Company News Room

Streamlined Radiology Scheduling for Providers

We're listening to our providers! Providence Imaging Center (PIC) recently completed a four month project with OE (Operational Excellence) in response to concerns from our referring providers, our patients and PIC staff. Concerns centered around several issues, one of them being wait times for our incoming calls. As part of the project we looked at our staffing levels, staffing experience and aspects of the phone system itself such as the length of our welcoming message and how long it took to get to a message option. We also changed the start time for the PET-CT scheduler to 8:00 a.m. to better accommodate those referring offices.

We have also restructured the coverage for each type of modality we offer, to ensure there will be a greater number of staff available to take your calls. Staff have been busy training and refreshing their knowledge to better serve our customers and it looks like it's working! Since the start of this project we have significantly reduced the wait time in all queues, bringing the average wait time of 1 minute down to less than 30 seconds. This exceeded our improvement goals and translates into faster and more reliable service for everyone.

Our scheduling phone numbers remain the same. For scheduling exams at either our Anchorage or Eagle River location, please call (907) 212-3151. For CT, MRI and PET-CT scheduling, call (907) 212-3146. Thank you for your valuable input; we always appreciate feedback from our patients and referring providers as we work to improve the services we offer at PIC.

Verna Haynes, PIC Scheduling Supervisor
Verna.Haynes@providence.org
(907) 212-7907

What is Operational Excellence?

"Operational Excellence is a philosophy of leadership, teamwork and problem solving resulting in continuous improvement throughout (an) organization by focusing on the needs of the customer, empowering employees, and optimizing existing activities in the process."1
The Operational Excellence (OE) department at Providence provides project management and supports the change process as improvements are made. OE project managers and change facilitators use a wide array of tools in their work, including many from GE Healthcare Solutions.
The project work relies on hours of independent observation and data collection to produce metrics which help identify points where maximum process improvement impact can be made. Approaches vary according to the task, and a project may include many phases.
OE work is assigned in response to customer requests to improve service or quality of care. For example, requests from physicians led to projects around glycemia management, and to the PIC call scheduling project described in this newsletter.
The OE department also provides training in the tools and approaches it uses, including Change Acceleration Process, Work-Out^TM, Lean and Six Sigma. CME and AaNA credit is available.
For project support or more information about OE work or training, please contact Theresa Carté, PhD (212-2716) or Jim Nesbitt, MD (212-5098).

1 http://en.wikipedia.org/wiki/Operational_excellence

Do You Have the Latest PIC Order Form?PIC's order forms, which were updated in February, are two color--black text with key points in red. You'll recognize them with the two x-ray people in the upper left corner. The updated two-part form includes the latest exam offerings at PIC in Anchorage and Eagle River. The form now sports convenient maps to both locations on the back of the patient prep sheet. There is extra space in the clinical indication section, and one fax number for all orders. Our goal is to make the form informative, yet simple to use. If you don't have the current order form, please contact Nathan Switzer at 907-212-6032, toll free 1-888-458-3151 ext. 6032, or Nathan.Switzer@providence.org  You can download and print a clean copy at provimaging.com/forms as well.

One Life Saved is Worth Regular Breast Exams

The United States Preventive Services Task Force issued a chilling announcement on November 16. Newly proposed recommendations from this group-a government funded committee with no medical imaging representation-advises against regular screening mammography for women between the ages of 40 and 49, replaces annual mammography with a mammogram every other year for women 50 to 74, and stops all breast cancer screening for women over the age of 74. Further, the recommendations do not support teaching breast self examination. These recommendations for change in the guidelines for screening mammography, clinical breast examination and breast self examination are in conflict with the facts. Careful review of the considerable literature from numerous clinical trials in the United States and elsewhere confirms that screening mammography reduces breast cancer as well as the morbidity associated with a breast cancer diagnosis. With screening mammography, the death rate from breast cancer has decreased by more than 30 percent since 1990. (Th e most recent of the clinical trials show a reduction in the death rate of greater than 40 percent, and specifi cally confi rms this benefit for women aged 40-49.) The reduction in the death rate is apparent in all women screened, including women in their 40s as well as older women. In addition to the dramatic decline in the death rate from breast cancer, less aggressive treatment may be needed for those women with an early diagnosis of breast cancer. The recommendations from the task force, if followed, could reverse this hard-won reduction in breast cancer morbidity and mortality, placing large numbers of women at risk for early death from breast cancer.

