Digital Mammography and PACS

Full field digital mammography (FFDM) is a recent addition to the medical imaging modalities that are available in digital format. FFDM potentially provides the customary advantages of digital modalities: distribution, sharing, and access through any Web-connected computer and integration with a patient’s electronic medical record.
For the advantages to be realized, it must be integrated with the institution’s other medical information technology (IT), including the general picture archiving and communications system (PACS). Indeed, other digital modalities such as magnetic resonance (MR), computed tomography (CT), and ultrasound (US) are usually integrated with the general PACS and other medical IT for just this reason. The images and associated information are stored on the PACS. The radiologist reads and manipulates the images on the PACS, and then reports results and distributes the report from the PACS.
Thus far, institutions have treated FFDM differently, in part because the technology is relatively new in its development. Although integrating FFDM with the PACS and other medical IT is a viable option, the early evolution of the technology has seen many most institutions initially choose to read and report digital mammograms using non-PACS workstations .
Integration vs. Non-Integration
When a facility implements FFDM, it must decide how to read, manipulate, and report on the mammograms. One option is to integrate the digital mammography device with the institution’s general PACS and utilize the PACS reading and reporting tools, as with other digital modalities. Another alternative is to purchase a mammography-only specialty workstation or mini-PACS from the FFDM vendor, which does not integrate mammography images with others in the facility’s IT system..
*Simpler installation: It may be less complicated to install a mammography “island” than to integrate FFDM with the institution’s major IT systems .
*Workload balancing. Radiologists reading FFDM on a general PACS can shift to reading other modalities whenever institutional needs dictate. This is likely to grow in importance as radiology enterprises continue to evolve toward global, distributed enterprises - that is, institutions in which radiologic information can be accessed by diagnosticians from any Web-connected computer no matter where they are located geographically. Then, radiologists will be able to balance the workloads of numerous satellite offices, clinics, or hospitals .
*Financial efficiency. With integration, the institution does not have to invest in additional technology and an additional service contract .
*Ease of access by referring and consulting physicians. On an integrated system, referring and consulting physicians can access mammograms and related reports via the general PACS’ Web distribution system, just as they access other edata. .
Display Issues with Third-Party Equipment
The potential quality and safety issues related to the use of a display that is not from the original modality vendor should not be underestimated, however, whether the third-party display device is part of an integrated PACS, a different modality vendor's workstation, or a third-party standalone workstation. Given the difficulty of handling display and annotation of images and CAD marks from different equipment vendors, the IHE has defined a Mammography Image Display Profile, described in an IHE guide , with which all modality, workstation and PACS vendors claiming to support mammography should comply. Failure to comply likely signals a significant deficiency in capability that will likely affect either patient safety or radiologist performance.
The use of soft-copy displays for primary mammography interpretation, is also explicitly regulated in the US within the scope of the Mammography Quality Standards Act, beyond the ordinary PACS regulatory requirements.

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