Mammograms go digital

Entertainment isn't the only place the digital revolution is happening. The diagnostic tools of medicine are going digital too and in many cases that means early detection of disease and improved prognosis. One of the new technologies making an impact is digital mammography. The addition of a digital system at Oak Hill Hospital puts Hernando County among the 8 percent of the country where it's available.

The new digital mammography system - the only one in Hernando County - is the jewel in the crown of Oak Hill's equally new Women's Imaging Center, which opened last month. The machine takes clear, sharp digital images very much like a digital camera. Ten seconds after the X-ray is taken it can be viewed and checked for quality.

"If the patient moved a little bit or if there was a skin fold or if the nipple was rolled under, I can see that immediately and know if I need to make any additional exposures," explains Stephanie Pratt, one of Oak Hill's mammography technicians. Pratt can also lighten or darken the picture, zoom into certain areas, type notes for the radiologist if needed or circle an area of interest.

Any doctor with access to the system and the patient's records, in or out of the hospital, whether it's a primary care physician or a doctor called in for a second opinion anywhere in the country, can view the image or have it sent to a phone. It can also be printed or burned to a CD.

"We don't have to worry about losing films anymore. It's all electronically filed," says Pratt. "The biggest advantage is no more repeats for technical issues."

Helping Doctors "See" Better

Improved image, ability to zero in instantly anywhere on the image and computer aided detection software helps radiologists spot even the tiniest calcifications more easily. They can throw away their magnifying glasses and get a good look at the whole breast with the touch of a button.

Dr. Scott Yochim, one of Oak Hill's radiologists thinks it's "awesome." From where Yochim sits one of the best advantages of digital over film (analog) is increased contrast resolution, which allows him to see the skin around the breast.

"With some kinds of cancers you'll have skin thickening. On the analogue image you can't really see the skin. And the subcutaneous fat you can't see very well either on the analogue but on he digital you see subcutaneous fat very well."

Since all previous film images have been scanned into the system, along with the patients records, questionnaires and doctor's notes, Yochim also has instant access to information when he needs it. "It's easy to compare with other studies because the prior studies are all on the digital system. So we're able to see skin better and we're able to differentiate soft tissue and calcification and if I hit a little key the computer aided detection software puts up a little box and says that the area is suspicious and then it's up to me to decide if I agree. It's like having a second reader," says Yochim.

Research Shows Value of Digital Mammo

The National Cancer Institute (NCI) conducted a $26 million trial comparing digital mammography to film mammography. It took place between 2001 and 2003 and included 49,500 women in the United States and Canada. It showed that the digital mammo was significantly better than film in screening three particular groups: Women under age 50, women who were pre- or perimenopausal and most important - women of any age with dense breasts.

Film X-rays can't fully penetrate dense breast tissue making it more difficult to detect abnormalities in their early stages. Younger women are most likely to have dense breasts though the denseness lessens with age. Estrogen replacement therapy, menopause and changes in weight can also affect it. But the only way for someone to find out if they have dense breasts is through mammography. So if a woman doesn't know what she has, it's advisable to ask her doctor.

Screening mammography in general has been shown to reduce breast cancer deaths anywhere from 18 to 30 percent. This study indicated that digital screening would detect at least as many breast cancers as film mammography over the whole population and more advanced or serious cancers in the groups mentioned above. It also showed that the kind of lesions in those groups detected by digital systems were the types of cancers that lead to death. Those same lesions did not show up in film mammograms.

However, that does not mean that film mammography, which has been used for more than 35 years, is obsolete or ineffective as a breast cancer screening tool. In fact the trial showed that there was no apparent advantage for women who were over 50, did not have dense breasts and were no longer menstruating.

The Comfort Zone

Because there is no film processing, and less possibility for 're-takes' digital mammograms take about half the patient's time. The radiologist's ability to adjust the image and access the medical records and history helps him or her read the X-rays faster. A voice recognition system for the radiology report also saves the radiologist a lot of time and patients get the results of their tests more quickly.

"Much of the written report they do is already pre-loaded," says Richard Linkul, Marketing Director at Oak Hill. "The image is there, the reports are there, he approves it, he signs off and it's now available for everybody."

"Before I'd dictate it into a system there would be a transcriptionist who would type up the report," says Yochim. "There'd be lots of errors because there would be things I would say that they didn't understand and there'd be typos so I'd have to go back and check the report hours or days later. Now I can read it and sign off."

The digital mammogram also addresses the chief complaint women have about them - the discomfort caused by the compression of the breast needed to get a good, readable image.

Deborah Harris, Patient Care Coordinator of the Women's Imaging Center says with digital mammography the time of compression isn't less but the machine's paddle shape and its ability to toggle lessens the pressure a bit.

"Before when compression went down it was the same thickness on the breast top to bottom. You know the breast is always thicker at the chest wall than it is the nipple," explains Harris. "It went down and if the nipple wasn't tight you just had to keep squeezing at the chest wall until that nipple got tight. Now it goes down, it knows when there's enough and it toggles itself so the whole breast has enough compression, it's not necessarily as tight on the chest wall and that's where everybody felt like it's pulling off."

Does Everyone

Need To Go Digital?

According to the NCI study, 40 percent of women who have screening mammograms have dense breasts and would benefit from digital mammography. For them, women under 50 and pre- or perimenopausal women, digital mammography is a better option.

But since there are so few digital mammogram centers, it is not recommended these women wait until they can find somewhere to get one.

For the rest - women over 50 who don't' have dense breasts and no longer menstruate, film mammography is just as accurate. The study also says no one who's had a film mammogram in the last years need to repeat the test unless they've developed symptoms.

It is believed the decline in the breast cancer death rate is a result of early detection. For this reason mammograms of any kind are considered extremely important.

"A woman should start screening at 40 years of age," says Yochim. "Women who have a family history of breast cancer should start 10 years before their relative had breast cancer. So if their mother was diagnosed at 40, they should start at 30."

For more information about digital mammograms or any of the other services provided by the Women's Imagining Center, call 888-219-4129, Ext. 6099.

For appointments, call 800-921-7158.

For more information on other Oak Hill services, visit www.OakHillHospital.com.