Optimizing Breast MRI Reading
 North Ottawa Community Health System in Grand Haven, Mich., is performing three to six breast MRI studies a week using a 1.5T MR from Siemens Medical Solutions.

From the latest software to meticulous scheduling processes, breast imaging facilities are optimizing their efficiency when it comes to performing and interpreting breast imaging studies.

Kevin Lampert, MD, and Lora Barke, MD, radiologists at the Sally Jobe Breast Center in Denver, Colo., read about 20 breast MRIs a day. “There’s no way we could get through that without a system like CADstream,” Lampert says. The CAD software from Confirma offers color mapping and image display that “just makes it so incredibly helpful in getting through large volumes of images quickly.” It’s imperative to use a CAD system in this day and age, he says. “The technologists don’t even have to do the post-processing they used to; they can just send images to CADstream so they can get the next patient on the table without wasting time doing manipulations.”

The physicians also like that CADstream helps them manage their high volume. A library accommodates all the patients we see so we don’t have to pull studies from our PACS.”

Another, low-tech aspect of good productivity at Sally Jobe are all the tasks fulfilled by various staff members. “We’ve been doing breast imaging biopsies for more than 25 years, so we have a system in place that’s incredibly efficient, from scheduling staff to techs and nursing,” says Barke. Office staff know the patient data required so they make the calls necessary to acquire that information and have it available to the radiologists. Biopsy aides assist in performing 15 to 20 biopsies a day. Their help allows the radiologists to keep moving from room to room. And, “once we’ve read an MRI exam, two full-time, dedicated nurses can act on them on our behalf,” says Lampert. “If the patient needs to come back for an ultrasound- or MR-guided biopsy, the nurses can take that responsibility out of our hands.”

“It’s a matter of optimizing workflow,” says Barke. The nurses, technologists and aides handle paperwork, “making the system that much more efficient for us so we can act as radiologists.”

Mike Schmidt, MD, one of two partners in Envision Radiology, which reads for North Ottawa Hospital in Grand Haven, Mich., started a breast MRI program a year ago. Using a 1.5T MR scanner from Siemens Medical Solutions, Schmidt says they are performing three to six breast MRIs a week and, even though it’s a 50-bed community hospital, “I’ll stand our images up against anybody’s in the nation.”

That’s because they have the trickiest cases over-read by ProScan Imaging, whose founder established many MRI protocols. “We’ve been able to promote to our community that the images obtained in our small hospital will have world-class interpretation,” he says.

That as well as using DynaCAD from Invivo Technologies have helped Schmidt and his partner grow the program at a slow and steady pace. Close to 2,000 images are obtained in each study and the data are pushed onto the workstation, ready for the radiologist to interrogate. “We can evaluate very systematically to the point where we feel comfortable that we have gone through the entire breast tissue carefully to analyze for any suspicious areas.”

The use of an in-depth questionnaire to obtain a thorough history is another important aspect of a good breast MR program, Schmidt says. Also, the schedulers know the most important questions to ask of patients and referring physicians which provide even more appropriate history. The practice takes care of obtaining a preauthorization from payors, Schmidt says. That way, when the patient comes in for her exam, there is no question about whether the test will be paid for. “That takes anxiety away from patients and it’s another way to make the throughput and the patient experience much better.”