Providence Imaging Center (PIC) is in the process of acquiring former Alaska Open Imaging (AOI) locations in Soldotna and Fairbanks. Services previously available at Alaska Open Imaging locations remain available to patients and providers. All offices will be closed Sept. 1-6 to ensure a successful transition.

Alaska Open Imaging is an established imaging business with locations in Anchorage, Wasilla, Soldotna and Fairbanks. Alaska Open Imaging offers a full array of imaging services, including PET, PET/CT, CT, MRI, mammogram, X-ray, ultrasound and bone density scanning.

Alaska Open Imaging has earned a reputation as an imaging service leader in Alaska with a focus on high-quality care and customer service. AOI was first in Alaska to offer PET, mainly used for cancer staging and evaluation.

We anticipate that PIC will continue to provide the excellence in imaging you’ve grown to expect. Established in 1986, PIC is known for bringing new imaging technology to Alaska, including the first PET-CT capable of delivering both functional and anatomical information in one scan. Our focus has been to provide both cutting-edge technology and compassionate care to the communities we serve.

Currently, we have locations in Anchorage and Eagle River and have been privileged to serve patients from all over Alaska. PIC has also had the opportunity to provide breast cancer screening to Alaskans, including those on the Kenai Peninsula, with our mobile mammography van.

In Soldotna, we are officially open for business as of 9/6/11, offering x-ray, CT or CAT scan, and open MRI at 35670 Kenai Spur Highway, Suite 104. Hours are Monday through Friday, 8:30 a.m. - 5 p.m. To schedule an appointment or for further questions, please call 907-260-6501. In Fairbanks, to schedule an appointment or for further questions, please call 907-474-2002.

If you are a patient or provider seeking past medical records from Alaska Open Imaging, please contact them at 1-888-416-2980.

To providers in the Kenai Peninsula, and to former AOI patients, we say "welcome!" We look forward to serving you "close to home" with the medical imaging expertise you expect.

PIC is pleased to announce the recent purchase and installation of an upgrade to our PET-CT scanner. The upgrade enables us to use less dose for each patient and obtain more sensitive diagnostic images. The improvement has been in place since August 1, 2011.

Scanning PET patients requires the injection of a radioactive tracer isotope called FDG. It is created in Seattle specifically for PIC patients, based on the patients height, weight, and appointment time. According to Kate Hiemstra, PET-CT technologist, “[FDG] has a very short half life, degrading quickly. It takes quite a coordinated effort to ensure that commercial flights bring the dose in a timely manner. The radiopharmacist must then adjust the dose appropriately so the right amount is there for each patient.”

PIC anticipates the  upgrade will reduce appointment cancellations due to flight delays and the other dose limiting circumstances that affect scheduling. According to Laura McDonough, PIC’s executive director, “We’re excited for these changes as we continue to improve our imaging process to better help patients, while maintaining the same standard of excellence we’ve provided over the past five years.”

To learn more about these improvements, or to schedule an appointment, contact our PET-CT scheduler at (907) 212-3146. We are proud to be one of only two PET facilities in the state who are currently accredited by the American College of Radiology.

Providence Imaging Center is the only facility in Alaska independently accredited by the American College of Radiology (ACR) in breast magnetic resonance imaging (MRI).

Anchorage, Alaska - Providence Imaging Center in Anchorage has been awarded a three-year term of accreditation in breast magnetic resonance imaging (MRI) as the result of a recent review by the American College of Radiology (ACR). MRI of the breast offers valuable information about many breast conditions that may not be obtained by other imaging modalities, such as mammography or ultrasound.

Caption: The new Sentinelle breast coil system provides women more comfort during the scan. The MRI table and coil are actually one piece of equipment, allowing us to accomodate a wider range of patients.

The ACR gold seal of accreditation (seen above) represents the highest level of image quality and patient safety. It is awarded only to facilities meeting ACR Practice Guidelines and Technical Standards after a peer-review evaluation by board-certified physicians and medical physicists who are experts in the field. Image quality, personnel qualifications, adequacy of facility equipment, quality control procedures, and quality assurance programs are assessed. The findings are reported to the ACR Committee on Accreditation, which subsequently provides the practice with a comprehensive report they can use for continuous practice improvement.