The task force acknowledges that mammography beginning at age 40 saves lives, just not enough of them. Screening 1,339 women between the ages of 50-59 with mammography saves one life, and the task force fi nds that reasonable. For women ages 40-49, 1904 screening mammograms are needed for each life saved, and the Task Force states that is not worthwhile. The incidence of breast cancer for women between the ages of 40 and 49 is one in sixty-nine. The task force focused on the potential "harms" of mammography (including discomfort of the exam, anxiety over positive results and possible overtreatment), stating that these outweigh the greatly decreased number of deaths each year resulting from breast cancer screening. While mammography is not a perfect tool, there are continuing improvements in the technology that add to the accuracy of the test. The benefit of screening mammography far outweighs the limitations.

The American Cancer Society, The American Society of Breast Disease, The Susan Komen Foundation, The American College of Obstetricians and Gynecologists, The Society of Breast Imaging, The American College of Radiology and the National Cancer Institute, among others, disagree with The U.S. Preventive Services Task Force recommendations. Each of these groups has issued formal statements urging women to continue with the current guidelines.

Alaskans are diagnosed with breast cancer every day, many following a routine screening mammogram. Do yourself a favor and continue to follow the current guidelines:

• Annual clinical breast examination from your health care provider
• Annual screening mammogram, beginning at age 40
• Breast self-examination has the potential to detect palpable breast cancer and should be considered.

Denise Farleigh, MD
Medical Director and Director of Breast Imaging at PIC

Getting Results - How the File Room Can Help You

The File Room staff at Providence Imaging Center (PIC) is able to meet the needs of our customers in today's digital world. All images created at PIC are securely stored electronically, and are able to be manipulated on a computer screen. Authorized healthcare providers can view these images via special secure internet access. (For more information on how to do this, contact Nathan Switzer, Marketing Representative, at 907-212-6032.) If filmed images are needed, these can still be printed, and delivered in the Anchorage area via courier.

The File Room is the place to go when patients want to access their imaging records. If patients wish to see their images, these can be burned onto a convenient imaging CD within minutes of the completed exam, at no charge for the first copy. The CD images can later be viewed in the privacy of the patient's home on any PC, and even exported in a photo file format (JPEG). If the patient wishes to share these images with another healthcare facility or provider, a CD can be easily mailed. Currently, about 600 CD's per month are used at PIC to provide information to patients and health care providers around Alaska and throughout the United States.

One important note about CDs: The radiology report will be included on the CD if the CD is burned aft er the report has been transcribed. In general, it will be on any CD that is burned 24 hours after the exam has been read by a radiologist.

You can contact the knowledgeable File Room staff to assist you with your imaging needs by phone or email. Call us at (907) 212-3144, or toll free at (888) 458-3151. Visit us at www.provimaging.com and click on "Contact". Then click "Medical Records" on the left side of the screen.

To email us your request, simply use picfieroom@provak.org

PET-CT Bone Scans Offer Detail Not Seen with Other Tests

Currently, Providence Imaging Center (PIC) has the only PET-CT scanner in the state. We are able to obtain both CT and PET images of the patient at the same time, in the same position. As a result, both anatomical and functional images are created and compared. In addition to the oncology studies, we are now also offering both both limited and whole-body bone scans. The PET-CT fused bone scan is used to image the structure of the bone and any abnormalities that might be present. These specialized bone scans are useful in evaluating several different conditions. These include post-operative fusions, infection or loosening of prosthetic joints, localization of bone pain, and the diagnosis or staging of metastatic bone disease. Due to the comparison of the CT images obtained simultaneously, PET-CT bone imaging is believed to be more specific than traditional nuclear medicine bone scans.

Our radioactive isotope, 18F-Fluorine, is made in Seattle by a cyclotron and flown to Anchorage each day. No preparation is needed for these scans, although appointments might still last up to two hours depending on the amount of imaging requested.

For more information, or to schedule a PET-CT bone scan at PIC, call us at (907) 212-2879.

Fiesta, Anyone? Fight Breast Cancer with a Mammogram Party!

Providence Imaging Center (PIC) now offers women a new way to take care of their recommended annual mammogram: They can invite their friends to get together and party while having a quick screening mammogram.

