Feature | September 17, 2009 | Cristen C. Bolan

Early adopters of technology and centers running clinical trials lead in patient care.

Elizabeth Wende Breast Care, LLC - Rochester, N.Y.

While the war on breast cancer wages on, there are signs that doctors and patients may be on the winning side. Over the past year, we have seen significant advances in diagnosing and treating breast cancer. On the front line, tomosynthesis is in development and has been hailed by the medical community as a promising innovation in the early diagnosis of breast cancer. Also highly-anticipated is elastography ­— ultrasound measuring stiffness of a lesion to differentiate benign and malignant tumors. Adoption of automated breast ultrasound (ABUS) as an adjunct to mammography is increasingly widespread, while breast MRI firmly establishes its position as an adjunct to mammography for those at increased risk for breast cancer. Interest in molecular breast imaging, along with positron emission mammography (PEM), are also on growth paths.
As we look ahead to the coming year, Imaging Technology News is highlighting the innovators and leaders in breast cancer treatment. We asked readers to submit nominations of worthy facilities to recognize based on their achievements in innovation, operational efficiency, customer service and teamwork. From there, the editors chose five centers to recognize as the “Top Women’s Imaging Centers to Watch in 2009.” Take a look — these are the ones to watch.
Baylor University Medical Center at Dallas - Darlene G. Cass Women’s Imaging Center - Dallas, Texas
Innovation: Baylor University Medical Center at Dallas Darlene G. Cass Women’s Imaging Center has been a leader in breast imaging in the Dallas area for 25 years and has two locations with advanced digital technology. Both locations have been designated as a Breast Imaging Center of Excellence by the Commission on Quality and Safety and the Commission on Breast Imaging since December 2007 and February 2009 respectively. Both centers also are accredited by the American College of Radiology (ACR) in mammography, and have participated in the ACR voluntary accreditation programs in stereotactic breast biopsy, breast ultrasound and ultrasound-guided breast biopsy since 1996. The two locations provide full-service diagnostic and interventional procedures, including digital mammography; breast ultrasound; breast biopsy — using all modalities and advanced vacuum assisted technology; cyst aspiration and bone density screening and evaluation. In addition, the BUMC campus facility offers breast MRI with plans to add PEM by late-2009. BUMC is a beta testing site for Hologic’s tomosynthesis, which provides a slice-by-slice view of the breast. A successful Mobile Mammography Program was in operation for 22 years, screening over 9,600 patients per year throughout the metroplex. The center has plans to open two additional screening satellite locations in the outlining communities this year. Our breast center just submitted application for accreditation through the National Accreditations Program for Breast Centers NAPBC.
Operational Efficiency: The patient-centered design promotes convenience, comfort and privacy at every step of the process. There are private consultation rooms where doctors meet with patients; a resource center with Internet access and educational materials on breast care. The staff includes mammography-trained technologists, RNs and radiologists who have special training and interest in breast imaging. A Breast Fellowship for Radiologists and a Mammography Technologist Internship Program is offered on site. Our suite is divided into four different sections with one central check in for diagnostic, screening, bone density and MR. Each diagnostic room has its own PACS station for review of previous images, allowing the technologist to stay with a patient throughout the exam. Our center has on-site mammography film digitization for all outside film. All of these breast healthcare components combined improve workflow and efficiency. The radiologists are provided with nine separate reading modules with assigned patient exams daily. Radiologists and technologists communicate exam status via our Exam Notes Function System through PACS.
Customer Service: Our key to success focuses on Baylor’s Five Pillars of Excellence: integrity, servanthood, quality, innovation and stewardship. A comprehensive Customer Feedback Consulting Service focuses on organizational improvement. Within the center, they monitor our patient satisfaction scores, which average 95.5 percent and above. The center provides a Baylor chaplain, a nurse navigator for emotional support, care coordination and referrals to services, and educational resources to assist the patient in understanding conditions, treatments, tests, and wellness focused information.
Teamwork: Our multidisciplinary team approach provides access to physician specialties, including surgical, medical, and radiation oncology; pathology, diagnostic imaging, breast screening, reconstructive surgery, and other specialties. Baylor’s Women’s Imaging Centers staffed by fellowship-trained radiologists, offer digital mammography, breast MRI, sonography and biopsy services. Technologists receive continued on-site continuing education to keep abreast the latest techniques in breast imaging. The Breast Site Committee provides a forum for quality assurance and guidance in the development of new programs. Physicians participate in biweekly multidisciplinary breast cancer conferences with roundtable presentations and collaborations on treatment recommendations and retrospective reviews of breast cancer cases aimed at maintaining and improving quality care for these patients. Collaboration with the Baylor Sammons Breast Center offers patient access to prevention and detection programs, breast health education, breast cancer risk assessments (based on the Gail model), Hereditary Cancer Risk Program, lymphedema education, and research clinical trials.

