In western countries, the carcinoma of the breast is the most common cancer in women. In order to improve the cure rate, it is of major importance to detect the disease at the earliest possible stage. As a results goverments have initiated nation-wide mammography screening programs. For this purpose, it is necessary to link a variety of IT systems, and to ensure smooth workflow across a multitude of locations. But curative mammography, too, entails particular requirements regarding image logistics and image display.
Mammographies are captured, to an increasing extent, digitally through Computed Radiography (CR) or Direct Radiography (DR) systems. The complementary exams relevant for mammography are usually also carried out in digital format (MRTs or ultrasound exams). In combination with information systems linked via worklists, this provides the cornerstone for the realization of a smooth holistic digital workflow. Patient admission is done in the information system, as is the planning of, and request for, the exam. The worklists generated automatically based on this information ensure the necessary consistency of the data. This safeguards that it is possible to locate all the data pertaining to a case. This applies to the technologist in radiology as well as to the reporting radiologist.
After the exam itself is finished, the technologist checks the quality of the images at a workstation. In doing so, he will take particular notice of good image quality and correct documentation in line with regulations. It is a requirement that - in addition to patient information - exposure data and further information relevant regarding the exam need to be linked to the image. If there are no objections, the images are then passed on to the physician for reporting. Dedicated workplaces can be defined for this automated transfer beforehand.
During reporting, routine work steps are automated by highly specialized hanging protocols. These have been programmed on the basis of know-how from many expert reporting physicians. The use of hanging protocols safeguards rapid and efficient reporting. In order to make sure that the physician "feels at ease" with his reporting environment, the hanging protocols as well as their graphic user interface can be adapted to the individual needs.
The main support for the reporting process is provided by automated pre-fetching of previous exams and their standardized display on screen. This helps the physician to carry out reporting in a safe and quick manner. A multitude of image processing, e.g., zooming, greyscale windowing, adaption of luminance and contrast or inversion, are there to provide additional support. In conclusion, this leads to increased certitude in reporting and therefore to optimized quality in reporting. Further support can be achieved by integration of computer-aided detection systems (CAD). For additional benefits regarding ergonomics, the application can be managed via keyboard as well as, in addition, a keypad.
Reporting documentation is realized in a structured manner and in accordance with international standards (the ACR scheme and BI-RADS classification). The categorization defines, on the one hand, mamma density (ACR) and, on the other hand, the risk for carcinomas is appraised. Subsequent care strategies for the patient can be deduced from this. Input takes place with an optimized workflow, via the numbers pad of the keyboard or an additional keypad.
Archiving of images and reports is done in a flexible manner, adapted completely to the needs of the individual customer. For example, data can be stored on CD or DVD in a single media archive, or in networked structures in the Storage Area Network (SAN). The most recent option is Storage Service for PACS (SSP). This service enables the customer to store his data in an external archive. This type of data storage enables cost-optimized operation for the user. With full orientation of fees towards use, the customer is not required to make investments and tie up capital. Cost can be planned because there are no additional expenditures for migration, administration, or maintenance.
No matter which archiving technology the user selects, his access to all previous exams is ensured at any time. This includes information from a third-party PACS, too. In addition, X-ray films generated and scanned externally can be integrated seamlessly into the workflow.
Mammography screening entails extended requirements regarding integration and image logistics. Software applications for screening campaign purposes which organize the invitation procedure and manage the client data.
VISUS is capable of covering all processes around image logistics for mammography screening online as well as offline. In doing so, JiveX supports mobile units as well as structured reporting at a multitude of sites and complies with the IHE-defined workflows.