Diagnostic Reading #29: Five Must Read Articles from the Past Week

It’s Friday, which means it’s time for another Diagnostic Reading! This week’s articles focus on the expanding purposes of VNAs, a study from the Annals of Internal Medicine about breast cancer risk factors, an article about the ICD-10 grace period and updates about presentations from ACR 2015.Carestream Logo

1) Time to Retire the term “VNA”? – Healthcare Informatics

This article addresses the acronym, VNA, and its definition: Vendor Neutral Archive. The growth of health IT products has also expanded their responsibilities. The author claims that a VNA is neither ‘vendor neutral’ nor an ‘archive.’ He goes on to explain, saying that these applications manage data rather than simply archive it.

2) Study: There’s More to Breast Cancer Risk than Density – Aunt Minnie

A study in the Annals of Internal Medicine noted that breast density is not the only factor that should be considered when determining which women should receive supplemental breast screening in addition to mammography. The researchers looked at a variety of factors including age and a consortium of risk factors. The authors writes, “Density information combined with breast cancer risk could be used to prioritize women who could benefit from breast imaging tests with better specificity than digital mammography, such as tomosynthesis.”

3) Number of Female Radiologists, Field Leaders Remains Low – Diagnostic Imaging

According to a presentation this week at ACR 2015, the number of women in radiology has not grown in the last 10 years. This research was done to see if the raised awareness of gender disparity has caused any change in gender representation in radiology. They found that women have consistently made up about 27% of the radiology field since 2004.

4) Newly Introduced Bill Looks to Establish ICD-10 Grace Period – Health Imaging

The US House is moving forward with the ICD-10 bill. The upgrade will take place on October 1. However, some healthcare executives and politicians were concerned that transition to the new coding from ICD-9 would cause confusion. For this reason, a bill was passed that says nobody can be denied Medicare reimbursement solely for using inaccurate codes during the first 18 months of implementation.

5) Medicare Imaging Spending is Down, with Some Variation by State – Radiology Business

At ACR 2015, presenters shared their findings on the trends of Medicare spending when it comes to imaging. They found that overall, national Medicare expenditures for imaging have fallen since 2006. They attribute this to factors based on education about radiation dose and the recession as well as policies instituted by the government. Some states did not follow these trends, read more to find out why.

 

 

Diagnostic Reading #26: Five Must Read Articles from the Past Week

Carestream LogoIt’s Friday, it’s almost the weekend, and that means it’s also time for a new Diagnostic Reading. This week’s articles include an article about technology and connectivity written by a Carestream’s director of IT, more questions about the USPSTF breast screening recommendations, tips to improve healthcare quality, the new CMS quality-based standards and how patient portals might cause disparities.

1) Is Technology Still the Main Road to the CustomerCIO Review

The growth of new media has been obvious in recent history. David G. Sherburne, Director of IT for Carestream, provides his insight on the growth of media when it comes to “C-Level executives.” Sherburne makes the initial observation that technology has created connectivity and ease of access across several levels. He notes that for this reason, he states that executives should abandon the old-fashioned silo system and work more closely with their “C-Level” peers.

2) Should women over 75 be screened for breast cancer?AuntMinnie

Many questions have been raised about the recent update by the USPSTF concerning recommendations for breast imaging. One of the disputed topics is about the recommendation for women over 75 years-old. This article explores the importance of continuing breast screening when women are older, highlighting how other organizations such as the American Cancer Society and the American College of Radiology have recommended that women should have annual screenings starting at age 40, and as long as they are in good health.

3) 15 ‘Vital Signs’ to Improve HealthcareFierce Healthcare

Quality healthcare is a point of emphasis at just about any facility. This article lists 15 metrics, as determined by the Institute of Medicine (IOM) that can affect the overall health of Americans and lead to better health care provision. These factors include patient safety, care access, community health, addictive behavior, preventative services, etc.

4) CMS Releases Strategic Vision for Physician Quality Reporting Programs – Healthcare Informatics

The Centers for Medicare and Medicaid Services have released standards for quality care reporting programs. This initiative moves the payment system away from the fee-for-service model and begins the shift toward reward incentives for providing quality care. Quality reporting and patient feedback are emphasized by the new plan.

