By Barbara Mortellaro

Austin Radiological Association in Austin, Texas, one of the largest private radiology groups in the country, reads about 1.8 million imaging studies a year for 21 hospitals and 44 service providers.

Of the nearly 2 million exams its staff interprets, about 164,000 are breast exams, including 2-D X-ray, breast tomosynthesis, ultrasound and magnetic resonance imaging. ARA’s radiologists who specialize in breast imaging read the studies for a number of hospitals and women’s imaging facilities in the region.



Austin is a “growing and highly competitive environment,” said Todd Thomas, chief information officer at ARA. It exceeded 2 million residents in 2016. In this fast-paced, growing environment, it is critical that ARA stay on top of developments in breast imaging procedures and screening follow-up protocols.

“That’s a must if we want to remain competitive and provide our growing client list with efficient and timely remote mammography reading services,” Thomas said.

Reading that many breast exams daily as quickly and efficiently as possible posed workflow challenges for the radiology group’s telemammography reading services. It found the answer to these challenges by implementing workflow software and automating its processes.

Ensuring timely and accurate fetching, delivery of priors
One of the biggest challenges ARA had was that its system for retrieving prior mammography exams from different PACS archives and sending them to the appropriate reading workstations wasn’t automated.

“We had numerous workarounds for manually querying prior exams and manually sending them to the appropriate workstation,” reports Brandon Redden, PACS analyst at ARA.

Because of its volume of work, the process was very time-consuming. Also, because its radiologists read at three different locations, they had to search five different distributed PACS archives for relevant prior exams.

Yet another significant issue: human error.

“Because it was a manual process and because we were reading 600 to 700 requests daily, the potential existed for historical studies to be overlooked, or the wrong studies to be accidentally retrieved,” Redden said.

About four years ago, when ARA’s daily volume was about 400 studies (and it did not yet have Hologic’s 3-D mammography technology), ARA invested in imaging workflow technology to automate the process of fetching prior 2-D screening and diagnostic mammography studies from across its five PACS archives. Today, this automation encompasses all breast tomography studies as well.

“Since we implemented imaging workflow automation, we can ensure that all newly acquired 2-D and 3-D mammography studies are delivered to their appropriate Hologic reading workstation, and that they are archived on the central ARA PACS,” Redden said.

All relevant prior exams are retrieved from the five PACS archives and are automatically distributed to the appropriate location to support ARA’s diagnostic reporting process, he said.



In addition, ARA sometimes needs the workflow solution it implemented in 2013 to normalize selected patient demographic data that is included in the fetched prior studies. For example, sometimes prior studies coming from one of the outside PACS may need its patient identification (medical record number) updated before it can be forwarded to the workstation where it needs to go, Redden said. Having a workflow system that can do this step automatically is very helpful, he said.

Meeting evolving needs
Since automating its workflow with software, ARA has seen several other benefits as well, including making better use of its staff’s time, Redden said. ARA has 103 full-time radiologists.

“We have been able to reallocate approximately 1.5 full-time equivalents to enhance other valuable aspects of our services,” he said. “The software solution has enabled us to be more efficient and productive with our clinical and IT resources. Being able to reallocate human resources since automating our pre-fetching process is a great case in point.”

The software also enables ARA to ensure that not only are prior studies delivered to the appropriate workstations in a timely and accurate manner, but the same is true of any new studies as well.

“Because our radiologists read mammography studies on three Hologic workstations in three different locations, they depend upon the robust routing rules of the software solution we implemented to ensure that all correct studies are delivered in a timely fashion to the correct location,” Redden said.

The hospitals and women’s centers that ARA radiologists read for are very appreciative of its accuracy and fast turnaround time because, in turn, it means that the centers can inform their patients of their results sooner and with greater confidence, Redden said. The bottom line is being able to deliver quality care quickly, and this simple software solution does all that and more, Redden said.

About the author: Barbara Mortellaro is the breast imaging QA coordinator at Austin Radiological Association.