For years, the radiology community has faced a problem: Fewer than 70 percent of mammograms provide a clear view of breast tissue, according to the American College of Radiology, a fact that can have life-threatening consequences for women.
So last year Stanford Department of Radiology Vice President of Education and Clinical Operations David Larson set out to find a solution. He launched the Mammography Position Improvement Collaborative with RAC in June 2021 with the goal of working with hospitals to identify new best practices in mammography.
It turned out that the demand for such a program was high. A total of 101 medical centers applied to be part of the collaboration’s first eight-month cohort, but only six were selected, and one of them was the MemorialCare Breast Center in Long Beach.
Under the program, which launched March 14 and will run through November 14, the Todd Cancer Institute center at Long Beach Memorial is working with five other major hospitals, including Stanford, to create a set of guidelines more effective and universal for taking mammograms.
Rather than trying to find a one-size-fits-all solution, the goal of the collaboration is to establish new processes that can result in more accurate mammograms, regardless of the specific challenges posed by a given patient or hospital.
“We struggle to really adopt solutions from one institution to another,” Larson said, “especially when it involves a lot of organizational and workflow changes.”
Thus, during the 10 learning sessions of the collaboration, participating hospitals are asked to consider different challenges – such as a patient who might not be comfortable while maintaining the correct position, or skin folds or other abnormalities that might be hiding cancer cells – and determining the steps that will lead to appropriate solutions.
Things like building a team, effectively defining a problem and its scope, setting specific goals, and analyzing the workplace and workflow to identify obstacles are all part of it. of the program that the ACR brings to the table.
“Any improvement is not easy to make. It’s not intuitive,” Larson said. “To do it reliably, you have to have project management, you have to improve methods, have organizational support, have access to data, all those things.”
In fact, as a requirement to join the collaborative, institutions had to have a dedicated “quality improvement coach” or someone with experience in quality improvement.
“Anyone who has done quality improvement recognizes that a quality improvement project can fail in many ways,” Larson said. “It has to do with the methodology, with the interactions between team members having access to the data, the support of local management or the collaboration between different parts of the organization.”
While this kind of problem-solving focus is beneficial in any field, it is clearly needed in the world of mammography.
Failure to meet mammography standards is one of the biggest reasons sites fail to get accredited with ACR, Larson said, and such accreditation is an important part of demonstrating the legitimacy of radiology procedures. of a hospital.
Inconsistency is also a problem recognized by major health organizations.
“His [an area] that the FDA specifically looked at, because they recognize the challenge,” Larson said. “This is very important in the diagnosis of breast cancer, the way the breast is positioned on an image can make the difference between whether a cancer is detectable or not.”
But the six institutions currently working in the collaboration are well placed to help solve the problem.
“We were already very data-driven; we had already implemented many quality improvement processes, components and software,” said Lisa Poorman, executive director and collaborative sponsor of the Todd Cancer Institute. “We were already trying to get there.”
Still, MemorialCare Breast Center Imaging Director Angela Sie said she was pleasantly surprised by the collaboration’s approach.
“For some reason I thought it was going to be, ‘Oh, this is what you need to do to optimize positioning,'” Sie said. “It’s much more process-based, and it really taught us how to tackle a problem, how to improve the solution, and how to measure your performance.”
The collaborative also implemented checks to ensure that the new processes are achieving the expected results. Each week, the team checks about 60 breast cancer scans that resulted from the collaboration’s process, according to MemorialCare Breast Center supervisor Bree Hysjulien, who is project manager for the collaboration.
The results of these reviews are collated and shared with other hospitals for comparison with other systems to test the effectiveness of new methods.
While the new practices and standards emerging from this collaboration are essential, a broader goal of the collaboration is to establish leaders in the field to spread this knowledge.
“That’s what we hope will differentiate it from just being a course you take or a project you take on once,” Larson said. “It not only becomes something that you root in your own organization, but then share and learn from others.”
The MemorialCare Breast Center team, for its part, is ready to take on this task.
“Nowadays with Zoom, you can have a conversation with anyone anywhere in the world,” Sie said. “We can discuss what we’ve been through, how it’s affected us and whether we’ve had lasting improvement, because the goal is to have lasting improvement in our positioning.”