4 steps to implementing abbreviated breast MRI screening into practice

The high sensitivity associated with breast MRI makes it an effective tool for detecting breast cancer, but the costs and long acquisition times have kept it from being embraced as a supplemental screening option. Researchers at one institution adopted an abbreviated protocol (AP) for breast MRI for patients with dense breasts, discussing their process in the American Journal of Roentgenology.

It took a full year to implement the protocol as a screening option, the authors noted, as it involves making key decisions and getting various stakeholders on board. These are four key steps providers must take to make such a protocol a reality:

1. Finalize the protocol

The first step, of course, was finalizing the protocol. After reviewing the work of prior researchers, the team chose a protocol that included “localizer sequences, an axial T2-weighted STIR sequence and an axial T1-weighted sequence with fat saturation before and after IV administration of gadolinium-based contrast material.” It had an acquisition time of less than 10 minutes, and three AP MRI examinations would be scheduled for a single 1-hour time slot.

The gadolinium involved in the protocol was something to keep in mind, the authors noted, due to the ongoing question of whether or not gadolinium is retained in the brain after enhanced MRI examinations.

2. Sort out the pricing and billing details

The AP MRI had to be a self-pay procedure, the authors added, because there is no CPT code for AP MRI examinations.

“Other radiology self-pay screening tests at our institution, such as unenhanced lung cancer CT screening and cardiac scoring, were used as precedents to determine the pricing of AP breast MRI,” wrote Holly Marshall, MD, department of radiology at University Hospitals Cleveland Medical Center, and colleagues. “Our price is substantially lower than that of the full breast MRI protocol. Many patients with high-deductible insurance plans have a lower out-of-pocket expense for AP breast MRI than for the full protocol.”

3. Determine how patients will be reached

After undergoing a breast cancer screening mammogram, patients with heterogeneously dense or extremely dense breasts would receive an informational pamphlet. The document explained the basic science behind breast density and listed some potential supplemental screening options, including the AP MRI examination or whole-breast ultrasound.

“This informational pamphlet encourages women who think they may be at high risk of breast cancer to make an appointment with our high-risk clinic, where they can discuss the pros and cons of supplemental screening and which modality is best for them,” the authors wrote. “The pamphlet includes a link to our website, which gives more information to patients who still have questions about AP MRI screening and whether it is appropriate for them.”

4. Communicate with your colleagues

Getting everything up to speed is a key aspect of any implementation process.

“The idea of AP breast MRI was initially presented to the leadership team of our breast program, which includes surgeons, medical oncologists, radiation oncologists, pathologists, medical breast clinicians, and providers of survivorship care,” the authors wrote. “We sought feedback and suggestions. A simple name for the study that is easy to distinguish from the full protocol was essential. We decided on Fast MRI and used this throughout the informational campaign.”

The electronic medical record was also updated so that it was crystal clear how physicians can order these examinations. Referring clinicians were also told that if they were ever unsure if a patient should be considered, they could make an appointment to discuss the matter in greater detail and “help the patient make an informed decision.”

“The days of personalized screening have arrived,” the authors wrote. “We believe it is vital to our breast imaging practice to educate patients about their breast density and to offer multiple screening options, particularly to patients with dense breast tissue, to maximize the impact of screening on the morbidity and mortality of breast cancer.”