5) Study: Patient Portals Could Widen Health Disparities – Healthcare Informatics

A recent study at Northwestern Medical has found that patient portals might widen disparities by race, education and health literacy. The study concluded that people who are not health literate are 3.5 times less likely to register for patient portals than their counterparts.

 

 

 

The USPSTF Misses Again on Breast Screening Guidelines

In a recent move that is drawing much ire from the medical and women’s health communities, the U.S. Preventive Services Task Force (USPSTF) declined to expand its recommendation on which women should receive regular mammography screening. What was offered upon this rejection was essentially the reinforcement of the conservative guidance from 2009.

The new guidance states that women in their 50s should only receive mammography screening every two years, rather than annually as is advocated by many women’s health and medical groups. Advocates for annual screening are also upset that the USPSTF did not recommend screening for women in their 40s, because of its belief that the benefits of screening in this age group do not outweigh the purported harms of screening.

To be blunt—this is questionable advice at best. The guidelines will do nothing but confuse women as again they are not emphatic, but leave decisions up to the women’s general physicians or OB-GYN.

Many women in the 40 to 49 group have dense breasts. Having regular screening mammograms can help this group be sent for further screening with adjuncts such as full breast ultrasound and MRI—helping to find earlier cancers.

Many countries, such as Sweden, Norway, Australia and Canada have adopted the approach that if you have dense breasts (or a certain amount of glandular tissue,) the woman should be screened yearly. Women with fatty breasts are screened every 2 years. This is without arbitrary age grouping.

The U.S. is getting better about dense breast notification, as 22 states have enacted laws about notifying women who possess dense tissue, and a number of other states have bills introduced about these notifications, but these new guidelines from USPTF could hinder this progress.

Breast cancer is heterogenous, i.e. ,many different types with some being much more aggressive than others. Finding cancers later may do more harm as treatments will be ineffective, more toxic and of course more expensive

Another one of the biggest pain-points in the new guidelines was that women over 70 were excluded. This is just not right. Many women in this age group are active, healthy and go on to live very long lives. Finding breast cancer in this age group can be easier due to the fact many women in this age group have fatty breast tissue, making cancer show up much easier. Small cancers can be treated and women can go on to live very productive lives.

On a personal note, two of my aunts had small cancers found when they were over 75. One lived to be 93, being cancer-free for almost 20 years, and the other lived to be 103!

As a woman, I am lucky I have had the opportunity to have advisors and the education to know what to do. There are many out there who are not so lucky. Much has been done to educate women on the importance of screening, and what the USPSTF is doing by confusing them will not help.

For an addition helpful viewpoint on this issue, please read Dr. Daniel Kopans opinion that was published on AuntMinnie.

Anne Richards, CarestreamAnne Richards, Clinical Development Manager, Women’s Healthcare, Carestream

 

 

Diagnostic Reading #25: Five Must Read Articles from the Past Week

Carestream LogoIt’s Friday, which means it is time for a new edition of Diagnostic Reading. This week’s articles include a study on radiology and patient care, the benefit of clinical decision support, breast cancer screening recommendations, the importance of telemedicine and an update about the future of Medicare without SGR.

1) ARRS: Patient Consults Improve Care, Raise Radiology Profile – AuntMinnie

A study presented at the annual American Roentgen Ray Society meeting in Toronto revealed that patients value the ability to meet with a radiologist to discuss diagnostic images. The study found that patients that met with a radiologist were likely to want to review exam results with a radiologist again. Furthermore, connecting with patients adds to the value of care provided by radiologists.

2) Clinical Decision Support can Cut Inappropriate Imaging – AuntMinnie

According to a report in Tuesday’s edition of Annals of Internal Medicine, clinical decision-support (CDS) can have a beneficial effect on imaging appropriateness. Hard-stop features could cut inappropriate imaging even more. These features disallow imaging procedures without the approval of another person, if the software considers the study to be inappropriate.

3) Speak Now About USPSTF Breast Cancer Screening Recommendations – Diagnostic Imaging

The United States Preventive Services Task Force has released recommendations for mammography. These recommendations discuss the issues of breast density and aging as some of the risk factors for breast cancer. USPSTF is asking for public comments on these recommendations until May 18, 2015.