The ACR is a national professional organization serving more than 34,000 diagnostic/interventional radiologists, radiation oncologists, nuclear medicine physicians, and medical physicists with programs focusing on the practice of medical imaging and radiation oncology and the delivery of comprehensive health care services.

Despite widely publicized claims to the contrary, thermography should not be used in place of mammography for breast cancer screening or diagnosis.

The Food and Drug Administration (FDA) says mammography— an X-ray of the breast—is still the most effective way of detecting breast cancer in its earliest, most treatable stages. Thermography produces an infrared image that shows the patterns of heat and blood flow on or near the surface of the body.

The agency has sent several warning letters to health care providers and a thermography manufacturer who claim that the thermal imaging can take the place of mammography.

Web sites have been touting thermography as a replacement for mammography and claim that thermography can find breast cancer years before it would be detected by mammography.

The problem is that FDA has no evidence to support these claims.

"Mammography is still the most effective screening method for detecting breast cancer in its early, most treatable stages" said Helen Barr, M.D., director of the Division of Mammography Quality and Radiation Programs in the FDA’s Center for Devices and Radiological Health. "Women should not rely solely on thermography for the screening or diagnosis of breast cancer." 

"While there is plenty of evidence that mammography is effective in breast cancer detection, there is simply no evidence that thermography can take its place," said Barr.

Thermography devices have been cleared by the FDA for use as an adjunct, or additional, tool for detecting breast cancer. Toni Stifano, a consumer safety officer in FDA’s Center for Devices and Radiological Health, explains that this means thermography should not be used by itself to screen for or to diagnose breast cancer.

The National Cancer Institute (NCI), part of the National Institutes of Health, estimates that about 1 in 8 women will be diagnosed with breast cancer sometime in her life.

The greatest danger, says Stifano, a breast cancer survivor herself, is that patients who substitute thermography for mammography may miss the chance to detect cancer at its earliest stage. There has been a steady decline in breast cancer deaths and one of the reasons is early detection through mammography, says FDA. 

As for concerns about exposure to radiation from a mammogram, evidence shows that the benefits outweigh the risks of harm, especially when compared to the danger of breast cancer.

FDA is advising patients to continue to have regular mammograms according to screening guidelines or as recommended by their health care professional.

Patients are also advised to follow their health care professional's recommendations for additional diagnostic procedures, such as other mammographic views, clinical breast exam, breast ultrasound, MRI or biopsy. Additional procedures could include thermography.

This year alone, the agency has sent warning letters to the following practitioners and manufacturer making misleading claims about thermography: 

• Warning Letter to Meditherm, Inc (April 4, 2011)⁴
• Warning Letter to Dr. Joseph Mercola, Dr. Mercola’s Natural Health Center (March 22, 2011)⁵
• Warning Letter to Central Coast Thermography (January 6, 2011)⁶

FDA’s position on thermography is shared by prominent organizations active in the fight against breast cancer, including the Susan G. Komen for the Cure, a nonprofit that has raised billions of dollars for education and research, and the American Cancer Society.

This article appears on FDA's Consumer Updates page⁷, which features the latest on all FDA-regulated products.

Posted June 2, 2011

View the PDF of this story here. Adobe Reader is required.

June 28, 2011

Commentary on the latest Swedish Two-County Trial Report by Daniel B. Kopans, MD Swedish Two-County Trial: Impact of Mammographic Screening on Breast Cancer Mortality during 3 Decades. Tabar L, Vitak B, Chen THH, et al. Radiology 2011; pre-release (ahead of print publication)

