Society of Breast Imaging From The Editor: IHE 2007 ACR ® First Class 1891 Preston White Drive AIM To Improve Digital CPT Code Mammography U.S. Postage Reston, VA 20191-4397 Mammography Performance Breast Imaging Update Accreditation PAID Permit #144 2 3 5 9 Waldorf, MD The Member Newsletter of the Society of Breast Imaging FALL 2006 Presidential Message: Maintenance of Certification, Maintenance of Confidence government invited their participation their respective 24 Boards. Six core R. James Brenner, MD, JD in return for reconsidering drastic competencies are defined by the reimbursement cuts. Since the begin- ABMS for all specialties and include ost of us have heard of the ning of this Century, highlighted in an medical knowledge, patient care, in- Mupcoming Maintenance of IOM (Institute of Medicine) report, terpersonal and communication Certification, or MOC, the public and payers have been advo- skills, professionalism, practice based program, perhaps even read about it cating a process that would improve learning and self-improvement, and in one of the national journals. Some the quality of healthcare in a manner system based practice. Board certi- may have already participated in one that could be objectively measured. fication reflects all of these and until element leading to MOC, a SAMS Pointing to other industries where 2002, those who received certifica- exam where questions are answered certain metrics could be used to mea- tion were not required to demonstrate following a conference presentation, sure quality, such advocates have any further evidence of continuing that can be applied toward completion declined to accept the autonomy of competency beyond compliance with of the ten year process. But I suspect the American physician and insisted approved programs for continuing that both the rationale and even de- on developing systems that at least education. Since 2002, ABR certifica- tails of the program are not familiar. begin to incentivise improvement in tion is granted for diagnostic radiologists That will change and the purpose of care. This effort in fact dates back at for ten years, after which re-certification this column is to facilitate that least ten years; consider the HEDIS is mandatory. Otherwise, evidence of change. This is an issue that affects standards that were applied to pri- MOC is voluntary but, as will be dis- not just breast imagers or even radio- mary care physicians to encourage cussed below, external events may logists; it affects all of medicine. compliance with best practice patterns modify this condition. There are a number of terms that such as recommending screening This historic assumption that relate to this subject with one of the mammography. Of interest, this year those who are involved in approved more interesting terms being “pay for California will institute a trial program, continuing education activities are performance.” (PFP) This lightening rewarding primary care physicians helping to insure continuing compe- rod phrase is certain to capture the who fulfill certain medical recom- tency has been challenged. The answer attention of most practitioners and its mendations. to this challenge is unknown. Under significance is illustrated by the The American Board of Medical such circumstances, MOC programs changing attitude of the AMA Specialties (ABMS), which includes may be seen as the next step in trying (American Medical Association) the American Board of Radiology to provide the public and payers a basis which initially resisted any partici- (ABR), has left the task of establish- for encouraging, if not insuring that pation in a PFP initiative, until the ing parameters for MOC to each of Continued on page 11 1 The Member Newsletter of the Society of Breast Imaging From The Editor: AIM To Improve Mammography Performance Without knowing more of the which are available in CD-ROM for- Murray Rebner, MD fine details I would like to offer my mat. The AIM program will start by comments on the program. First, I do testing radiologists with community arla Kerlikowske’s article not think any breast imager would be practice representative screening K describes how the NCI’s opposed to the AIM concept. We are cases. Over time, perhaps the pro- Breast Cancer Surveillance all aware that mammography, albeit the gram could also select diagnostic Consortium (BCSC) will use a 2.5 mil- gold standard for breast cancer screen- cases to further sample the breast lion dollar award to improve mammo- ing, is far from perfect. For phase one, imager’s skills. Assessment and man- graphic interpretation. The AIM determining what, if any, minimum agement recommendations based on (Assessing and Improving Mammog- volumes of screening studies read per the diagnostic workup could also be raphy) project will attempt to do so by year are associated with better per- evaluated. It makes no sense to this writer a three phase effort. In phase one, formance is important. However, the to identify potential areas of improve- researchers will determine the