Exam change benefits patients

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Editor's note: This Monday Medical column first appeared in the Steamboat Today on Aug. 1, 2005.

Breast Cancer Awareness Month in October highlights our community's support for issues that are related to breast cancer. We thought this would be a good opportunity to inform the women in our region of some of the changes in Yampa Valley Medical Center's cancer screening program.

Most women have a "screening" mammogram on an annual or regular basis. These exams are now handled in a different fashion from the "diagnostic" mammograms that are performed to evaluate a specific symptom or problem.

Formerly, both types of mammograms were reviewed and a preliminary report was given by one of our radiologists at the time of the examination. This is now the procedure only for diagnostic mammograms. We are occasionally asked about the reasoning behind this change.

Whether it be a mammogram, chest CT scan or brain MRI, we are aware that every patient would like results immediately. But for many procedures - including screening mammography - this is no longer advisable.

Yampa Valley Medical Center (YVMC) has changed its reading and reporting procedures for screening mammography to comply with the American College of Radiology guidelines and the patient care model now seen in the most well-known breast-imaging centers.

In the past, a radiologist would often have to be pulled out of another study or procedure to review a mammogram prior to the patient's leaving the hospital. Occasionally, this led to a lengthy wait for some patients as well as a tendency for the radiologist to order additional views. Often these views turned out to be unnecessary, which means that these patients were exposed to unnecessary radiation.

Large research studies that include thousands of patients have shown that the most accurate results are achieved when a full day's mammography films are read in one sitting, in a dedicated block of time and under specifically controlled lighting conditions.

At YVMC, we now have an allotted time for reading the screening mammograms that were performed in the previous 24 hours. Each reading involves a careful analysis of the current films as well as films from prior years, when available. The search includes the standard use of a magnifying lens as well as computer analysis.

These films are very challenging to read, as the radiologists are looking for tiny calcifications or subtle changes in the tissues from one year to the next. In the vast majority of cases, no further imaging is needed and the patient and her physician will receive a letter notifying them of a normal examination.

If the radiologist determines that additional views are needed, the patient will be called to arrange another imaging appointment. When the patient returns for this exam, an ultrasonographer who specializes in breast ultrasound will be scheduled to be available in case the radiologist also requests that procedure.

Although this new system results in a short wait for the screening mammogram results, it offers several benefits to our patients. The majority of patients are spending less time at the hospital, and fewer patients are being exposed to unnecessary radiation. Most importantly, we feel confident that the changes that have been made will lead to the highest level of accuracy in our readings and ultimately the highest level of patient care.

J. D. Gilliland, M.D., is a diagnostic radiologist at Yampa Valley Medical Center. Mary Jo Wiedel is director of radiology at YVMC.

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