View the original commentary here on SBI's Web site

"Mammography screening is one of the major medical advances of the last 50 years. The death rate from breast cancer had been unchanged for at least 50 years. Mammography screening began at a national level in the U.S. in the mid-1980’s, and, as would be expected, the death rate began to decline in 1990. Since then the death rate has decreased by over 30%. Therapy has helped to reduce deaths, but therapy only saves lives when cancers are found early. Data from the Netherlands and Sweden have clearly shown that it is screening that accounts for most of the decrease in deaths. The major impact of screening has been lost by the numerous controversies that have swirled around mammography. For many years the debate centered on whether or not screening could save lives. Once this became apparent (although there continue to be those who doubt the clear scientific evidence), the debate has been over whether or not there is benefit from screening women ages 40-49. Following the first randomized, controlled trial of breast cancer screening performed within the Health Insurance Plan of New York (HIP) in the 1960’s, a large study was undertaken in Sweden that involved women in two counties and has been named the Two County Trial. Over 130,000 women were involved in the trial. A little more than half of the women were invited to be screened while the other half were not invited, but got the standard health care at the time. This trial was designed to see if high quality mammography screening alone, without clinical breast examination (CBE), could reduce deaths from breast cancer. The first publication from the Two County trial in the mid-1980’s clearly showed a decrease in deaths for screening from age 40-74, and this resulted in the start of screening in the U.S. and around the World.

This latest paper with 29 years of follow-up of the Two County Trial not only confirms the fact that screening with mammography, alone, can save thousands of lives, but it also shows that the benefit continued even after the screening ended. Fortunately, most breast cancers do not kill women quickly. The very fast growing cancers, unfortunately, are not often detected by screening periodically, and many of these are not detected early enough to save lives. However, there are many cancers that, if not found early enough will, ultimately kill women 5, 10, or more years after diagnosis. These are the cancers which, if found early, can prevent a woman from dying later in life. This recent study from the Two County Trial clearly shows that these are the lives that are being saved by screening. Even though many women die from their breast cancers years after their cancers are diagnosed, screening prevents many of these deaths and even 20 years after screening fewer women die in the screened group. The benefit of screening, in preventing these deaths is clear, and it is also clear that the benefit came from screening women beginning at the age of 40. Mammography screening is not perfect. It does not find all cancers and does not lead to a cure for all women, but screening beginning at the age of 40 saves thousands of lives.

The United States Preventive Services Task Force, unfortunately, caused a great deal of confusion by suggesting that women did not need to be screened until the age of 50. It is now clear that this would result in tens of thousands of deaths that could be prevented by annual screening beginning at the age of 40. This latest paper again confirms the value of screening beginning at the age of 40.

With regard to the “number needed to screen” to save a life (NNTS). This was raised by the US Preventive Services Task Force because they were prohibited, by their charter, from doing “cost/benefit” analysis. It was a way for them to suggest that screening younger women was not worth the cost. An individual woman gets screened only once a year so that the NNTS is fairly meaningless to her. Adding insult to injury, the USPSTF used the wrong data to determine NNTS. They used numbers for the randomized, controlled trials which were actually the number of women needed to be invited to be screened (many refused the invitation). This latest study provides the actual number of women needed to be screened and is far more accurate and smaller than that used by the USPSTF.

The USPSTF clearly based their guidelines on scientifically unsupportable analyses. They should, once more, support annual screening beginning at the age of 40."

Daniel B. Kopans, M.D. Professor of Radiology, Harvard Medical School
Senior Radiologist, Breast Imaging Division
Department of Radiology, Massachusetts General Hospital
Avon Comprehensive Breast Evaluation Center
ACC Suite 240
15 Parkman Street
Boston, MA 02114

June 29, 2011 - A landmark study published in the July 2011 issue of Radiology, one of the leading journals for medical imaging, should put an end to the controversies over the effectiveness of mammography screening. 

The study, known as the Two County Trial in Sweden, is a randomized, controlled trial (RCT), one of the most rigorous types of scientific studies available to evaluate the efficacy of medical tests.  The 29-year follow-up is the longest for any mammography RCT. More than 130,000 women from 40 to 74 years of age were included in the trial. Roughly half were screened over a seven year period.   

Essentially, the trial compared the death rate from breast cancer from two randomly assigned groups of women: women who were invited to be screened with mammography alone, compared with a control group of women who were not invited to be screened at all.  About 85% of the women invited were actually screened.  The death rate was 30 percent lower among the women invited to be screened.   

