1. Mobile Digital Telemammography Dr. Joseph Gitlin Presentation at The Cancer Summit Rapid City, South Dakota October 12 th, 2004

2. Mobile Digital Telemammography This is a demonstration and evaluation program to provide high quality mammography and other health services to women in underserved areas. It is based upon the premise that the value of early detection of breast cancer has been widely accepted by recognized authorities, and that mammography is the most efficacious method of providing screening and diagnostic examinations.

3. Mobile Digital Telemammography The concept is based upon the convergence of digital imaging, computer technology, and satellite telecommunications combined in a mobile setting to improve access to high quality care for women in underserved areas.

4. Mobile Digital Telemammography With the support of the Komen foundation, Phase I was completed in 2002. The objectives included testing the feasibility of utilizing a mobile unit for: Digital mammography examinations Satellite transmission of images for interpretation Providing prompt results to the patients

5. Mobile Digital Telemammography The design of the demonstration and evaluation project was based upon the results of Phase I. In addition to digital mammography, the services available to participating women include: Breast examinations PAP smears Bone densitometry Diabetes screening

6. Mobile Digital Telemammography In addition to providing health services to women with limited access to high quality care, it is expected that the program will: Increase compliance with follow-up recommendations Mitigate the shortage of radiologists Provide data on costs and benefits

7. Mobile Digital Telemammography A community outreach program will be developed with the participation of local Service and Tribal units. This will be aimed at: Increasing participation by eligible women Compliance with follow-up recommendations Emphasizing patient privacy measures

8. Womens Health Care Unit with Digital Mammography

9. Mobile Unit Functional Floor Plan

10. Mobile Digital Telemammography NIH Guidelines Evaluate the role of the MDT program and its telecommunication capabilities in improving womens access to breast cancer screening: Education about self-examination Clinical breast examination Expert mammography interpretation Immediate consultation with sub- specialists

11. Mobile Digital Telemammography Among the several evaluation measures of interest related to mammography and the other services in the health care delivery program are: Participation by eligible women Compliance with follow-up recommendations Analysis of abnormal findings Short term outcome such as biopsy results Costs and benefits

12. Mobile Digital Telemammography The evaluation will be based upon selected data related to services provided on the mobile unit and comparable information from previous years. These data will be obtained from the Resource and Patient Medical System maintained for both Service and Tribal units. The data will be processed under strict security measures in accordance with HIPAA regulations to protect patient privacy.

13. Mobile Digital Telemammography It is expected that the mobile unit will be able to provide mammography and other health services to 60 eligible women per week for a total of 2500 per year. The evaluation is planned for two years to support the collection of sufficient data to determine the costs and benefits of this innovative health care delivery program.

14. Mobile Digital Telemammography Tentative program schedule: Acceptance testing of Mobile Unit 10/25/04 Dedication ceremony at Belcourt10/27/04 Staff training, operational testing Nov. 2004 Begin health care delivery Dec. 2004 Begin evaluation Jan. 2004

15. We are on the threshold of a very special and unprecedented undertaking- the opening of the National Museum of the American Indian. –W. Richard West Jr.

16. Mobile Digital Telemammography Comments, Questions, Letters of Support, or Copies of the presentation, please contact: Dr. Joseph N. Gitlin Associate Professor of Radiology Johns Hopkins Medical Institutions 14208 Northwyn Drive Silver Spring, Maryland 20904 Email: jgitlin@jhmi.edu

17. Early detection through screening is our best defense against morbidity and mortality from breast and cervical cancers and precancers. Julie L. Gerberding, MD, MPH, Director Centers for Disease Control and Prevention