4 rads: Take all imaging to the cloud—and let breast specialists lead the way

Four breast radiologists are calling for the creation of a national imaging repository housed in the cloud and spearheaded by their specialty.

Citing the American College of Radiology’s Imaging 3.0 initiative, which helps rads take a leadership role in improving U.S. healthcare, Ray Cody Mayo III, MD, of the University of Texas and colleagues hold that universal access to all diagnostic images would align with the 3.0 principle of emphasizing patient-centered care.

“A cloud-based image exchange network could provide secure, patient-portable accessibility of prior examinations for more accurate and timely interpretation of mammograms with objectively improved patient outcomes at reduced costs,” Mayo and co-authors write in an article published online Sept. 24 in JACR. “Ultimately this resource should include the entire radiology department because of the importance of comparing with prior examinations for all imaging studies.”

Mayo’s co-authors are David Avrin, MD, of UC-San Francisco, Jessica Leung, MD, of the University of Texas and Kathryn Pearson Peyton, MD, of the image-sharing network lifeIMAGE.

They make their case on what the cloud imaging repository would do to improve interpretation performance, patient outcomes, patient experience, value creation, cost savings and revenue generation.

The value added by reviewing all prior mammograms “cannot be overstated,” they write in noting ways the repository would make for better image interpretation.

“The improved performance of mammographic interpretation when prior examinations are available is well documented,” they add before ticking off studies that showed use of priors improving earlier detection of breast cancer by 25 percent, reducing false positives in screening mammography by up to 60 percent and cutting false positives in diagnostic mammography by as much as 80 percent.

The authors further expect their proposed image repository would facilitate:

• Better patient outcomes. “With diagnostic mammography, comparison with prior examinations improves true-positive findings, resulting in improved sensitivity for detection of malignancy,” Mayo et al. write. “These improvements are attributable to the ability to accurately detect subtle incremental mammographic changes that may otherwise be overlooked.”
• Improved patient experience. By reducing recall rates, quick access to priors “should minimize perceived ‘harms’ of screening mammography” and help patients cut through the confusion of disputed guidelines, the authors write. “We expect that improved mammographic accuracy provided by prior comparisons would result in greater certainty regarding the benefits of screening mammography and therefore decrease the controversy surrounding screening guidelines.”
• Value creation. The cloud enhances interoperability for patients entering the hospital or imaging center system, the authors state. “Medical-records staff members may easily procure needed prior comparisons as well as offer patients access to web-based applications for engagement in controlling their own imaging records. This may result in greater patient satisfaction and higher compliance with screening.”

The breast imaging department represents an ideal place to start as the ideals of Imaging 3.0 are put into action, the authors conclude, stressing that many if not most breast imaging departments already have in place proven processes for transferring images from prior exams.  

“As efficiency gains are realized, other services could piggyback on the modular cloud-based imaging exchange network,” they write, pointing to such burgeoning efforts as RSNA’s Image Share and the Sequoia Project.

“The success of this technology will also require buy-in from patients, and there are few groups more engaged than the emotionally motivated breast cancer population,” Mayo and colleagues write. “The high-profile advocacy, awareness and funding initiatives surrounding breast cancer will be an important factor leading to the adoption of cloud-based image sharing. A cloud-based image sharing network is a tangible project to put the spirit of Imaging 3.0 into action.”