Breast-imaging interpretations by telemedicine? More than a few have said that it couldn’t be done—or, at least, that it couldn’t be done well. The files are too large, the cases too complex. But now the doubters are being proven wrong as a new, carefully thought-through telemedicine innovator specialized in breast imaging has launched from its home base in the New York metropolitan area.
Providing reads by radiologists specialized in breast imaging dispersed around the country, BelleBridge, headquartered in Shelton, Conn., is a high-tech, highly specialized wunderkind. Its radiologists read digital mammograms with or without computer-aided detection (CAD) overlays, as well as images captured with breast ultrasound, breast MRI and tomosynthesis. They are certified by the American Board of Radiology and licensed in all 50 states. And they use PACS, RIS and MQSA management tools to expertly interpret and appropriately manage follow-up exams for both screening and diagnostic exams.
Until now, diagnostic exams have challenged breast telemedicine with difficulties. Diagnostic breast exams, those performed due to suspicion of disease, almost always require real-time collaboration between technologist and radiologist while the patient is still in the imaging suite.
How to bring the two professionals, breast radiologist and technologist, together over the patient when the radiologist is not physically present?
“We have closed that gap utilizing secure, HIPAA-compliant audio-video technology, as well as real-time ultrasound streaming and live conferencing,” explains Elmar A. Davé, BelleBridge co-founder who serves as its chief operating officer. The streaming comes by way of a telemedicine cart, innovated by BelleBridge and registered with the FDA. “These capabilities allow offsite breast radiologists to work with facility technologists just like the two are standing side by side.”
Focus on specialization
Taken together, these developments represent an important breakthrough, Davé adds, because many facilities throughout the United States don’t have access to enough radiologists specialized in breast exams.
“Too often, general radiologists are reading the exams,” he says. “Don’t get me wrong—many general radiologists do an excellent job reading breast studies. But some don’t have the numbers to be qualified by MQSA, which requires the interpretation of at least 960 exams in the prior 24 months.”
At the same time, some generalists are not comfortable reading breast imaging studies, and others are concerned about medical liability. “Breast imagers tend to be less concerned about medical liability,” says Davé. “They feel more confident in what they are doing. BelleBridge’s breast imagers are able to provide credentials as well as confidence regardless of where the patient is located. Any hospital and medical facility that does not have a breast-specialized radiologist on site or simply needs to distribute breast imaging study over-flow can have confidence that their imaging examinations are interpreted by high-quality, dedicated breast radiologists.”
"One of the key differentiators of the BelleBridge model, distinguishing it from conventional teleradiology, is the combination of its breast imaging specific logistics processes and technology,” he adds. “The possibility for a mammography or ultrasound technologist to collaborate with a breast-specialized radiologist via audio/video technology and, as needed, live-stream ultrasound data while the patient is still in the imaging suite is meaningful telemedicine in its purest sense."
Early detection from afar
Then, too, specialized breast expertise is sometimes as critical to cancer screening as it is to cancer diagnostic evaluations. Mammography is the gold standard for screening exams, but close to 40 percent of women have breasts with optically dense tissue. For these patients, it’s useful to do adjunctive breast-screening ultrasound exams, and expert readers are needed to interpret automated breast ultrasound studies.
“Half of cancers are not detected for patients who have dense breasts on mammography,” says Davé, adding that using ultrasound as an adjunct in these cases increases detection rate by about 35 percent.
Meanwhile there are other reasons physicians may have cause to look to telemedicine for breast-imaging proficiency. Local radiologists take vacations, retire and otherwise have less-than-constant availability. Major metropolitan areas find themselves with overflow