Building a Turnkey Women's Imaging Service

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Building a profitable breast imaging service entails deploying the right technology for a multimodality approach, effectively triaging high-risk women, and taking great overall care of the CEOs of family health

Women’s imaging is smart business: for the over-40 female population, yearly breast-cancer screening is an annuity that, in the right hands, translates into downstream revenue for radiology providers and increased market visibility among women and their families and friends. That’s why some of the country’s leading imaging organizations are investing in women’s health, implementing a range of modalities and an array of marketing and wellness initiatives designed to attract and keep valuable female patients.

It all starts with the right mammography equipment, according to Gerald Kolb, chief knowledge officer at Solis Women’s Health, Austin, Tex, a privately owned outpatient imaging company with 13 comprehensive breast centers and 15 mammography centers in six states. “We believe quite strongly that if we discover cancers early, they are, for all intents and purposes, curable,” he says. “The full range of modalities in our comprehensive breast centers includes digital mammography, ultrasound, and stereotactic biopsy capability. The first thing we do when we acquire a center is make it all digital.”

Though it is, of course, possible to perform high-quality screening using plain-film mammography, Elsie Levin, MD, medical director of Sagoff Breast Center at Faulkner Hospital, Boston, is a believer in full-field digital mammography. Although her facility completed its digital transition just last year, she says, “There are a tremendous number of advantages to digital mammography. You get greater productivity, and with dense breasts, digital mammography has the edge.”

Kathy Schilling, MD, medical director of breast imaging and intervention at the Center for Breast Care of Boca Raton Community Hospital, Boca Raton, Fla, concurs. She says, “Digital mammography is the best way to identify the majority of breast cancers. It’s the best screening tool we have, it’s widely available, and it finds more cancers in patients with dense breasts or patients who are pre- or perimenopausal.” She stresses, however, that the right equipment is nothing without the right staff. “You need digital mammography, but you also need dedicated breast imagers,” she says.

Mark Farmer, director of outpatient services at Charlotte Radiology, Charlotte, NC, adds, “You need computer-aided detection to assist the doctors in reading the exams. Besides equipment to perform diagnostic mammograms and biopsies, additional modalities are needed to assist further in your diagnosis, including breast ultrasound and breast MRI.”

Kolb notes that there are advantages to digital mammography beyond its diagnostic superiority: The modality also allows Solis Women’s Health to deal with a shortage of qualified imagers. “The fundamental thing that digital mammography brings you is the ability to move images around,” he notes. “We have a very significant investment in PACS and RIS. Now, if I want to open a new center in Phoenix, where we have one comprehensive site and seven screening sites, I can put a new comprehensive center in that market and absorb some of the cost by sending the physician screens from other locations to read.”

A Multimodality Approach

MRI has always played a role in breast-cancer care, but has only recently gained traction as an additional screening modality. In July 2008, the American Cancer Society (ACS) revised its guidelines on breast-cancer detection to include annual MRI exams for high-risk women. Some, like Levin, view the modality as essential to comprehensive care: Sagoff Breast Center was an early adopter of the technology, installing its first dedicated breast MRI unit in October 1997.

“That’s been my baby,” Levin says. She estimates that Sagoff Breast Center performs around 350 screening MRI studies per month. “I do a lot of high-risk screening, so medical oncologists who run clinics in the Boston area send me their patients with a genetic susceptibility and patients with a family history of breast cancer. We have long MRI experience; fortunately, people have been pleased with the service and the interpretation.”

Charlotte Radiology also has a dedicated breast MRI unit–and specially trained mammographers to read the images that it produces. “That’s one thing that’s been an important aspect of the care we provide,” Farmer