Breast Imaging Services Research Articles

Evolution of a local adolescent breast imaging service

The pathway for paediatric patients (<18 years) with breast-related symptoms from primary care has evolved in recent years within our region. Historically patients were managed at their local site within the region with varied management approaches, including young patients undergoing potentially unnecessary breast biopsies, and timelines adopted. In 2020, the establishment of a dedicated paediatric breast clinic enabled a smoother referral process from primary care, an appropriate clinical setting for the patient population and a standardised management pathway. A retrospective review was performed of patients aged between 9 and 18 years referred to the breast service between 2017 and 2022. We reviewed the trends in referral numbers over the years, referral indications, ultrasound findings and clinical outcomes. There has been a yearly increment in the number of patients referred, primarily driven by the 15-18 age group. The primary referral indication was a breast lump (52%), gynaecomastia (14%), abscess (9%), and breast pain (6%). The most prevalent ultrasound findings were a normal breast (41%) and a fibroadenoma (25%). Of patients presenting with a breast lump, 40% demonstrated a normal ultrasound and 46% fibroadenomas. Conservative management was opted for the majority of patients with simple fibroadenomas and gynaecomastia. An unusual case of dermatofibrosarcoma protruberans was identified, stressing the importance of prompt surgical review for rapidly growing masses. The new clinic structure has optimized under-18 patient care, reducing unnecessary interventions and alleviating pressure on adult breast units. We propose a management pathway that can be adopted at a local/regional level.

Mammography and Breast Ultrasonography Services in Ghana, Availability, and Geographic Access.

Breast cancer is the leading type of cancer diagnosed and the second leading cause of cancer-related death in Ghana. Mammography and ultrasound have proven benefits in the early detection of breast cancer. This study evaluates mammography, breast ultrasound, and radiology work force availability throughout Ghana. A survey was administered to all hospitals in Ghana from November 2020 to October 2021. Mammography, breast ultrasound services, and the number of radiologists were assessed. For mammography, the number performed per month, cost incurred by the patient, where images were read, and how long it took to receive reports were also assessed. Health Facilities Regulatory Authority records on diagnostic centers were obtained to identify additional in-country breast imaging services. Three hundred and twenty-eight of 346 hospitals participated in the survey (95%). Only 21 hospitals reported on-site mammography. One hospital reported performing >100 mammographies per month. The average cost to the patient ranged from 100 to 500 Cedis ($17-87 US dollars [USD]), although three hospitals performed mammography at no cost. An additional 10 mammography machines were identified at diagnostic centers throughout the country, with 41.3% of the female population living within 1 hour of mammography services. There were 135 hospital-based breast ultrasound services identified with 69.5% of the female population living within 1 hour of these services. There were an additional 190 ultrasound machines at diagnostic centers. There were 96 in-country radiologists identified. Although there is limited availability and utilization of mammography in Ghana, there is more readily available ultrasonography. A focus on increasing breast cancer early diagnostic capabilities with breast ultrasound should be prioritized in addition to further expansion of the radiology workforce.

AI Applications to Breast MRI: Today and Tomorrow.

In breast imaging, there is an unrelenting increase in the demand for breast imaging services, partly explained by continuous expanding imaging indications in breast diagnosis and treatment. As the human workforce providing these services is not growing at the same rate, the implementation of artificial intelligence (AI) in breast imaging has gained significant momentum to maximize workflow efficiency and increase productivity while concurrently improving diagnostic accuracy and patient outcomes. Thus far, the implementation of AI in breast imaging is at the most advanced stage with mammography and digital breast tomosynthesis techniques, followed by ultrasound, whereas the implementation of AI in breast magnetic resonance imaging (MRI) is not moving along as rapidly due to the complexity of MRI examinations and fewer available dataset. Nevertheless, there is persisting interest in AI-enhanced breast MRI applications, even as the use of and indications of breast MRI continue to expand. This review presents an overview of the basic concepts of AI imaging analysis and subsequently reviews the use cases for AI-enhanced MRI interpretation, that is, breast MRI triaging and lesion detection, lesion classification, prediction of treatment response, risk assessment, and image quality. Finally, it provides an outlook on the barriers and facilitators for the adoption of AI in breast MRI. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 6.

Optimizing the Patient Experience for Women With Disabilities in the Breast Imaging Clinic.

