We've had digital mammography at our breast center for about three-and-a-half years now. As one of the veteran technologists (read: OLD) who remembers many years of analog mammography, I've noticed some interesting changes in priorities these days. I'm wondering if I'm the only one experiencing this. See if these things strike any chords with you:

1.      The same radiologists who once demanded that all screening exams include exaggerated cc and/or lateral views have suddenly and inexplicably developed a passion for radiation protection regarding our patients. "Four views and only four views!" is the new battle cry. Could this concern possibly relate to the fact that in analog days, the radiologist could view films at a glance rather than having to scroll, click and manipulate? Just a guess .

2.      The most important person in the department is now the PACS or IT administrator. If this all-important person isn't in the department, we become paralyzed by fear of system failure. Some of us are afraid to come to work when "the PACS guy" is on vacation. The irony of this is that it's not funny. We really should be scared. Very scared.   

3.      I've noticed a sudden increase in interest in the mammography audit: "We must see our numbers now!" Does anything to do with upcoming regulations linking reimbursement to outcomes, like call-back rates?

4.      And those call-back rates, which the vendors told us would decrease with digital mammography (I mean, you can zoom, window and level, and reverse images now, right?), have actually increased. We see more on the first views, true. But we never call a diagnosis based on those views. Each patient comes back. And since we see more possible abnormalities, more come back. Uh-oh; what does that mean for Item #3? Will we all be in soup lines?

5.      Our filmless world has more paper than ever. Yes, we scan everything into the medical record or PACS. After we copy it. As a precaution.

6.      It used to take several technologists to keep up with some of our radiologists' reading patterns. Now it takes several radiologists to keep up with our technologists' imaging patterns. (That's a fun one!)

7.      Good news--the health care plan will ensure that all eligible women can have mammography!  Bad news--dramatically fewer women will be eligible.

Ah, health care is full of irony. And we old (sorry, seasoned) folks are enjoying it the most. So if you see us walking around laughing to ourselves, it might not be as bad as it looks.

Sandy Mueller, BA, RT(R)(M), RDMS, is the technical manager of Adventist Hinsdale Hospital's Outpatient Imaging Centers in Hinsdale, Ill.