Researchers at the University of Pennsylvania Cancer Center have received a $6.3 million grant to design and develop a prototype of an integrated database that will be capable of instantly retrieving and storing digital breast images from mammography facilities across the country.
"This generous grant will help us revolutionize the way that digital mammograms are currently accessed and archived," says Mitchell Schnall, MD, PhD, associate professor of medicine and principal investigator on the project. "With our model, we'll demonstrate that creating a national database housing thousands of digital mammograms will offer enormous advantages in detecting and diagnosing women with breast cancer in a more controlled and cost effective manner," Dr. Schnall explains.
Digital mammography -- a sophisticated process of viewing breast images on a computer -- is expected to replace the conventional, X-ray type mammogram within the next decade. Since the digital images are generated electronically, they can be transferred quickly and easily to another physician for a second-opinion -- a process known as telemammograhy -- and electronic storage prevents the likelihood of the images getting misplaced or lost. Currently, Penn is one of only a handful of institutions around the country offering digital mammography to women.
While a significant advancement in medical technology, these digital mammograms are data-laden taking up to 160 megabytes of stored information in a computer system for each patient. "Digital images are very large files that take up a lot of computer space," says Dr. Schnall, "so storing and transferring these images is just one major challenge of this exciting project." Other challenges involve ensuring patient confidentiality on a system that will be capable of housing breast images and medical histories.
To meet these challenges, the researchers are using Next Generation Internet technology, a super-fast, network computer system equipped to transfer large data files, execute real-time queries, and access information securely. Dr. Schnall and his colleagues will be spearheading this project from Penn, and will be networked or linked to computer systems operated by investigators at the University of Chicago, the University of Toronto, the University of North Carolina-Chapel Hill, Lockheed Martin Energy Systems and IDX Systems Corporation.
"A major portion of the project will be spent on ensuring patient confidentiality and this new system will be superior to the process already in existence." Dr. Schnall says women will be asked to give an electronic consent, such as a PIN number or password, authorizing the transfer of their images. Likewise, workstations may be equipped with thumbprint identification or smart cards allowing only certified radiologists access to view the images. "This system allows for total audit-ability, in essence an electronic paper trail that will show exactly where the image go and who specifically views them," he explains.
The database model, which is expected to be complete in 2003, will create an unparalleled opportunity for researchers to study and understand many epidemiological issues associated with breast cancer. "With mammograms stored in one central location, researchers will have better access to certain demographic information, enabling them to develop educational or interventional programs," says Dr. Schnall.
The prototype will solve many problems associated with the current system of mammography retrieval and storage. Clinicians accessing this new database will be able to instantly retrieve a woman's mammogram prior to her appointment, thereby unburdening her with the responsibility of having to physically obtain her X-ray mammograms when going to a new physician. Additionally, this system will offer an avenue for obtaining expert consultation from a third party in real time, making difficult diagnostic evaluations more effective and improving patient care in under-served areas that are without access to breast imaging expertise.
This research is supported by a grant from the National Library of Medicine and the U. S. Department of Health and Human Services.
Editor's note: To contact Dr. Schnall, please call Sue Montgomery in the Public Affairs office at 215-349-5657.