While there are varying opinions on what age to begin and at what interval to perform breast cancer screening, screening mammography is recommended for all women irrespective of disability. Unfortunately, women with disabilities are more likely to present with later-stage disease and higher mortality owing to the barriers for more widespread screening in this population. Women with disabilities may experience challenges accessing breast imaging services, and imaging centers may have suboptimal facilities and staff who are inexperienced in caring for this population. Efforts to increase accessibility by employing universal design to increase ease of access and provide training to improve the patient experience will go far to improve outcomes for patients with disabilities. To date, there exists no comprehensive guidance on how to improve breast cancer screening programs for women with disabilities. The purpose of this paper is to review barriers to screening faced by patients with disabilities, describe strategies to overcome these barriers, and provide guidance for radiologists and referring providers in selecting the best exam for the individual patient.

Impact of the COVID-19 Pandemic and Vaccine Availability on Utilization of Breast Imaging in a Multistate Radiology Practice.

Data were obtained from medical health records across 77 Radiology Partners practices in the US. The data provided us with the total monthly mammography, breast ultrasound, and breast MRI procedures from January 2019 to September 2022. An interrupted time-series (ITS) analysis was conducted to evaluate the effect of the COVID-19 pandemic and the COVID-19 vaccination. We chose March 2020 and December 2020 as critical time points in the pandemic and analyzed trends before and after these dates. The starting level (at baseline in January 2019) of the total breast imaging procedure volume was estimated at 114,901.5, and this volume appeared to significantly increase every month prior to March 2020 by 4,864.0 (p < 0.0001, CI = [3,077.1, 6,650.9]). In March 2020, there appeared to be a significant decrease in volume by 104,446.3 (p=0.003, CI = [-172,063.1, -36,829.5]), followed by a significant increase in the monthly trend of service volume (relative to the pre-COVID trend) of 20,660.7 per month (p=0.001, CI = [8,828.5, 32,493.0]). In December 2020, there appeared to be a significant decrease in service volume by 69,791.2 (p=0.012, CI = [-123,602.6, -15,979.7]). Compared to the period from March to November 2020, there was a decrease in the monthly trend of service volumes per month by 24,213.9 (p < 0.0001, CI = [-36,027.6, -12,400.2]). After March 2020, the total service volume increased at the rate of 25,524.7 per month (p < 0.0001, CI = [13,828.2, 37,221.2]). In contrast, the service volumes after December 2020 appeared to grow steadily and slowly at a rate of 1,310.8 per month (p=0.118, CI = [-348.8, 2970.3]). Our study revealed that there has been a recovery and a further increase in breast imaging service volumes compared to prepandemic levels. The increase can be best explained by vaccination rollout, reopening of elective/nonemergency healthcare services, insurance coverage expansion, the decline in the US uninsured rate due to government interventions and policies, and the recovery of jobs with employer-provided medical insurance post-pandemic.

Quality Assurance Guidelines for Breast Imaging – Breast Imaging Society, India

Quality Assurance in Breast Imaging is one of the cornerstones for providing high-quality breast care. It is central to achieving and maintaining high standards of breast radiology services. Uniform guidelines for the entire nation ensures that high standards can be achieved irrespective of geographical location of the imaging center and financial capability of the patient. No consensus document or guidelines focuses on Indian patients and its healthcare infrastructures. In this document, a task group formed by the Breast Imaging Society, India (BISI), sought to formulate quality assurance standards for all breast imaging modalities available in India. A breast imaging framework, practicable for all breast radiologists and institutions, has been provided to establish the minimum quality standards required for breast imaging services. The guidelines encompass all aspects of breast imaging, including mammography, breast ultrasound, breast magnetic resonance imaging, and breast interventions. The recommended reporting format for various modalities is also included. The guidelines also provide the minimum training requirement for all members of the breast imaging service provision team, including radiographers and radiologists. The minimum standards for the equipment, as well as the unit, have also been addressed. The current quality assurance guideline aims to provide a holistic approach to standardize breast care imaging services in India.

The Breast-Imaging Operations, Practices and Systems Inventory: A framework to examine mammography facility effects on screening in rural communities.

