Centers focused on women's health are an important part of the imaging landscape and continue to undergo refinement, striving to meet their patients' needs. To do so, their dedicated staffs have to keep many balls in the air at once - staying up-to-date with the latest technology, maintaining an efficient workflow and being profitable - all while providing a high quality of care to as many women as possible.
To recognize the enormity of this juggling act and the women's centers that meet the challenge with excellence, each year Imaging Technology News features "Top Women's Centers to Watch." These facilities manage to keep up in all areas, setting a high bar in the areas of innovation, operational efficiency, patient service and teamwork.
This year, we honor four centers - Columbia Regional Breast Center, Progressive Radiology, Stamford Hospital Women's Breast Center and Jefferson Radiology - that are making a difference in women's lives. The next few pages are filled with details about their efforts, and ITN congratulates them for their achievements.
Jefferson Radiology, East Hartford, CT
INNOVATION: Jefferson Radiology was the first practice in Connecticut to introduce automated breast screening ultrasound (ABUS) technology for women with dense breast tissue, choosing a system from U-Systems. ABUS is a type of breast imaging that uses sound waves to create 3-D photos of breast tissue. While mammography is still the gold standard for the early detection of breast cancer, ABUS may improve the chances of detecting cancer in those with dense breast tissue or implants. Automated breast ultrasound is intended as an adjunct to mammography.
Jefferson Radiology implemented iCad's TotalLook to convert standard mammography films to digital images for the use of comparative review on digital review workstations. Once converted, TotalLook allows storage of those images in the PACS system for future use.
OPERATIONAL EFFICIENCY: Jefferson Radiology evaluated every step of the mammography process. It looked at everything from referring physician ordering to reporting of results and made efforts to streamline the process, while ensuring the greatest level of patient care. It revised the ordering process to allow referring physicians to order exams effortlessly. A requisition that includes preprinted mammography exams was created. These updated forms allow referring physicians to order the necessary studies and potential reflex tests without having to make additional calls.
The implementation of ABUS greatly improved ultrasound efficiency as well as patient throughput. The timing of ABUS exams compared to traditional ultrasound reduces the patient exam time considerably.
Jefferson Radiology also uses a dedicated mammography reporting system. This module, within the radiology information system (RIS), appropriately generates the mammography report, which includes breast imaging reporting and data system (BIRADS) category, density and overall impression. The report is then auto-faxed to the referring physician immediately upon receiving the radiologist's signature. This allows the referring provider to act immediately upon patient results.
In addition, the mammography reporting system prints lay summaries for patients, based on BIRADS category. These letters provide patients with the results of their exam, as well as information about supplemental screening exams, such as ABUS and breast magnetic resonance imaging MRI. Tracking reports can be generated from this system to monitor followup and notify patients/referring physicians of overdue recommendations.
Jefferson Radiology utilizes a dedicated core specimen radiography unit (Bioptics) in the procedure room for stereotactic needle-core biopsies. The Bioptics unit rapidly verifies the presence of micro-calcifications in core biopsies and increases the standard of care for patients by eliminating delays waiting for verification of core samples.
PATIENT SERVICES: Jefferson Radiology is a partnership of more than 50 radiologists, offering sub-specialized diagnostic and interventional imaging services. All physicians in the group are board-certified and committed to delivering the highest quality of radiology and imaging services possible. Established in 1963, it is the largest radiology private practice in Connecticut.
TEAMWORK: Jefferson Radiology employs talented and caring staff that takes a team approach to managing patient care. The team consists of mammography facilitators, mammography technologists, nurse navigators and a dedicated quality assurance coordinator. They all work with the sub-specialized, breast fellowship-trained radiologists.
The dedicated mammography facilitators interact with patients to schedule exams and guide them through the facility during the mammography process in a kind and caring manner to help reduce anxiety. The technologists are specially trained professionals who perform mammography exams and ABUS. They work closely with the radiologist to ensure optimal imaging is performed.
The nurse navigator is a registered nurse who helps overall workflow by prepping biopsy patients, completing consent forms, educating patients about the procedure, comforting them during the exam and coordinating follow-up care with surgeons. The quality assurance coordinator is responsible for training staff and maintaining equipment accreditation. Additionally, on a quarterly basis this individual conducts mammography audits to ensure the highest quality of imaging.
