By Marcy Rushford
Earlier in October, I wrote about how the primary goal of National Breast Cancer Awareness month is to emphasize the need for women over age 40 to get a mammogram every year and how digital mammography remains the gold standard for detecting breast cancer. Last week, Dr. Rosen wrote about advances in biopsy procedures that make them quicker and less invasive. But the latest innovation in breast cancer detection has been the adaptation of Magnetic Resonance Imaging technology, which we will start offering at BMH early next month.
Most people associate a MRI, as it is commonly known, with ligament or muscles injuries. A patient who comes in for an ankle x-ray and nothing shows up, for example, so the doctor orders a MRI and finds a torn achilles tendon. But you can use MRI for just about anything. We can look for cancers and strokes. We can look at spinal cords for slipped discs. The MRI aligns atoms in the body to create an image in the computer screen with different shades of gray, and those shades mean different things depending on what you’re looking at. A patient with stomach pain may have a mass show up on ultrasound. A MRI can better characterize that mass to determine what kind of treatment he or she will need.
In 2003, the American Society of Clinical Oncology reported findings on just how powerful a tool MRI can be in diagnosing breast cancer for women who are considered to be at high risk for breast cancer due to family history. Additional research revealed its ability to detect tumors in women with dense breast tissue, which obscures the effectiveness of a mammogram. How it works is a dye is injected intravenously, which causes a tumor to light-up on the MRI scan. The technology can also help further define an abnormality found on a mammogram to determine if it’s malignant or benign. A MRI-guided biopsy can help us get a better sampling if that’s the only place we can detect a suspicious mass, and in patients with breast cancer a MRI can help tell us whether or not a cancer is spreading.
The major drawback of a breast MRI, as reported in the 2003 study, was the number of “false positives” it produced. In one study group, as many as 17 percent of the subjects tested positive for a tumor when they actually did not have breast cancer. This is one of many reasons why mammograms are still the baseline test for all women and MRIs are considered a next step diagnostic tool for special cases.
MRI technology has been in use at BMH for quite some time now. It is a little unique among imaging technologies because of the very powerful magnet. We screen patients very closely to make sure it’s safe for them to enter the environment where the magnet sits, and the American College of Radiology (ACR) has given our unit its gold seal of accreditation for achieving the highest level of image quality and patient safety according to its guidelines. As we get set to offer Breast MRI at Brattleboro Memorial Hospital, we are also adding genetic risk evaluation capabilities to determine it is used with high risk patients. We have partnered with ProScan Imaging, a radiology group that specializes in MRI interpretation, and with City of Hope, a National Cancer Institute designated Comprehensive Cancer Center. Both groups have extensive knowledge in their respective areas of expertise to ensure quality of service.
Here in Windham County, we know there is a high risk population where screening mammography is not enough to be definitive. Offering MRI service as part of our Comprehensive Breast Care program will benefit patients who have had a diagnosis of cancer. They won’t have the mental or financial stress that comes from traveling back and forth between the physician who is medically managing them here and an MRI facility located elsewhere. A lot of other resources are already available within the community. If a patient has questions, a single phone call to Kelly McCue, our nurse navigator, can help them find the support they need for their specific condition.
Marcy Rushford, CRA, MBA, RDMS, RT(R,M) is the Director of the Radiology and Cardiology Unit at Brattleboro Memorial Hospital. She is one of less than 700 radiology administrators in the U.S. to have passed the Certified Radiology Administrator (CRA) exam, which measures skills and expertise in medical imaging management.