Setting up efficient breast imaging reading workflow

Supporting screening workflow

Screening workflow puts very specific demands on your Breast Imaging PACS. Often images are taken at several different locations, including satellite offices and mobile trailers, but read at a center. Such a distributed scenario is in place to serve women living in rural areas. Choose a Breast Imaging PACS that supports distributed environments, telemammography and remote reading, even over latent networks. This includes local cache functionality and worklist subscription, which ensures that relevant examinations are transferred automatically according to preset requirements.

Screening programs usually involve a high volume of women being examined. In order to achieve high quality interpretations, many imaging providers practice double or triple-blind reading. Make sure your Breast Imaging PACS supports this workflow.

Concentration of information

The core of creating efficiency in breast imaging workflow is ensuring that your radiologists are as productive as they can be. You want to make sure they spend their time reading images, not searching for information, moving between workstations or waiting for different tools to launch. Some of the considerations to take into account:

• Make sure you have a dedicated Breast Imaging PACS that can support images from all modalities regardless of type or vendor. Using multiple breast imaging modality workstations for Mammography, Ultrasound and Breast MR reading will result in radiologists losing time as they move between different workstations, as well as losing focus. It will also require them to readjust their eyes if they have to move from room to room.
• Give your radiologists their own workspace. If possible give them their own individual room for each to organize their workspace and make sure your Breast Imaging PACS can support individual settings. When each radiologist logs in he/she should automatically get his/her preferred settings. Some radiologists want to read with high contrast, while some want a more neutral setting. Your Breast Imaging PACS should support these customized options.
• A seamless integration between your Breast Imaging PACS and other systems, such as RIS, HIS, mammography reporting or existing archives is a must for achieving optimal efficiency. Integration between systems means information only has to be entered once since the information will be accessible from the other systems automatically. This enables radiologists to have access to all the information, prior reports and prior examinations needed to make a diagnosis from a single workstation.

Smart tools enable efficient reading

With the high volumes read by breast imaging radiologists, every PACS feature that helps accelerate diagnosis matters. Problems arise for radiologists when images are displayed in different sizes, hanging protocols miss important images, or settings are changed since the last time they logged in. These are all examples of distractions that slow down the radiologist’s productivity. What should be available in a Breast Imaging PACS includes the following:

• A Breast Imaging PACS should be able to display prior and current images side-by-side with the same size regardless of modality type and vendor.
• A Breast Imaging PACS should integrate easily with third-party applications, such as CAD products.
• Images should be displayed according to each radiologist’s preference as soon as he/she starts reading. This is best done using a combination of automatic hanging protocols and manual preparation by the technician.
• All images that were acquired in the examination need to be displayed in a thumbnail view. If a technologist made an extra view because he/she wants a radiologist to see something then the radiologist needs to see that extra image. Hanging protocols can be used to automatically include all acquired images in a hanging.
• A Breast Imaging PACS should provide radiologists with settings and worklists specific to each individual. The radiologists should be able to search for patients any way they want, the system should remember their favorite settings, etc.

An ergonomic working environment

Radiologists spend several hours each day reading images. Make sure their working environment doesn’t wear them down. A few practices to consider:

• Put adjustable chairs and tables in the reading rooms
• Place the top of the monitor screen at eye level and the viewing area of the monitor at 15–20 degrees below eye level
• Eye-to-screen monitor distance should be 66 cm which is approx an arm’s length
• Appropriate ambient light in the room

Efficiency and patient care

In this article we have discussed some of the aspects of setting up efficient breast imaging workflow. The complex environment within breast imaging, often including high volumes, many different modalities and images produced at several locations, put high demands on the imaging practice and its radiologists. The right Breast Imaging PACS can help you maximize productivity, decrease report turnaround times and thus reduce women’s anxiety.