All of these staff members work as a team, managing a patient's experience throughout the entire process to reduce anxiety and provide the best care possible. The most recent team accomplishment was the designation of Jefferson Radiology as a Breast Imaging Center of Excellence (BICOE) by the American College of Radiology (ACR).
Columbia Regional Breast Center, Longview, Wash.
INNOVATION: Columbia Regional Breast Center was one of the first facilities to go digital in 2005. It replaced three film screen units with two Hologic Selenias for full-field digital mammography (FFDM). It purchased a Kubtec specimen unit in 2009 and has used the Fischer Mammotest for stereotactic biopsy since 1995. It uses the Stentor (acquired by Philips and then marketed as iSite) and GE Centricity picture archiving and communications systems (PACS).
OPERATIONAL EFFICIENCY: Although Columbia Regional replaced three film units with two FFDM systems, it did not reduce technical staff, because it increased patient load by eight to 10 patients per day. With three techs and two rooms, the rooms are constantly utilized and the flow is kept consistent. Patients rarely wait more than five minutes to be seen because of this rotation.
The admitting staff not only registers the patient, but also walks her to the dressing room/waiting area so the technologist can focus on the technical aspects of the patient without feeling rushed. Patients often comment about the center's efficiency and kindness, as well as its smiling staff. Because of the switch to digital, the center is able to accommodate late (and early) patients or unexpected add-ons easily and without disrupting the schedule. Patient satisfaction progressed from good to great.
PATIENT SERVICE: Columbia Regional provides patients with soft gowns with large armholes and Velcro fasteners, which they appreciate. Since the majority of patients have gone to the center for years, the admission process is quick. The backlog is less than two weeks, and diagnostics are seen within 24 hours or the same day. Staff members feel they are much more productive, yet less tired at the end of the day, since the darkroom and all the components of processing have been eliminated.
Columbia Regional started a Breast Cancer Support Group 15 years ago, and it is still going strong. Meetings include an educational component for the first hour, followed by "sharing time." There are 25 to 30 survivors at each meeting. Group members formed a Relay for Life team, calling themselves "The Hot-Flashing Lumpy Ladies," and they have been recognized as the center's top fundraising team six times.
The center reaches out to the community with forums and speaking engagements throughout the year. For the last eight years, it has sponsored a Fashion Show and Luncheon in October with the help of a local Macy's department store. The event features a keynote speaker, and survivors serve as the models. This event has grown from 35 guests to 243 last year.
TEAMWORK: This is the area in which Columbia Regional feels it is outstanding. The technical staff is mostly comprised of women who have been in the field of mammography for more than 22 years. It celebrated the 25th anniversary of its opening in February. From day one, administrators supported all of the technical staff's endeavors. The center has a strong reputation in its community for expertise and caring. Radiologists and technologists share the same passion and work well together.
The center is connected to the breast surgeon's office so it can offer continuity of care in a seamless workflow. There is a Breast Case Management meeting every other Wednesday, attended by radiologists, surgeons, pathologists, oncologists and support staff. The center is in the final stages of gaining National Accreditation Program for Breast Centers (NAPBC) accreditation.
"We are a cohesive team that puts the patient first in all that we do," says Ruth Melvin, R.T. (M), manager of the center. "We appreciate the opportunity to showcase our center, as we are so very proud of what we have accomplished."
Stamford Hospital Women's Breast Center, Stamford, CT
INNOVATION: Stamford Hospital Women's Breast Center (SHWBC) has become the premier facility for women's breast health in Connecticut's Fairfield County. The center offers state-of-the-art, all digital screening and diagnostic mammography with computer-aided detection (CAD), screening and diagnostic breast ultrasound, and bilateral breast MRI with dedicated breast coil and CAD software. It also offers stereotactic breast biopsy, breast needle localization, ultrasound-guided fine needle aspiration, core biopsy and needle localization, MRI-guided core biopsy and needle localization, as well as Dexa (bone density screening). In 2010, SHWBC performed a total of approximately 40,000 exams.
