To enable imaging facilities to improve and maintain the quality of their breast MRI services, the ACR® has launched the Breast Magnetic Resonance Imaging Accreditation Program (BMRAP). Like other ACR accreditation programs, BMRAP involves peer-review assessment of imaging centers’ processes and equipment, along with the caliber of their images and personnel.
Constance Lehman, MD, PhD, chair of the ACR Committee on Breast MRI Accreditation, says, “Imaging centers can fill out forms attesting to the qualifications of their staff and the quality of their services, as well as promote the integrity of the images they provide, but at the end of the day, it isn’t enough. Accreditation is critical because it involves the thorough, repeated, objective evaluation of every aspect of facilities’ breast MRI offerings. Only through that type of assessment can truly high standards of breast care be set and upheld.”
BMRAP will address multiple areas, including the formulation and refinement of quality standards and best practices for breast MRI providers. Other areas to be covered are the enhancement of personnel qualifications, imaging-equipment features and capabilities, quality-control measures, and image caliber itself. There is no equipment field strength requirement, but equipment must have a dedicated breast coil and be capable of performing simultaneous bilateral imaging. Equipment must also meet state and federal performance requirements for maximum static magnetic field strength, maximum rate of change of magnetic field strength (dB/dt), maximum radiofrequency power deposition (specific absorption rate) and maximum auditory noise levels.
Moreover, the program will play a pivotal role in allowing facilities that perform only breast imaging to fulfill any applicable accreditation requirements under the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Under MIPPA, all facilities in which the technical component of advanced diagnostic-imaging services is provided must become accredited by a CMS-designated accrediting organization by January 1, 2012, in order to qualify for Medicare reimbursement. The rule affects providers of outpatient MRI, CT, PET, and nuclear-medicine imaging services to Medicare beneficiaries.
Achieving accreditation under BMRAP takes four to six months, providing all ACR information-submission deadlines are met. As part of the application process, facilities must submit CDs or DVDs of clinical images and corresponding data for each magnet used in breast MRI exams at their sites. Two bilateral breast MRI cases (from different patients) must be presented for evaluation.
Of these cases, one is to involve a known, enhancing, biopsy-proven carcinoma (in the case of a needle biopsy, the biopsy may have been conducted either before or after the MRI exam; in the case of an excisional biopsy or lumpectomy, the surgery must have been performed after the MRI exam). The second case must have been interpreted with a final MRI assessment of ACR BI-RADS® category 1 (negative) or 2 (benign findings).
The ACR currently does not require that applicants also forward phantom images for accreditation review, but it might add such a mandate as the program matures, Lehman notes. Only traceable shipping methods may be used to send CDs or DVDs for review.
Other accreditation requirements are equally stringent and broad in scope. For example, facilities performing breast MRI must possess the capacity to execute mammographic correlation, directed breast ultrasound, and MRI-guided intervention, or must have a referral arrangement in place with cooperating facility that can provide these services. That cooperating facility must hold ACR accreditation in breast MRI (but until May 10, 2011, the ACR’s acceptance of the cooperating facility’s application for accreditation in breast MRI will be considered sufficient).
Similarly, for initial accreditation, board-certified interpreting physicians must possess (among myriad other qualifications) certification in radiology or diagnostic radiology from the American Board of Radiology, the American Osteopathic Board of Radiology, the Royal College of Physicians and Surgeons of Canada, or the Collège des Médecins du Québec. Such physicians are also required to have supervised, interpreted, and reported on 150 breast MRI examinations (or to have interpreted and reported on 100 breast MRI examinations in a supervised