Patient Throughput Times for Supplemental Breast Cancer Screening Exams

Main Article Content

Michael Plaza
Denzel Cole
Marcos A. Sanchez-Gonzalez
Christopher J. Starr

Keywords

Breast MRI, Patient flow, Patient throughput, Breast cancer screening, Breast ultrasound

Abstract

Background: To optimize screening abbreviated breast MRI (ABMR) operations, patient throughput times of ABMR were compared to breast ultrasound (US) and full protocol breast MRI (FPMR).
Methods: Patient throughput times (mean ± standard error) and its subcomponents were analyzed for 95 ABMRs, 90 breast US exams, and 50 FPMRs. Total patient throughput was measured from registration time to the time of the last acquired image. Actual exam time was time difference between the first and last acquired images and pre-examination time was the calculated difference between throughput and actual exam times.
Results: ABMR total patient throughput time was shorter than FPMR (55.7 ± 1.7 vs. 63.1 ± 2.0 min; difference, 7.4 min, 13%; p<0.001), but longer than breast US (39.1 ± 1.3 min; difference, 16.6 min, 30%; p<0.001). ABMR had shorter actual scan times than FPMR (13.4 ± 0.14 vs. 18.6 ± 0.25 min; p<0.001), but longer than US (9.6 ± 0.46 minutes; p<0.001). There was no difference in the pre-examination times between ABMR and FPMR (42.3 ± 1.7 vs. 44.6 ± 1.9 min; p = 0.357); pre-examination times were longer for both MR exam types compared to US (29.5 ± 1.3 minutes; p<0.001).
Conclusion: ABMR patient throughput times are faster than FPMR, but these gains are limited as they have no impact on pre-examination activities which comprise the lengthiest components of the patient flow process. US patient flow currently remains faster than ABMR; however, comparable ABMR times could be achieved by further omitting certain sequences and optimizing pre-examination processes.