The mammography department includes seven digital units, including two large field-of-view digital units, one from GE Healthcare and one from Hologic. It also added a new digital mobile mammography coach. SHWBC utilizes nine GE ultrasound units and two GE MRI units. Both MRI units have dedicated breast coils; one of which is a dedicated Sentinelle breast table. The Sentinelle table is also utilized when performing MRI-guided procedures.
For specimen radiography, the center has Xpert40 and Xpert20 digital X-ray specimen units, both from Kubtec. All SHWBC technologists are certified in breast imaging within their perspective modalities. Furthermore, each patient who is having a procedure is assigned to a specialized nurse, who cares for her before, during and after her procedure.
The SHWBC team includes more than 65 individuals. Many of the staff members have been recognized as leaders and achievers within their respective fields. One of the mammography technologists accompanied a portable digital X-ray unit to Haiti last year, to help with the earthquake relief efforts. SHWBC also was the first breast center in the nation to be recognized and accredited by the NAPBC.
Currently, SHWBC is gearing up to launch its use of Hughes risk assessment software. This tool will provide patients and their referring clinicians with their individual lifetime probability of developing breast cancer, based upon personal risk factors. This information will allow the center to customize future surveillance and care for its patients.
OPERATIONAL EFFICIENCY: Administratively, SHWBC has adopted voice recognition systems for transcribing reports and auto-fax systems that automatically fax patient results to referring clinicians upon radiologist signoff. This greatly reduced report turnaround time. Insurance authorization specialists dedicated to radiology help ensure timely scheduling and completion of breast exams. Separate sites are connected via PACS, so all images can be viewed instantly from any location. Through constant improvement initiatives, the central scheduling office reduced its abandoned call rate by 5 percent in 2010, as well reducing the time it takes to answer a call by almost 15 percent.
In order to address the national decline of 2010 mammogram volumes, SHWBS designed an initiative to recover patients who did not return for their annual mammogram. The initiative resulted in an 87 percent recovery rate.
Creative scheduling allows a patient to have mammograms and breast ultrasounds on the same day in a timely fashion. A weekly updated grid showing next available scheduling slots for all breast imaging modalities allows SHWBC to manipulate scheduling capabilities to accommodate patient needs.
PATIENT SERVICES: SHWBC is a designated Planetree hospital, which is an organization based upon a patient-centered philosophy. It is committed to improving medical care from the patient's perspective and provides an optimum healing environment for body, mind and spirit. The center has a spa-like environment, providing waffle-weave robes for every patient and a relaxing ambiance.
A dedicated Nurse Navigator provides "one-on-one" assistance to help patients navigate through the system, as well as provide emotional support. Breast Cancer Awareness month, October, is celebrated with "Paint the Town Pink" events, ranging from fashion shows and luncheons to elegant evening soirees. All proceeds go to breast health initiatives. Every patient coming in for breast imaging during that month receives a special gift.
SHWBC has extended evening hours Monday through Friday, plus Saturday and Sunday appointments. Breast biopsy appointments are available on select Saturdays. All patients coming in for diagnostic exams receive preliminary verbal results before they leave the center. This mitigates a patient's anxiety level by not having to wait for results.
Mobile mammography is a unique service offered by SHWBC. The mobile coach offers screening mammograms for under-insured or uninsured women. It also serves a number of corporate accounts, allowing women to have a screening mammography without having to miss work.
TEAMWORK: Specialized breast imaging radiologists have a distinctive close working relationship with the on-site dedicated breast surgeons. This relationship fosters exceptional quality and continuity of care for patients utilizing these services. Mammography and ultrasound technologists share a common work area, allowing for increased interaction across modalities.
The cancer center within the center customizes treatment for patients who need it. An interdisciplinary Breast Tumor Board reviews every newly diagnosed breast cancer case. The panel consists of radiologists and surgeons, as well as pathologists, medical and radiation oncologists, plastic surgeons and a geneticist. They customize the workup and care for each of these patients. In addition, a weekly Core Biopsy Case Review meeting reviews every core biopsy result (benign or malignant) for radiologic to pathologic correlation. These weekly meetings help ensure that patients receive meticulous, top-quality care.
Progressive Radiology, Washington, D.C.; Md.
