CHICAGO – The lead author of a study on telemammography said he has used a system using nothing more than “commonly available” broadband Internet cable to transmit breast images from a remote location 110 miles away to New York Presbyterian Hospital-Columbia New York Medical Center (New York) in an effort to find a remedy to what was termed a “mammography crisis.”

Alan Melton, assistant clinical professor of radiology at the center, told an audience at a press conference during last week’s annual meeting of the Radiological Society of North America (RSNA; Oak Brook, Illinois) that he believes his results – in a twist on astronaut Neil Armstrong’s famous line – represent “a small step for medicine, but a giant leap for women.”

“We’ve proven that telemammography works,” Melton said. “The ability to transmit mammograms over long distances could significantly help to solve the crisis in access to screening mammography, as well as improve the accuracy of interpretation of the examinations.”

Melton’s study, which included 1,314 diagnostic screening mammograms, determined that it is possible to transmit full-field digital mammography (FFDM) images to another location without compromising accuracy, security or the use of computer-aided detection (CAD) software.

In his study, Melton used two FFDM units and a computer-aided detection system. The digital images were transmitted via Internet cable in a “highly secure environment,” including private networks and firewalls, to an interpreting workstation at the hospital. Each image was transmitted in less than 25 seconds.

Cases averaging greater than 95 megabytes of data were sent real-time, maintaining “full security,” according to Melton.

In those cases where abnormalities were seen on the images, they were “marked digitally” and returned to the remote location, so that “technologists would know which [additional] views [of the breast] to take,” Melton said, noting that Columbia has been on a digital system for 2-1/2 years.

The researchers determined through a series of tests that the digital mammograms sent to the remote workstation were identical to the original images. The analysis included comparison of image quality, file sizes, CAD markings and image interpretation by an independent reader.

Initially, Melton said he was told it would require sophisticated equipment from big names in networking to create such a system, but that didn’t prove to be the case. Still, the center did “a lot of work” to ensure that the images adhered to DICOM (Digital Imaging and Communications in Medicine) standards.

Also, he said, the FDA requires that in transmission, there can be no degradation of the image in transmission. “The most difficult image to read in radiology is the screening mammogram,” Melton said. “The second most difficult is the chest X-ray.”

As of last week, 8,400 cases had been transmitted and interpreted using Melton’s system, he said. And over that number of cases, there has been “only one maltransmission,” he said.

There are real implications for women. For example, most guidelines suggest that women begin having a baseline mammogram beginning at age 40. Melton pointed out that there are 1.2 million people turning 40 every year.

One threat to women’s access to mammography is that as the population ages, simultaneously fewer medical school residents are choosing to enter breast radiology, he said.

According to a 2004 report from the Institute of Medicine (Washington), women’s access to breast cancer screening is endangered due to a shortage of specialists in breast imaging and interpretation.

Between 2000 and 2003, the number of mammography facilities operating in the U.S. dropped from 9,400 to 8,600 – an 8.5% decrease – causing women in some areas delays of up to five months for screening mammography services, according to the report.

Reasons for the shortage of those in breast imaging radiology results include a low level of reimbursement for mammography interpretation and the fact that there is a high level of malpractice suits related to mammography interpretation. In fact, Melton said that breast imaging interpretation is the “No. 1 cause of malpractice” suits filed, although they are not the leader in award amounts.

The real reason there should be a focus on telemammography, he said, is that there has been a 46% reduction in breast cancer mortality since mammography screening became a mainstay of women’s care.

He suggested a model of having regional breast screening centers of excellence where radiologists highly skilled in reading breast images specifically offer the best source of interpretation of mammograms.

That could eliminate existing backlogs for women to get appointments for mammograms, as well as help in providing access to care in underserved areas.

“Finding more breast cancers earlier, which I believe we can do through digital mammography and centers of excellence, will significantly reduce the number of women dying from breast cancer,” Melton said in a statement.