CAD’s the Word in Mammography

Vol. 15 •Issue 15 • Page 8

CAD’s the Word in Mammography

CAD. A couple years ago this would have been just another acronym in the acronym-filled radiology world. But CAD– computer-aided detection—is no longer a fringe application. It’s arrived. CAD’s something that radiology professionals are sure of and that radiologists are excited about using.

R2 Technology, Sunnyvale, Calif., was first to receive Food and Drug Administration (FDA) approval with the Image Checker, their CAD technology for mammography. The system digitizes a film mammogram and analyzes the images for regions suggestive of micro-calcification clusters, masses, or architectural distortions, using the system’s processing software. Any suspicious areas are marked on the image, which is displayed on a monitor. This software allows the computer to distinguish between a normal mammogram and a mammogram with abnormalities. Since receiving pre-approval and subsequent approval from the FDA, R2 Technol-ogy has been actively working on improving the product. Not only does the system clearly recognize micro-calcifications, but it also now recognizes the masses with even greater accuracy.

Because the sensitivity has gotten better and because of proven improvements in workflow, the radiologists are not as leery of the product as they were when it first came on the market.

At first, radiologists were “very defensive with a huge fear factor,” according to some of the sales people associated with the product. Radiologists I have worked with have in the past claimed that they can do a better job by doing a second read with one of their colleagues. These days, it is a very different story, with radiologists saying they would not read without CAD.

Two similar products have also received FDA marketing approval this year. One is the Second Look system made by CADx Medical Systems, Laval, Quebec. Second Look also digitizes the film mammogram and creates a “mammograph” that marks the areas of concern for the radiologist to compare after the initial reading.

The other product, Mammo-Reader, is made by Intelligent Systems Software, Clearwater, Fla.

R2 Technology recently partnered with GE Medical Systems, Waukesha, Wis., in providing GE’s full-field digital unit with CAD capabilities. This partnering, as well as the acceptance of CAD, has increased the number of installs of the R2 Image Checker from 140 in 2000 to almost 400 this year. CADx Medical Systems and Intelligent Systems Software are seeing similar successes.

Reimbursement has also made a difference in purchases of CAD systems. What was once completely cost prohibitive for mammography facilities may now actually have a return on investment, or at least enable them to break even. Last year, Medicare increased reimbursement rates for screening mammography with CAD to $17.74.

Of this total, $14.48 is for technical fees and $3.26 for professional fees. Also last year, the American Medical Association (AMA) issued a separate CPT code for CAD (76085) to be used as an add-on code with the screening mammography code (76092).

The media have focused on digital mammography as the latest and greatest product—so much so that my CEO just recently sent me an e-mail asking about filmless mammography at a competing hospital. Mammographers and radiologists have known for quite some time that the digital unit has several merits; however, it is not any better at diagnosing cancer than conventional mammography.

CAD has contributed to the significant progress that has been made in mammography in the last decade. Screening mammography, the gold standard, allows detection at early stages and has reduced breast mortality. In a study done last year in Plano, Texas, researchers concluded that CAD in screening mammography increased breast cancer findings by 20 percent.

With statistics like this, it would not be a stretch to say that CAD may soon become the standard of care in mammography.

Laura McKay is the director of Radiology and Medical Imaging at Maricopa Integrated Health System in Phoenix.