Optimizing Breast MRI
One of the major points shared in this article, is that on average the national recommendations for MRI of the breast out of mammography imaging cases is five to six percent.
Sites that are not matching the national average may want to evaluate their reading programs, review their internal processes and better educate their breast reading radiologists. Many recommendations for the MRI breast studies are often generated from the mammography radiologist. Many radiologists have voiced to us their primary concern being the reportedly number of false positives that are produced from dynamic breast MRI procedures. This is one of the reasons MRI Optimize Consultants believes with the right education for the staff performing the exams, the correct processes in place designed to check and double check procedures, the correct preparation and timing of the exam with regards to the patients’ cycle, and so much more is important to reduce the number of false positives.
Here is the article below in its entirety…
Breast MRI imaging offers an opportunity for a radiology practice to differentiate itself.
Just a few years ago, the American College of Radiology predicted a lucrative 20 percent increase per year in the utilization of breast MRI, and a 2008 study concluded that, “Breast MRI is recommended for preoperative evaluation of the newly diagnosed breast cancer patient.”1
Despite this, many patients are not getting recommended for preoperative breast MRI or as follow-ups. Some centers do not have the dedicated coil, and others believe the liability that comes with imaging breast MRI is not worth the trouble. That liability could be the high number of false positives (averaging 9 %), lesions that need biopsied which turn out to be negative and the possibility of other lesions missed. Add to that varied difficulties of interpretation after surgery, multicentric disease, and the fact that often the patient is upset or psychologically sensitive to “any findings”, and most practicing rads might want to run! The national average for breast MRI recommendations after mammograms ranges from 5 percent to 6 percent. One practice I know performs approximately 10,000 mammograms annually, yet recommends less than 1 percent of those mammograms for breast MRI follow-up.
Breast MRI imaging offers an amazing opportunity for a radiology practice to differentiate itself. However, remember that breast MRI only should be attempted at centers with high-field systems and experienced MRI technologists who understand the critical nature that every small decision could impact the outcome of breast MRI results. Technology, patient preparation, and practice will play an important role in getting accurate results.
Dr. Bruce Porter (at Firsthill.com), one of the leaders in breast imaging nationally, has instructed and supported second reads for many radiologists to bring successful MRI breast imaging to their practices and communities.
Sentinelle Medical, makers of multi-channel RF breast coils, detachable breast imaging tables, and Aegis evaluation software, recently sold to Hologic Medical, who seem to be positioning themselves as breast diagnostic supply providers. The Aegis software reports in real-time, so the software does not require a load up and processing timeframe.
In addition, the high number of multi-channel RF coils has lead to the ability to increase slice thinness and still retain high resolution and signal-to-noise ratio. The Sentinelle coil was designed for thin 0.7 mm axial slices, said Sentinelle CEO Cameron Piron. Yet, I have seen some centers using the 16 channel Sentinelle coil at 3 mm slice thicknesses in the sagittal plane on 3 Tesla systems, based on the radiologists’ personal preferences.
Invivo also has been making dedicated high-resolution RF coils that comply with multiple high-field MRI system manufacturers.
Steven Harms, MD, FACR, radiologist and developer of the dedicated Aurora breast MRI system, said that he knows of several situations where the Aurora breast scanner and a 3T system are side by side, using multi-channel breast coils. In those situations, all breast cases are sent to the Aurora scanners because of the higher spatial resolution, high contrast, and early detection, despite the 3T’s higher signal-to-noise ratio.
For centers not currently employing a high-resolution dynamic breast MRI portion to their practice—but would like to employ breast imaging immediately, Alliance Imaging now has eight of the Aurora dedicated breast MRI-only mobile systems for use around the country.
New technology is just one part of the picture, though. To provide the best in breast MRI, centers should feature highly critiqued MRI protocols, experienced MRI technologists, radiologists who know breast MRI reads, 3D dynamic post processing system and enough routine breast MRI cases to consistently deliver accurate results.
Optimizing Breast MRI
To make women feel more comfortable for breast MRI, some imaging centers have created a health spa-type feel with décor, thick lush robes, sealed slippers, and even personal nurse guides. I’ve also seen centers give away a rose to every patient.
Other important tips for a successful breast MRI include: scheduling patients according to their menses cycles and temporary discontinuation of hormone replacement therapy; removing all street clothes to avoid artifacts; and fostering clear communication to the patient on what to do and expect during the procedure.
But ultimately, what works best is the patient getting some personal time with the reading radiologist so they understand the diagnosis and complexity of the diagnosing process.
Author Catherine Leyen, ARRT(R)(MR)(CV), is co-founder of MRI Optimize Consultants LLC, Tempe, Ariz.
1. Hollingsworth AB, Stough RG, O’Dell CA, Brekke CE. Breast magnetic resonance imaging for preoperative locoregional staging. Am J Surg. 2008;196(3):389-97.