effect timing of the interpretations may also ment to the breast imager if he/she of volume of mammography examina- be important. If radiologist A reads cannot easily follow up in these ar- tions interpreted per year on radiologists’ 480 cases per year and reads 40 cases eas by taking more training. The idea interpretive performance, independent each month, and radiologist B, a back of providing in-person, interactive of other variables such as patient, phy- up reader in a practice, reads 480 cases training with expert breast imagers sician, and facility factors. In phase over the last month of the year for two is an excellent way of doing this. two the investigators will create assess- years to comply with FDA regulations, CME credits could be obtained in the ment tests from community practices does radiologist A perform better than process and maybe over time, a ro- and determine whether cancer preva- radiologist B due to more frequent ex- tating group of expert radiologists lence or other mammographic findings posure to the modality? Also, is there a and technologists could travel to dif- influence performance. Finally, the daily interpretation volume above ferent parts of the country and offer researchers will develop in-person, inter- which performance declines? We are this service. This would be a differ- pretive training programs with expert all under pressure to do more with less. ent refreshing way of meeting CME breast imagers and see if these improve Certainly, experience and ancillary needs. Current topics such as CAD, performance. support tools such as physician ex- breast MRI and digital mammography tenders, checklists in lieu of dictation, etc. might also be integrated into the in- would factor into this determination. teractive sessions. However, at this time I agree that a lower Finally, as I said earlier, I do not volume limit is the place to begin. think any breast imager opposes the The second and third compo- concept of improving mammographic nents of the program, in my mind, will interpretation. However, some would essentially be linked. Anytime we oppose participating if the process hear about more test taking (SAMS, was not made extremely “user recertification, etc.) the natural reaction friendly”. I am sure that the investi- SBI News is published by the Society of Breast Imaging is to say “not again!” However, as Dr. gators have realized this and done To submit articles for publication, please Brenner points out in his presidential their best to minimize inconvenience send your material to the editors c/o: message, Maintenance of Certification to the participants. Those who wish SBI Headquarters likely will become linked to reimburse- to take part hopefully will be given 1891 Preston White Drive ment (pay for performance). Mammo- credit, in the form of time, by their Reston, VA 20191-4397 graphy assessment tests already exist and colleagues. Secondary benefits from For membership or provide good clinical and didactic the program such as fewer malprac- additional society information, call: (703) 715-4390 teaching for a variety of diagnostic tice suits are likely to result. If, as fax: (703) 716-4487 problems. Dr. Ed Sickles and colleagues Dr. Sickles says, the program has the website: www.sbi-online.org at the ACR have created three such self potential to substantially improve EDITOR assessment modules (Interpretive mammographic performance in clinical Murray Rebner, MD; email: [email protected] Skills Assessment) for mammography settings, why not support it? I do. ● 2 FALL 2006 IHE Digital Breast Imaging Dianne Georgian-Smith, MD Massachusetts General Hospital Boston, MA ince June 2005 when the Additional problems have Hinging on workflow problems S first meeting of users in digital stemmed from PACS systems now is the issue that technologists may imaging occured. The digital managing and storing large files have to push images to interpretation breast imaging, the IHE mammography which are approximately 30 MB per workstations and PACS. This prob- subcommittee has made amazing image from an area of radiology lem leads to human errors of forget- progress working with the vendors to where large volumes of patients pass ting to do so particularly if sending define electronic and information through daily. images to PACS is not integrated to systems’ standards within digital Workflow issues are paramount. the interpretation. Previous digital breast imaging. They can be broken down into acqui- images are not always immediately As many of you know first hand, sition, post-processing, and reporting available and may have to be pushed there are many problems currently components. Problems exist in which or pulled from the PACS system, but within digital breast imaging that images are poor quality at the acqui- one may not know on which vendor’s resulted from the fact that the FDA sition systems making it difficult for machine the previous ones were im- required mammography vendors to technologists to screen for motion or aged if there has been cross-over.