Do you know any women who are due for their annual or fi rst (baseline) mammogram, but are too anxious to actually schedule it? Why not set up a mammogram party? Surrounded by friends in their support network, who are also due for their annual screening, makes it a fun event in a relaxed atmosphere. PIC is now accepting reservations for private mammogram screening parties.

Each party includes:

• 5-10 consecutive, private mammogram screening appointments
• Exclusive use of our warm, festive women's lounge
• Appetizers catered by Peppercinis
• An assortment of nonalcoholic beverages including sparkling cider, coffee, tea and water

Take care of your health, and enjoy your friends' company by arranging for a fun evening in a casual setting. To find out more, or to schedule your own mammogram party, email mammoparty@provimaging.com or call Yolonda at (907) 212-4984. For answers to some frequently asked questions, visit our web site at provimaging.com/mammogram-party

Making It Personal: Meet the People of Providence Imaging Center

Katherine "Kat" Bruce is the newest addition to the File Room (see a story about

 our File Room in this issue) and began at PIC in January. Kat moved to Alaska two years ago from Chicago, Illinois, driving directly to Anchorage - "the perfect location to balance the conveniences of city life and our love of the great outdoors." Prior to working with Providence, she was employed with the State Medical Examiner's Office as an autopsy technician and death scene respondent.

"Before settling in Alaska, we moved according to my husband's Air Force assignments. Those 5 years were mostly spent in Colorado; however, we also lived in Mississippi for a brief time," Kat shares. "I very much enjoy snowboarding and martial arts; and ... I look forward to learning gardening!"

How does she like her new position? According to Kat, "There is always encouragement to learn more in my position... this gives me a lot of confidence in my ability to help. People can count on me because of the training I receive. I can honestly say I am proud to be part of such a successful and devoted team. I look forward to many years of employment with Providence."

Imaging Options Now Available In Eagle River

Providence Imaging Center (PIC) is pleased to announce the opening of its first satellite clinic, in order to provide imaging services to residents in the growing Eagle River community. PIC opened its doors in September 2008, on the first floor of the new Providence Building located across from SBS and Fred Meyer, at 17101 Snowmobile Lane. Advantages of this new location are ample parking, as well as access to laboratory services in a shared lobby. Open Monday-Friday, 8:30 a.m.-5 p.m. (closed for lunch from 12 p.m-1 p.m.), services include:

• Digital x-ray (no appointment needed)
• CT or "Cat" Scan
• Ultrasound
• Twice monthly mobile digital mammography in the coach, for screening patients

To schedule an appointment at this location, simply fax an order to (907) 212-5828. Call us during scheduling hours (M-F, 7 a.m.-6 p.m.) at (907) 212-3151. To reach the front desk directly, dial (907) 726-6610. Handy Eagle River maps are available on our updated direction cards.

Convenient Saturday Hours for Patients

Who is able to easily escape from the business of their daily lives to get a necessary imaging test? Not many! We are proud to offer Saturday hours at our Anchorage location, Providence Alaska Medical Center (PAMC). Imaging exams offered on Saturday include:

• Digital screening mammograms
• Digital x-ray (no appointment needed)
• Bone density (DXA) exams
• MRI (routine studies)

Many of these exams are also available with evening appointments. Saturday hours are 8 a.m.-2 p.m. For scheduled tests, please remember to call Mon.-Fri., 7 a.m.-6 p.m.

1.5 vs. 3.0 Tesla MRI: Which Field Strength is Best for my Patient?

When more and more facilities lay claim to having the "most advanced MRI technology available anywhere", how do you know whom to believe? Is it all about magnet muscle, or is there something else to consider when choosing where to send a patient? We believe there is. In June 2008, PIC decided to replace one of our two 1.5 T scanners (T stands for "Tesla", a measure of magnetic strength) with a 3.0 T magnet. The 3.0 T brings with it the newest GE technology, including the ability to perform studies simply not possible on the 1.5 T, including some of the following not currently offered anywhere else in Anchorage:
MR Spectroscopy
Diffusion Tensor Imaging
Fiber tracking
Cartilage mapping
Some functional applications in brain imaging

This pairing of 1.5 and 3.0 T magnets means that for the first time in Alaska, one Imaging Center has two different high-field MR scanners in one location, each with their own strengths. Your patients are now directed to the machine that will best visualize the area in question.

