Implementing Abbreviated MRI Screening Into a Breast Imaging Practice
Leesburg, VA, June 10, 2019
—MRI remains the most sensitive tool for detecting breast cancer, but cost and acquisition time continue to be deterrents for women at average risk, according to a Clinical Perspective study published in the American Journal of Roentgenology
For patients at University Hospitals Cleveland Medical Center who received a digital mammography (DM) or digital breast tomosynthesis (DBT) screening examination, patients with heterogeneously dense or extremely dense breast tissue received their density notification and mammogram results by mail, alongside a pamphlet explaining a new supplemental screening option: abbreviated protocol MRI.
Choosing to implement the EA1141 study protocol—localizer sequences, axial T2-weighted STIR sequence, axial T1-weighted sequence with fat saturation before and after IV administration of gadolinium contrast—a team led by Holly Marshall maintained a schedule of three 10-minute examinations in a single one-hour time slot (i.e., the time allotted for a complete MRI exam).
After presenting the concept of “Fast MRI” to her hospital’s leadership board of surgeons, pathologists, breast clinicians, and medical and radiation oncologists, Marshall created online educational resources for referring physicians and patients.
Marshall’s colleagues noted that it took 10 months to establish pricing through their institution’s finance department, as abbreviated MRI is a self-pay procedure that cannot be billed to insurance because no CPT code exists for it.
Relying upon radiology self-pay tests such as unenhanced lung cancer CT screening and cardiac scoring as precedents for cost determination, Marshall concluded that her institution’s price is “substantially lower than that of the full breast MRI protocol” and “many patients with high-deductible insurance plans have a lower out-of-pocket expense for [abbreviated protocol] breast MRI than for the full protocol.”
Founded in 1900, the American Roentgen Ray Society (ARRS) is the first and oldest radiology society in the North America, dedicated to the advancement of medicine through the profession of radiology and its allied sciences. An international forum for progress since the discovery of the x-ray, ARRS maintains its mission of improving health through a community committed to advancing knowledge and skills with an annual scientific meeting, monthly publication of the peer-reviewed American Journal of Roentgenology (AJR), quarterly issues of InPractice magazine, topical symposia and AJR Live Webinars, print and online educational materials, as well as awarding scholarships via The Roentgen Fund®.