Digital mammary tomosynthesis: my adoption journey

By Dr. Regina Hooley

In the July 2018 issue of DOTmed HealthCare Business News Magazine

Radiologists frequently ask about the adoption of digital mammary tomosynthesis (TCD) and on the best way to implement this review. clinicians and patients. As a bad imager and Associate Professor and Vice President of Clinical Affairs at the Department of Radiology and Biomedical Imaging at Yale School of Medicine, I have a leading experience in the transition from conventional full field 2D digital mammography to DBT. In fact, Yale participated in a very recent clinical trial of DBT even before this form of screening was approved by the FDA, and since then I have witnessed its many benefits for both my peers and my patients. Reflecting on these experiences, from setting up to today, I can confidently say that all health executives who decide whether or not their institutions should move to DBT should make up their minds with a resounding yes.

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As in any industry, the introduction of new technologies and protocols can be daunting for employees already familiar with traditional processes. Fortunately, from my experience, this was not the case with DBT. Everyone in my group quickly discovered that it was not at all difficult to teach mammography technologists how to use it, largely because the technique is very similar to the conventional 2D FFDM. The key to success is that technologists must learn to teach patients to breathe during the exam because the tomosynthesis takes a few seconds longer than the traditional 2D FFDM. As is always the case, it is still important that patients try not to move while the technologist takes the "picture" in 3D so that the image is not blurred. Mastering the technical use of this new technology may not seem so different from its predecessor, but its effects are far from the same.

The main benefit of the DBT was clear and undeniable to me very soon after the initial use. It is not a secret today that the main benefit of TCD for clinicians and patients is that TCD offers more accuracy. Any radiologist knows that, above all else, accuracy is the most important part of a mammogram and a biopsy. This is what allows us to identify more early cancers so that patients diagnosed with bad cancer often have the option of less aggressive treatment while increasing their survival. From my personal experience, I know that accuracy is what also helps reduce false positive boosters, which reduces the need for diagnostic mammograms and short-term follow-up recommendations.

The only advantage of accuracy extends well beyond what we encounter at the beginning. By providing more accurate mammograms and biopsies, clinicians are really offering something on a larger scale – more positive experiences for patients. Patients diagnosed with cancer are able to start treatment sooner, hopefully, to improve, while fewer women experience the anxiety undoubtedly badociated with a booster for an additional diagnostic checkup. In my practice, we noticed a 50% decrease in screening reminders and fewer short-term follow-up mammograms. The precision of DBT improves the overall patient outcome for all, from start to finish. Similarly, institutions as a whole can benefit from the ability to serve more patients in a day, and more positive experiences can translate into higher performance scores.