CMOS X-ray Imaging Enables More Efficient Stereotactic Biopsies

Alana Achterkirchen, Rad-Icon Imaging, a Division of Dalsa Corp.

Technological advances in screening and diagnostic breast imaging have enabled practitioners to deliver high-quality, accurate health care services. Patients benefit from digital mammography because it is faster and uses less radiation than the standard film-based mammogram. The images are seen on a high-resolution monitor, allowing radiologists to see in greater detail, and if an abnormality is found, there are many options for further evaluation.

(Left) A breast tissue sample is seen on the imaging grid. (Right) The needle is localized within a sample on the grid.

Advances in digital detector technology have made it possible for radiology departments to make additional improvements in efficiency and effectiveness. A complementary metal oxide semiconductor-based (CMOS) digital x-ray detector from Rad-icon Imaging, a division of Dalsa Corp., helped one Connecticut hospital step up its breast-imaging program.

When a mammogram indicates the presence of a breast abnormality such as a suspicious solid mass or microcalcifications, stereotactic needle biopsy is a nonsurgical method of assessing it. The area of concern is biopsied with a vacuum-assisted needle. A surgeon can perform an excisional biopsy in an operating room (OR) to remove the entire lesion. The lesion is then imaged to ensure that the entire tumor has been removed, and the procedure is completed. Ideally, the imaging process should happen as quickly as possible because the patient and surgeon must wait in the OR for confirmation of a clear margin around the tissue specimen.

Stereotactic breast tissue cores are shown in a specimen tray. Images courtesy of Rad-icon Imaging.

Challenges arise in efficiently imaging a patient’s tissue specimen if the radiography department is physically located in a different area from the operating room. Even if there are multiple specimen radiography systems, located far away, scheduling the timing to coincide with the procedure often can be next to impossible in a busy hospital environment. Yet health care providers with a focus on high-quality care can leverage technology to improve their services and streamline their processes.

One hospital,¹ in Stamford, Conn., strives to offer the latest in imaging technology and services to provide patients with the highest quality care. Its mammography department is staffed by three radiologists and seven technologists and completes approximately 17,000 mammograms, 200 stereotactic breast biopsies and 160 x-ray needle localization procedures annually. Its search for a specimen radiography system began when it realized that its growing procedure volume warranted a more efficient process for x-raying specimens than having an operating room aide or technologist carry them to a mammography room downstairs – if one was even available.

This SkiaGraph 8 x 8-in. CMOS x-ray panel from Rad-icon Imaging enables more efficient biopsies.

“Specimens were being held by our techs as they waited to get into a mammography room to image them,” said the hospital’s chief administrator of ambulatory imaging. “The time between removal of a specimen and actual imaging was growing longer. Our surgeons actually were calling downstairs before a procedure even began to hold open a mammo room. We were tying up a full mammography unit waiting for the specimen to come down from the OR. There was a big bottleneck, and our surgeons and radiologists were becoming unhappy.”

The hospital took steps toward acquiring a digital specimen radiography system for real-time mobile digital imaging to increase the efficiency of its procedures. It called Rad-icon Imaging’s partner Kub Technologies Inc. of Milford, Conn., for a demonstration of a mobile radiography system designed for imaging biopsy cores and surgically excised tissue specimens. The system, called XPert 40, comes fully equipped with a DICOM-compliant workstation for travel between OR suites and can be wheeled around for easy mobility. Its compact size, user-friendly software and standard AC power requirement allow it to be operated in most medical environments.

The core of the mobile radiography system is Rad-icon’s detector, which has an active area measuring up to 8 x 10 in. The 16-bit contrast resolution of the digital image sensor, combined with a 1.0-mA x-ray source output, enables it to image even the tiniest microcalcifications in the largest specimens. The company’s x-ray sensors’ resolution is as low as 48 μm, providing high sensitivity and dynamic range, and hits the sweet spot in imaging small variances in tissue samples where the contrast also is very small. The resulting digital images are crisp and detailed enough to help physicians in busy medical practices who perform many procedures a day.

Since its installation at the hospital in 2007, the mobile radiography system has been used exclusively to image stereotactic breast biopsy material and breast needle localization tissue. When suspicious tissue is extracted, cores or specimens are walked a short distance across a hallway to the XPert imaging system and placed in the machine. An image appears on a monitor within seconds, and the hospital’s picture archiving communications system enables viewing in the operating rooms almost instantaneously.

“We wanted ease of use, we wanted prompt service, and image quality had to be top of the line,” said the chief administrator of ambulatory imaging of the search for an optimal digital radiography system for the hospital. “The images we’re getting are spectacular. When you’re looking at microcalcifications that are smaller than a grain of salt, image quality is the most important thing.”

The hospital calculates that members of the medical staff save about 20 minutes for each stereotactic procedure because the new imaging system is right across the hall. With about 20 procedures each month, the hospital saves more than six hours, time that can be spent on other clinical matters, including positioning patients for imaging or reading mammograms. Patients also spend less time on the table under anesthesia, resulting in a more positive experience. And because there are no waits to image specimens, there are no longer charges for extra OR time.

“The mobile imaging system is just steps away,” said the director of breast imaging. “We walk through a door, across a hallway, and a few seconds later, we’ve got the image. There’s a significant time savings over the way we imaged before. The image quality is great.”

The bottom line: At the hospital, the addition of a top-tier specimen radiography system from a company that prides itself on instilling clinical confidence by delivering high-quality digital images – and offering fast and effective service and support – has resulted in a host of benefits. The medical staff is grateful. “We know the unit will be up and running, that the radiologists and surgeons are happy with the image quality, and that our techs are happy because the unit is easy to learn and use. And we haven’t had one malfunction or mechanical problem,” said the director of breast imaging. “I would recommend our imaging system to anyone.”

Meet the author

Alana Achterkirchen is the director of business development and marketing for Rad-icon Imaging, a Sunnyvale, Calif.-based division of Dalsa Corp.; e-mail: sales@rad-icon.com.

Note

1. For privacy reasons, the names of the hospital and its employees have been withheld.