Posted on Jun 07, 2019
As developments in technology and technique continue to improve breast cancer detection, advanced imaging is becoming a routine part of breast screening for women. While the use of more complex modalities has the potential to help with early detection, it’s important imaging facilities make necessary adaptations in order to maintain high-quality patient care and avoid disruption in workflow.
We spoke with Dr. Gale Sisney, breast imaging expert and director of three major breast imaging centers and academic cancer centers, to discuss three areas of impact imaging centers should address in order to avoid backlog and ensure accuracy in their breast imaging.
In the last 20 years, breast imaging has become very specialized. Newer technology is capable of detecting breast cancer at a smaller size than previously possible, and improved accuracy is decreasing call back rates.
But as 3D mammography, breast MR, and image guided biopsy become preferred modalities for many patients, including high risk women and women with high breast density, patient studies are growing in both number and complexity.
“Tomosynthesis, for example, is now widely accepted. Now, that doesn’t increase the technologist’s time - but what it does do, is double the radiologist’s interpretation time. So, with the same patient volume, an imaging center needs twice the radiologists. Or, they need the radiologist to work twice as hard, which is almost impossible.” says Dr. Sisney.
As work volumes increase, and as radiologists struggle to keep up with workloads, Dr. Sisney predicts many imaging centers are either already facing issues with backlog or are likely to in the near future.
A reading radiologist for DocPanel, an on-demand marketplace for complete subspecialty reading coverage, Dr. Sisney helps imaging centers manage and grow their business by providing remote reads for breast imaging.
“Imaging centers should absolutely be turning to remote reading. It can improve efficiency, and it can improve the quality of their reads. I’ve proven this.” says Dr. Sisney. “Unfortunately, there’s a big misconception that remote reading for breast imaging isn’t good. For instance, right now, a lot of people think tomosynthesis files are too big to even be read remotely. But that just isn’t true. There‘s no delay; there’s no hindrance.”
Dr. Sisney emphasizes that utilizing fellowship-trained remote readers not only increases efficiency, but also strengthens quality.
“I provide physicians with very, very clear reports. I communicate with the techs I work with. I’m able to take my time and not rush through an interpretation.” says Dr. Sisney. "Their patients are getting the same quality of care as anyone who goes to a major academic breast imaging center.”
Despite the capabilities of new equipment and regardless of who’s interpreting a study, one of the ongoing issues with image quality is the positioning of the patient by the technologist.
“A technologist’s positioning is really an art - but imaging centers often overlook that. It’s something that needs to be addressed. There should be continued support for the techs with hands-on education.” says Dr. Sisney. “Breast MR, for example, is extremely complicated. And it’s being used more and more often - both for regular screening and to evaluate the extent of disease in women who have recently been diagnosed with breast cancer. In order for a technologist to use the machine to its full potential, they need to have a thorough understanding of how it works.”
A technician’s ability to accurately apply the correct sequence and protocol also impacts the accuracy of an image.
“When I read for imaging centers via DocPanel, I do oversight of all their image quality. I set up standard protocols, so they know exactly what to do, and if the technologist has any questions - they’re able to call me right away.” says Dr. Sisney.
Some of the biggest challenges for a technologist are high patient workload, the speed at which they need to perform the exam, and the number of exams that they need to perform in a single day - these can all distract away from the patient.
Good communication between the radiologist and the technologist, says Dr. Sisney, helps ensure accuracy and attention to detail are not compromised even when workload is high. It also helps nurture continued adaptation for new techniques as they are developed.
Dr. Gale Sisney is a Diplomat of the American Board of Radiology and a Fellow of the American College of Radiology. She was named to Leading Physicians of the World (2017) by the International Association of Healthcare Professionals and is the former Director of Breast Imaging at Georgetown University, University of Wisconsin, and University of Colorado.