How Mass General slashed delays for diagnostic breast imaging
A noted East Coast health system is detailing how it was able to slash delays for diagnostic breast imaging through a recent quality-improvement initiative.
Boston-based Mass General Brigham had identified concerns with care postponements after conducting a recent “safety event analysis.” Experts there note that delays in diagnostic resolution—following an abnormal screening mammogram—can lead to patient anxiety, later-stage cancer diagnoses, and poorer breast cancer survival.
To address this, the multisite hospital system implemented a standardized, high-priority scheduling guideline, researchers write Oct. 5 in JACR. It requires completion of designated diagnostic breast imaging within 3 weeks of order placement, with high-priority indications including new breast masses or nipple changes.
Researchers say the practice update is paying off, with improved timeliness of diagnostic breast imaging, particularly for patients with concerning symptoms.
“Multisite operational quality improvement initiatives may represent a scalable strategy to reduce delays in diagnostic breast imaging and support more timely breast cancer diagnosis,” lead author Manisha Bahl, MD, MPH, medical director of quality for breast imaging at Mass General Brigham, and colleagues wrote Monday.
The health system first implemented its standardized scheduling guidelines in August 2024. High-priority indications were developed through multidisciplinary stakeholder consensus and included new axillary masses, unilateral nipple discharge, skin dimpling or indentation, and symptoms occurring during active cancer treatment. Exams not meeting these criteria were categorized as “other.”
Breast imaging radiologists developed the intervention in collaboration with operational leaders, scheduling staff, informatics specialists and data analysts—all led by the system chief medical officer. Strategies to implement the new guidelines included distributing standardized scheduling guidance across participating sites, educating schedulers on qualifying indications and escalation workflows, and monitoring operations during the rollout.
“The intervention did not include dedicated high-priority appointment slots, routine rescheduling of lower-priority examinations, or postponement of lower-priority examinations to accommodate high-priority patients,” the authors noted. “Rather, schedulers were instructed to identify examinations meeting high-priority criteria, schedule these examinations within 3 weeks whenever possible, and use established escalation workflows when an appointment within this timeframe was not initially available.”
For the study, researchers compared results during the year leading up to implementation (representing 34,000 exams) against the year ending on Sept. 30, 2025 (another 37,000 exams). This included over 7,200 high-priority, post-implementation breast exams, representing about 20% of the total. Completion of diagnostic breast imaging within 3 weeks improved from about 57% prior to the intervention up to more than 65% afterward. Meanwhile, median time to exam completion decreased from 18 days down to 14.
Prior to the practice changes, exams of symptomatic patients had a lower 3-week completion rate (50%) when compared to those without any of the concerning signs addressed by the guidelines (61%). However, after the initiative, the numbers flipped, with 61% of symptomatic patients undergoing diagnostic imaging within 3 weeks versus 50% for those without any symptoms.
“Although implementation of the high-priority scheduling guideline was associated with improved timeliness, a large proportion of examinations still were not completed within the targeted 3-week interval,” the authors noted. “These findings reflect the operational complexity of providing timely diagnostic breast imaging access within large multisite healthcare systems, where performance may be influenced by imaging capacity, workforce availability, facility-level variation, geographic distribution of services, and local workflow differences. Nevertheless, the observed improvement among high-priority examinations suggests that standardized prioritization frameworks may help reduce operational variability and improve access for patients with symptoms concerning for breast malignancy.”
Read more, including potential study limitations, in the Journal of the American College of Radiology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.