So does every patient need a 3 Tesla MRI? Isn't a magnet twice as strong always twice as good at everything? The short answer is no. There are several factors to consider, including diagnosis, area to be scanned and the patient's body type.

For example, a 3.0 T is preferred for most neurological studies, e.g. brain, cranial nerves, etc. A 3 Tesla scan is preferred for orthopedic imaging such as wrists and knees, among other areas. Finally, 3.0 T is recommended for all vascular  applications (MR Angiography).

A well-equipped 1.5 T magnet is preferred for applications such as body imaging because signal loss artifact (image distortion) can occur on large body parts on a 3.0 T. Examples include MRI of the breast and liver. Pelvis and renal MRI are all done on our 1.5 for this reason. Additionally, various body types can be better imaged on our lower field strength magnet.

As a result, PIC is able to better serve/image various patients, body parts and pathology by customizing the study using both magnet strength and protocols (each protocol is like a "recipe" of which scan techniques to use, depending on the patient and the diagnosis). When a patient walks through the door, we've got the options to send them to the appropriate high-field scanner, with the latest technology and comprehensive certifications you expect.

New Services and Equipment Announced

PIC is pleased to announce two new imaging technologies, along with some new services, that include:

• 64 slice CT ("Cat Scan")
• 3.0 T high-field MRI
• Cardiac CT scan for coronary calcium
• Vascular Ultrasound Screening
• Bone Density reporting that now includes FRAX results, the patient's risk of fracture

Why the New Equipment?

PIC replaced one of its 1.5 Tesla high field MRI scanners last summer with a 3.0 Tesla MRI, twice as strong as typical high-field magnets. The 3.0 Tesla scanner complements our 1.5 Tesla offering by allowing us to better image patients who need neurological and angiography workup, and is the most advanced magnet currently available for outpatients in Alaska (see story above). The new 64 slice CT scanner replaced a 16 slice scanner used for many years, and brings with it the ability to quickly scan patients with a minimal radiation dose. The increased resolution gives our radiologists superior 3D reconstruction images.

New Services

In Anchorage, two new retail services are available to help screen patients for cardiovascular disease. Cardiac CT scan for coronary calcium is a non-invasive way of obtaining information about the presence, location and extent of calcified plaque in the coronary arteries-the vessels that supply oxygen-containing blood to the heart wall. Calcified plaque is a buildup of fat and other substances,  ncluding calcium, and is a sign of atherosclerosis, a disease of the vessel wall, which iscalled coronary artery disease. Vascular Ultrasound Screening is a panel of three tests that looks for vascular disease outside the heart, and includes screening for:

• Carotid Artery Disease
• Aortic Aneurysm
• Peripheral Artery Disease in the legs

For more information about any of these services, please contact Nathan Switzer at (907) 212-6032, or via email at Nathan.Switzer@providence.org

Accreditation and Radiology: Passionate About Getting it Right

What do you expect when you send patients to an imaging facility? Timely reports? Accurate reads? Friendly schedulers? Respectful treatment of your patients? Shouldn't you also expect that staff are specialists in their field, and that equipment is working accurately?

We want our referring offices and patients alike to know our staff are certified in their specialty, and that our imaging equipment meets an independent, high standard for quality. We are excited to partner with the American College of Radiology (ACR), an independent organization that evaluates qualifications of personnel, equipment performance, effectiveness of quality control measures, and quality of clinical images. It is believed that these are the primary factors that impact the quality of clinical images and the quality of patient care. Currently, PIC is fully accredited in mammography; breast ultrasound; ultrasound-guided breast biopsy; and stereotactic-guided breast biopsy. These four offerings make us the only Breast Imaging Center of Excellence in Alaska. Additionally, we are accredited in MRI, including five subspecialities. Our goal is to add CT and PET-CT by the end of the year.

What about staff? Our radiologists are board certified, and each technologist is required to be certified in their specialty - something we take very seriously. Staff are given time and support to maintain their continuing education credits. "PIC was the first imaging center in the nation to be certified in stereotactic breast biopsy. We pursue these designations because participation in these programs ensures a high skill level for our technologists and radiologists. This in turn encourages us to stay abreast of the latest education available so that we can provide the best quality care to the patients we serve," shares Dr. Denise Farleigh, PIC's Medical Director. Visit www.acr.org/ and click on "Accreditation" for more information about the Breast Imaging Centers of Excellence and other ACR accreditation programs.

