because there was no flexibility with
patient scheduling, last minute add-ons
could not be accommodated, and it was
inefficient and costly. Migration of films to
on-site storage can be accomplished as
patients make their appointments or simply by pulling all mammography jackets
and moving them to an on-site location.
Some facilities may choose to digitize priors
and discard the film.
It was immediately apparent that
SHWBC’s PACS vendor was not ready for
mammography. The PACS system did not
have a software overlay for labeling of laterality (right/left markers), exposure factors, patient name and identifiers, facility
name, and address. This was obviously a
problem, as MQSA requires this information to be on the films/images.
Not being able to use PACS to store
mammography images forced the facility
to continue to print film. As an added
precaution, images were also downloaded
(on a weekly basis) on to discs for permanent storage in case films were lost or
reprints were needed. We worked with
our PACS vendor to build the software
specific to mammography. Now that
PACS and digital mammography have
evolved, facilities transitioning from analog to digital will more than likely not
come up against the initial issues that
• Check that worklists (list of patients for
the day) are compatible within the vendor pool. Manually entering information leads to errors.
• Look into which CAD version the vendors use. Vendors typically have their
own CAD system which may lead to
added expenses if the facility is forced to
• When purchasing upgrades or “add on”
equipment, be sure that it will function
with the current set up.
• Finger pointing occurs when issues
arise. Blaming the problem on the
opposing vendor can be very common.
• There may be a difference in image
appearance/quality which can lead to
customer service, when at all possible, any
requested add-on exams should be done as
same day studies rather than asking the
patient to return at a later date.
Designating rooms to have specific uses
helps for ease of scheduling, as well. For
example, designating a room as a “
procedure suite” will ensure slot availability for
this type of exam. However, it is important
to make these designated rooms available
for screening or diagnostic exams if a procedure isn’t booked within a specified
period of time (eg, 24 hours in advance).
Leaving a slot open because there aren’t
any procedures booked is not a wise
It is not uncommon to have a mix of vendors when equipping a mammography
department. But it also adds a bit of a
challenge to daily functions. Digital mammography units within the department
may be from different vendors. The vendor of a dedicated mammography review
workstation may differ from the PACS
vendor. If there is a vendor mix, keep in
mind the following:
One important advantage of digital mammography units is the ability to decrease
the amount of time required to do both
screening and diagnostic mammography.
By decreasing the exam time, volume will
SHWBC’s original capacity model
designated 15 minute slots for screening
mammography appointments and 30
minutes for diagnostic exams. Eventually,
appointment times were fine tuned to 20
minute screenings and 30 minute diagnostics. Scheduling slots should not be too
lean, as this is a high anxiety environment
that requires increased staff sensitivity and
Developing “scheduling sets” will help
organize patient flow and lessen last
minute add-ons that can delay scheduled
exams. Core biopsy cases that require a
post clip placement mammogram should
automatically be scheduled as a set.
Screening mammograms with screening
breast ultrasounds should follow the same
scheduling set template. For the sake of
One important advantage of digital mammography units is the
ability to decrease the amount of time required to do both
screening and diagnostic mammography.
Next Available Grid
Developing a “next available” grid is a
valuable tool that allows visualization of
wait times at the center, making it possible
to manipulate patient access quickly and
easily. For example, if diagnostic mammography wait times are going beyond
the standard set for the breast center, some
of the screening mammography slots can
be changed to diagnostic slots or screening
volumes can be reduced which will in turn
reduce diagnostic call backs for an extended
period of time.
Table 2 shows an example of SHWBC’s
next available grid, which includes next
available slots for an ancillary site. It reveals
the value of including ancillary site information. If a patient is not happy with waiting 27 days for a screening mammogram
at one location (Tully), a next day appointment at an alternate location (Darien) can
The “next available” grid should be sent
to specific staff on a regular basis—
frequency is up to the facility (eg, daily,
weekly, etc). The grid also provides accurate, reliable data to use in response to
incorrect accusations regarding exam wait
times and can help to justify requests for
expanded hours, additional equipment,
and additional staff.
This particular grid can be generated
manually by the central scheduling office
so it does not require any special software
to set it up.