Tomosynthesis and Value-Based Care Bring Significant Tech Demands


The good news is there’s a lot we can learn from women’s imaging. The bad news is that expanding value-based care to all imaging areas will require stronger technology support than many hospitals currently have.

The Mammography Quality Standards Act was enacted in 1992, and its regulations went into effect in 1999. The result, according to Dr. Marcia Javitt, was an increase in imaging ordered through clinical decision support based on appropriate use criteria.

Javitt says physicians from women’s imaging have emerged as the very best in evidence-based image interpretation, transparency, and accountability. There are several reasons for this:

  1. MQSA requirements include follow-up of positive mammographic findings, tracking pathology results for all biopsies, and radiologic-pathologic correlation.
  2. Outcomes audit data are tabulated for each interpreting physician and in the aggregate at mammography facilities at least every 12 months.
  3. Computerized tracking is typically used to calculate the data required for most MQSA audits. Sensitivity, specificity, recall rate, positive predictive value level 2, and cancer detection rate are included at the minimum.

In addition, says Javitt, the entirety of the clinical process and patient experience is scrutinized, including: study appropriateness; time to final report; timeliness of reporting critical findings; equipment utilization; radiation exposure; prevalence of contrast-induced nephropathy; ease of access to care; waiting time for appointments and service; peer review; patient mortality; length of hospital stay; time to diagnosis; medical errors; and complication rates.

Clearly the degree of system integration, workflow management, and data analysis will need to rise for many hospitals as they attempt to bring this level of sophistication and value emphasis to the rest of the imaging department.

Concurrent with the workflow/analysis requirement is a need for greater storage and network bandwidth. Tomosynthesis is becoming widely adopted, especially for breast screening. While a conventional 2D breast image is about 22 MB, a digital breast tomosynthesis (DBT) image is about 380 MB. Because it is common practice to store three copies of each image, both storage and bandwidth will need to increase by an order of magnitude.

Want to learn more about the promises and implications of digital breast tomosynthesis? Join McKesson, our partner EMC, and Radiology Regional Center on Feb. 23 (8 am PST/11 am EST) for an informative webinar on lessons learned and best practices in DBT. Register now.

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