Develop and test a measurement framework of mammogram facility resources, policies, and practices in Appalachia. Survey items describing 7 domains of imaging facility qualities were developed and tested in the Appalachian regions of Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. Medicare claims data (2016-2018) were obtained on catchment area mammogram services. Construct validity was examined from associations with facility affiliation, community characteristics, mammogram screening uptake, and market reach. Analyses were performed with t-tests and ANOVA. A total of 192 (of 377) sites completed the survey. Five factors were initially selected in exploratory factor analysis (FA) and refined in confirmatory FA: capacity, outreach & marketing, operational support, radiology review (NNFI = .94, GFI = 0.93), and diagnostic services (NNFI = 1.00, GFI = 0.99). Imaging capacity and diagnostic services were associated with screening uptake, with capacity strongly associated with catchment area demographic and economic characteristics. Imaging facilities in economically affluent versus poorer areas belong to larger health systems and have significantly more resources (P < .001). Facilities in economically distressed locations in Appalachia rely more heavily on outreach activities (P < .001). Higher facility capacity was significantly associated (P < .05) with larger catchment area size (median split: 48.5vs 51.6), mammogram market share (47.4vs 52.7), and screening uptake (47.6vs 52.4). A set of 18 items assessing breast imaging services and facility characteristics was obtained, representing policies and practices related to a facility's catchment area size, market share, and mammogram screening uptake.

Improving Time to Diagnostic Resolution in the Breast Imaging Service: A Tertiary Center's Experience and Process of Improvement.

Breast imaging services often experience a significant degree of variability in patient flow, leading to delay in time to diagnostic resolution, commonly referred to as time to resolution (TTR). This study applies Lean Six Sigma Methodology (LSSM) to reduce TTR and enhance patient outcomes. This study was IRB-approved. A baseline audit was done using cases of mammographic recalls (BI-RADS 0) to measure baseline TTR. Multidisciplinary meetings with all members of the breast imaging service, alongside a study of patient complaint data, were utilized to identify issues that were causing prolonged TTR. Following that, possible solutions were proposed and implemented. A post-implementation audit was conducted, and the resulting TTRs were compared. Significant differences in TTR between the pre- and post-solution implementation were assessed using the Mann-Whitney U test. During the baseline audit of 8 months, 589 cases of mammographic recalls (BI-RADS 0) were identified, and the resulting average TTR was 86.3 days. During the post-implementation period of 3 months, 370 mammographic recalls (BI-RADS 0) occurred, with a resulting average TTR of 36.0 days. After applying LSSM, TTR was reduced by 58.3% (P < 0.01). Some changes implemented included training the coordinators, establishing a rapid diagnostic clinic using previously underutilized equipment, and having radiologists assigned full-time to the breast imaging service. Our team has successfully managed to identify various causes behind the prolonged TTR using LSSM. Team collaboration was essential to study and decide on a more achievable TTR.

European Society of Breast Imaging (EUSOBI) guidelines on the management of axillary lymphadenopathy after COVID-19 vaccination: 2023 revision

Axillary lymphadenopathy is a common side effect of COVID-19 vaccination, leading to increased imaging-detected asymptomatic and symptomatic unilateral axillary lymphadenopathy. This has threatened to negatively impact the workflow of breast imaging services, leading to the release of ten recommendations by the European Society of Breast Imaging (EUSOBI) in August 2021. Considering the rapidly changing scenario and data scarcity, these initial recommendations kept a highly conservative approach. As of 2023, according to newly acquired evidence, EUSOBI proposes the following updates, in order to reduce unnecessary examinations and avoid delaying necessary examinations. First, recommendation n. 3 has been revised to state that breast examinations should not be delayed or rescheduled because of COVID-19 vaccination, as evidence from the first pandemic waves highlights how delayed or missed screening tests have a negative effect on breast cancer morbidity and mortality, and that there is a near-zero risk of subsequent malignant findings in asymptomatic patients who have unilateral lymphadenopathy and no suspicious breast findings. Second, recommendation n. 7 has been revised to simplify follow-up strategies: in patients without breast cancer history and no imaging findings suspicious for cancer, symptomatic and asymptomatic imaging-detected unilateral lymphadenopathy on the same side of recent COVID-19 vaccination (within 12 weeks) should be classified as a benign finding (BI-RADS 2) and no further work-up should be pursued. All other recommendations issued by EUSOBI in 2021 remain valid.Graphical abstract

Surviving the COVID-19 pandemic: navigating the recovery of breast imaging services in a safety-net hospital.

