Updated Physicians Report Writer Transforms Bone Density Testing at Busy Women’s Breast Center

Carol Milgard Breast Center, Tacoma, Washington


February 8, 2013
Carol Milgard Breast Center Hologic
In addition to full breast imaging services, the Carol Milgard Breast Center is equipped with the Hologic Discovery bone densitometer, so that patients can have their mammogram and bone density tests done in the same appointment.

Dr. John Peixotto of the Carol Milgard Breast Center remembers the old days — before Version 7.0 of the Hologic Physicians Report Writer DX software was installed this past spring — when he was still at the mercy of the dictaphone. Typically, he’d spend an average of three to five minutes per patient dictating bone densitometry test results generated from the Center’s Hologic Discovery system. That may not seem like much. But for a facility like the Milgard Center, which does an average of 20 tests a day, that translated into a lot of extra time crammed into an already busy day. 

“Most facilities like ours do seven bone density tests a day. We do triple that,” notes Dr. Peixotto. “With bone density testing, it’s not like interpreting X-rays; you’re just dictating numbers over and over. It’s time-consuming and it can be error-prone. So we were thrilled when Hologic upgraded its Physicians Report Writer. Hologic put a lot of thought into the upgrade and used good algorithms to generate the appropriate reports. It’s so much faster and more accurate — we can generate complete reports in about 20 seconds.”

Bringing Technologies Together

While the new Physicians Report Writer makes life much easier for Dr. Peixotto and the other five radiologists on staff, making sure the new software was properly integrated into the Center’s network didn’t happen overnight. 

The Milgard Center is an unusual breed of breast centers; in fact, rarely has any community come together to pull off such an incredible feat. Before the center opened in 2009, there were numerous breast clinics in the area offering a range of screening and diagnostic breast imaging services. When a woman needed additional tests, she often had to make several appointments and travel to different clinics — some of which utilized digital equipment, others analog. 

The center’s Medical Director Khai Tran, M.D., stepped in and proposed pooling the resources of the three largest providers of imaging solutions in the Tacoma area. Four years later, several clinics were consolidated into a central hub — the Carol Milgard Breast Center in Tacoma — with three satellite clinics strategically located to provide convenient, accessible and consistent care for women throughout the area. 

However, bringing three different facilities together created some real challenges when it came to integrating systems and software, especially since each facility had its own ways of reporting, along with different PACS systems. One of Hologic’s senior connectivity specialists worked hand-in-hand with the Milgard Center’s Information Technology staff to integrate the software into its network. Says Dr. Peixotto: “Version 7.0 enabled us to bring all of the data from the separate facilities together and has the connectivity we required to automate reporting, as well as more ways to store and recall data.” Hologic also applied an algorithm to its bone densitometry scans to make them compatible with the Physicians Report Writer software, so that facilities like the Milgard Center can easily transfer past scans into its new system.

FRAX 10-Year Fracture Risk Assessment Results for the First Time

Since it was first introduced commercially in the early 2000s, the Discovery system has always generated extremely precise and reproducible results, thanks to its high-resolution detector array, true fan-beam linear acquisition geometry and internal reference system. And now, with the upgrade to Version 7.0 of Physicians Report Writer DX, the system not only improves workflow, but provides a new level of information: the patient’s FRAX, the 10-year facture risk assessment developed by the World Health Organization. Hologic was the first manufacturer to integrate FRAX into its bone densitometer, helping radiologists like Dr. Peixotto and his team identify and proactively treat patients with a high risk of debilitating bone fractures due to low bone mass and other risk factors, helping prevent problems down the line. 

Customized Reports Generated in Seconds 

Version 7.0, which comes standard with the Hologic Discovery system, also gives radiologists the flexibility to tailor the report templates to reflect their needs and personal preferences. This includes four key areas: indication, interpretation, recommendation and follow-up. The radiologist can reword each line in the template to make sure it’s exactly what he or she wants — and add pieces of information along the way. Those changes can be made public, so that all doctors in the practice use the same template. Or the report can be customized by each individual doctor, allowing him or her to add comments or highlight certain areas, for example. Once all of the changes are made to the templates, reports are then generated automatically. 