Web site: www.baylorhealth.com/PhysiciansLocations/Dallas/SpecialtiesServices/Wom…

The Center for Breast Care in Boca Raton - Boca Raton, Fla.
Innovation: The Boca Raton Breast Center is focused on personalizing breast care throughout all phases of the care cycle, beginning with high-risk clientele to conduct BRCA half testing and to develop individualized prevention programs. Kathy Schilling, M.D., has developed imaging protocols to carry personalized care in the screening phase, diagnostic phase, staging and
treatment planning and during surveillance of breast cancer survivors. The center’s services include digital screening and diagnostic mammography, ABUS, MRI, bone densitometry and percutaneous biopsy, and PEM. Dr. Schilling routinely uses MRI during the diagnosis, staging, planning, treatment, and surveillance phases. For molecular medicine imaging, Dr. Schiller uses Naviscan’s PEM, and last year performed the first PEM-guided biopsy in the United States. Dr. Schilling is also involved in a study correlating shear wave ultrasound technology with positive bx results to minimize the invasiveness of the process.
Operational Efficiency: The center provides same-day evaluation and reporting of all their exams. The opening of two satellite screening centers assisted in diminishing the overload at the main site. By staffing each of four digital mammography units at the main center with two mammography technologists, patients are currently scheduled every 15 minutes, permitting the evaluation of 120 patients per day. Negative cases can schedule their next appointment prior to leaving the center. Cases that need additional imaging stay until they are performed and a diagnosis with follow-up recommendations are made. Should a patient require biopsy, she will be informed, have her referring physician notified, a prescription will be faxed and the appointment made by one of two nurse navigators. Currently, diagnostic and screening mammograms can be scheduled the same day within our system. We currently have all our BIRADS 4 and 5 patients seen by our clinical staff, which includes one medical oncologist who specializes in genetics and risk assessment. When a diagnosis is made, we refer the patient to a surgeon, for an MRI, and to our weekly multimodality conference.
Customer Service: Patient satisfaction overall scores exceeded 90 percent for the last 14 months and hit their highest scores over the last three fiscal years (FY09 was higher than 08 and 07). Patient satisfaction scores are shared with employees on a monthly basis. Management conducts a monthly meeting with staff to discuss specific modality scores and staff’s impact on scores. Since meetings have been implemented, we have exceeded our goal of 91.5 percent monthly. Staff is recognized and rewarded quarterly for positive patient feedback. Patient feedback is derived from press Ganey surveys, letters to administration, and internal comment cards patients complete on the day of their visit.
Teamwork: Staff shadow other peers in their role, and managers shadow staff to better understand what their job entails. The biopsy technologists and the nurses schedule patients together. A dedicated team provides multiple comprehensive services surrounding breast care in one location. Education contributes to much success internally and throughout the local community and imaging community at large. There are structured educational programs for the clinical and non-clinical staff on technology, various treatment modalities, and general compliance matters. The breast imagers offer programs for the staff, and outside educators are invited to make presentations.
Web site: www.brch.com

Elizabeth Wende Breast Care, LLC - Rochester, N.Y.
Innovation: The center offers diagnostic exams, including digital mammography, breast MRI, breast ultrasound, stereotactic breast biopsy, bone density (Dexa) scan, and computer-aided detection. Investigational studies involve breast tomosynthesis, ultrasound elastography, FFDM technology, coned-beam breast CT. Current research projects at Elizabeth Wende Breast Care (EWBC) include: Breast tomosynthesis - EWBC is participating in a multifacility IRB approved study with the Hologic Dimensions Breast Tomosynthesis unit.
Cone beam breast CT - EWBC is doing an IRB approved study evaluating non-contrast and contrast enhanced cone-beam CT for breast imaging (Koning Corp.) with a new breast CT imaging modality.
Elastography - EWBC is enrolling 50 patients to trial a new, noninvasive ultrasound technique measuring stiffness (elasticity) of a lesion to differentiate benign and malignant lesions relative to normal breast tissue. The equipment is developed by Siemens Healthcare. The primary investigator is Richard Barr, M.D., radiologist, located in Youngstown, Ohio. Other participating sites are located in London, England; Villejif Cedex, France; Cary, North Carolina; and Cleveland, Ohio.
Breast MRI - EWBC is retrospectively reviewing the clinical experience of its community-based breast MRI program with second look ultrasound. EWBC is retrospectively reviewing the asymptomatic high-risk screening MRI studies in patients with a personal history of breast cancer, BRCA gene positive, or significant family history. EWBC is also retrospectively
reviewing contrast-enhanced MRI examinations of patients undergoing chemotherapy to record the response to therapy.
Operational Efficiency: Chartless environment, a Web-based dashboard system, and online results and diagnostic workup, including ultrasound and core biopsy.
Patient Care: Patient advocates are available at all times to provide support for the patient and her family, field questions, solicit comments, and make the patient comfortable. They track the patient flow, making sure that no one is overlooked or waiting too long. Patients who go on to core biopsy are tended to with personal care, receiving follow-up phone calls and additional support as needed.
Teamwork: The staff has weekly department manager meetings to work out inefficiencies and their effects at all levels. This generates a weekly newsletter to all employees, who can respond to any concerns through their department manager. Each department has scheduled internal meetings to work out inefficiencies within the department, with dialogue and suggestions from every staff member. Annual employee meetings update all staff on overall the condition of facility, including OSHA and HIPAA updates.

