16 Matthew Bell, MD, is a board-certified diagnostic radiologist with a specialty in breast imaging. He spent some time with us talking about how digital imaging storage technology impacts and enhances his daily work. Scality: On average, how many individual studies do you read each day? Dr. Bell: A typical day would be 40 screening mammograms, 15 to 20 diagnostic patients (most with mammogram and ultrasound), some with only one or the other, 2 to 4 MRI scans, and 2 to 5 biopsies. What percentage of your work requires comparison with prior studies of the same area? The vast majority of my work requires, or at least benefits from, comparison with prior studies. Exceptions mainly being baseline studies or patients that don’t have any recent prior exams (within the past ten years). How far back do you typically look when reviewing priors? A minimum of two years back for most patients. High risk and/or complicated patients may need comparison with exams dating back up to ten years. For a routine mammogram, I understand that there’s almost always a comparison with past studies. What percentage of mammograms are return patients versus new, first-time patients? Approximately 80% of the patients receiving screening mammograms have had previous mammograms. How far back do you look on those prior mammograms? Is it different for a patient who has a history of cancer? With the inherent efficiencies of digital PACS (picture archiving and communication system) it’s possible to quickly look back at many years’ worth of prior exams. For a straightforward, normal appearing exam, comparing up to two years back is often sufficient. For complex, potentially abnormal appearing exams, comparing up to ten years may be necessary. What are the advantages of being able to view accurate past studies? The advantages are great: Fewer false positives. An exam read as abnormal requires follow-up that involves additional imaging and possibly even a biopsy to prove that there is no significant pathology. Avoiding those additional procedures when they’re not necessary is, of course, a goal, and having quality past studies available for comparison can be pivotal. Fewer false negatives. Accurate past studies help avoid the misinterpretation of an exam as normal that in fact has significant pathology. Accurate and timely diagnosis means that the patient can get additional diagnostics and/or treatment more quickly. The respective converses are also true: more true positives and more true negatives. In a nutshell, by comparing to priors, I can see what is stable and therefore most likely benign and what is new and potentially significantly abnormal. When it’s not a pre-set appointment, so pre-fetch wasn’t an option, how long do you typically have to wait for retrieval of a past study? The wait time is widely variable. Generally obtaining prior exams from a local facility is faster than from out of state. Screening mammograms should be read within 30 days. Diagnostic exams will be read [the] same day with the caveat that recommendations, for example to biopsy, are contingent upon comparison with priors. MRI scans are typically read same day with or without priors. When prior exams become available, a comparison is made and an addendum to the report is generated. I know that you work in multiple facilities; does the retrieval time vary by facility? Different facilities have different PACS and different retrieval times. The more integrated the facility is with others, the more efficient the retrieval of priors is. How much impact would it have if you couldn’t trust the integrity of the stored data? Huge impact. Missing or corrupted exams significantly affects interpretation. On a scale of 1 to 10, how much do you value data integrity? 10—absolutely. What are the implications of less-than-optimal data integrity? For breast imaging, high resolution and faithful retrieval of prior studies is essential to accurately diagnose breast cancer. How much do you value speed of access to past studies? Very highly. In a busy facility, it’s critical to have rapid access to prior studies. As a partner in a radiology business, how concerned are you with economy when it comes to data retention costs, given the importance of keeping prior exams available? Cost is certainly a consideration, but quality and efficiency are most important. Do you have concerns about data Privacy? Certainly. Data encryption and adherence to HIPAA standards are absolutely necessary.
