Mammography seems to endure more trials and tribulations than any other imaging modality. Perhaps top on the list are recent studies calling into question its ability to save lives. But unfortunately the list doesn’t end with this heated debate. A fair share of breast cancer cases are not detected at the screening stage, which makes mammography an especially litigious imaging exam. Not surprisingly, malpractice insurance rates reflect the litigious nature of mammography. Furthermore, reimbursement for mammography is quite low, making it difficult for breast imaging centers to turn a profit. This combination of factors has led breast clinics around the country to close their doors; which means that radiologists and technologists at the remaining centers are pressured to see more patients and complete more exams. And patients face up to six-month wait times to get appointments.

But there is good news. The other side of the story shows radiology departments and breast imaging centers throughout the country finding that investing in computer-aided detection (CAD) can make a significant difference in their practice. R2 Technology, Inc.’s (Sunnyvale, Calif.) ImageChecker system for mammography provides radiologists with a second set of eyes by highlighting suspicious areas on a mammogram. The system can reduce the false negative rate, detecting subtle cancers that even the most experienced radiologist might miss. Moreover, centers that have purchased the ImageChecker find that it boosts patient confidence.

—Margaret Bertrand, M.D, physician/owner at Bertrand Breast and Osteoporosis Center

On the financial front, Medicare is reimbursing for mammography CAD, making it possible for a growing number of centers that have purchased the ImageChecker to cover the cost of the technology and even realize a return on their investment. More importantly, a number of private payors are following suit. It is, however, a testament to the technology that many women are willing to pay out of pocket for an additional computer reading. Foster & Gross Radiology (Laurel Springs, N.J.), which charges its patients for the service, reports that women will visit from up to 50 miles away for a mammography screening with the aid of the ImageChecker CAD system.

In the radiology world, everyone does seem to agree on one thing: mammography isn’t perfect. Retrospective studies reported in the New England Journal of Medicine, Archives of Internal Medicine and American Journal of Roentgenology have shown that 20 to 50 percent of breast cancers go undetected at the screening stage. Approximately half of the undetected cancers are missed due to observational oversights normally caused by fatigue. CAD technology can significantly reduce the incidence of false negative readings, which may, in turn, translate into a higher percentage of early stage cancer detections and greatly improved survival rates. A clinical trial of R2’s ImageChecker system and re-analyses of updated software have demonstrated that use of the ImageChecker could result in earlier detection of up to 23.4 percent of the cancers currently detected with screening mammography in those women who had a prior screening mammogram nine to 24 months earlier.

Please refer to the May 2002 issue for the complete story. For information on article reprints, contact Martin St. Denis