TMIST Trial Expands Mammography Access to the Uninsured

Etta Pisano 16May17_0002 headshotThis post was contributed by Etta Pisano, MD, FACR, principal investigator of the Tomosynthesis Mammographic Imaging Screening Trial (TMIST).

With 70 sites up and running – and 60 more in the pipeline – TMIST is picking up speed.

One of the factors that I am proud to highlight is that radiologists are very interested in using TMIST participation to offer breast cancer screening to women in their community who may not otherwise have access to these lifesaving exams.

TMIST is one of a comparatively few large clinical trials that offers provider reimbursement for women who qualify for charity care at a participating site.

For the initial exam for each woman enrolled (insured or uninsured), sites receive $500. If the woman is insured, they also receive the usual payment from the insurer. If the woman is uninsured and qualifies for charity care at the site, sites receive an additional $138.17 from TMIST for this initial exam.

For each follow-up screening for insured women, TMIST pays sites $150 on top of the insurance payment. For each follow-up exam for uninsured women who qualify for charity care at the site, TMIST pays sites $150 plus an additional $138.17.

This possible total $288.17 TMIST payment ($150 + $138.17) for each follow-up exam for uninsured patients may be triple that paid to providers for such services by major breast cancer care charitable organizations. 

A recently approved $30,000 reimbursement advance can help select facilities immediately hire a research assistant as an on-site coordinator and avoid added responsibilities to existing staff. This can be particularly impactful for sites in underserved areas — including small and rural practice providers.

An added benefit is that, in addition to offering screening to women who may not get this care otherwise, we are expanding representation in clinical trials. This can help ensure that TMIST conclusions will be more generalizable across populations – strengthening its real-world impact.

I am proud to lead the TMIST trial and proud of the radiologists taking part.

As we will ultimately recruit 165,000 women to TMIST, at up to 150 sites, we still need more radiology facilities to take part.

I invite you to visit to find out how TMIST participation can strengthen your practice, enable you to author papers published in major medical journals, help shape future breast cancer screening, and expand access to the underserved in your communities.

  • Have questions about TMIST? Please email— we will answer your questions and walk you through how to get started.

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RADvocacy: Leveraging the Power of our Medical Expertise

Georgia Giakoumis SpearThis post was contributed by Georgia G. Spear, MD, Chief of Breast Imaging, NorthShore University HealthSystem and Clinical Assistant Professor of Radiology, The University of Chicago

Early detection saves the most lives. As a breast imaging radiologist, I believe the onus is on us to take action and provide the best care for our patients. Advocacy allows us, as physicians, to educate the public and legislators in our area of expertise – a critical role that positively impacts the care of our patients in a complex health care environment.

It was my privilege and honor to provide medical expert testimony in the State of Illinois at both the Senate and House committees in 2018, resulting in unanimous passage of breast density notification legislation, effective January 1, 2019.

As a member of the Breast Imaging Committee of the Illinois Radiological Society, I was also active in the creation of this legislation, HB 4392, which serves to notify women of their breast density, educate women on the implications of having dense breast tissue and guide women to their breast imaging provider to address whether supplemental screening may be right for them. This legislation, coupled with an Illinois State mandate passed in 2009 requiring coverage for supplemental screening with ultrasound or MRI for women with dense breast tissue, will allow women to benefit from testing that may be necessary to maximize our ability to detect breast cancer early when it is manageable and treatable.

Recently, I traveled once again to my State Capitol in Springfield, Illinois, to provide medical expert testimony to the Senate committee on a piece of legislation, SB 162, that will expand coverage to diagnostic mammograms when deemed medically necessary and would cover breast ultrasounds for evaluating dense breast tissue. This legislation, which can influence compliance with the life-saving benefits of annual screening mammography, passed the Senate and I will be returning to support this bill at the House committee.

I view my role as a physician as a privilege, and I am grateful to extend the best care possible to my patients daily in my clinical practice. Leveraging my medical expertise to influence changes that will affect all women is priceless.

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The Role of Medical Physics in the Field of Radiology

MAHESH mahadevappaThis post was contributed by Mahadevappa Mahesh, MS, PhD, FACR, chair of the American College of Radiology (ACR) Commission on Medical Physics and Ashley E. Rubinstein, PhD, a medical physics resident at the UTHealth McGovern Medical School.

Dr. Mahesh: In January 2019, the American College of Radiology (ACR) Board of Chancellors approved the establishment of Richard L. Morin, PhD, Fellowship in Medical Physics, sponsored by the Commission on Medical Physics. The fellowship allows us to provide a medical physics resident-in-training an opportunity to learn about the inner workings of the college, and at the same time attract younger medical physicists to become members of the College and contribute to all of the important work we will be doing in the coming years as we continue moving into value- and population-based healthcare.

As this was the first time the fellowship was available, we weren’t sure what to expect. We received ten strong applications and the Commission had a difficult time selecting one fellow. After reviewing all of the applications closely, we unanimously selected Ashley E. Rubinstein, Ph.D. as the inaugural fellow.

Ashley RubinsteinDr. Rubinstein: I am extremely honored to have been chosen for the Fellowship. I first heard about this opportunity through Dr. Susan John, the Chair of Diagnostic and Interventional Imaging at the UTHealth McGovern Med School, who encouraged me to apply. During residency, I have become involved with global health initiatives through the IAEA and RAD-AID, where I have used ACR standards and guidelines as a framework for improving radiological care. I knew the Morin Fellowship would be a wonderful opportunity for me to learn more about the ACR and how I, as a physicist, can impact the field of radiology.

 Dr. Mahesh: Dr. Rubinstein, we are very excited to welcome you to the College’s annual meeting, ACR 2019, this May – and to have you spend a week at the ACR headquarters to learn about the inner workings of the College and also to complete a project as part of your fellowship.

We know that accredited medical physics residency programs do a great job training our incoming medical physicists like you, but we also realize that a lot of what the ACR does is somewhat of a black box to this group. This fellowship will provide an opportunity for you and other young medical physicists to not only learn, but also play a more active role in the key activities of the College in the coming years.

Dr. Rubinstein: Thank you, Dr. Mahesh. I look forwarding to gaining a better understanding of the context in which ACR standards have been established and the precise impact these standards have had on the field of radiology. I also look forward to promoting the principles of the ACR both in the United States and globally. Thank you so much for this opportunity.

  • Do you have questions about the new Morin Fellowship?
  • Do you have questions about radiation, image quality, the physics of medical imaging or the Commission on Medical Physics’ work? We’d love to answer them.

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