This latest paper not only confirms that screening with mammography alone can save thousands of lives, but furthermore, the mortality benefit continues over time.  More than half of the cancer deaths in this study occurred more than 10 years after screening began, demonstrating an enduring effect for almost three decades.  

The Two County Trial screened women in their forties about every 24 months, and women aged 50-74 about every 33 months.  The mammograms were obtained using only a single view of each breast.  If the American Cancer Society recommendations were to be followed (screening annually starting at age 40), with two views of each breast, the number of lives saved is likely to be higher than was seen in this trial.  For women who actually participate in screening, the benefit is likely to be even higher.  Mammography screening is not perfect.  It does not find all cancers and does not lead to a cure for all women, but screening beginning at the age of 40 saves thousands of lives each year.

In contrast, the US Preventive Services Task Force (USPSTF) issued guidelines in 2009 suggesting that women need not begin screening until the age of 50. They used an estimate of only a 15 percent decrease in breast cancer deaths in their calculations.  Had they used the estimate of 30 percent, they may have reached different conclusions and made different recommendations.  Furthermore, the estimate of the “number needed to screen” to save a life (NNS) from this latest study is far more accurate, and much lower, than that estimated by the USPSTF for women under the age of 60 years.   

The USPSTF should withdraw its 2009 guidelines and support annual screening, beginning at the age of 40, for all women.  Physicians who have been asked by the USPSTF to discuss screening with each of their younger patients would be wise to consider the results of this important screening trial.  

While treatment for breast cancer has improved over the years, early detection with mammography is crucial to better results. Mammography screening is clearly the main reason that deaths from breast cancer have decreased in the United States since 1990.  

*This is an article which can be found on the Los Angeles Times Web site

June 28, 2011

"What this tells us is that, in the long term, screening for breast cancer is a very good investment," said epidemiologist Robert A. Smith, director of cancer screening at the American Cancer Society and a coauthor of the paper appearing in the journal Radiology.

Critics had argued that overuse of the procedure produced too many false positives, requiring many women to undergo unnecessary invasive procedures — which have risks of their own — to rule out the presence of a tumor.

"There is little question that there is some overdiagnosis," Smith said, "but the number we have identified is really quite small. We estimated it is less than half the number of lives saved, so it is really pretty low."

The findings are "a really big deal," said Dr. Loretta Lawrence, chief of breast imaging at North Shore University Hospital in Manhasset, N.Y. "A 30% reduction in mortality translates to 15,000 to 20,000 lives saved by mammography screening each year."

The new study does not address the controversy surrounding the value of screening women in their 40s because the results did not stratify women by age. Nor does it address the controversial issue of how frequently a woman should have a mammogram: In the U.S., annual mammograms are generally recommended, and some scientists have argued that the period between screens should be lengthened. The women in the study were screened less frequently: every 24 months for women aged 40 to 49, and every 33 months for older women.

The findings are unlikely to change clinical practice in this country because professional groups already recommend routine screening. But because the screening seems so effective, they might reduce the pressure to extend the period between mammograms and to limit the tests for younger women.

But Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., who has argued frequently that women are being overscreened, said the study didn't take into account the tremendous advances in breast cancer therapy over the last two decades. As treatments have improved, the vast majority of patients have done well, regardless of how early their tumors were diagnosed.

"That is probably the explanation for why more recent trials of mammography have found less effect or no effect," he said.

The Swedish Two-County Trial, run by a team headed by cancer screening specialist Stephen W. Duffy of Queen Mary University of London, examined women with no history of breast cancer in two counties in Sweden. The women were divided into 48 geographic groups, which were then randomly assigned either to receive an invitation to enter a screening program or to receive normal care. About 77,080 women were in the invitation group and 55,985 in the normal care group. The screening phase of the study lasted about seven years.

The team concluded that regular screening reduced deaths from breast cancer by 31% during the 29 years of follow-up. Because only about 70% of the women invited to enter the screening program actually did so, said Dr. Lawrence Bassett, a professor of breast imaging at UCLA's Geffen School of Medicine, the reduction in mortality among those who were actually screened was 40%.

Duffy noted that most of the deaths prevented by screening would have occurred more than 10 years after the screening started. The long-term benefit of the screening is thus actually more than double the benefit reported in shorter studies, he said.

