In order to determine feasibility of providing real time screening mammography interpretations to American Indian women on rural reservations, satellite transmission of images to an academic medical center was implemented. Quality of transmitted images and report turnaround times were measured.

A mobile unit of the Aberdeen Area Indian Health Service was equipped with a GE Senograph 2000D to transmit digital mammograms by commercial satellite service, and initially located in Fort Yates, N.D. Screening mammograms transmitted to a GE SenoAdvantage 2.0 workstation at the University of Michigan Breast Imaging division were interpreted and reported in real time. Report turnaround time was tracked,consisting of image transmission, faxing of clinical history sheet, radiologist interpretation, paper report generation and faxing report back to the unit. Fax/telephone service to the unit was by satellite, without other means of communication. Breast phantom images were transmitted for QA. Radiologists were asked to rate image quality as compared to our workstation for local patients.

In the first four weeks, 177 patient screening exams were performed. Mean report turnaround time=39.3 minutes(5-245 minutes). 83% of all reports and 94% of last week’s reports were received in <60 minutes of image transmission. Transmission times improved from 2 minutes to 45 seconds per image. Delayed reports were usually due to fax delays, but improvements occurred. Breast phantom appearance on the monitors was within ACR limits. Radiologists rated image quality as equivalent to the locally performed digital images. A film digitizer will be implemented this month to enable immediate transmission of prior comparison film mammograms.

Despite the large mammogram image file size, image transmission time was reasonable, and images were not compromised by satellite transmission. Report turnaround times can be short with on-line interpretation.

Satellite transmission of digital mammograms with on-line reading could enable immediate additional imaging, which would increase compliance with call backs for additional imaging in rural areas