It’s Time to Ditch the Disk: On Cancer

Rand, AlexAlexander Rand, MD, University of Vermont, and Michael Chorney, MD, Penn Medicine, University of Pennsylvania Health System, contributed to this post.

Opinions are the authors’ own and do not reflect their institutions’ opinions.

Imaging is critical for the detection and evaluation of cancer. Cancers manifest on dedicated screening and diagnostic studies as well as incidentally on other studies. Tumors may change in size, distribution and enhancement pattern during treatment, which directly impacts treatment decisions. Radiologists must be able to assess cancer’s complex evolution over time on imaging to provide the best patient care. Unfortunately, health care’s current reliance on compact discs (CDs) for image transfer often leaves radiologists without prior examinations for comparison.

Cancer screening imaging enables early detection and prompt treatment to reduce patient mortality. Radiologists strive both to detect cancers and discriminate between benign and malignant masses or nodules. Some cancers, particularly breast cancers, may only become apparent with subtle changes in size and morphology over time. Long-term stability of a mass makes cancer less likely. If suspicion for cancer remains very low, or biopsy carries high risk for morbidity, follow-up imaging can help determine if intervention is warranted. However, patients often forget to bring their CDs or discover that the images are missing or corrupted. When prior images are unavailable, the radiologist may be compelled to recommend another imaging study or biopsy. Unnecessary follow-up studies and biopsies may cause patients anxiety, stress or complications, as well as burden the already strained health care system. Chorney, Michael

Cancer patients may receive follow-up imaging at multiple institutions, especially for emergent complications. Radiologists’ frequent lack of comparison examinations from other institutions hinders the interpretation of these studies. Direct comparison to historical images ought to be readily available to better assess tumors, therapeutic response and emergent oncologic complications.

We encourage practices to transition from CDs to cloud-based file-sharing to have patients’ prior examinations readily available to interpreting providers at all institutions at which a patient may seek care. The comparison image availability would enable faster, better cancer screening interpretation, diagnosis, assessment of disease progression and detection of complications. Costly and sometimes unnecessary biopsies and additional rounds of follow-up examinations would be reduced.

The #DitchTheDisk Task Force actively seeks patient and practitioner advocates as we embark on a journey to change the method of personal health record storage. Please fill out this form or email ditchthedisk@acr.org to get involved.

Stay tuned for our next blog on how CDs impact patient care in the trauma setting. Share your thoughts using #DitchTheDisk on social media, commenting below or by joining the discussion on Engage (login required).

Certification in Radiology

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This post was contributed by Howard B. Fleishon, MD, MMM, FACR, vice chair, American College of Radiology (ACR) Board of Chancellors.

The American College of Radiology (ACR) Task Force on Certification in Radiology has been busy since it was created in January 2019.

I want to thank Eric Friedberg, MD, for founding and previously leading this task force – along with his duties as Vice Chair of the ACR Commission on General, Small, Emergency and/or Rural Practice (GSER).

As this task force is intended to function across ACR commissions and committees, and in recognition of the importance of Dr. Friedberg’s work on the GSER, leadership of this task force has recently been transferred to the ACR Board of Chancellors vice chair.

As an update – under Dr. Friedberg’s leadership, four subcommittees have been developed to:

  • Research the history of certification in medicine and radiology
  • Examine best practices for credentialing and future trends in medical specialties and other industries
  • Develop and implement focus groups and general surveys to get feedback from the membership
  • Organize information and references

At RSNA 2019, this ACR task force will meet with representatives from the American Board of Radiology (ABR), American Board of Medical Specialties (ABMS) and others.

The next planned immediate task force deliverable is a report to the ACR Board of Chancellors and ACR Council in May. We also anticipate development of a more comprehensive white paper on certification in radiology.

This is an important member-driven initiative.

We will continue to keep you informed.

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

How We Achieved Universal 3D Mammography Coverage in Hawaii — and How You Can, Too

GrosskreutzScott Grosskreutz, MD, diagnostic radiologist and president, Hawaii Radiological Society, contributed this post.

Hawaii’s small size and geographic isolation are part of the state’s charm, but these factors can contribute to slower adoption of newer technology such as digital breast tomosynthesis (DBT). In 2018, less than half of women in Hawaii were covered for DBT —the lowest rate of all 50 states. Our radiologists want to be able to provide the most accurate examination for all our patients, and DBT has been shown to improve breast cancer detection and decrease recall rates.

The Hawaii Radiological Society (HRS) introduced a bill into the state legislature last session, which would have mandated insurance coverage of tomosynthesis. Dr. Kelly Biggs, chair of the American College of Radiology® (ACR®) Breast Imaging Commission’s Government Relations subcommittee, provided supporting material, and Dr. Dana Smetherman, chair of the ACR Breast Imaging Commission, published a commentary with HRS president Dr. Elizabeth Ignacio in Hawaii’s largest newspaper advocating tomosynthesis.

With testimony from dozens of radiologists, patients and referring providers, the bill sailed through the House and Senate chambers on the first three readings without a single no vote, but was effectively tabled when the Conference Committee declined to convene. HRS

We immediately met with legislators who agreed to reintroduce the bill during the next session and reached out to medical directors of third party payers in Hawaii. Together, we established insurance coverage and convinced the state workers’ trust fund board to provide full DBT coverage – meaning that women in Hawaii will soon have 100% coverage for DBT. This universal coverage relieves mammography staff from the fiscal necessity of requesting copays from uninsured patients, enabling them to focus on patient care and productivity.

From our experience we offer the following suggestions:

1) Achieving coverage for DBT is a team effort. The ACR provides great resources and support, including access to experts who can help you develop your strategy for achieving coverage.

2) Share your local DBT experience. Straub Hospital in Honolulu provided a study of two-dimensional (2D) vs three-dimensional (3D) mammography. They found that DBT had almost double the cancer detection rate compared with 2D. What’s more, a large percent of women in Hawaii are of Asian ancestry, who tend to have the densest breast tissue of any ethnic group. It’s important that this demographic-specific information about the benefits of DBT in assessing women with dense breast was shared through our advocacy efforts.

3) If at first you don’t succeed, don’t give up! By immediately arranging sponsors for the bill’s reintroduction, we ensured public attention remained on the issue.

4) The medical directors working for insurance companies are our physician colleagues and share our concern for our patients. Their organizations focus on cost effectiveness and cost containment. We need to respect their concerns and be responsive to their questions. Developing a good working relationship ensures that your advocacy effort will have a fair hearing when future issues arise.

Nationally, 93% of women ages 40 to 74 have coverage for DBT, according to Truven Health Analytics. It’s time to make DBT 100% covered for all women in the US.

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Coverage for tomosynthesis by state in 2018

 

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