The purpose of this study was to determine the impact of COVID-19 on county safety-net breast imaging services and describe the steps taken to actively manage and mitigate delays. This was an IRB exempt retrospective review of our county safety-net breast imaging practice analyzed for 4 distinct time periods: (1) "Shut-down period": March 17, 2020 to May 17, 2020; (2) "Phased re-opening": May 18, 2020 to June 30, 2020; (3) "Ramp-up": July 1, 2020 to September 30, 2020; and (4) "Current state": October 1, 2020 to September 30, 2021. These time periods were compared to identical time periods 1year prior. For "Current state," given that the 1-year prior comparison encompassed the first 3 periods of the pandemic, the identical time period 2 years prior was also compared. Our safety-net practice sustained significant volume losses during the first 3 time periods with a 99% reduction in screening mammography in the shut-down period. Cancers diagnosed decreased by 17% in 2020 (n = 229) compared to 2019 (n = 276). By implementing multiple initiatives that targeted improved access to care, including building community-hospital partnerships and engagement through outreach events and a community education roadshow, we were able to recover and significantly exceed our pandemic screening volumes by 48.1% (27,279 vs 18,419) from October 1, 2020 to September 30, 2021 compared to the identical time period 1 year prior, and exceed our pre-pandemic screening volume by 17.4% (27,279 vs 23,234) compared to the identical time period 2 years prior. Through specific community outreach programs and optimized navigation, our safety-net breast imaging practice was able to mitigate the impact of COVID-19 on our patient population by increasing patient engagement and breast imaging services.

Abstract P3-04-02: Population level access to diagnostic mammography and ultrasound guided breast biopsy in Nigeria: a geospatial analysis

Abstract Introduction: Breast cancer is the most common cause of cancer-related mortality among women in Nigeria. Physical proximity to a diagnostic center is an important component of access, which has direct implication on the cost and timeliness of diagnosis and treatment. Beyond diagnostic mammography, ultrasound (US)-guided biopsy is an essential tool in the diagnostic pathway for suspicious lesions of the breast and is recommended by the Whole Health Organization Breast Health Global Initiative for LMICs. Unfortunately, there is a dearth of data on the population level access to mammography and US-guided breast biopsy in Nigeria and little is known about the geospatial inequities in access that targeted programming or investment could potentially address. This study undertook a comprehensive evaluation of breast imaging and diagnostic services in Nigeria and using a previously validated geographic information system (GIS) model, evaluated geospatial access to diagnostic mammography and US-guided breast biopsy in Nigeria. Methods: A comprehensive list of public and private facilities offering diagnostic mammography and/or US-guided breast biopsy was compiled using publicly available facility data from the Nigerian Ministry of Health, a survey administered to members of the Breast Imaging Society of Nigeria (BISON) as well as key stakeholder interviews from each of the countries six geopolitical zones. A novel survey was delivered to BISON members to identify additional/new facilities not captured by the latest Nigerian Ministry of Health data. Facility location, administration (public vs. private) and duration of service delivery were elicited from respondents and paired with the Ministry of Health facility dataset. Data on provider training and volume were also captured in the survey. All facilities were geolocated using Google Earth™ (Google, Mountain View, CA). A previously described cost-distance model, that uses open-source population density data to 100m2 (GeoData Institute) and road network data (OpenStreetMap) was used to estimate population level travel time to the nearest diagnostic center. Any portion of a route that included travel over terrain without roads was assigned a walking speed of 5 kmh-1. Geospatial access was calculated for mammography and US-guided biopsy separately and as well as by geopolitical zone. This study was approved by the research ethics board at Obafemi Awolowo University. Results: In addition to publicly available data from the Ministry of Health, facility and practice data was obtained from 63 Nigerian Radiologists from across the country. In total, 124 centers were identified that offer diagnostic mammography, of which 78 (63%) are privately administered. Nine of the countries 36 states did not have a center offering this service. Across the country, 33 centers offer US-guided breast biopsy, of which the majority (72.7%) are public. At a population level, 83.1% of the population has access within 120 minutes of continuous one-way travel to a center with diagnostic mammogram or US. At 240 minutes of continuous one-way travel, which corresponds to a full day of travel round-trip, 80.8% of the population has access to US-guided breast biopsy. However, there are differences in access between geopolitical zones. Just 68.7% of the population in the North East geopolitical zone has access to US-guided biopsy within a day’s travel (i.e. 240 minutes one-way). The remaining five geopolitical zones have population level access to this service of ≥80%. Conclusions: This is the first comprehensive evaluation of breast cancer imaging and diagnostic services in Nigeria. Our results, demonstrate that the majority of the population in Nigeria has reasonable geospatial access to basic breast cancer imaging services. However, there are inequalities in access between states and geopolitical zones in the north and south of the country, which may have an impact on timely diagnosis and care. Citation Format: Adeleye Omisore, Elizabeth J. Sutton, Gavin Tansley, Rachael Adeyanju AKINOLA, Gregory Knapp. Population level access to diagnostic mammography and ultrasound guided breast biopsy in Nigeria: a geospatial analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-04-02.

