Emerging Approaches to Osteoporosis Screening: Allison Breast Center

Allison Breast Center in Richmond, Virginia, has always conducted business according to a patient-centered philosophy. Michael Bigg, MD, JD, who owns the women’s imaging center, says, “Our business model is providing a very personalized service to our patients.” Gillian Bigg, SRN, general manager of the center, says, “They receive their results from Michael Bigg before they leave. The physician goes over the results with the patient before the patient’s departure, resulting in there being no call-backs. They appreciate the same-day results, as well as not having to return for any additional imaging.” That level of attentiveness has helped Allison Breast Center meet its patients’ needs. Michael Bigg notes, “Women come to us because they are very proactive about their health. We have been operating with this model for 25 years, and we have acquired very loyal patients who have referred their friends and family members. Women can choose where they get their mammograms, and they choose to come to us.” These proactive, empowered patients had, in the past, inquired about being screened for osteoporosis, in addition to obtaining breast-cancer screening, but Allison Breast Center held off because it lacked the physical space for a dual-energy x-ray absorptiometry (DXA) system. When a simple adjustment from its PACS vendor, Sectra, made it possible for the center’s mammography system to provide fast, low-dose osteoporosis assessments, Allison Breast Center jumped at the opportunity. “We have waited for the osteoporosis functionality to become available in the United States for a long time,” Michael Bigg says. “It’s quick and has proved to be very successful. Already, many of our patients are taking advantage of this new service.” Low-impact Implementation The implementation of the Sectra OneScreen solution is simple and inexpensive; no hardware or software investments are required, and the solution can integrate with any PACS. The mammography system is calibrated by Sectra staff to include a protocol for imaging of the hand, and the PACS is updated to receive the data. OneScreen works by taking a single, 10-second standard radiograph of the hand. This is used to assess a patient’s osteoporosis risk—at a fraction of the radiation dose of a traditional DXA exam. Sheena Hutchins, lead technologist at Allison Breast Center, says, “From a technologist’s point of view, this is very quick and simple to perform. The patients find it very easy.” Michael Bigg adds, “We are still able to have people out of here within 30 minutes of arriving. We respect that they have better things to do than sit around in a physician’s office all day.” OneScreen is available on all digital mammography systems, as well as CR and DR systems. “Patients who have also had a DXA exam say the OneScreen gave them the same results: Reproducibility is very dependable with OneScreen,” Michael Bigg says. “With modern DXA machines, it also takes a while to start the study, and the radiation dose to the patient is higher. OneScreen is quick, and the radiation dose is limited; it is also beneficial to patients who want to receive their reports before they leave.” Enhanced Patient Care The addition of the Sectra OneScreen osteoporosis-screening technique enhances Allison Breast Center’s competitive position in its market, while underscoring its commitment to personalized patient care. The center set the price for the screening at $35, which more or less covers its cost of providing the service. “We priced it so that women could afford it,” Gillian Bigg notes. “This is not something we expect to make an abundance of money from, but we do know our patients will tell their friends and coworkers. We explain to the patients that Sectra OneScreen is an FDA-approved osteoporosis-screening tool that is just as accurate as DXA, but better, in that they receive immediate results and a lower radiation dose.” When Michael Bigg meets with patients following their combined exams, he has the ability to advise those who have osteoporosis (or are at risk for the disorder) about lifestyle choices that can help reverse the condition. “I’ve talked to every patient who has had the test done,” he notes. “It can be a lengthy process, coaching them on diet and exercise, but it is time well spent.” To reinforce his advice, Gillian Bigg is working on an osteoporosis cookbook with recipe recommendations for patients experiencing bone loss. Michael Bigg recommends that patients with positive diagnoses return annually for assessment of the progression of the disorder. He notes that the Sectra OneScreen report itself is patient friendly, making it easy for women to understand their risk levels. “I really like the way the information is presented,” he says. “A standard DXA report is four pages of numbers, and that is not the answer the patient needs. The OneScreen report really cuts to the numbers that matter.” A pamphlet designed by Allison Breast Center, and given to women who have undergone the screening, further explains how to read the report (see figure).

Figure. A pamphlet developed by Allison Breast Center helps with patients’ comprehension of the OneScreen report.

Michael Bigg concludes that the Sectra OneScreen service will be beneficial for Allison Breast Center’s patients, especially for those who do not qualify for free osteoporosis screenings. “Although the Patient Protection and Affordable Care Act allows women 60 and over to have a DXA exam every two years, many potentially vulnerable patients are excluded from this regulation,” he notes. “We are able to offer this as an extremely low-dose and very inexpensive test. We have already identified patients in their early 40s who have osteoporosis. Those women would have to pay a large amount of money, out of pocket, for a DXA exam.” Cat Vasko is editor of ImagingBiz.com and associate editor of Radiology Business Journal.