Moreover, the screening technique used in the Swedish study "is nothing near what it is now … and probably underestimates the benefit," Lawrence said. The physicians in Sweden used only one view per breast, while radiologists now use two views. And radiologists use digital imaging, which is much more sensitive than the film used in the Swedish study.

"The study probably underestimates what the benefit would be today because the technology is so much better now," Bassett added.

Much of the current controversy about mammography was triggered by a November 2009 report by the U.S. Preventive Services Task Force, which recommended that most women under 50 did not need routine screening. Although the chance that a woman in her 40s will be diagnosed with invasive breast cancer is small — about 1.44% — such tumors account for about 17% of breast cancer deaths, according to the American Cancer Society.

Most organizations that set guidelines for screening have chosen to ignore the task force's recommendations and continue to urge that women be screened beginning at age 40. The American Cancer Society, for example, recommends a mammogram every year starting at 40, the National Cancer Institute recommends the test every one to two years starting at 40, and the American College of Obstetricians and Gynecologists recommends a test every one to two years for women in their 40s and every year for those over 50.

Medicare and most insurance companies have continued to pay for the tests.

"Mammography has taken quite a hit in recent years" from short-term studies, said Dr. Stamatia Destounis, a radiologist at Elizabeth Wende Breast Care in Rochester, N.Y. She said radiologists know it is valuable, but family doctors, ob-gyns and others that might recommend mammography have been confused. "I'm hoping that this study will convince them about the long-term value of screening," she said.

Welch agreed that screening helped some women, "but it comes at a real human cost" of anxiety, false alarms and even unnecessary breast cancer treatments for others.

"There is no simple right answer for this stuff," he said. "Women who feel good about screening should continue to have it, and those who don't feel comfortable shouldn't be coerced into undergoing it."

Nobody's arguing that mammography doesn't save lives, said Dr. Susan Love, head of the Dr. Susan Love Research Foundation in Santa Monica. "Really, what has been the source of more controversy is: What is the right schedule? This doesn't really add to that discussion."

thomas.maugh@latimes.com

As many medical providers already know, Providence Alaska Medical Center is adopting a new electronic medical record (EMR) system on Feb. 26, 2011. This new system, called Epic, will replace a wide range of existing software systems and paper processes at Providence. It will create an environment that is focused on patients, with a “single point of truth” for their health information. 

As providers, you may currently be using ProvPort to access your patients’ records. ProvPort will no longer contain current information on Feb. 26, 2011, when Epic goes live. A new program called EpicCare Link will replace it, and allow for improved access to the records you need. In addition, it will allow you and your designated staff the ability to perform order entry, and includes real time results generated by your patients on your opening login screen.

In order to have seamless access to this critical information, please fill out the EpicCare Link application today. One form, the EpicCare Link User Agreement Form, needs to be filled out once for your entire practice/office. A second form, called the EpicCare Link User Authorization Form, needs to be filled out by each individual who needs access to these records (physicians, allied health professionals, nurses, medical assistants, clerical support staff, etc.).

Patients who use services at Providence (including Providence Imaging Center) will have new access to medical records as well. Medical providers can electronically release results to their patients via a portal called MyChart (a product that comes with the EPIC EMR). For example, if a patient comes to Providence Imaging Center for a foot x-ray (it must be a finalized results, signed by the radiologist), s/he can view the results on a web-enabled computer with a secure username/password. The results must first be reviewed by the ordering clinician, and then released to MyChart.

We are excited to begin using this new EMR, and our staff is currently training in a practice environment to become familiar with Epic's new look and feel. Please bear with us as we transition to the new system on February 28th. We may need a little extra time with you while scheduling your appointment on the phone, or while helping patients check-in for exams. We may also have a higher call volume from medical providers, who may need a little extra help navigating in EpicCare Link. Many of these providers who are credentialed at Providence Hospital are learning how to use the new system as well.

Are you a clinician with questions?  Learn more on Providence Hospital’s web site at providence.org/alaska/medstaff/epicupdate.htm Medical providers  may also download and print the EpicCare Link forms there.