4) Telemedicine a High 2015 Priority for Healthcare Executives – FierceHealthIT

A survey of 233 healthcare professionals conducted by REACH Health has indicated that telemedicine has taken a position of precedence among healthcare executives. About 60 percent of respondents considered telemedicine to be a high priority this year. These professionals see telemedicine as an important way to improve care. The author notes that patients are interested in telemedicine and aware of its benefits.

5) The SGR is history. Now what? – Health Imaging

With legislation to repeal SGR last week, it is time to look towards the future of healthcare. This article explains what the SGR repeal means and how it will affect healthcare legislation. The author discusses the importance of the new value-based healthcare model that will be put into place called the Merit-Based Incentive Payment System.

 

 

Diagnostic Reading #20: Five Must Read Articles from the Past Week

Carestream logoIt’s Friday, which means it’s time for a new edition of Diagnostic Reading! This week’s reading includes the benefits of big data, the effectiveness of early imaging, pediatric radiology, an update on healthcare legislation, and an article about the importance of mammography technicians to women’s health. Have a great weekend!

1) The Benefits of Data-Driven Healthcare– Hospital Impact
This article addresses the issue of data analysis. The author makes a point to say that though data is important, simply collecting the data is useless. Evidence-based reports are noted as the most effective way to improve healthcare. If data can be used to determine which departments are underperforming, then the issue can be repaired.

2) JAMA: Early Imaging Questionable for Older Adults with Back Pain– Aunt Minnie
Researchers from the University of Washington found that early imaging for back pain in adults older than 65 years old has no significant clinical value. This study, which was recorded in the Journal of the American Medical Association, emphasized that though there are no benefits for patients, early imaging procedures add to healthcare costs. Also read: Adults at Low Risk of Heart Disease Shouldn’t Get Screening

3) Building Trust in Pediatric Imaging– Diagnostic Imaging
When working with pediatricians, it is important for radiologists to gain rapport. This trust comes from more than just accurate readings. Radiologists also need to exhibit interest in the patient and commitment to reducing radiation dose. This article looks more deeply into the relationships between radiologists and pediatricians and gives insight on how to build trust.

4) Washington Debrief: Interoperability Bill Would Penalize Non-Compliant Vendors– Healthcare Informatics
This article discusses new pieces of healthcare legislation that have been introduced. First, EHR providers and vendors will be required to be interoperable by 2018. Second, this article talks about data security. Legislators are making progress towards securing patient records and notifying patients in the event of a data breach. Lastly, lawmakers have been working to fix the current Medicare system in order to improve the physician reimbursement.

5) NCoBC: Mammography Techs Play Crucial Role in Women’s Health– Aunt Minnie
Mammography is one of the most rapidly growing segments of health imaging. This article discusses the importance of the technologist. Patient-technologist interactions have become more intensive and the technologist has taken on greater responsibility when it comes to education. The author lays out guidelines for mammography technologists to thrive in the new scene.

Diagnostic Reading #7: 10 Most Popular Blog Posts from the Second Half of 2014

CARESTREAM Touch Ultrasound System - 1Carestream has worked hard to provide content of value throughout 2014. We have used our blog to deliver information about Carestream technology, address major industry trends, and inform readers about the medical imaging and IT fields. In this edition of Diagnostic Reading, we look at our most read blog posts since July. The topics include, the recent unveiling of our newest technology, industry infographics, image quality, digital 3D mammography, and dose reduction.

1) A LOOK AT THE NEW CARESTREAM TOUCH ULTRASOUND SYSTEM

Carestream unveiled its newest technology in Chicago at RSNA 2014. The CARESTREAM Touch Ultrasound System officially moved the company into the ultrasound market. This post contains information about the new technology, including images that explain its features and capabilities.

2) INFOGRAPHIC: THE EVOLUTION OF RADIOLOGY REPORTING

This infographic follows radiology reporting throughout history. It covers traditional hand written reports, transcribed reports, and voice recognition. Pros and cons of these types of report are listed. Ultimately, the evolution brings us to multimedia reporting and highlights its benefits.

3) UNCOMPROMISED QUALITY: BONE SUPPRESSION AND CHEST X-RAY IMAGES

Since being FDA approved earlier this year, radiologists are 58% more confident in their ability to read chest x-rays with bone suppression software. Since the software produces 2-D images rather than 3-D images, it also reduces the typical dose for patients receiving chest x-rays.

