With the promise of fewer false-positives and increasing cancer detection, the adoption of digital breast tomosynthesis (DBT) is rapidly becoming part of routine clinical practice. For example, in May of last year, market research firm KLAS conducted a survey that found demand for tomosynthesis increasing dramatically; of 121 imaging providers surveyed, more than half said they would choose tomosynthesis if they had the chance to start their practices over again.
However, in an article published in the December issue of the Journal of the American College of Radiology, Christoph Lee, M.D., and Constance Lehman, M.D., Ph.D., radiologists with the University of Washington School of Medicine, warn that the pace of DBT's adoption is outrunning the collection of clinical effectiveness data and the evolution of reimbursement policies, leaving radiology groups with questions about whether--and how--to adopt this technology into their practices.
According to the authors, the financial implications for practices acquiring and adopting DBT "are not trivial." For example, they point out that there currently is no guaranteed third-party reimbursement for the exam. Additionally, they say, while some payers may reimburse adjunct DBG through an Accessory Current Procedural Code, that reimbursement averages only about $50 above the standard digital mammography reimbursement, which isn't much considering the substantial upfront costs of acquiring a mammography unit with DBT capability (about $750,000).
What's more, the authors point out, there are costs associated with DBT adoption, such as the need for additional space and dedicated workstations for the technology, and additional IT support for the large amount of additional imaging data that will need to be archived.
DBT seems to have both negative and positive impacts on practice workflow. For example, there are concerns that DBT could double interpretation time. The fact that an advantage of DBT is a reduction in false-positives, however, could allow practices to eliminate unnecessary diagnostic workups.
"Because diagnostic breast imaging is conventionally more time consuming, with relatively less financial support for physician time compared with screening, shifting practice volumes in favor of more screening and less diagnostic imaging could be advantageous from both financial and workflow management perspectives," the authors said.
Regarding the use of DBT best practices, the authors believe that comparative effectiveness research involving multiple stakeholders is the best course of action, since it requires less time than traditional clinical trials and "offers real-world evidence of the incremental effects of new imaging modalities on patient outcomes and costs.
"For DBT," Lee and Lehman said, "radiologists should engage multiple stakeholders, including patients, providers, payers, and policymakers, to determine how best to collect observational data at the local practice setting in real time, aggregate data across practices, and harness data analyses into evidence that can affect patient care."
They added that radiology practices should engage with patients, advocacy groups, and referring physicians to communicate and educate them about supplemental screening technologies.
To learn more:
- read the article in the Journal of the American College of Radiology