Radiologists also need to be aware that, like all breast MRI, abbreviated breast MRI has high sensitivity and accuracy for invasive cancers and high-grade ductal carcinoma in situ, but is less sensitive for low-grade DCIS. That’s not unexpected as we have already seen that with routine breast MRI.
Diagnostic Imaging: What about the challenges around clinical implementation. What seem to be the obstacles there?
Heacock: Clinical implementation is increasingly important. We’ve reached the stage at which the literature has been very exciting on the promise of abbreviated breast MRI, but the clinical implementation is just getting started. Especially after ECOG-ACRIN 1141 results were published, radiologists need to know how to optimize abbreviated MRI and put this into practical use.
There are a couple of different issues that need to be considered. One of the first is that there is no standardized reimbursement or CPT code for this exam yet. There have been a variety of ways outpatient centers or hospitals have sought reimbursement for abbreviated MRI. Some states have limited coverage of this through HMOs. Other places are offering this as a self-pay examination. Reimbursement remains an ongoing issue.
It’s also important to know that when we talk about 10 minutes of scan time, we’re talking about table time – the amount of time that the patient is on the table being scanned. For the patient, this starts when they hear the MRI start imaging and ends when they get off the table.
But, there’s a lot that goes on behind the scenes that the patient doesn’t see that still contributes to exam time. The technologist and other staff set up the machine, start an intravenous line, position the patient’s breasts within the breast coil, and put the patient on the table. After the examination is complete, they take out the IV, clean the room, and turn it around for the next patient. So, that 10 minutes of exam time, how does that translate into total workflow time? It’s been shown that, as you decrease the scan time, you need to also look at decreasing the turnaround time in order for this to be efficient.
For example, if your breast MRI slot at your practice is usually one hour, maybe you could perform three abbreviated MRIs in that same one-hour time period. You need to be aware that it may be more challenging than you think to set this up because you have to address technologist and workflow issues.
Diagnostic Imaging: How can practices or imaging centers get over these stumbling blocks and improve their implementation?