4) DREAM JOB: APPLICATIONS ENGINEER, DIGITAL MEDICAL SOLUTIONS

This Q & A with Marty Pesce asks questions about his experiences as an applications engineer for Carestream. The interview discusses the nature of a job as a radiologic technologist. Pesce also had the opportunity to answer questions about his personal experiences in the radiology field.

5) IMPLEMENTING EFFECTIVE WAYS TO REDUCE AND TRACK RADIATION DOSE FOR X-RAY EXAMS

El Camino Hospital in Mountain View, California, has taken measures to dramatically track and decrease patient dose. The hospital attributes this success to their transition from CR to DR technology. It claims that better imaging software leads to less repeated imaging.

6) DIGITAL BREAST TOMOSYNTHESIS NECESSARY FOR IMAGING DENSE BREAST TISSUE

This post emphasizes the importance of Digital Breast Tomosynthesis (DBT), or 3-D mammography for women with dense breast tissue. Numerous studies are noted by the author, including a JAMA study that found that by using DBT, there was a 41% increase in the detection of possibly lethal cancers.

7) RADIOLOGY’S RESPONSE TO HEALTHCARE CONSOLIDATION – STEP ONE: THE GLOBAL WORKLIST

With hospital mergers becoming prevalent, this post suggests that interoperability will continue to be a challenge. The adoption of software such as CARESTREAM Vue Connect could ease the transition. Combining data allows for both institutions to access their own information, as well as having access to new patient information.

8) THE ROLE OF A FULLY INTEGRATED RIS-PACS: DREAM OR REALITY?

Seventy-eight percent of office based physicians use some sort of electronic health record system (EHR). This post addresses the possibility of  radiologists and physicians working together using RIS and PACS to document patient records. There are inevitable challenges, but ideally this could mean “one patient, one record.”

9) RADIOLOGY AND MACRO HEALTHCARE TRENDS PART II: COST

In a time when Americans find it difficult to afford medical bills, radiologists must be conscientious about cost. Inappropriate imaging exams and lack of quality drive up costs, this post discusses how imaging appropriateness and effective reading of images can reduce costs in the field of radiology. Additionally, the post addresses other ways that health IT can help lower imaging costs.

10) THE THREE-PHASE PROCESS TO IMPLEMENT A PACS-DRIVEN TELERADIOLOGY SERVICE

Innovative Radiology adopted CARESTREAM Vue Motion. Since the implementation, efficiency has been higher. Additionally, Vue Motion connected Innovative Radiology with more than 40 sites in early 2014.

Diagnostic Reading #3: Five Must-Read Articles from the Past Week

 

On-site or cloud-based teleradiology can provide effective patient care.

An on-site or cloud-based teleradiology system can connect radiologists to reports, images, and patient history to provide efficient and effective care.

This week’s Diagnostic Readings include updates on meaningful use, analysis of telemedicine growth, tips about dose management and more. Check out our weekly series, “Diagnostic Reading,” for news and updates in healthcare IT and radiology.

1) Survey Indicates Telemedicine Adoption Growth among Healthcare Executives

This post presents the results of a survey taken by 57 healthcare executives. The findings explore the extent to which health care systems are adopting telemedicine and electronic health records (EHR). The author explores the the channels of telemedicine that are the most popular among this sample group.

2) Enterprise Imaging—Walking the tightrope: Optimizing radiation dose management 

Since the 1980s, the annual per-capita radiation dose from medical exposure has risen from 0.53 mSv to 3.1 mSv. This article from the November edition of Applied Radiology explores the challenges and solutions of moderating dose. The author discusses how the balance of radiation dose management can be optimized.

3) AMA Urges CMS to Drop Meaningful Use Penalties

This article addresses the existing meaningful use criteria and the difficulties that some medical centers may encounter. This piece discusses that reasons outside of a physician’s control may be the reason for their lack of interoperability. Due to these difficulties, the American Medical Association has asked the Centers for Medicare & Medicaid Services to “suspend all penalties to physicians and healthcare facilities for failure to meet meaningful use criteria.”

