Heacock: By being aware. Just saying you are going to cut the exam time down by offering abbreviated breast MRI is a great first step. After that, you need to look at how you schedule breast MRIs at your practice and how you change over to the next study. Some places that have been doing this successfully have been batching the abbreviated MRIs together. So, with the example of the one-hour slot, if you’re switching to three exams instead of one, you do them all together in a row. The breast coil is there and available for use immediately for the next patient. This is more efficient than mixing-and-matching studies throughout the day – an abbreviated breast MRI followed by a different body part back to an abbreviated MRI. That’s going to be less efficient for workflow and turnaround.
You can also take a look at how your room is set up. Maybe you could increase turnaround time with duplicate breast coils with one patient being scanned while you’re positioning the next patient to be ready to go. You can switch out the gantries immediately. However, these solutions depend on how much space you have in your practice and how much duplicate equipment you would have to purchase. A radiology practice needs to identify what their potential workflow issues are to minimize turnaround time while offering abbreviated breast MRI.
We’ll see more implementation challenges arise with greater implementation of abbreviated MRI, but these are the major ones identified so far.
Diagnostic Imaging: Then, where do we go from here? What are the next steps with abbreviated MRI, and what needs to happen to move things forward?
Heacock: I think the literature at this point is excellent and has shown the promise of abbreviated breast MRI. The first big multi-center trial preliminary results have just come out, and they will be doing ongoing analysis that will be important. Part of what ECOG-ACRIN 1141 is doing is a cost-effectiveness analysis which will be very interesting. Radiologists want to know they are providing value to the patient by offering abbreviated breast MRI. To have a formal cost-effective analysis is going to be important when offering this to patients and obtaining reimbursement in the future.
There are other ongoing large prospective trials that are going to be investigating abbreviated breast MRI in different subpopulations and risk categories. For example, ECOG-ACRIN 1141 looked at women with no prior breast cancer history who had dense breasts – they were average-risk women with dense breasts. There are ongoing studies evaluating patients in different countries that have had a history of breast cancer or are high-risk BRCA mutation carriers and a history of breast cancer. These are intermediate risk patients and I think we’re going to see abbreviated MRI is a great way to screen them, as well.
Ultimately, we need to understand how cost-effective abbreviated breast MRI is and determine which patient populations benefit most. I look forward to seeing the results of these large trials and hope they will help patients have better access to this new screening tool.