By DENNIS GRUBAUGH
HIGHLAND — The latest in mammography technology has arrived at HSHS St. Joseph’s Hospital, promising new hope for detection of even the smallest of breast cancers.
The $350,000, Hologic brand 3-D equipment was installed the last week of January and officially debuted in early March.
The unit is located in the Basler Family Women and Children’s Center, where most of the radiology services of the hospital are based. Rooms within the center also allow for breast biopsy work and bone density scans.
The unit can alternate from 3-D to 2-D imaging. While the quality of the image is much more advanced with 3-D, some insurers have been slow to cover it.
The machinery took about a week to install, with the old unit coming out in two days and the rest of the time spent on setting the new equipment in place and making the necessary connections. Staff went through training, and the Food and Drug Administration had to approve use of the 3-D technology.
“The pictures we get are amazing,” said Lisa Kustermann, a special procedures tech, who is registered in mammography and several other technologies.
The new equipment has special comfort features for the patient, a breast cushion to make the plate softer and warmer and a screening paddle designed to comport with the contour of the body. Both compression and procedural time are reduced with the new unit.
The machine can also raise or lower with the height of a patient, going low enough that it can even screen a patient in a wheelchair.
Women love the equipment, Kustermann said.
“One of the first patients I did (in training) told me ‘It was less pinchy.’ And it’s quicker. A lot of women say it’s so fast. They walk in, they walk out,” Kustermann said. A routine procedure takes about five minutes.
The 3-D result is similar in nature to a standard mammogram, except that you can scroll through dozens of images, representative of “slices,” or layers, of the breast, taken at a variety of angles. The same basic X-ray technology is employed for both 2-D and 3-D.
“However many slices we get depends on how thick the breast is,” Kustermann said. The machine shoots pictures on a 15-degree arc, leaving 15 exposures that the machine then reconstructs into 1-millometer slices. “You can look at each piece of tissue.”
Amazingly, the smallest spec — or tumor — might be visible in a single slice but not in the next, she said.
Patients are being advised to check with their insurance companies regarding coverage.
“Some women will get just the 2-D mammogram, depending on whether their insurance is paying for it,” Kustermann said. “If the patient wants it and insurance isn’t covering it, the patient is welcome to pay for it themselves.”
Medicare, she said, is covering the procedure.
Kustermann is one of three in her crew. The others are Jill Helmkamp and Tiffani Dyer, both registered mammographers.
Patients do not need a doctor’s order to get a mammogram, and results are sent to their personal doctor. If a patient has had an abnormal mammogram in the past, insurance companies are tending to pay for those, depending on the type of breast tissue they have. If it’s more dense, it’s most likely covered by insurance since those individuals are considered more at risk, she said.
Family history, past biopsies and other factors weigh in the decision-making.
The American College of Radiology recommends women 40 and older have a mammogram annually.
HSHS St. Joseph’s decided to get the 3-D equipment as part of an effort to build its women’s and children’s services. A $500,000 capital campaign coordinated by Amy Liefer was used to buy both the 3-D equipment, and pay for facility preparations in coordination with the new HSHS Rescue Flight helicopter. Liefer is director of HSHS St. Joseph’s Foundation.
The foundation launched the campaign in late October and had raised the full amount by mid-December. The success of the campaign was due in large part to an estate gift that was left to the hospital by former patient Ruth E. Schroeder in memory of her and her husband, William. The Schroeder gift covered more than half the cost of the 3D mammography machine.
One of the benefits of a 3-D mammography is obviously the clearer image. Another is fewer return visits by patients.
“The impact this technology will have on our patients is tremendous,” said Elizabeth Govero, interim president and CEO of St. Joseph’s. “The 3-D image details offer a clearer overall view of the breast tissue. It helps us detect cancer earlier, see lesions more clearly, and reduce the number of unnecessary biopsies.”
A radiologist needs more time to decipher the data contained in 3-D mammogram, also referred to as digital breast tomosynthesis.
“A basic mammogram is four pictures. With a tomogram, you may have 60 pictures in one breast, or 60 times four images that he’ll have to look at,” said Kustermann.
Radiologist Dr. Miguel Gelman believes the results will be worth it.
“I think it’s going to be great. It has been shown that 3-D increases the sensitivity for detection of smaller cancers that sometimes are not visible on the standard 2-D mammography,” he said.
Gelman is a member of the MidAmerica Radiology group, which has seven doctors who work at hospitals in the region, and one of four who is at St. Joseph’s routinely. He worked with 3-D equipment at other hospitals and found cancers that were not showing up on 2-D.
“Breast cancers occurs at 1 percent incidence. You have to read 100 mammograms to find one (cancer),” Gelman said. “What we’re seeing (with 3-D) is an increase in the detection rate from 10 percent to 15 percent. Those are small numbers, but thousands of breast cancers are going to be diagnosed earlier.” Early detection is, of course, critical to care.
St. Joseph’s moved from X-ray film to 2-D digital technology five years ago when it was still at the old hospital. When it moved to the new facility in 2013 the digital equipment moved, too. Three years later, it is again on the cutting edge of mammography.
“One of the advantages of 3-D has been shown that it decreases the number of callbacks, which is very important,” Gelman said. “The most stressful part from a patient’s point of view is being called back because there was something seen and there’s a chance it might be cancer. With 3-D, the percentage of patients who have to be called back is almost decreased by half.”
St. Joseph’s sent out notification letters to let patients know of the changes. Many have already begun scheduling visits.