References

1. Kerlikowske K, Zhu W, Tosteson AN, Sprague BL, Tice JA, et al. Identifying women with dense breasts at high risk for interval cancer: a cohort study. Annals of internal medicine. 2015; 162(10):673-81.
2. Sprague BL, Gangnon RE, Burt V, Trentham-Dietz A, Hampton JM, et al. Prevalence of mammographically dense breasts in the United States. JNCI: Journal of the National Cancer Institute. 2014;106(10).
3. Berg WA, Rafferty EA, Friedewald SM, Hruska CB, Rahbar H. Screening Algorithms in Dense Breasts: AJR Expert Panel Narrative Review. American Journal of Roentgenology. 2020.
4. Berg WA, Zhang Z, Lehrer D, Jong RA, Pisano ED, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 2012;307(13):1394-404.
5. Sung JS, Stamler S, Brooks J, Kaplan J, Huang T, et al. Breast cancers detected at screening MR imaging and mammography in patients at high risk: method of detection reflects tumor histopathologic results. Radiology. 2016;280(3):716-22.
6. Choudhery S, Patel BK, Johnson M, Geske J, Fazzio RT, et al. Trends of Supplemental Screening in Women With Dense Breasts. J Am Coll Radiol. 2020;17(8):990-8.
7. Berg WA, Vourtsis A. Screening breast ultrasound using handheld or automated technique in women with dense breasts. Journal of Breast Imaging. 2019;1(4):283-96.
8. Lee CS, Monticciolo DL, Moy L. Screening Guidelines Update for Average-Risk and High-Risk Women. AJR Am J Roentgenol. 2020;214(2):316-23.
9. Miles R, Wan F, Onega TL, Lenderink-Carpenter A, O'Meara ES, et al. Underutilization of supplemental magnetic resonance imaging screening among patients at high breast cancer risk. Journal of Women's Health. 2018;27(6): 748-54.
10. Harvey SC, Di Carlo PA, Lee B, Obadina E, Sippo D, et al. An Abbreviated Protocol for High-Risk Screening Breast MRI Saves Time and Resources. J Am Coll Radiol. 2016;13(4):374-80.
11. Heacock L, Reig B, Lewin AA, Toth HK, Moy L, et al. Abbreviated breast MRI: road to clinical implementation. Journal of Breast Imaging. 2020; 2(3):201-14.
12. O'Brien JJ, Stormann J, Roche K, Cabral-Goncalves I, Monks A, et al. Optimizing MRI logistics: focused process improvements can increase throughput in an academic radiology department. American Journal of Roentgenology. 2017;208(2):W38-W44.
13. Plaza MJ, Perea E, Sanchez-Gonzalez MA. Abbreviated Screening Breast MRI in Women at Higher-than-Average Risk for Breast Cancer with Prior Normal Full Protocol MRI. Journal of Breast Imaging. 2020.
14. Kalbhen CL, McGill JJ, Fendley PM, Corrigan KW, Angelats J. Mammographic determination of breast volume: comparing different methods. AJR Am J Roentgenol. 1999;173(6):1643-9.
15. Kruskal JB, Reedy A, Pascal L, Rosen MP, Boiselle PM. Quality initiatives: lean approach to improving performance and efficiency in a radiology department. Radiographics. 2012; 32(2):573-87.
16. Borthakur A, Weinstein SP, Schnall MD, Conant EF. Comparison of study activity times for “full” versus “fast MRI” for breast cancer screening. Journal of the American College of Radiology. 2019;16(8):1046-51.
17.Patient Throughput: A Critical Strategy for Success.” The Chartis Group.2007. [Available from: http://www.chartis.com/resources/ files/whitepapers/pre-2013/chartis_group_patient- throughput-critical-strategy-for-success.pdf. .
18. Thompson AC, Prill MJK, Biswal S, Rebner M, Rebner RE, et al. Factors associated with repetitive strain, and strategies to reduce injury among breast-imaging radiologists. Journal of the American College of Radiology. 2014;11(11): 1074-9.
19. Dialani V, Tseng I, Slanetz PJ, Fein-Zachary V, Phillips J, et al. Potential role of abbreviated MRI for breast cancer screening in an academic medical center. Breast J. 2019;25(4):604-11.
20. Shankar PR, Hayatghaibi SE, Anzai Y. Time-Driven Activity-Based Costing in Radiology: An Overview. J Am Coll Radiol. 2020;17(1 Pt B):125-30.
21.Geuzinge HA, Obdeijn I-M, Rutgers EJ, Saadatmand S, Mann RM, et al. Cost-effectiveness of Breast Cancer Screening With Magnetic Resonance Imaging for Women at Familial Risk. JAMA oncology. 2020;6(9): 1381-9.
22. Taneja C, Edelsberg J, Weycker D, Guo A, Oster G, et al. Cost effectiveness of breast cancer screening with contrast-enhanced MRI in high-risk women. J Am Coll Radiol. 2009;6(3):171-9.
23. Bakker MF, de Lange SV, Pijnappel RM, Mann RM, Peeters PHM, et al. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med. 2019;381(22): 2091-102.
24.Comstock CE, Gatsonis C, Newstead GM, Snyder BS, Gareen IF, et al. Comparison of abbreviated breast MRI vs digital breast tomosynthesis for breast cancer detection among women with dense breasts undergoing screening. Jama. 2020;323(8):746-56.
25. Kuhl CK, Strobel K, Bieling H, Leutner C, Schild HH, et al. Supplemental Breast MR Imaging Screening of Women with Average Risk of Breast Cancer. Radiology. 2017;283(2):361-70.
26. Vlahiotis A, Griffin B, Stavros AT, Margolis J. Analysis of utilization patterns and associated costs of the breast imaging and diagnostic procedures after screening mammography. Clinicoecon Outcomes Res. 2018;10:157-67.
27.Marshall H, Pham R, Sieck L, Plecha D. Implementing abbreviated MRI screening into a breast imaging practice. American Journal of Roentgenology. 2019;213(1):234-7.
28.Chadderdon AL, Carns DR, Pudalov LR, McKernan LC, Honce JM. Underlying Mechanisms of Psychological Interventions in Magnetic Resonance Imaging and Image-Guided Radiology Procedures. Top Magn Reson Imaging. 2020;29(3):157-63.
29. Chow R, Bruera E, Temel JS, Krishnan M, Im J, et al. Inter-rater reliability in performance status assessment among healthcare professionals: an updated systematic review and meta-analysis. Supportive Care in Cancer. 2020:1-8.
30. Collado-Mesa F, Kaplan SS, Yepes MM, Thurber MJ, Behjatnia B, et al. Impact of COVID-19 on breast imaging case volumes in South Florida: A multicenter study. Breast J. 2020.
31. Prabhakar AM, Glover Mt, Schaefer PW, Brink JA. Academic Radiology Departmental Operational Strategy Related to the Coronavirus Disease 2019 (COVID-19) Pandemic. J Am Coll Radiol. 2020;17(6):730-3.