This PenTip is intended as a general introduction to 100 plus additions added to the procedures and imaging exams based on input received from clients, and to incorporate the proposed BI-RADS changes. Please refer to the individual PenTips for additional specific detail.

Common exam additions:

  • Exam modifier titles now address laterality of previous surgeries, therapies, and reconstructions.
  • Preview button added to each of the exam screens, allowing instantaneous preview of the report.
  • New category to advanced specials, “Calcifications” now includes common benign descriptors.

Peer Review additions:

  • Added a warning to the Peer Review system; notify if a radiologist is below the moving average annual goal.
  • Added ability to fetch exams and reports for independent review, exclusive of exam interpretation, providing selection by a combination of by density, by BI-RADS, and risk level assessment, by radiologist.

Additions to the mammography exam include:

  • Ability to specify best seen “slice” in MLO and CC for tomo studies and only seen by tomographic imaging.
  • Ability to indicate that an abnormality is “developing”.
  • Lymph node selection expanded to include “focal cortex” and uniform thickening as modifiers.
  • In preparation of the new BI-RADS, “eggshell” has been retired from the calcification type list, and “lobulated” as a shape modifier has been retired. Macrolobulated was added as a margin descriptor per new BI-RADS.
  • Hide depth selector was added (can be defaulted like other items) to suppress the depth of an abnormality.
  • “Clinical Info” is now displayed and editable on the negative mammo screen.
  • Added feature to preselect comparison (by the number of years) for those facilities that reply on the tech or the process was completed by the radiologist. Contact tech support to enable preselected comparisons.
  • Added combinations of mammography and ultrasound for 3 and/or 6 month follow-up for BI-RADS 3.

Additions to the ultrasound exam include:

  • Added exam modifiers to indicate exam is for “screening” and/or whether it was conducted by an “automated” device for differentiation regarding reimbursement and added various statistics for sensitivity.
  • Breast density indicators have been added based on advance documentation for the new BI-RADS release.
  • Added ability to indicate laterality of various regions of combinations of “limited scanning” for breast and axilla.
  • Radial scar as a primary abnormality descriptor was added.
  • Added combinations of mammography, and ultrasound for 3 and/or 6 month follow-up for BI-RADS 3.

Additions to the biopsy exam procedures include: 

  • Added discordance, insufficient samples, indeterminate FNA, cellular atypia, and radial scar to signify reason for repeat to accommodate sub-categories for auditing and a modifier to signify repeat is for research.
  • Modified and added admin reports to tabulate reasons, complication and repeat percentage for biopsy audits.
  • Added ability to indicate that post imaging was done in a “separate room” to capture a secondary imaging fee.
  • Added delayed bleeding, delayed infection, and wound not healing to complications, completing the various categories for biopsy audit.

Additions to the localization exam include:

Ability to specify the length of the wire and length protruding from the skin to verify location preceding transportation to (OR) a separate room imaging feature was as added as well.

Specimen additions:

Added lumpectomy, full or partial or skin-sparing mastectomy as specimen type.

Additions to the recall system include:

  • Added recall types – automated ultrasound, combination unilateral mammo and ultrasound, and NM.
  • The recall system was expanded (now called the recall event system) facilitating individual recalls by breast, By modality, in addition to the primary exam recall, as well as annual alternating modalities (offset by 6 months, for example).
  • Added independent abnormality follow-up interval checker by breast and recall interval to the existing overall exam BI-RADS recall interval inconsistency checker to verify recall events are initiated for each breast.

Added to DEXA study:

  • Ability to incorporate the FRAX major and hip fracture index percentages into report.
  • Added various formatting capabilities to automatically inherit similar region scan data and calculate percentage changeover scan history by region. Also added the option to display scan data in row and column format.
  • Added the first generation of direct import of scan data into DEXA report from the DICOM file (Hologic).
  • Added two additional assessment categories for premenopausal patients, BMD normal and below for age. This automatically inhibits references to the World Health Organization Criteria in the narrative report.

Breast density software integration:

  • Added last specified breast density value to the interpretation worklist, providing assorting mechanism for radiologist work assignment, and a notification system to proceed to ultrasound (breast density laws).
  • Added DICOM interface to process results from Volpara density assessment software, as well as Hologic and iCAD systems to automatically preselect breast density in the report. The interpretation worklist density is suffixed with a “C” for computed. Access is provided to view the exact percentage of density by breast.

Scanner interfaces:

Expanded interfaces to support multi-page and duplex (both sides of paper) scanning into the patient record.

SoftCopy integration:

  • Expanded the offering of interfaces for bi-directional synchronization with softcopy reading workstations.
  • For clients that drive PenRad from their PACS worklist, a pop-up message appeared warning if another patient was selected prior to completing the current open exam during (wet read interruption for example). The new modifications allow the ability to automatically suspend the ‘work in process’ exam and present the newly selected patient exam.

Expanded risk assessment tools, options and interfaces:

  • Expanded ability to capture patient’s relative information for onset of unilateral and/or bilateral breast cancer, and BCRA testing information by relative, to facilitate Tyrer-Cuzick risk assessment algorithm (optional).
  • Added various automatic statements derived from combinations of patient breast density, patient risk value percentages, if full risk assessment has not been updated with Hughes Risk Assessment software within two years (optional), patient exam and recall/reminder letters.
  • Expanded the interface with Hughes to complete bi-directional communications, to share data regardless of where it was acquired (Hughes, PenRad tablet/kiosk or directly captured within PenRad.)
  • Added an inexpensive way for facilities to use any wireless Internet tablet (>$200 tablet) or kiosk in center to allow patients or mobile staff to update history, risk factors, cancer and age by relative, saving tech/support staff time, and presenting a high-tech image to the community.
  • Expanded bi-directional automation support for Hughes Risk Application enabling access to all risk Assessment models, eliminating duplicate data entry to public web sites. For centers with PenRad and breast surgeons utilizing Hughes Risk, PenRad provides a common, well-integrated system for both practices.

Added various items to the radiologist profile:

  • Added dual read option that requires exams be dual read prior to approval for distribution (by exam type).
  • Added option to exclude a radiologist from participating in a second read.
  • Added option to automatically use PenRad’s PenView softcopy interpretation software versus the PACS software for breast imaging exams and/or PenRad’s Compass software for breast MRI interpretation.
  • Added alternate disagree system that advances the exam to a third reader allowing agreement with reader one or incorporating changes recommended by reader two.

Added support to view patients with multiple MRNs during interpretation:

  • For facilities where patients have multiple MRN for same patient due to mergers and consolidations, we have done the impossible for automation. We can retrieve from PACS, mammography, breast nuclear, ultrasound, and MRI images for patient by MRN and same DOB, and open the PenView softcopy viewer to allow interpretation without requiring a radiologist to manually open from their PACS viewer for comparison images.

Admin report additions:

  • Restructured various reports to allow more detailed filtering for research, by expanded set of filter criteria. For
    example; tomo versus2D, screening US versus diagnostic, automated US versus conventional, etc. This
    enhancement specifically benefits customers capturing data for various new technologies under evaluation.
  • Added the ability to generate patient letters directly from administrative reports, for example; patients with
    dense tissue and/or high risk assessments for additional ultrasound and/or MRI screening. Additionally, we
    have developed another application for letters facilitating satisfaction surveys on follow-up imaging.
  • Added various reports recommended by clients for special needs or projects.


Recommendation for product development? | 763.475.3388

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