While it took Dr. Peixotto about four hours to customize the templates, he says it was well worth the time spent. “I looked at each variation of patient type — there are only about 50 different possibilities — and then made the necessary changes to the templates. Once those were set, the software interprets the DXA results and automatically populates each section of the report. So now all of our radiologists are able to quickly generate the same type of reports for each type of patient.”

In addition, report data is sent via HL7 text message to the Center’s HIS/RIS and EMR. “The reports generated from Physicians Report Writer flow right into our electronic medical record,” notes Dr. Peixotto. “Each of us can connect to the Center’s network and pull up reports from a laptop at home, in the office —wherever. There’s no need for special computer equipment, and we can view reports at our convenience.”

Bone Density Testing and Mammography Go Hand-in-Hand

So why would a breast center make bone density testing such a key part of its offering, anyway? According to the Centers for Disease Control and Prevention (CDC), osteoporosis kills more women than breast cancer and heart disease combined, yet the level of awareness about bone disease is a fraction of what’s being done for breast cancer awareness. Says Dr. Peixotto: “As a comprehensive center for women’s health, we understand the importance of making sure our patients have access to everything they need, from mammography, breast MRI and ultrasound testing to biopsies and bone density testing.”

In fact, according to Pam Duke Ash, Bone Densitometry Technician at the Milgard Center, many patients have their bone density test done at the same time as their mammogram. “Our patients really like having both tests done together — it’s so convenient for them, especially for those women who are being treated for breast cancer.” As Pam explains, drugs like tamoxifen can affect bone density, so patients undergoing chemotherapy typically have testing done every year or so to be sure their medications are not depleting their bones. 

A “Hologic Shop”

Not only did the Milgard Center choose Hologic for its bone densitometer, but it also made the decision early on to go digital all the way — starting with mammography equipment from Hologic. According to Marcy Parson, Founding Center Program Director, who now works for the American College of Radiology and previously served on the Hologic Board of Advisors: “Our radiologists had the opportunity to evaluate a variety of digital systems and selected Hologic for its superior image quality and the efficiencies it allows us to build into our workflows.” 

All six mammography rooms at the Milgard Center utilize Hologic Selenia digital mammography systems and Selenia TechMate Workstations — and each of its five satellite clinics also have a Selenia system, with the mammograms read by Dr. Peixotto and his team. In addition, the Center purchased two Hologic ATEC automated tissue excision and collection systems for stereotactic and MR-guided biopsies, and a Hologic ultrasound system.

“We’re a Hologic shop,” notes Dr. Peixotto. “We chose Hologic because they focus only on women’s healthcare, and we wanted the best of the best for our new center. We started with digital mammography and biopsy equipment, then added bone density testing.”

And notes Pam: “Our patients are so thankful that they can have everything done here at the Center — and we appreciate that we can get most of our equipment from Hologic. Their equipment is fast and easy to run. There aren’t a lot of extra steps. And everything is digital, so you don’t have to wait for films. Very seldom do we ever get behind and part of the reason is the reliability of the Hologic equipment and how easy it is to use.”

There’s another big benefit to being a “Hologic shop,” as Dr. Peixotto notes. “In the past, we had a hard time getting hold of anyone and getting equipment fixed. But Hologic is a great business partner. They are very responsive. If we make a phone call, they are right here — repairing equipment, keeping everything well maintained and helping us with education. One of our radiologists is even on Hologic’s advisory committee, which provides direction for future upgrades.” 

Case study supplied by Hologic Inc.

The views and opinions expressed herein are those of Dr. John Peixotto and his colleagues at of the Carol Milgard Breast Center and are not necessarily those of Hologic, Inc.

Hologic, ATEC, Discovery, Physicians Report Writer, TechMate and associated logos are trademarks and/or registered trademarks of Hologic, Inc. and/or its subsidiaries in the United States and/or other countries. FRAX is a trademark of the World Health Organization Collaborating Centre for Metabolic Bone Diseases, located at the University of Sheffield Medical School, UK

This information is intended for medical professionals in the U.S. and other markets and is not intended as a product solicitation or promotion where such activities are promoted. Because Hologic materials are distributed through websites, eBroadcasts and tradeshows, it is not always possible to control where such materials appear. For specific information on what products are available for sale in a particular country, please contact your local Hologic representative or write to womenshealth@hologic.com.

  • With Version 7.0 of the Hologic Physicians Report Writer software, Dr. Peixotto and his staff can generate complete reports in about 20 seconds.