A Model for Women’s Breast Health Centers Everywhere

The Carol Milgard Breast Center in Tacoma, Wash., was conceived from the ground up to provide women with the fastest, most effective and most comprehensive care. Its services include digital mammography, high-resolution ultrasound, dedicated breast magnetic resonance imaging (MRI), as well as a full compliment of biopsy techniques using stereotactic, ultrasound and MRI guidance. “The mission of our dedicated staff is to provide accurate and timely diagnosis of breast disease,” said Khai Tran, M.D., the center’s medical director. “We raised the level of care for women seeking breast imaging services throughout the region.”
Before the Milgard Center opened, there were numerous breast clinics in the area offering a range of screening and diagnostic breast imaging services. But, if a woman needed additional tests, she often needed to make multiple appointments and travel to multiple clinics. Some clinics utilized analog mammography, some digital mammography. Some patients received their diagnosis within a few weeks, for others, the agonizing wait between screening and diagnosis could take months.
A Dream Becomes a Reality
Four years ago, Dr. Tran proposed pooling the resources of the three largest providers of breast imaging solutions in the Tacoma area: Franciscan Health System, MultiCare Health System and TRA Medical Imaging. They would consolidate several clinics to create a central hub utilizing state-of-the-art digital imaging services, and couple the hub with three satellite clinics, strategically located to provide convenient, accessible and consistent care to all women in the area. His proposal was accepted, and after four years of planning and a $5 million grant from the Gary E. Milgard Family Foundation, the new center opened its doors in February 2009.
“We created an entirely new breast imaging program based on the spoke-and-hub model with the Milgard Center as the hub,” explained Dr. Tran. “Now, in place of eight independent sites providing the same services and buying similar equipment to compete with each other, we are collaborating and reducing the duplication of services,” he said. “This saves a lot of healthcare dollars and gives women, who otherwise may only have had access to analog mammography, access to high quality digital mammography, which is superior.”
Digital Technology Raises the Level of Care
“Digital technology is a key platform in elevating the level of patient care and making it more accessible,” explained Dr. Tran. The Milgard Center has six Hologic Selenia digital mammography systems, three for screening mammograms and three for diagnostic mammograms. Five additional Selenia systems are located in the satellite clinics for screening mammograms.
In addition, the Milgard Center has two Hologic ATEC Automated Tissue Excision and Collection) systems for stereotactic and MR-guided biopsies. “Our radiologists had the opportunity to evaluate other digital systems and selected Hologic because of its superior image quality and the efficiencies it allows us to build into our workflows,” Parsons said.
“Image quality is the singular factor that truly impacts patient care,” agreed Tran. “Digital technology allows us to see more during the test. The analogy I often use in comparing analog to digital is like putting on your glasses and seeing things for the first time.”
“Plus, digital technology allows us to communicate in a very seamless way so images can be sent from one place to another and stored reliably without loss in quality,” Tran said. “Now, you can have your mammography done 40 miles or 400 miles away on a digital mammography unit and send those images electronically to the center to be interpreted. Every step along the way, from screening through diagnostic and additional testing, digital technology enables us to send things along quicker, so there’s generally less waiting around.”
All mammography rooms at the Milgard Center utilize Hologic Selenia TechMate workstations so technologists can view the digital images without leaving the room or interrupting the exam. In a screening environment, if something suspicious presents during the exam, the digital technology enables the technician to alert the breast radiologist to take a look at the image almost immediately. “All this information is a tool our technologists need to do their job,” explained Parsons. “The ability to manipulate images and do what we need to do at the time of the exam has decreased the number of callbacks.”
Digital technology enables the Milgard Center to use the high-quality images in different forums for ongoing patient care. Dr. Tran and his colleagues use the technology in the center’s private consultation rooms to show images when meeting with patients who need additional tests. “That’s probably the one thing in the Milgard Center that has received the most immediate and positive response from patients, because I don’t have to show them analog films anymore. I can magnify images on a 3D-inch monitor and show them everything they need to see including MRI. That is a huge plus and patients love it.”
The Milgard Center also uses the digital images in their weekly conferences where surgeons, oncologists and radiologists review cases to enhance training opportunities. “With digital technology and high definition video technology we can display images in a way we were not able to before and that helps our clinicians do a better job making decisions for their patients,” explained Tran.
A Model for the Future
“The patients and the community are absolutely thankful they have a state-of-the-art center and the satellite clinics in their backyard, where they can get everything done,” said Tran. “They can get their screenings, and if necessary, go on a callback and get their diagnostic exam, ultrasound or biopsy in the same location and, often on the same day. That really shortens the time it takes for a diagnosis. They no longer need to go from one place to another, to another.”
As it moves forward, the Milgard Center plans to extend its digital screening services to women in outlying areas, possibly with mobile screening.
“As we move into a new era of healthcare where we have limited resources, it will be essential to collaborate, so we can better afford cutting-edge technologies that can often be very expensive,” he said. “It is our hope that the Milgard Center’s success will be a model for other areas of the country, as well as other types of services. This kind of collaboration is the future.”