4)  It’s Time for Radiology to Take Peer Review Seriously

This post discusses the importance of knowing your diagnostic accuracy rate in radiography. The author writes about comparing accuracy rates to bench marks and national standards. These ideas could lead to more accurate readings and more industry-wide credibility.

5) To Improve Mammography Reading Accuracy, Follow Through with Workups

This article discusses the correlation between reading high volumes of mammography readings and accuracy rates. The study conducted at the Group Health Research Institute in Seattle found that radiologists with higher numbers of annual workups had higher screening sensitivity and cancer-detection.

Digital Breast Tomosynthesis Necessary for Imaging Dense Breast Tissue

Digital Breast Tomosynthesis

The image on the left is a DBT image, and the image on the right is traditional 2D mammography.

Digital breast tomoysnthesis (DBT), or 3-D mammography, has often been referred to as being the key to advancement in breast imaging. With more and more states passing laws requiring that women be notified if they are classified as having dense breast tissue, DBT is proving to be beneficial in accurate detection—a JAMA study showed that using 3-D mammography resulted in a 15% reduction in recall rates and a 41% increase in the detection of potentially lethal cancers.

Dense breast tissue and the accompanying notifications to women who possess it has become a frequent conversation topic over the past couple years. As of now, 20 states have enacted laws that require medical professionals to notify women if their mammograms reveal them to have dense tissue. Organizations such as Are You Dense Advocacy are fighting the good fight trying to get more states on board with these notifications because of the major risk dense breast tissue presents— making it more difficult to detect cancer in a mammogram than normal tissue.

At the International Congress of Radiology (ICR) in September 2014, Dr. Marwa Adel from Misr University for Science and Technology and Cairo Scan in Egypt presented two cases:

  1. The first case, Dr. Adel and company compared breast cancer visibility in digital mammography with that of DBT. Cancer visibility was ranked higher for DBT than for digital mammography in 52% of cases and was equivalent in 49 cases (33.6%). When observing the group with higher breast tissue density, the cancers were rated more visible in 64.6% of the cases.
  2. In the second study, DBT also proved better than digital mammography in image quality of masses. DBT was rated as equivalent or superior to digital mammography in 96% of the total findings.

Dr. Adel and the other authors of the studies concluded that DBT is superior to digital mammography in diagnostic performance. Particularly when it comes to dense breast tissue, it is clear that the use of DBT is vital to providing improved diagnosis to patients.

There are important questions regarding financial, technical, product, and workflow issues related to DBT that should be answered before a facility installs a system. As women’s healthcare continues to evolve, more and more facilities are able to implement DBT machines and be in a position to provide the highest quality of care to their patients.

At RSNA 2014, Carestream will showcase enhancements to its DBT module including a DBT image map that indicates the location and orientation of the currently displayed slice in the breast, a slabbing tool that allows  adjust of the slab thickness , improved workflow settings and the display of DICOM-compliant 2D synthetic views, which are calculated from the 3D dataset.  For more information, you can visit us in South Hall at booth #4735.

UPDATE, NOVEMBER 10, 2014: According to an article published last week by Health Imaging, “the Centers for Medicare & Medicaid Services (CMS) established two new add-on codes that will go into effect Jan. 1, 2015, and extend additional payment when DBT is performed along with 2D digital mammography.”  You can click the link to get more details about the designated codes and payment amounts for DBT. CMS said it will also “revisit payment for DBT and 2D mammography for 2016 as part of a review under its misvalued codes initiative.”

Ron Muscosky, Worldwide Product Line Manager, HCIS, Carestream Ron Muscosky, Worldwide Product Line Manager, Healthcare Information Solutions, Carestream 

 

 

JAMA Study Showcases the Benefits of 3-D Mammography

Anne Richards, Clinical Development Manager, Women’s Healthcare, Carestream

Anne Richards, Clinical Development Manager, Women’s Healthcare, Carestream

The case for the importance and relevance of mammograms has had its battles in 2014. The CNBSS announcement sought to prove that mammograms do not result in better detection and essentially, do not save lives. Those working in women’s health were up in arms about this study, claiming it as being dangerous and working to discredit it. With an announcement made yesterday by the Journal of the American Medical Association, the pro-mammogram field has secured a victory.