Stop by the Providence Imaging Center booth this Sunday, February 28 to learn about mammogram parties and our Mobile Coach at the Cancer Center Open House that takes place from 1-5 p.m.  Enjoy the fun events and mini talks that are detailed in this PDF flyer.  We hope to see you there!

A radiologist examines breast X-rays after a cancer prevention medical check-up at the Ambroise Pare hospital in Marseille, southern France, on April 3, 2008.

Credit: Reuters/Jean-Paul Pelissier

CHICAGO (Reuters) - Newer digital mammograms may deliver significantly lower radiation doses than conventional film mammograms, especially for women with larger and denser breasts, U.S. researchers said on Thursday.

Health

A study of nearly 50,000 women that compared digital mammography systems to film mammograms found the radiation dose was about 22 percent lower on average with the newer digital mammography exams.

"The ability to reduce the radiation dose for many women is another step forward for breast cancer screening with mammography - which saves thousands of lives each year," Edward Hendrick of the University of Colorado-Denver and a consultant to General Electric's GE Medical Systems, said in a statement.

The results were part of the Digital Mammography Imaging Screening Trial of 49,528 women, which in 2005 found that digital mammograms detected up to 28 percent more cancers than film mammograms in women under 50 who have not gone through menopause and in women with dense breast tissue.

Dr. Carol Lee, chairwoman of the American College of Radiology Breast Imaging Commission, said the previous study showed that the performance of digital was equivalent or slightly better in certain groups.

What is new, she said, is "that can be achieved with overall a lower radiation dose."

Both film and digital mammograms make X-ray images of the breast, but digital mammograms are collected and stored on a computer, making them easier to access than conventional film mammograms.

Lee said generally, the radiation dose from film or digital breast mammograms is not large enough to be worrisome, and women should not skip getting a recommended mammogram if digital mammography is not available in their area.

But in general, she said, lowering the radiation dose is preferable. "We certainly want to keep radiation dose as low as possible and still achieve the desired goal of a good image," Lee said in a telephone interview.

In the study, researchers used digital mammography equipment made by Fischer Imaging Corp, Fujifilm Medical Systems, GE Healthcare and Hologic Inc.

Lee, who was not involved in the research, said only the systems made by GE and Hologic are still available, and said companies have made significant advances in the technology since the data in the study were collected, suggesting the newer machines may deliver an even lower radiation dose.

"Unfortunately, studies and information lag behind the actual practice," Lee said.

Besides lower radiation exposure and better performance for certain women, Lee said digital mammography offers the same kinds of advantages that digital photographs have over pictures taken with older film technology.

"You can zoom in. You can change the contrast level and things like that. When you took a picture with your old film camera, what you took is what you got," she said.

The study was funded in part by the National Cancer Institute and published in the American Journal of Roentgenology.

On November 16, new recommendations were published by the United States Preventive Task Force regarding screening mammography.  We believe that the "new" look at the data draws some mistaken conclusions.  Dr. Denise Farleigh, our medical director, recently went on record to explain how she feels about this recent development, which has caused a firestorm of national reaction.

Here is a TV interview with KTUU's Lori Tipton that took place November 24th, and includes the testimonial of a local breast cancer survivor Sheila Reilly, whose cancer was found with a routine screening mammogram she had in her early 40s.

http://www.ktuu.com/Global/story.asp?S=11570474 

Here is an editorial piece from the Anchorage Daily News Compass:  Other points of view that was published on November 26.

One life saved is worth regular breast exams

By DENISE FARLEIGH

Published: November 25th, 2009 09:51 PM
Last Modified: November 25th, 2009 09:51 PM

The United States Preventive Services Task Force issued a chilling announcement on November 16. Newly proposed recommendations from this group -- a government-funded committee with no medical imaging representation -- advises against regular screening mammography for women between the ages of 40 and 49, replaces annual mammography with a mammogram every other year for women 50 to 74, and stops all breast cancer screening for women over the age of 74. Further, the recommendations do not support teaching breast self-examination.