Impact of Patient Navigation on Reducing Breast Imaging Disparities and Applications in the COVID-19 Era.

The coronavirus (COVID-19) pandemic has impacted breast cancer screening with concerns that this may lead to increased overall breast cancer mortality and worsened racial and ethnic disparities in breast cancer survival. As pandemic recovery efforts are underway, we must be prepared to address barriers to timely access of breast imaging services, including those that existed prior to the pandemic, as well as any new barriers that may arise as a result of the pandemic. Patient navigation is an important tool that has been shown to address barriers to timely breast imaging access and help reduce disparities. Patient navigation programs can serve as a key part of the strategy to mitigate the impact of the COVID-19 pandemic on timely breast cancer diagnosis. These programs have been shown to be successful in promoting adherence to breast cancer screening guidelines as well as encouraging timely diagnostic follow-up, particularly in underserved communities. Further research is needed to explore the role of using a telehealth platform for patient navigation and evaluate the cost-effectiveness of patient navigator programs as well as more randomized controlled trials to further explore the impact of patient navigation programs.

Time to biopsy of screening mammography-detected abnormalities: Evaluating the impact of same-day services implemented during the COVID-19 pandemic.

1511 Background: Screening mammography programs often require patients undergo multiple visits (screening exam, diagnostic exam, and biopsy) before tissue diagnoisis of screen-detected abnormalities. During the COVID-19 pandemic, same-day breast imaging services were leveraged to decrease the number of visits following abnormal screening exams. Specifically, in May 2020, we implemented an immediate-read screening mammography program to synergize with our pre-existing same-day breast biopsy program, such that every effort was made to perform diagnostic imaging during the same visit after an abnormal screening mammogram. This study aims to evaluate the impact of these same-day breast imaging services on time and number of patient visits to undergo breast biopsy after an abnormal screening mammogram. Methods: Consecutive screening mammograms performed during normal business hours pre- (6/1/16 to 5/30/17) and post-implementation (6/1/20 to 5/30/21) of same-day services were identified. Patient demographics, imaging and biopsy results, and visit dates were extracted from the medical record. Multivariable logistic, linear, and ordinal regression models estimated with generalized estimating equations were fit to assess the association of period (pre- versus post-implementation), patient age, and race and ethnicity (White versus races other than White) with having a same-day biopsy (biopsy on the same day as the abnormal screening exam), number of days to biopsy, and number of visits. Adjusted odds ratios (aOR) and beta estimates (aBeta) of each covariate and corresponding 95% confidence intervals (CI) were estimated. Results: A total of 409/25,922 (1.6%) of patients (median age 61, IQR 50-70) pre-implementation and 221/20,452 (1.1%) patients (median age 62, IQR 49-71) post-implementation had screen-detected abnormalities leading to diagnostic breast imaging and biopsy. Median number of days from screening to biopsy decreased from 16 days pre-implementation to 5 days post-implementation (p &lt; 0.001). Pre-implementation, 86.8% of patients required 3 visits between screening and biopsy, while post-implementation only 23.1% required 3 visits (p &lt; 0.001). Compared to pre-implementation, the post-implementation period was associated with increased odds of undergoing same-day biopsy (aOR 20.7, 95% CI 8.3-51.7), p &lt; 0.001), fewer days from abnormal screening mammogram to biopsy (aBeta -13.3, 95% CI -15.7 to -10.9, p &lt; 0.001), and fewer visits (aOR 0.05, 95% CI 0.02-0.09), p &lt; 0.001), controlling for age and race and ethnicity. Conclusions: Same-day breast imaging services decreased time and patient visits between abnormal screening mammogram and breast biopsy. Same-day services implemented out of necessity during the COVID-19 pandemic should be continued after the pandemic has subsided to improve timeliness of care.

