OCTOBER 18, 2016, FORT DETRICK, Md. (NNS) – Many know October is Women’s Health and Breast Cancer Awareness Month. What might not be common knowledge is how Naval Medical Logistics Command (NMLC) supports women’s health and breast cancer prevention. One way NMLC helps is by ordering practically all breast screening equipment that land-based medical treatment facilities around the world use to provide life-saving screenings.
Stationed at Fort Detrick, Maryland, NMLC’s vision is to become the Department of Defense’s premier medical logistics support activity. Its mission states, “We deliver patient-centered logistics solutions to military medicine.”
Achieving a step in realizing its vision, the Naval Diagnostic Imaging and Radiotherapy Board (NAVDIRB) was established to be the Bureau of Medicine and Surgery’s agent in evaluating new and emerging medical and dental imaging equipment and radiotherapy technologies. Its role is to recommend short- and long-range planning, policy, governance and acquisition strategies for all diagnostic imaging, radiotherapy equipment modalities, and related support equipment, including military construction projects.
“Sites interested in obtaining new or replacement mammography systems initiate an equipment request on a NAVMED 6700 form,” said Anthony Angelo, senior clinical engineer and chief, Clinical Engineering Division, NMLC’s Medical Equipment and Logistics Solutions Directorate. “The equipment request should include cost-benefit analysis information describing the need and justification for the system at the requested location.”
A cost benefit analysis is a systematic approach to estimating the strengths and weaknesses of alternatives — for example in transactions, activities or functional business requirements — and is used to determine options that provide the best approach to achieve benefits. In other words, cost benefit analysis gives a simple, quantitative approach for deciding whether to proceed with a decision such as buying new equipment, leasing equipment, or maintaining current equipment.
This information is reviewed by NMLC clinical engineers and the site’s respective regional medical physicist. Initial recommendations from those reviews are presented at the NAVDIRB for an approval decision. Upon approval, contracting actions are authorized to commence, according to Angelo.
NMLC specifically handles the purchasing of radiology equipment, including mammography. Currently, the U.S. Food and Drug Administration (FDA) has approved three mammography tomosynthesis systems — a new dimension in breast cancer detection. Conventional digital mammography produces one image of overlapping tissue, which in certain cases can make it difficult to detect a cancer, according to published reports. Performed with digital mammography using the same scanner, breast tomosynthesis takes multiple images of the entire breast. The Selenia Dimensions was the first system approved for tomosynthesis. Since its approval, additional vendors have become FDA-approved for breast tomosynthesis.
“Mammography is a highly-specialized and heavily-regulated radiologic service; a facility’s mammography program receives an FDA inspection yearly and is accredited by the American College of Radiology every three years,” said Cmdr. Ryan Rockhill, MD, radiology staff physician, body and breast imager, lead interpreting physician, breast imaging academic chief, Naval Medical Center San Diego. “This includes inspection of the imaging equipment, review of image quality and processes used for image acquisition, and an audit of the radiologists performing the exams.”
The standards for mammography and the screenings associated with it are exceptionally high. If a facility has its Mammography Quality Standards Act (MQSA) Certificates revoked by the FDA, it cannot perform mammography until it is recertified under the MQSA and implementing regulations. Recertification could require a two-year waiting period, according to the FDA website.
Facility refers to any hospital, outpatient department, clinic, radiology practice, mobile unit, office of a physician, or other facility that conducts mammography activities, including the operation of equipment to produce a mammogram, processing the mammogram, initial interpretation of the mammogram, and maintaining viewing conditions for that interpretation.
“Mammography technologists also receive specialized training in addition to those of a diagnostic technologist,” Rockhill said. “They are required to obtain a certain number of continuing education hours and to perform a minimum number of exams. Radiologists reading mammograms are required to obtain a certain number of continuing education hours and to read a minimum number of mammograms, as well.”
“Digital Breast Tomosynthesis (DBT), also known as three-dimensional mammography, is an emerging technology that acquires multiple low-radiation dose images of the breast and reconstructs them into thin slices for interpretation,” he said. “The technology allows for improved cancer detection and reduced call-back rates by reducing overlap of breast tissues. This is especially important in women with dense breast tissue. This technology can be used as a screening and diagnostic tool, and further complements mammography, ultrasound, MRI, and nuclear medicine as methods for evaluating for breast cancer.”
The American College of Radiology no longer considers DBT experimental, according to Rockhill. The American Medical Association has approved Current Procedural Terminology codes for DBT for reimbursement. All of the “Big 3” Navy MTFs offer DBT, and some clinics will be receiving DBT soon.
“I believe that DBT will become a prominent component of breast imaging in the next few years, complementing — if not outright replacing — standard two-dimensional mammograms in most patients. As patient awareness of this technology and understanding of limitations of standard mammography in dense breasts increase, so will the demand,” said Rockhill.
While everyone recognizes October as Breast Cancer Awareness Month, and like other equally important monthly observances, awareness shouldn’t be limited to only once a year. Continuing awareness can ensure earlier detection, and where more treatment options are available, can hopefully lead to cure or elimination.