Communication and Collaboration
The Commission on Breast Imaging works with stakeholders from throughout the College to improve screening and address controversy.
The Commission on Breast Imaging was formed to address issues related to breast imaging and breast imagers, including development of Practice Guidelines and Technical Standards and ACR Appropriateness Criteria® as well issues related to screening and government regulations.
The commission is very active and is organized into the following committees, which interact with one another and work in collaboration with other commissions: Breast Imaging Reporting and Data System (BI-RADS®), Communications, Economics, Government Relations, Appropriateness Criteria and Guidelines, Education, Screening, and Emerging Technologies.
The Committee on BI-RADS completed the image-rich fifth edition atlas, a product of the hard work and collaboration of many volunteer members and dedicated ACR staff. Considerable effort was made to harmonize terminology and medical auditing among modalities used for breast cancer detection and diagnosis. The hard-copy version is currently available, and an e-book version will be available by spring 2014, with a mobile device app available later in the year.
As of February 2014, the Breast Imaging Centers of Excellence (BICOE) program includes 1,134 facilities, while 177 facilities participate in the National Mammography Database (NMD), with data on over 5 million mammography exams. Beginning in 2011, BICOE facilities were invited to participate in the NMD for free for the first year. In 2014, participation in the NMD may offer the opportunity for physicians to use their registry data towards PQRS reporting requirements for CMS reimbursement. NMD is already a qualified Practice Quality Improvement project for part 4 MOC credit from the ABR, and it may be possible to align multiple reporting opportunities so that participating physicians can meet multiple requirements by completing one activity.
The Committee on Guidelines and Appropriateness Criteria works in conjunction with the Commission on Quality and Safety. It is currently working on appropriateness criteria for two new subjects: breast pain and palpable breast masses in males. The committee is reviewing stage 1 breast carcinoma. Practice Guidelines adopted at the May 2013 AMCLC include imaging management of DCIS and invasive breast carcinoma, performance of contrast-enhanced MRI of the breast, and performance of screening and diagnostic mammography. Two breast guidelines are in review for the 2014 cycle: performance of ultrasound-guided percutaneous breast interventional procedures and performance of stereotactic-guided breast interventional procedures.
The Committee on Communications is constantly busy and extremely active. Often with little notice and great urgency, this committee finds itself responding to external challenges of the efficacy and importance of screening for breast cancer and its surrounding issues. Working with ACR PR staff, and often in conjunction with the Society of Breast Imaging, the committee crafts responses to new publications (both positive and negative) and provides interviews and information for the public and for the media. Links to statements and commentaries are posted on the ACR website.
The Mammography Saves Lives Campaign™, a coalition that includes the ACR, the Society of Breast Imaging, and the American Society of Breast Disease, was refreshed beginning October 2013 (to coincide with National Breast Cancer Awareness Month) with an updated website and new TV and radio public service announcements. The messaging from the previous round of the public service campaign reached roughly 200 million people. The cost of buying equivalent advertising time would have been well over $1.25 million (more than 10 times the total cost of the campaign to date).
The Committee on Screening & Emerging Technologies responded in detail to draft documents published by the Institute for Clinical and Economic Review. The institute participated with the New England Comparative Effectiveness Public Advisory Council and California Technology Assessment Forum to address the comparative effectiveness of imaging methods for women with dense breasts. Although no radiologists were selected to be on the panels, representatives from the ACR attended and provided expert advice.
The Committee on Economics works in collaboration with the Commission on Economics. Much has happened in this area, including a new set of codes for interventional procedures. The six new bundled breast biopsy codes and eight new bundled breast localization device codes were effective as of January 1, 2014. The committee also is reviewing and providing input on breast ultrasound and breast tomosynthesis code proposals on an ongoing basis.
The Committee on Government Relations provided comment to the USPSTF, which began the process of updating its guidelines on breast cancer screening. The committee has also been active in providing resources to state radiological societies dealing with pending dense breast legislation. National dense breast legislation is also a possibility, and the committee is working with ACR staff on this issue.
The commission has also participated in many other activities, too numerous to mention in the confines of this short article. It is important to stress that our ACR volunteers and staff are a knowledgeable, experienced, productive, and professional group and work well together on behalf of breast imagers and our patients.
By Barbara S. Monsees, MD, FACR, Commission on Breast Imaging, Chair