Digital Breast Tomosynthesis: Cost-Effectiveness of Using Private and Medicare Insurance in Community-Based Health Care Facilities.

OBJECTIVE: The purpose of this study was to determine whether digital breast tomosynthesis (DBT) is a cost-effective alternative to full-field digital mammography (FFDM) for both Medicare and privately insured patients undergoing screening mammography. MATERIALS AND METHODS: A retrospective data analysis was performed between July 15, 2013, and July 14, 2014, with data on women presenting for screening mammography that included any additional radiologic workup (n = 6319). Patients chose to undergo DBT or FFDM on the basis of personal preference, physician suggestion, and cost difference. The summation of findings over the 1-year period were used to calculate recall rates, cancer detection rates, and billing costs for a regional private insurer and Medicare. RESULTS: Data from the 6319 patients who participated were divided: 3655 patients underwent DBT, and 2664 underwent FFDM during the year of screening. Private insurance billing cost $2.9 million, and Medicare cost $1.2 million for screening, follow-up imaging, and radiologic procedures. Per-person costs were approximately $40 higher for the DBT group using both forms of insurance. However, cost per cancer detected was lower in the DBT group for both private and governmental insurance, leading to potentially $3.7 million and $899,000 saved per 100 cancers found. After standardization of the difference in cancer detection rates between the two groups, DBT was a cost-equivalent alternative to FFDM for private insurance billing but was a cost-inefficient alternative with respect to Medicare costs. CONCLUSION: In a community-based setting, DBT is a cost-equivalent or potentially cost-effective alternative to FFDM and has the capacity for improving cancer detection and recall rates.

Evaluation of appropriate short-term mammographic surveillance in patients who undergo breast-conserving Surgery (BCS).

BACKGROUND: Mammography is an important surveillance tool for detecting ipsilateral breast tumor recurrence (IBTR) after BCS. Although IBTR is rare in the first 2 years, various organizations have established protocols for postoperative mammographic surveillance. Currently there is no consensus on the optimal interval for imaging evaluation of patients following BCS. METHODS: We conducted a retrospective review of patients who underwent BCS at Aultman Hospital between 1/06 and 12/08. To be included in the study, patients had to be diagnosed with invasive primary breast carcinoma or ductal carcinoma in situ (DCIS), treated with BCS (with or without postoperative breast radiation), and have had at least one postoperative surveillance mammogram at our Breast Care Center. Our mammographic surveillance protocol for patients undergoing BCS consists of ipsilateral mammograms (affected side) around 6 and 18 months and bilateral mammograms around 12 and 24 months. All mammograms that were Breast Imaging-Reporting and Data System (BIRADS) 0 or 4 were reviewed by a single radiologist (T.B.P.). RESULTS: A total of 375 patients constituted the core group for this study. Each interval mammographic screening (6- and 18-month mammograms) resulted in additional imaging in 3-4 % of patients. There was a very low yield for identifying IBTR: 1/266 (0.4 %) for the 5-10-month postoperative mammogram and 1/286 (0.3 %) for the 16-21-month postoperative mammogram. CONCLUSIONS: Based on our data and the low expected yield of IBTR in the first 2 years, annual mammographic surveillance appears adequate following BCS and interval ipsilateral mammograms at 6 and 18 months do not provide additional clinical benefit.

Pulmonary CT angiography to evaluate for pulmonary embolism in children visiting adult-centered community hospitals.

OBJECTIVE: The objective of our study was to determine the rate of pulmonary embolism (PE) on pulmonary CT angiography (CTA) in children and adolescents visiting adult-centered community hospitals. We also investigated alternative diagnoses that may account for presenting symptoms. MATERIALS AND METHODS: We identified consecutive children and adolescents (age ≤ 19 years) who underwent pulmonary CTA during a 12- and 24-month period, respectively, at two community hospitals. Staff radiologists' clinical interpretations of pulmonary CTA studies were compared with interpretations performed by a blinded, subspecialty-trained thoracic radiologist, with a third tie-breaking interpretation performed in cases of discrepancy. A systematic review of pulmonary CTA studies for possible alternative diagnoses was completed. Diagnostic rates of PE on pulmonary CTA studies in adults at these hospitals were also reviewed for comparison. RESULTS: The study population consisted of 130 individuals (32 boys and 98 girls; median age, 18 years; age range, 11-19 years) who underwent 137 examinations, 11 as inpatients and 126 as outpatients. CTA studies were positive for PE in six patients (4.6%). CTA showed an important alternative diagnosis, such as pulmonary consolidation, in 27 patients (21%). By comparison, pulmonary CTA studies in adults at these two hospitals yielded a 16% positive rate for PE. CONCLUSION: The prevalence of PE in young ambulatory patients with clinically suspected PE at adult-centered community hospitals is substantially lower than in adults. Alternative diagnoses, such as pulmonary consolidation and pneumothorax, are discovered more frequently than PE on pulmonary CTA studies. Pulmonary CTA should be used with discretion in adolescents, especially when radiography may provide the necessary diagnosis.