Hoag Hospital Breast Care Center - Newport Beach, Calif.
Innovation: For diagnostic breast imaging, the center offers direct-to-digital mammography; dedicated breast MRI; breast ultrasound and are participating in the tomosynthesis clinical trial. Minimally-invasive breast biopsy methods use image-guidance such as stereotactic mammography, ultrasound or MRI. Hoag Hospital is one of only 11 test sites in the United States participating in a multicenter clinical trial studying digital tomosynthesis. Hoag is also conducting its own clinical trial comparing digital tomosynthesis to MRI. The center offers the latest techniques in breast surgery, including oncoplastics surgery, which combines the techniques of oncologic surgery with plastic surgery; and innovative breast radiation therapies, including: intraoperative radiation therapy, Mammosite brachytherapy, and 3D conformal radiation therapy.
Operational Efficiency: Hoag has been recognized by the National Consortium of Breast Centers (NCBC) as a Certified Quality Breast Center; a stratified certification program through their National Quality Measures for Breast Centers (NQMBC) Program. This program uses quality metrics to allow breast centers to compare their performance with others across the country. Example quality measures in breast imaging, surgery and pathology include timeliness of care, mammography call back rate, five-year stage specific survival rate, patient satisfaction survey response rate and breast conservation surgery rate, among other indicators.
Customer Service: Hoag is committed to patient-centered care through seamless coordination by its multidisciplinary team of specialists in conjunction with the hospital’s latest technology in breast screening, diagnosis and treatment.
Teamwork: The center provides a multidisciplinary care team of breast specialists, consisting of radiologists, technologists, breast surgeons, medical and radiation oncologists, pathologists, plastic surgeons, social workers, a breast care navigator, and a breast health educator.

Vanderbilt Breast Center at 100 Oaks - Nashville, Tenn.
Innovation: Technology includes digital mammography with computer-aided detection, onsite dedicated, breast MRI, dedicated ultrasound IU22’s, breast biopsy, and stereotactic radiation therapy. The center also evaluates and treats non-cancerous and male breast conditions.
Operational Efficiency: Whiteboard, a patient-tracking software program, locates each patient at any moment and is accessible at each computer. The system captures the length of time each patient spends in each room or at each modality. This provides information on where the bottlenecks occur and provides true room utilization. We use the system to forward information to the surgical side of our center such as BIRADS 1, BIRADS 3. The radiologist reading area is centered around the patients. A system for gathering all information, films, reports, path and reviewing before the surgeon or radiologist sees the patients improves both patient and provider satisfaction.
Customer Service: We are in the top 10 percent of the nation in patient satisfaction with our overall quality of care from PRC data. We offer several conveniences, such as free lot parking, free valet parking, and check-in kiosks. The seven surgeons at the center run morning and afternoon clinics, allowing patients to be worked up on the radiology side and then see the surgeon. If needed, more imaging or a biopsy can be done on the same day. Two nurse practitioners see more benign cases and run a clinic five days a week. We have research working in correlation and stationed in our center to gather specimens and work with patients as they move through our clinic. Genetic nurses counsel patients and do testing. A mutidisplinary clinic sees newly diagnosed cancer patients with medical oncologist, radiation, plastics, radiology, and surgeons to discuss the patient’s treatment and see the patient before they leave. We have a huge outreach program and are involved in many health fairs and private groups. We do not turn anyone away. Our facility sees walk-in patients for screenings daily and on weekends.
Teamwork: A leadership team and group discussions enable staff to coach one another to stay positive. Two clinical directors, one surgeon and a radiologist work well together and for the team. These leaders and our teamwork are key reasons this center received the Center of Excellence award from the ACR. It takes leaders who lead by example. www.vanderbilthealth.com/100oaks

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