These recommendations for change in the guidelines for screening mammography, clinical breast examination and breast self-examination are in conflict with the facts. Careful review of the considerable literature from numerous clinical trials in the United States and elsewhere confirms that screening mammography reduces mortality from breast cancer as well as the morbidity associated with a breast cancer diagnosis. With screening mammography, the death rate from breast cancer has decreased by more than 30 percent since 1990. (The most recent of the clinical trials show a reduction in the death rate of greater than 40 percent, and specifically confirms this benefit for women aged 40-49.) The reduction in the death rate is apparent in all women screened, including women in their 40s as well as older women.

In addition to the dramatic decline in the death rate from breast cancer, less aggressive treatment may be needed for those women with an early diagnosis of breast cancer.

The recommendations from the task force, if followed, could reverse this hard-won reduction in breast cancer morbidity and mortality, placing large numbers of women at risk for early death from breast cancer.

The task force acknowledges that mammography beginning at age 40 saves lives, just not enough of them. Screening 1,339 women between the ages of 50-59 with mammography saves one life, and the task force finds that reasonable. For women ages 40-49, 1904 screening mammograms are needed for each life saved, and the Task Force states that is not worthwhile. The incidence of breast cancer for women between the ages of 40 and 49 is one in sixty-nine.

The task force focused on the potential "harms" of mammography (including discomfort of the exam, anxiety over positive results and possible over-treatment), stating that these outweigh the greatly decreased number of deaths each year resulting from breast cancer screening. While mammography is not a perfect tool, there are continuing improvements in the technology that add to the accuracy of the test. The benefit of screening mammography far outweighs the limitations.

The American Cancer Society, The American Society of Breast Disease, The Susan Komen Foundation, The American College of Obstetricians and Gynecologists, The Society of Breast Imaging, The American College of Radiology and the National Cancer Institute, among others, disagree with The U.S. Preventive Services Task Force recommendations. Each of these groups has issued formal statements urging women to continue with the current guidelines.

Alaskans are diagnosed with breast cancer every day, many following a routine screening mammogram. Do yourself a favor and continue to follow the current guidelines:

• Annual clinical breast examination from your health care provider
• Annual screening mammogram, beginning at age 40
• Breast self-examination has the potential to detect palpable breast cancer and should be considered.

Providence Imaging Center (PIC) is pleased to announce that our PET-CT Scanner is now fully accredited by the American College of Radiology (ACR).  It is the only unit in Alaska that is an integrated PET-CT, and that is accredited in both Brain and Oncology applications.  For an interesting article on how inline PET-CT is superior to software fusion, read this article published in the The Journal of Nuclear Medicine.

Click here for more general information on PET-CT at PIC.

Get the latest news about Providence Imaging Center by downloading the PDF file; you will need to download Adobe Reader in order to access this file.  You may also go to our News Page and click on our Summer/Fall 2009 Newsletter link in order to view a text version of the newsletter.

Stories you will find in this publication include:

• MRI Optimized 
• New Services
• Accreditation and Getting It Right
• Patients and Imaging Costs
• Quick Reference to Providence Imaging Center

Providence Imaging Center (PIC) is pleased to announce that new diagnostic imaging services are available in Eagle River! In addition to digital x-ray and regular visits by PIC's mobile digital mammography coach, CT exams with IV contrast and ultrasound are now offered to those who live in the Birchwood-Chugiak-Eagle River area.  

While ultrasound has been available for several weeks, the newest addition is CT or "Cat" scan with IV iodine contrast.  PIC has secured physician oversight that allows us to use the IV contrast required for many computed tomography exams; the intravenous injection of iodine helps the radiologist evaluate blood vessels and organs such as the liver, kidneys and pancreas.

If you have an order for either of these exams, and you would like to take advantage of this convenient location, please call PIC at 212-3151 to schedule an appointment.  Our expert and compassionate staff are happy to assist you, and answer any questions you may have regarding these new services.  Please remember that a signed clincian order is needed by PIC staff in order to schedule the appropriate test; your health care provider can fax it to PIC at (907) 212-5828.

Our goal is to provide services that help people stay closer to home.  Next time you need one of these imaging tests, please consider using PIC in Eagle River.  We are open Monday-Friday, 8:30 a.m. - 5 p.m., and closed from 12 - 1 p.m. for lunch.  We hope to see you here!