Developing Breast Imaging Services in Low-Resource Settings

Developing Breast Imaging Services in Low-Resource Settings

Acceptance of artificial intelligence (AI)-based screening for breast health in urban slums of central Karnataka, India - SWOC analysis.

Artificial intelligence-based imaging is a low-cost, radiation-free solution for the breast imaging process that uses infrared radiation emitted by the body. This is a novel procedure that, when feasible, could be a better solution, particularly in underprivileged communities having low access to breast health care. To assess the acceptance and explore challenges for an artificial intelligence-based screening solution for breast health among the urban slum population. A mixed-method study was conducted in urban slums of central Karnataka, India. The study was carried out for a period of two years in 2019-21 among women in the reproductive age group in urban slums of central Karnataka to understand the acceptance of an artificial intelligence-based imaging solution for screening breast health. In-depth interviews were conducted to identify the strength, weaknesses, opportunities, and challenges (SWOC) screening for breast health. Quantitative data were analysed using Statistical Package for the Social Sciences (SPSS) v16.0, and for qualitative data, manual descriptive content analysis was carried out, and the sub-themes were generated. A total of 768 women accessed the thermalytix ® breast imaging services, the majority of them in the age group 31-40 years (35%), belonging to the Muslim religion (68.5%) with a mean monthly family income of Rs. 11,950.67/- SWOC analysis identified reduced cost for the screening services and involvement of female self-help groups (SHGs) as strengths. Weaknesses included poor breast health awareness among women and the stigma associated with breast cancer. Artificial intelligence-based screening is a feasible solution for breast health in low-income, low health access areas like urban slums. Engagement of the local community and active involvement of the health system is of paramount importance for the sustainability of any novel strategy.

Pandemic Response to COVID-19: Lessons from Restructuring Breast Imaging at a Multi-site Academic Center in New York City.

Purpose of ReviewThe COVID-19 pandemic has been an unprecedented challenge for healthcare delivery, disrupting normal workflows and demanding re-allocation of resources. In the setting of breast imaging, this entailed an initial marked reduction of services during the acute phase of the pandemic followed by a gradual reopening with modified protocols to minimize potential virus exposure.Recent FindingsProtocols were devised for providing limited breast imaging services during the acute phase of the pandemic and for safely reopening during the post acute phase. Example cases of breast cancers diagnosed during the acute phase of the pandemic are provided to illustrate the modified workflow.SummaryThis manuscript reviews practical strategies for restructuring breast imaging workflow, onsite policies, and staffing at a multi-site academic center in New York City during the COVID-19 pandemic. By sharing our experience, we hope to provide others with a roadmap for managing breast imaging services during future unforseen crises.

Out-of-Pocket Costs of Diagnostic Breast Imaging Services After Screening Mammography Among Commercially Insured Women From 2010 to 2017

This cross-sectional study evaluates the out-of-pocket costs of diagnostic breast imaging services incurred by commercially insured women who underwent additional imaging evaluation and procedures after screening mammography.

Prioritizing breast imaging services during the COVID pandemic: A survey of breast imaging facilities within the Breast Cancer Surveillance Consortium

The COVID-19 pandemic disrupted breast cancer screening and diagnostic imaging in the United States. We sought to evaluate how medical facilities prioritized breast imaging services during periods of reduced capacity or upon re-opening after closures. In fall 2020, we surveyed 77 breast imaging facilities within the Breast Cancer Surveillance Consortium in the United States. The survey ascertained the pandemic's impact on clinical practices during March–September 2020. Nearly all facilities (97%) reported closing or operating at reduced capacity at some point during this period. All facilities were open by August 2020, though 14% were still operating at reduced capacity in September 2020. During periods of re-opening or reduced capacity, 93% of facilities reported prioritizing diagnostic breast imaging over breast cancer screening. For diagnostic imaging, facilities prioritized based on rescheduling canceled appointments (89%), specific indication for diagnostic imaging (89%), patient demand (84%), individual characteristics and risk factors (77%), and time since last imaging examination (72%). For screening mammography, facilities prioritized based on rescheduled cancelations (96%), patient demand (83%), individual characteristics and risk factors (73%), and time since last mammogram (71%). For biopsy services, more than 90% of facilities reported prioritization based on rescheduling of canceled exams, patient demand, patient characteristics and risk factors and level of suspicion on imaging. The observed patterns from this large and geographically diverse sample of facilities in the United States indicate that multiple factors were commonly used to prioritize breast imaging services during periods of reduced capacity.

