Maximizing Value Through Innovations in Radiologist-Driven Communications in Breast Imaging

Mammography Home Workstations and Remote Diagnostic Breast Imaging: Current Practice Patterns and Planned Future Directions

OBJECTIVE

Assess current practices and plans regarding home workstations and remote diagnostic breast imaging in the United States.

METHODS

A 43-question survey relating to remote breast imaging was distributed to Society of Breast Imaging members from July 6, 2023, through August 2, 2023. A descriptive summary of responses was performed. Pearson's chi-squared test was used to compare demographic variables of respondents and questions of interest.

RESULTS

In total, 424 surveys were completed (response rate 13%, 424/3244). One-third of breast imaging radiologists (31%, 132/424) reported reading examinations from home or a personal remote site for a median of 25% of their clinical time. The most common types of examinations read from home were screening mammography (90%, 119/132), screening US (58%, 77/132), diagnostic mammography and MRI (both 53%, 70/132), and diagnostic US (49%, 65/132). Respondents from private practices were more likely than those from academic practices to read diagnostic imaging from home (67%, 35/52 vs 29%, 15/52; P <.001). Respondents practicing in the West were less likely to read breast imaging examinations from home compared with those in other geographic regions (18%, 12/67 vs 28%-43% for other regions; P = .023). No differences were found among respondents' overall use of home workstations based on age, gender, or having dependents. Most respondents (75%, 318/424) felt that remote breast reading would be a significant practice pattern in the future.

CONCLUSION

Home workstations for mammography and remote diagnostic breast imaging are a considerable U.S. practice pattern. Further research should explore radiologist preferences regarding remote breast imaging and its impact on clinical care and radiologist well-being.

Patient Communication Innovations in Breast Imaging

Effective patient communication is paramount in breast radiology, where standardized reporting and patient-centered care practices have long been established. This communication profoundly affects patient experience, well-being, and adherence to medical advice. Breast radiologists play a pivotal role in conveying diagnostic findings and addressing patient concerns, particularly in the context of cancer diagnoses. Technological advances in radiology reporting, patient access to electronic medical records, and the demand for immediate information access have reshaped radiologists' communication practices. Innovative approaches, including image-rich reports, visual timelines, and video radiology reports, have been used in various institutions to enhance patient comprehension and engagement.

Radiologists' Communicative Role in Breast Cancer Patient Management: Beyond Diagnosis

In the landscape of cancer treatment, particularly in the realm of breast cancer management, effective communication emerges as a pivotal factor influencing patient outcomes. This article delves into the nuanced intricacies of communication skills, specifically spotlighting the strategies embraced by breast radiologists. By examining the ramifications of communication on patient experience, interdisciplinary collaboration, and legal ramifications, this study underscores the paramount importance of empathetic and comprehensive communication approaches. A special emphasis is placed on the utilization of the SPIKES protocol, a structured method for conveying sensitive health information, and the deployment of strategies for navigating challenging conversations. Furthermore, the work encompasses the significance of communication with caregivers, the integration of artificial intelligence, and the acknowledgement of patients' psychological needs. By adopting empathetic communication methodologies and fostering multidisciplinary collaboration, healthcare practitioners have the potential to enhance patient satisfaction, promote treatment adherence, and augment the overall outcomes within breast cancer diagnosis. This paper advocates for the implementation of guidelines pertaining to psychological support and the allocation of sufficient resources to ensure the provision of holistic and patient-centered cancer care. The article stresses the need for a holistic approach that addresses patients' emotional and psychological well-being alongside medical treatment. Through thoughtful and empathetic communication practices, healthcare providers can profoundly impact patient experiences and breast cancer journeys in a positive manner.

Community Outreach in Breast Imaging: What Radiologists Can Do to Close the Gap for the Uninsured Population

After implementation of the Affordable Care Act in 2010, the uninsured population of the United States decreased significantly. As of 2022, there were approximately 26.4 million uninsured individuals in the United States. The lack of coverage and access to services disproportionally affect minority groups in the country, reflecting the influence of the social determinants of health in their uninsured status. Use of screening mammography, an effective modality that results in early detection of and decreased mortality from breast cancer, was delayed or postponed by women of all races due to lockdowns and fear during the COVID-19 pandemic. Since then, the return to mammographic screening has lagged among minorities, further increasing their disproportionate screening gap. Radiologists-and more specifically breast imagers-must recognize these issues, as people who are uninsured and part of minority groups are diagnosed with breast cancer at later stages and have higher mortality rates, less continuity of care, and overall lower survival. The purpose of this article is to familiarize radiologists with the uninsured population, explain how they are disproportionally affected by breast cancer, and propose strategies that breast imagers can pursue to improve screening access and decrease compliance gaps for this patient population. ©RSNA, 2023 See the invited commentary by Nguyen in this issue. Quiz questions for this article are available through the Online Learning Center.

Imaging-led symptomatic breast clinics: a case for direct access to radiology

Radiologists play a pivotal role in patient management in modern hospital medicine and more so with regard to breast imaging. The diagnosis of breast pathology hinges predominantly on mammography and ultrasound imaging. With reduced clinician confidence in clinical examination alone, virtually all patients with breast symptoms are being referred for imaging. The traditional 'one-stop' clinics are victims of their own success and demand outstrips availability. This article makes a case for imaging-led breast clinics to increase efficiency, reduce duplication of work and cost, and increase throughput of patients.

Underutilization of Supplemental Magnetic Resonance Imaging Screening Among Patients at High Breast Cancer Risk

BACKGROUND

Women at high lifetime breast cancer risk may benefit from supplemental breast magnetic resonance imaging (MRI) screening, in addition to routine mammography screening for earlier cancer detection.

MATERIALS AND METHODS

We performed a cross-sectional study of 422,406 women undergoing routine mammography screening across 86 Breast Cancer Surveillance Consortium (BCSC) facilities during calendar year 2012. We determined availability and use of on-site screening breast MRI services based on woman-level characteristics, including >20% lifetime absolute risk using the National Cancer Institute risk assessment tool. Multivariate analyses were performed to determine sociodemographic characteristics associated with on-site screening MRI use.

RESULTS

Overall, 43.9% (2403/5468) of women at high lifetime risk attended a facility with on-site breast MRI screening availability. However, only 6.6% (158/2403) of high-risk women obtained breast MRI screening within a 2-year window of their screening mammogram. Patient factors associated with on-site MRI screening use included younger (<40 years) age (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.34-4.21), family history (OR = 1.72, 95% CI: 1.13-2.63), prior breast biopsy (OR = 2.09, 95% CI: 1.22-3.58), and postsecondary education (OR = 2.22, 95% CI: 1.04-4.74).

CONCLUSIONS

While nearly half of women at high lifetime breast cancer risk undergo routine screening mammography at a facility with on-site breast MRI availability, supplemental breast MRI remains widely underutilized among those who may benefit from earlier cancer detection. Future studies should evaluate whether other enabling factors such as formal risk assessment and patient awareness of high lifetime breast cancer risk can mitigate the underutilization of supplemental screening breast MRI.