Overcoming tomosynthesis implementation challenges

As breast cancer screening modalities evolve, policies and best practices must be determined for the latest technology, digital breast tomosynthesis (DBT), according to an article published in the December issue of the Journal of the American College of Radiology.

The most recent adoption of DBT, which gained FDA approval in 2011, has begun to replace digital mammography (DM) with promises of decreasing false-positives and increasing cancer detection rates. However, the cart appears to have been put in front of the horse in many ways, leading to rapid installation of the modality without much proof of its clinical relevance and cost-effectiveness.

“The adoption of DBT is outpacing the collection of clinical effectiveness data and reimbursement policies, leaving individual radiology groups with little guidance regarding whether and how to implement this emerging technology into their practices,” wrote Christoph I. Lee, MD, MSHS, and Constance D. Lehman, MD, PhD, both of the University of Washington School of Medicine in Seattle.

DBT has been rapidly embraced for several reasons, including the encouraging findings of early observer performance studies, increased patient throughput, streamlined equipment needs, reduced physical space requirements, and less training for technical staff and physicians.

Many practice management implications exist for radiologists, such as the lack of third-party reimbursement for DBT, associated costs, and increased interpretation time. While a radiologist’s workflow could be adversely affected by an increase in interpretation time, it could be redeemed by the elimination of unnecessary diagnostic workup. DBT could also potentially eradicate the need for conventional DM views, which would further increase workflow efficiency too.

Practices will also need to address the time investment that will come from increased interaction and communication with patients. As more states pass legislation regarding density reporting laws, patient demand for supplemental screening is rising.

Additionally, DBT best practices and policy decisions should be identified and supported with evidence from the community level. “Individual radiology practices, regional radiology alliances, and local and state radiology societies must become more willing partners in informing patients, referring physicians, third-party payers, and policymakers about their early experiences adopting DPT into practice,” the authors wrote.

Comparative effective research will be a vital component in determining DBT’s performance measures and therefore added value in society’s cost-aware health care system.

Finally, practices will need to interact with local patients, patient advocacy groups, and referring physicians to further education about supplemental screening technologies, advised the authors.

“To move early adoption toward more appropriate adoption of DBT, we must become engaged stakeholders to help guide future policies and best practices,” concluded Lee and Lehman.