by Ashley Mayzner
Portfolio Executive
10/16/20

When digital breast tomosynthesis was approved for mammography by the Food and Drug Administration in 2011, the 3-dimensional technology brought increased insight into women’s health care, but it did not replace 2D imaging. Instead the two systems complemented each other. Today, however, new technology is poised to change that.

As 2-dimensional full-field digital mammography (FFDM) systems and first-generation digital breast tomosynthesis (DBT) near the end of their service lives, facilities have an opportunity to replace both pieces of equipment with a singular device. Mammography technology is evolving, and supply chain leaders should consider the factors outlined below — advancements in early detection, how to increase throughput and total cost of ownership — when evaluating mammography purchases at their facility.

Advancements in early detection

The 3-dimensional DBT did not replace FFDM because patients are still required by the FDA to have an FFDM exam for screening. The combination of FFDM and DBT provides the radiologist with great depth resolution while still providing a retrospective 2D image that can be compared to previous mammograms. 

With the first generation of DBT systems, two separate radiographic exposures were required in order to leverage the synergy of FFDM and DBT. A second generation of DBT systems has changed that with technology that is FDA approved to create 3D breast tomosynthesis and a 2D synthetic image from just one rotational exposure. This technology is already on the market and can reduce the radiation dose to sensitive breast tissue while still giving the radiologist all the information needed to make an informed decision. 

Current DBT systems offer exposure angles for 3D images that range from the standard 15 degrees to up to 50 degrees. Systems with a wider degree angle allow for higher depth resolution, less noise, and less superimposition, which can lead to an increase in detection rates. By creating better tissue separation, wide angle DBT systems have the potential to help avoid unnecessary biopsies and misdiagnoses.

Because early detection is key for treating breast cancer, considering the latest advancements in detection is crucial to consider when purchasing a mammography system.

How to increase your throughput

In health care there is always a need to increase patient throughput without having to budget for additional capital expenditures. There are now additional features that can create a faster workflow and streamline the patient experience. The normal amount of time for a DBT exam is about eight minutes, which includes time to complete each view, reconstruct, reposition and wait time in between each position. New mammography technology allows the same detailed images to be acquired in six minutes or less, allowing for up to 10 exams per hour.

Besides faster scan times, new mammography technology offers additional productivity boosts with artificial intelligence breast density software and contrast-enhanced images.

Breast density scoring is required by the FDA on every mammogram, and the radiologist must provide it. AI software that automatically assesses the density of the breast tissue reduces radiologist workload and eliminates the need for women with dense breasts to be recalled for additional imaging after they have left the clinic. Furthermore, with the use of contrast-enhanced mammography to detect or rule out lesions in difficult cases, a facility could potentially eliminate the need for scheduling an MRI or ultrasound for further characterization necessary with older technology and equipment. 

New mammography technology also offers throughput advantages that go beyond breast imaging. For more complex pathology, some suppliers have taken the ability to confirm a diagnosis a few steps further with one-click lesion targeting, biopsy applications and integrated specimen imaging.

Further productivity gains are available with drastic reductions in the time needed to complete quality assurance testing. Required quarterly detector calibrations can take up to 76 minutes away from normal business hours, creating less time for patients to be scanned. Now, some mammography units can complete these quarterly exams in just five minutes, equating to 90% less downtime.

It is important for supply chain professionals to understand that mammography systems play a critical role in a larger process of diagnosing breast cancer. Evaluating the workflow and other supplies used in conjunction with the mammography system is pertinent to selecting the right system for your facility.

Total cost of ownership

Equipment price, service maintenance, replacement parts, accessories and supplies should all be factored into evaluating the total cost of ownership for mammography systems. Purchasing a service agreement at the time of sale is beneficial because buyers can typically negotiate better coverage and pricing than if they waited for the warranty period to end. Most mammography units have around a 5 to 10-year replacement rate, which likely means the system detectors will need to be replaced during the life of the system. Detector replacement can be costly if they are not fully covered under a warranty or service maintenance agreement. 

Finally, you will want to factor any disposable costs that may be associated with the mammography unit purchased by your facility. Some mammography systems only have the capability to utilize vendor-specific breast biopsy products with their equipment, which could limit a facility’s ability to standardize consumables, such as biopsy needles, to maximize cost savings.

It is important to do your research when purchasing a new mammography unit. Consult with the radiologists and any specialists who read breast imaging at your facility. They may be able to provide feedback on how you can implement some of these newer technologies in your clinical practice.

In summary, advancements in mammography have the ability to increase your facility’s throughput and scope of diagnostic services you offer patients, while maximizing cost savings through standardization and service maintenance agreements negotiated at the point of sale.

For more information on how Vizient can help you with your mammography equipment purchase decisions, contact Ashley Mayzner.

About the author. Ashley Mayzner is a portfolio executive on Vizient’s capital and imaging team.  She offers expertise in women’s health portfolio with a background of over 10 years as a diagnostic imaging professional.