INNOVATION: Progressive Radiology continues to build on its reputation and commitment to excellence in healthcare through innovation, using the most advanced technologies in patient care. The women's imaging center employs high-resolution digital mammography, PACS and a custom RIS application. Every exam is performed with high-quality, safe diagnostic examination tools to provide accurate, expedient results to assist medical providers.
Progressive Radiology uses several types of imaging modalities and IT technology to screen, diagnose and recommend followup, including: screening and diagnostic mammography, breast and pelvic ultrasound, CT, MRI and bone densitometry.
The fully digital mammography site was installed in January 2010, with a 5-megapixel radiologist reading station and an upgraded PACS. The PACS and mammo module are from Intelerad. Fujifilm computed radiography (CR), Drypix 5000 and Clearview 4 port reader are the hardware for the mammo.
The PACS allows referring physicians to easily and securely access images, view reports and review all current and past exams from a local workstation. Both the radiologist and clinician can reference a patient's records quickly and efficiently while adhering to patient privacy regulations.
Progressive Radiology has 10 facilities located in the Maryland and Washington, D.C., area. The centers also provide MRI, open MRI, CT, ultrasound and X-ray exams. All its radiologists are board-certified and subspecialty-trained.
In 2010, Progressive Radiology redesigned its website, www.progressiveradiology.net. This allows patients to utilize a single online source to obtain all the information they need for their diagnostic exam, to request appointments and more. It also created a FaceBook page to help the community at large keep apprised of its initiatives.
OPERATIONAL EFFICIENCY: Progressive Radiology partnered with MedAnywhere, a RIS application developer, to establish efficient application modifications, including patient scheduling, insurance authorizations and third-party application integration, such as PACS and MR spectroscopy (MRS). The RIS to MRS interface facilitates thorough and expedient reporting turnaround time. A new MRS was installed to streamline the workflow process, creating a paperless environment, where staff can precisely monitor patient volume, patient recall rates, diagnosis accuracy, breast cancer detection rates and patients lost to followup.
PATIENT SERVICE: The group strives for excellence in patient satisfaction. In 2010, a professional customer service training initiative was established, and all of Progressive's staff participated in this very successful program. Patient surveys conducted at the centers reflected outstanding patient experiences.
Progressive Radiology provides exam results within 24 hours, and sooner for urgent or stat exams. As part of a diagnostic mammography workup, the radiologist spends time with the patient, answering questions and reviewing images upon request. Patients leave the facility feeling reassured, knowing the results of the diagnostic exam and what is expected in followup with their physician. Positive breast imaging results are communicated to referring clinicians immediately to expedite patient care.
Scheduling coordinators work with patients and physicians to accommodate patients' busy schedules. Progressive's locations can accept walk-in patients and same-day add-on appointments. The transition to digital mammography has increased efficiency, which expanded daily screening mammography capacity, allowing the center to increase the number of scheduled time slots. Screening mammography and ultrasound hours are extended into the early evening and Saturdays to better accommodate patient work schedules.
Progressive provides educational brochures and pamphlets endorsed by the American Cancer Society for patients to take home. Patients may benefit from articles written by Progressive's radiologist on procedures and other health-related topics. Its radiologists provide informative talks to the community and physicians.
TEAMWORK: Progressive Radiology's operational philosophy is depicted in its logo, "excellent service every time." This commitment to excellence can only be achieved through strict adherence to high standards and teamwork.
Within the organization, every staff member works collaboratively to accommodate patients' needs, serving them in a courteous, respectful manner. The front desk and schedulers work closely with referring practices to accommodate patient appointment requests. The clinical liaisons ensure that referring physicians have the materials and information at their disposal to streamline their patients' experiences.
The radiologists are on-site working closely with the technologists to collaborate on patient care, exam protocols, image quality and results. The radiologists are accessible at all times to internal staff and referring physician practices. Radiologists provide educational programs, on- and off-site lectures and training to referring physicians and the healthcare community. The IT department provides secure connectivity and maintains a streamlined workflow 24 hours a day for internal and external users.
Progressive's community outreach initiatives are an opportunity to form alliances and "give back" to the community. One example is a recent fundraising campaign where breast cancer awareness T-shirts were designed and sold to the community and staff. All of the revenue went directly to the American Cancer Society.