens that he is in discussion with colleagues away from the practice. “Then I can simply turn on the notebook, dial in using UMTS and load images from the PACS” explains the radiologist.
The team from the Dortmund practices would no longer like to dispense with the computed radiography system and return to film development with all its inconveniences. Dr. Amirfallah puts a value of approx. 15 to 20 square meters on space saved since the conversion to digital radiography. The former darkroom will initially be redesigned as a comfortable waiting area, possibly with access to the World Wide Web.
Waiting times cannot be avoided in radiology. Numerous patients come with acute complaints and must be urgently diagnosed. In doing so, they benefit in the Dortmund practices from the efficient work processes and fast assessments which the doctors also create in a digital system with online speech recording. The diagnosis is usually completely finished even before the patient leaves the diagnostic centre. Necessary further treatment can be initiated immediately.
Dr. Amirfallah: “If we had known how pleasant and beneficial the practice runs with a CR system, we would have invested in the new technology earlier”. The faultless commissioning and implementation of the digital system with simultaneous ongoing certification of the screening unit by the Munster reference centre still impresses the radiologist and his colleagues.
The use of digital methods for diagnostics changes the operation of the practice. The examination times shorten, the digital image processing needs time, however ensures certain diagnoses.
And all that in a clearly comfortable environment for doctor and patient.