Since mid-May, digital mammography has become the norm at Sanford Vermillion Hospital. And in the few months that it has been offered in the community, it has greatly enhanced the ability of to health care providers' efforts to detect breast cancer in its early stages.
"From a lay perspective, most of what we hear out there today is that there are very few advantages to continuing to use analog – that digital is quickly becoming the standard in the industry," said Tim Tracy, CEO at Sanford Vermillion. "I would say that in the very near future, analog is going to be very closed to being phased out."
Tracy, whose expertise lies in administration, not radiology, said even he can notice the many advantages of digital mammography.
"I can look at the images myself, and it's very, very easy to see the differences between digital and analog," he said. "They talk about the margins of the tissue – with an analog image, those margins may have appeared fuzzy. You can clearly see the margin in a digital image."
Sanford Vermillion's digital mammography equipment offers radiologist the ability to take very specific, high resolution images. "There is also technology available which allows radiologists to use a computer to screen an image followed up by the read from the physician," Tracy said, "which I understand enhances the accuracy across the board, because the computer may catch some things, and the physician is able to follow up on that. And of course, the physician catches things the computer never would because of the training he or she receives. But the image quality and the ability to hone in on a small piece of tissue are really two of the major advantages."
From a business perspective, Sanford Vermillion's new mammography equipment isn't receiving the volume of patients to justify the investment in terms of simple dollars and cents.
"We probably would have ended up with a mobile unit in the not too distant future," Tracy said, "but because of the Dakota Hospital Foundation, we've ended up with a fixed one, because they saw a need for it."
The hospital foundation, he said, reviewed the breast cancer mortality and morbidity rates in Clay County and compared them to nearby counties, the state, and the nation.
"For whatever reason, the mortality rates were higher in Clay County than they were in the surrounding areas," Tracy said. "In some cases, it's very significant when compared to neighboring counties. So the foundation board saw a need, and they said, 'we've got to do this.'"
The Dakota Hospital Foundation purchased the digital mammography machine, launching a capital campaign to pay for the more sophisticated technology. Sanford Vermillion also continues its commitment to meet all of the healthcare needs of people in the region, including offering uncompensated to care to some patients based on their financial circumstances.
"We have committed to performing 50 mammographies in the course of the next year at no cost to the patients if they qualify," Tracy said. "And, when we talked about this, and were discussing the needs of our patients, we noted that there is a digital mammography unit in Sioux Falls, there is one in Yankton, and one in Sioux City, so to be able to access that current, cutting-edge technology, someone would have to travel at a minimum to Yankton, and if they didn't visit a doctor there, they would have to go to Sioux Falls or Sioux City.
"If you think about it in terms of our poverty income levels here, which are higher than most counties, then you start thinking about gas prices, and whether everyone does have access, even if it only 30 miles away," he said. "The answer is no, and if we don't have a means of qualifying the patients to get a mammography without some financial disadvantages, we will have people who will just go without. What ends up happening is they start developing some symptoms, and that's why they eventually come in. By that time, it's really too late. The screening is what we're looking for, and digital does a much better job of screening, in my lay opinion."
"The biggest advantage of digital mammography is the amount of detail that we are able to capture in each image," said Randy Jarvis, radiology manager at Sanford Vermillion. "We are using such high resolution monitors, and the radiologists are able to manipulate the images using computer software – we are able to see much more detail than we could with just plain film."
A woman undergoing a mammography won't notice much difference in the procedure with the new equipment compared to the analog mammography device that used to be in place at Sanford Vermillion. "But the image capture function with the new digital equipment is way ahead of the film capture," Jarvis said.
After a woman receives a digital mammography exam at Sanford Vermillion, the images are digitally transmitted to a radiologist in Sioux Falls. The Sioux Falls specialist then makes a report which is sent back to the woman's local physician.
"It isn't any faster to have a radiologist in-house than it is to have them in Sioux Falls," Tracy said, "because with electronics, we no longer have to mail films, or have them taken to specialists by courier, and then have their reports returned to us by courier. By the time we get done now, we've taken what used to be week-long process and narrowed it down to as little as 24 hours."
"We've taken a number of days off the process," Jarvis said.
"All of the images are stored electronically," Tracy added. "So if you want to look progressively at a woman's mammograms over a five year period, specialists can look at those, particularly if you see something that is suspicious."
"The standard is to compare new images with those from past tests," Jarvis said. "And since we're just getting started with digital mammograms, when we send our digital images up to Sioux Falls, we still have to send our old film images from previous years' exams for comparison. We haven't quite seen all of the advantages in speed that we will down the road. Going down the road, we will eventually be able to compare digital to digital."
"This may be a $250,000 upgrade, with another $100,000 upgrade to come fairly soon this year or early next year that will further enhance the service," Tracy said, "but it's been part of an over a $1 million campaign with Sanford Vermillion upgrading our radiography suite to digital, putting in a new CT scanner, putting in a new ultrasound unit, and a new bone scan unit.
"We've spent well over $1 million in upgrades over the past four years or so," he said. "That's a huge commitment to the community, because right now there's no way you can pay for the cost of the equipment with the number of exams we do in Vermillion. That's why we do it, and you don't see anyone else do it here. You could still buy a less expensive analog machine, but it's not what the public needs or wants or demands anymore."
In the scheme of breast cancer health for women in the Vermillion area, the new digital mammography serves a valuable role in early detection.
"The mammogram, the self-exam and the clinical breast exam – those make up the front line of early detection," Jarvis said.