Mammography Saves (Hundreds of Thousands of) Lives!

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R Edward Hendrick

This post was contributed by R. Edward Hendrick, PhD, FACR, from the University of Colorado, and by Jay A. Baker, MD, from Duke University and President of the Society for Breast Imaging (SBI). Both are members of the American College of Radiology (ACR) Commission on Breast Imaging.

Along with Mark A. Helvie, MD, from the University of Michigan, we recently authored a landmark study published in Cancer, the peer-reviewed journal of the American Cancer Society, confirming a truth that those of us in the radiology community have long known: mammography saves lives.

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Jay Baker

Over the past 30 years, up to 614,500 breast cancer deaths have been averted through the use of mammography screening and improved treatment. Up to 46,000 such deaths were prevented in 2018 alone.

Despite this strong evidence of mammography’s life-saving value, only about half of U.S. women over 40 years of age currently receive regular screening mammograms as recommended by ACR/SBI screening guidelines.

Our hope is that our findings will help women recognize that early detection and modern, personalized breast cancer treatment can save their lives. Our findings support that average-risk women get screened annually starting at age 40 and that high-risk women talk with their doctor about earlier screening.

Often, when we speak with reporters about mammography screening, they want to focus on the risk of call-backs for additional imaging and breast biopsies. We have to remind them of the overwhelming truth that, as our study shows, mammography finds breast cancers early, when treatment can be most effective.

Fortunately, the mainstream media coverage of our study – from leading outlets such as NPR, U.S. News & World Report, and CBS – represents a positive step forward in correcting misinformation and raising public awareness that early detection saves women’s lives.

We anticipate that scientific advances and innovation in mammography and treatment will further reduce breast cancer deaths and morbidity.

In the meantime, it’s important that we continue to encourage our female patients, and the women in our lives, to comply with ACR/SBI screening guidelines and continue to inform patients, payers and the public that Mammography Saves Lives!

  • How are you working to educate patients about the importance of mammography screening?
  • Join the conversation on social media using hashtags #StartAt40 and #MammographySavesLives, and by following @BreastImaging, @RadiologyACR and @MammoSaves on Twitter.

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

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The Nuts and Bolts of Clinical Decision Support

Dr. SilvaThis post was contributed by ACR Economics Commission Chair Ezequiel Silva, MD, and RBMA Federal Affairs Committee Chair Linda Wilgus, CPA, MBA.

If you’re a radiologist or a radiology business manager, by now you may know that starting Jan. 1, 2020, Medicare will require referring providers to consult appropriate use criteria (AUC) prior to ordering advanced diagnostic imaging for Medicare patients. More importantly, furnishing facilities will need proof of that consult to get paid for those exams.

What you may not know are the specifics of how to get there. Linda Wilgus CPA MBA

  • How should you prepare?
  • Why should your practice be working with your referring providers on this mandate now?
  • How and where do you document the consult?
  • Are there any facilities that are exempt?
  • What if referring and rendering providers don’t share a common electronic health record or electronic medical record system?

This just scratches the surface of the questions that have been asked, and will be asked in the months to come.

Fortunately, the American College of Radiology (ACR) and Radiology Business Management Association (RMBA) are co-hosting a free webinar on Wednesday, Feb. 20 at 7pm EST to help you understand the specifics of how to implement clinical decision support (CDS) in your practice.

You don’t have to be caught off guard – you can register for the webinar now and we, along with these other experts, will answer your questions in real time:

  • Mike Bohl, MHA, IHE International Radiology Planning Committee Co-chair, Chief Operations Officer, Radiology Group, PC, SC
  • Bob Cooke, National Decision Support Company Vice President

Even if you can’t join us on the 20th, by registering, you’ll get a link to the recorded webinar as soon as it’s available.

We’ve also gathered a variety of resources at ACR.org/CDS to help you explore this issue further as we approach January 2020.

Don’t miss this opportunity to participate in a robust Q+A with your peers and CDS experts. See you on the 20th!

  • What questions do you have about AUC/CDS implementation?
  • What step(s) have you, or your practice, already taken to ensure you’re prepared for the PAMA mandate? 

Please share your thoughts in the comments section below and join the discussion on Engage (login required).

Prioritizing Health and Radiation Safety in Radiopharmaceutical Therapy

wallnerThis post was contributed by Paul E. Wallner, DO, FACR, chair of the ad hoc workgroup on NRC training and experience requirements for the ACR Commission on Government Relations-Federal Regulatory Committee

The U.S. Nuclear Regulatory Commission (NRC) is exploring the idea of reducing training and experience (T&E) requirements for physicians authorized to use therapeutic radiopharmaceuticals regulated under 10 CFR Part 35, Subpart E (“Unsealed Byproduct Material—Written Directive Required”). The controversial concept would involve less comprehensive T&E pathways to authorized user (AU) eligibility for clinicians without the appropriate ABR, ABNM or AOBR board certification or the currently specified alternate pathway. The target audience would be referring clinicians who, for whatever reason, do not wish to refer their patients to the radiopharmaceutical therapy experts.

Supporters of weakened 10 CFR 35.390 AU T&E prerequisites—primarily commercial entities that manufacture or supply therapeutic radiopharmaceuticals—suggest there is a shortage of AUs, creating rural access problems. They argue that unitized dose delivery systems negate the need for physicians to have radiation and nuclear materials expertise. Such arguments are unsubstantiated, anecdotal and often conflicted.

With approximately a thousand trainees in the traditional pipelines of nuclear medicine, radiation oncology and nuclear/diagnostic radiology, demand for radionuclide therapy AUs under Subpart E will be adequately covered for the foreseeable future. With many considerations influencing treatment and referral decisions, it is unlikely that expanding the AU population with inadequately-trained clinicians would create additional points of access in rural areas. Rather, it is more likely that large facilities already licensed by NRC or the Agreement States for these uses would be disrupted internally. This concept would circumvent radiation best practices and cancer care standards while fostering an environment of financially-motivated utilization, thereby reducing the quality and safety of radiopharmaceutical therapy.

As a member of ACR’s Federal Regulatory Committee (FRC), I have chaired an ad hoc workgroup responsible for leading the College’s response. The workgroup consists of leaders and volunteers from ACR’s Commission on Government Relations, Commission on Radiation Oncology, Commission on Nuclear Medicine and Molecular Imaging, and Commission on Medical Physics-Government Relations Committee. Over the past year, we provided testimony to NRC’s federal advisory committee, wrote letters to NRC staff and leaders, collaborated with likeminded professional organizations, and met face-to-face with NRC’s Commissioners to educate them about our community’s concerns.

On January 29, 2019, ACR submitted public comments answering specified questions from NRC and asking the agency to not pursue regulatory revisions to reduce the aforementioned T&E requirements for individuals without appropriate board certification. The NRC staff and Commissioners intend to make a decision later this year on whether or not to open up the rulemaking process. Moving forward, ACR will continue to work to promote the best interests of patients and the public on this important health and radiation safety issue.

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