3-D mammography, known in the medical field as breast tomosynthesis, was the focus of a study released on June 24, 2014 in JAMA. The results of the study showed that using 3-D mammography resulted in a 15% reduction in recall rates and a 41% increase in the detection of potentially lethal cancers. These results are certainly positive, especially as millions of women will be having the mammograms and/or digital breast tomosynthesis this year.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

The benefits of tomosynthesis do not come without issues. First off, the machines are expensive upfront costs for facilities. The New York Times article about the study estimated the tomosynthesis machines to cost about $500,000—almost double the cost of digital mammography machines. Reimbursement is an issue in some facilities—both in terms of the technology and from insurance companies since tomosynthesis exams are new to women’s health initiatives.

Second, the images captured by 3-D mammography machines create bigger volumes of data since the file size of a 3-D image is exponentially larger than a 2-D one. This creates the need for more storage space, resulting in higher IT costs for the facility.

Third, 3-D mammography images are creating a bottle-neck in terms of efficiency in reading and analyzing the exams. There is more substance to study and analyze in a tomosynthesis exam, so initially it takes longer for the radiologist to read and report the exam. Workstations with dedicated tools for tomosynthesis are helping to reduce this reading time.

Even with these three issues, the benefits that 3-D mammography provides to the patients outweighs each one. Providing quality care to the patient should always be the number-one priority for medical professionals. If it takes more expensive equipment, then the facility should make the investment because the benefits has the potential to save lives. Giving that up to save money and time is not worth the risk.

The Breast Density Notification Train is A-Rollin’

Sean P. Reilly

Sean P. Reilly, Publisher, Imaging Technology News and Diagnostic and Interventional Cardiology

What started with a chug and a whisper is growing in both momentum and volume. Can you hear that whistle blowing?

For years, mammography has been the breast cancer screening standard of care for women over 40 and, to its credit, has saved countless lives by detecting breast cancer early enough to provide life-saving treatment. Despite recent controversial studies that challenge the value of annual screening, or screening of women under 50, mammography has been, and will likely continue to be, the gold standard for breast cancer screening for years to come.

There is, however, a growing population of women, healthcare providers, and legislators who passionately believe mammography screening may not be the ideal solution for all women — particularly for those with dense breast tissue, where cancer is more difficult to detect.. Cancer is being missed and these women are paying a high, and sometimes the ultimate, price.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

 

The good news is there are several imaging modalities available today that may more effectively detect early-stage breast cancer in dense-breasted women, including magnetic resonance imaging (MRI), ultrasound or automated breast ultrasound (ABUS), molecular breast imaging (MBI) and breast tomosynthesis, to name a few. The bad news is, with these promising technologies come challenges, not the least of which is increased cost. Providers have been slow to adopt these modalities for initial (or adjunct) screening due to the upstart cost of obtaining the equipment, workflow, staffing and training issues, lack of reimbursement and other challenges. So women with dense breasts, or women with a history of breast cancer, are instructed to continue with annual mammograms—just like forty something-year-old women with no family history of breast cancer.

While providers and payers grapple with the possibilities and challenges of personalized breast screening for women (as this interview with Gary Levine, M.D., president, National Consortium of Breast Centers, demonstrates), there is a movement under way to inform women with dense breast tissue of their increased risk factors and screening options. Breast density advocates like Nancy Cappello, Ph.D., founder of Are You Dense, Inc., and JoAnn Pushkin, co-founder of D.E.N.S.E., have led the charge by increasing awareness in women who have, in turn, captured the attention of healthcare providers and lawmakers. Slowly but surely, it seems to be working. To date, 17 states (CT, TX, VA, NY, CA, HI, MD, TN, AL, NV, OR, NC, PA, NJ, AZ, MN, RI) have enacted mandatory density inform laws, six additional states (DE, KY, MA, MI, OH, and SC) have legislation pending and, in time, others will likely follow. Federal legislation is also in play. At the moment, over 50 percent of American women now live in states requiring some level of notification. The train has left the station and is gaining speed.

I’d sure hate to be the governor of the final state to sign off on breast density inform legislation—wouldn’t you?

ABOUT THE AUTHOR

Sean Reilly is healthcare brands group publisher (Imaging Technology News and Diagnostic and Interventional Cardiology) at Scranton Gillette Communications.