Imaging department reaps benefits of tomo after careful implementation

Curious about what rolling out digital breast tomosynthesis (DBT) may do to daily operations in your department or practice?

Lilian O. Ebuoma, MD, of the Baylor College of Medicine department of radiology, and colleagues recently implemented DBT at their breast imaging department. They wrote about the experience for the Journal of the American College of Radiology, stressing the importance of taking things one step at a time.

“We had to decide on a clinical pathway that would give our radiologists time to transition, not cause workflow bottlenecks, or increase patient wait times,” the authors wrote. “A vital aspect of implementing DBT into clinical practice is successfully integrating it into established workflow patterns, with minimal negative impact.”

Ebuoma and colleagues wrote that the first step was getting staff fully prepared for the transition. From the person answering questions from behind the front desk to the radiologists interpreting the images, each staff member had to adapt to this new technology and how it would impact their day-to-day operations.

“With growing expectations for rapid report turnaround times, we knew that it was crucial for our team to integrate this new technology as seamlessly as possible to avoid potential negative downstream effects and workflow inefficiencies,” the authors wrote.

Next, the team was faced with a decision: do they use DBT for screening purposes only, diagnostic purposes only, or a hybrid of the two? To answer that question, the team weighed the advantages and disadvantages of each method.

Some in the industry believe using DBT for only diagnostic examinations is the best method for implementation, noting that it keeps the volume low as radiologists adapt. The authors disagreed with this sentiment, however, and said it leads to radiologists wasting DBT’s potential.

“An important thing for a practice to keep in mind when using the diagnostic-only pathway is that it undermines the main advantages of this technology: the improved cancer detection rate and reduced screening recall rates,” the authors wrote.

The department ultimately settled on the screening-only method, meaning that all patients would be screened with DBT. The perceived downside to this approach is that it takes radiologists significantly longer to read DBT examinations than standard digital mammograms, but the authors found that the numerous benefits of DBT make the delay appear insignificant by comparison.

“It is important to keep in mind that overall, despite the increase in interpretation time, there may be no significant change to the workflow, given the decrease in unnecessary time-consuming diagnostic mammographic examinations and ultrasound evaluations,” the authors wrote. “Also, the patient-centered outcomes of reduced recall rates and improved cancer detection rates trump any slight increase in interpretation time.”

Two years later, the team took its final step and moved from screening-only to a combination of screening and diagnostic DBT examinations. The staff also uses DBT for troubleshooting when necessary, giving everyone an extra tool to use when problems arise.  

With their own successful implementation now complete, the authors said they hoped the benefits of DBT could be properly spread.

“Marketing of this new technology should target both physicians and patients,” the authors wrote. “In addition to journals, conferences, and advertisements, a newsletter citing the evidence to support DBT can be circulated to referring physicians in the community. Patient-directed brochures that address common questions and promote DBT’s benefits can be distributed and placed in patient waiting areas.”