Diagnostic interval for non-screening patients undergoing mammography during the COVID-19 pandemic.

ObjectiveDuring the COVID-19 pandemic, there was a temporary cessation of mammography screening. However, in some facilities, diagnostic breast imaging services continued for patients with a high clinical suspicion of breast cancer. The objective of this study was to evaluate changes in the diagnostic interval (DI) of non-screening patients presenting for diagnostic mammography during the first wave of the COVID-19 pandemic.MethodsRetrospective chart review was performed on patients presenting for non-screening diagnostic mammography from April 1 to June 30, 2020 (pandemic group) and April 1 to June 30, 2019 (pre-pandemic group). Age, reason for referral, number and type of imaging studies/biopsies necessary for a final diagnosis were recorded. Diagnostic interval (DI) was defined as the number of days from the date of the diagnostic mammogram to the date of the final diagnosis.ResultsCompared to the pre-pandemic group (n = 64), the pandemic group (n = 77) showed a reduction in DI of the entire cohort (pandemic: 1 day; pre-pandemic: 15 days, p < 0.0001) for patients not requiring tissue sampling (pandemic: 1 day; pre-pandemic: 11 days, .p < 0.0001) and those requiring tissue sampling with benign pathology (pandemic 9 days; pre-pandemic, 33 days, p = 0.0002). A higher percentage of patients in the pandemic group had their assessment completed during the initial visit (pandemic: 50.6%; pre-pandemic: 23.4%, p = 0.0009).ConclusionDuring the first wave of the COVID-19 pandemic, the DI for patients with non-screening-related diagnostic mammography was significantly shorter, with a higher percentage of patients completing their assessments on the initial visit, compared to one year prior.Key Points • Despite reductions in manpower and clinical services, during pandemic times, it is possible to maintain a diagnostic breast imaging service for women at high clinical suspicion for breast cancer. • During pandemic times, breast imaging departments should consider restructuring to a Rapid Diagnostic Unit model with a navigation team that follows patients through the assessment process to a final diagnosis.• Departmental restructuring and patient navigation during pandemic times could either maintain or shorten the diagnostic interval for patients presenting for diagnostic mammography.

Impact and challenges of consultancy role regarding the delivery of breast imaging services in the United Kingdom: consultant breast radiographers' perspective

Background: Breast cancer is the leading cause of death in women worldwide. Imaging and radiographers play an important role in the diagnosis and treatment of breast cancer. With the increase in demand and a shortage of radiologists in the UK, consultant breast radiographers were introduced to perform some roles previously performed by radiologists. However, there is a scarcity of researchto assist other countries, such as Zambia, who are planning to extend the role of radiographers.Objective: To explore the impact and challenges of the radiography consultancy role regarding the delivery of breast imaging services in the United Kingdom.Methods: The study was guided by a qualitative research design. The sample was purposively selected, and semi-structured interviews was used to collect data from consultant breast radiographers in the UK. Data saturation was reached after interviewing eight participants. Interviews were audio-recorded, transcribed and data analysed thematically.Results:Two themes were identified: the impact and challenges of the radiography consultancy role regarding the delivery of imaging breast services. The creation of consultant posts impacted positively on the service delivery: reduction in patient waiting times, career progression and job satisfaction, and reduction in the workload of radiologists. Participants also faced challenges: increased workload and time pressure, isolation and poor support from colleagues, and animosity from a few radiologists.Conclusion: It is evident that consultant breast radiographers have contributed greatly to improved healthcare delivery. However, consultant breast radiographers encounter challenges in their role as consultants. Radiographers undertaking new roles should be supported to improve the delivery of imaging services.