PET scanning the heart cuts costs - European-Hospital

Money and mammography
Could a fully digital breast imaging service be financially viable?
USA - North-Western Medical
School has used Activity Based
Costing (ABC) to analyse five major
services provided by its mammography
section: screening, diagnostic,
breast ultrasound (US), interventional
procedures, and reviews of external
mammograms.
The ABC analysis revealed that
only two services showed a profit,
screening mammography and intervention
procedures. There was no
consistent relationship between the
financial contribution of the service
and the total mammography volume
and therefore no economy of scale.
This suggested that the more a service
is provided, the greater the
financial loss. When indirect costs
were included in the cost structure all
the mammography programmes in
the survey registered losses.
The report pointed out that the
term ‘mammography’ refers not to a
single examination but to a set of
diagnostic procedures, the most com-
mon and familiar being screening
mammography, in which the examination
consists of two standard
views of each breast interpreted by
the radiologist. The ACR-published
standard for diagnostic mammography
defines it as a problem-solving
breast evaluation, which is indicated
by a particular concern. However,
using computer-aided diagnosis in
screening mammography may
increase the inexperienced image
reader’s sensitivity to breast cancer
and so give more false-positive interpretations.
This leads to an increase
in the number of diagnostic mammograms
and a reduction in productivity.
Diagnostic mammography on the
other hand is a much more comprehensive
examination and consists of
customised views of the breast
depending on the findings of concern
and may involve tailored or comprehensive
imaging analysis. Often
associated with diagnostic mammography
the interpretation of outside
mammograms can be time-consuming.
In a negative financial outcome
for diagnostic mammography these
three examinations, each with a loss
per procedure, were often grouped
in delivering comprehensive breast
ONCOLOGY NEWS
imaging services. In addition, the volume
of different procedures was interrelated;
growth in screening mammography
being followed by growth
in diagnostic mammography, breast
US, and interventional procedures.
Breast centres with a good reputation,
due to referrals, have a higher proportion
of diagnostic mammograms and
difficult outside mammograms, and
because these are provided at a financial
loss per examination, there are
economic disincentives in concentrating
high-quality mammography talent.
The new digital mammography
environment promises to change the
entire practice of mammography in
terms of who and how and where
digital mammograms are acquired,
interpreted, and stored. But migrating
from a film-based examination to a
fully digital one will require substantial
capital investment. Clearly a
financially self-supporting mammography
service would facilitate this
transition. The report concluded that,
to realise the real benefits of a fully
digital breast imaging service, a different
financial environment would be
needed.
Report by Peter Howieson
Superheat
system success
Boosting the effects of
radiation and chemotherapy
Germany - Interest in a therapy system
named BSD-2000 has increased
significantly since a Phase-III
European trial, involving patients
with advanced cervical cancer,
showed that radiation combined with
the system resulted in an almost a
50% higher survival rate than for the
patients treated with radiation alone.
To date, six systems have been
installed in Bavarian clinics alone
and, in April, the seventh BSD-2000
system will become operational at the
Schlossberg Clinic, in Oberstaufen.
The system’s manufacturer, the USbased
BSD Medical Corporation,
which develops microwave and radio
frequency systems for thermal medicine
applicable to the treatment of
cancer, benign diseases and other
medical conditions, explained that its
cancer treatment systems are used to
superheat and kill cancer cells and to
boost the effectiveness of radiation
and chemotherapy. ‘The BSD-
2000/3D employs a revolutionary
annular phased array of 24 dipole
radiofrequency (RF) antennae placed
around the patient to focus RF energy
steered in 3D on the cancer.
Cancers targeted are primarily those
located deep in the body, such as colorectal,
bladder, ovarian and prostate
cancer.’
The firm added that the
Schlossberg Clinic (a member of the
Munich Comprehensive Cancer
Centre, and holder of a clinical cooperation
contract with the LMU
Munich University Medical School at
Klinikum Grosshadern, which specialises
clinical cancer research) will
use the system in combination with
chemotherapy and radiation, in a
pilot project that could lead to use of
the BSD-2000/3D in other centres
owned by the Humaine Kliniken
Group.
Details: www.BSDMC.com
EUROPEAN HOSPITAL Vol 14 Issue 2/05 9