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Improving Breast Imaging Quality Standards
make an important contribution by taking on nontechnical responsibilities, including quality control and administration.
BEYOND MQSA TO BIQSA
Medical technology is constantly evolving. Although mammography is still the only recommended breast cancer screening test for the general population, a number of other breast imaging technologies are clinically available, and more are in development. Some of the available imaging technologies, including breast ultrasound and MRI, are already commonly used in the diagnosis of breast cancer. Furthermore, recent studies have suggested a potential role for specific technologies in screening some portion of the population, such as high-risk women. Of concern is the adoption of some technologies for screening despite the limited evidence of their effectiveness. There is no mandatory quality oversight of these other technologies, and quality is known to be variable. Thus, the goal of MQSA to ensure quality breast cancer screening and diagnosis could go unfulfilled if it continues to focus solely on mammography.
Mandatory accreditation for breast imaging methods not utilizing ionizing radiation that are routinely used for breast cancer detection and diagnosis should be required under the next MQSA reauthorization. This would entail a name change to the Breast Imaging Quality Standards Act (BIQSA). Initially, breast ultrasound and MRI, along with associated interventional procedures, should be subject to mandatory accreditation, although in the case of MRI, accreditation programs specific to breast imaging must first be developed. In addition, a committee of experts and patient advocates should determine if and when other technologies should be subject to accreditation or certification.
Accreditation programs already exist for breast ultrasound through the American College of Radiology (ACR) and the American Institute of Ultrasound in Medicine. The ACR also has an accreditation program for general MRI, and has begun a dialogue regarding the development of a breast-specific MRI accreditation program. Compulsory accreditation for these breast imaging methods would lead to standardization and could greatly improve the overall quality of breast cancer detection and diagnosis.