Division of Breast Imaging, Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Division of Breast Imaging, Department of Radiology, University of Cincinnati Medical Center and College of Medicine, Cincinnati, OH, USA.
Breast J. 2019 Mar;25(2):262-268. doi: 10.1111/tbj.13198. Epub 2019 Feb 12.
The purpose of this study was to evaluate providers' ordering practices and perceptions of breast magnetic resonance imaging (MRI) in an academic network in order to better understand and educate a referral base. An online survey was distributed to primary care providers (PCPs) and specialists in our hospital and community practices. Questions included provider demographics, current ordering practices, challenges to ordering, and perceptions about breast MRI. Of 525 ordering providers, 134 responded (26% response rate). Of 134 providers, 57 (42%) order breast MRI in practice. Of those who do not, the most consistent reason was a lack of familiarity with the use of breast MRI (32/77 [42%] of cases). Of 57 cases, 45 (79%) order less than 10 exams annually. The most frequent indication is for high-risk screening (40/47 [84%]). PCPs order fewer breast MRI compared with specialists (P = 0.01). Both PCPs and specialists have mixed perceptions of the clinical utility of breast MRI. However, 30% of all providers are ordering more breast MRI since the enactment of breast density legislation in Massachusetts. Furthermore, 29% report they would order breast MRI more often to screen women with dense breasts if there was a low cost option. Referring provider surveys are useful tools for assessing a radiology practice. Our study suggests a growing clinical interest in breast MRI for screening; however, there is a need for provider education on the clinical utility of breast MRI. Increasing the radiologist's role in targeted educational interventions may help improve awareness and lead to more appropriate utilization of resources.
本研究旨在评估医疗机构提供者在学术网络中进行乳房磁共振成像（MRI）检查的情况，以更好地了解和教育转诊基础。我们向医院和社区实践中的初级保健提供者（PCP）和专家分发了在线调查。问题包括提供者的人口统计学信息、当前的检查申请情况、检查申请面临的挑战以及对乳房 MRI 的看法。在 525 名进行检查申请的提供者中，有 134 名（26%的回复率）做出了回应。在这 134 名提供者中，有 57 名（42%）在实践中申请进行乳房 MRI 检查。在不申请进行乳房 MRI 检查的情况下，最常见的原因是对乳房 MRI 的使用不熟悉（32/77 [42%]的情况）。在 57 例申请中，有 45 例（79%）每年申请的检查次数少于 10 次。最常见的适应症是高危筛查（40/47 [84%]）。与专家相比，PCP 申请的乳房 MRI 检查较少（P=0.01）。PCP 和专家对乳房 MRI 的临床应用均存在混合看法。然而，自马萨诸塞州颁布乳房密度法规以来，所有提供者中仍有 30%的人申请进行更多的乳房 MRI 检查。此外，29%的人报告说，如果有低成本的选择，他们会更频繁地申请乳房 MRI 检查来筛查乳腺密度高的女性。调查转诊提供者是评估放射科实践的有用工具。我们的研究表明，对乳房 MRI 筛查的临床兴趣正在增加；然而，需要对提供者进行有关乳房 MRI 的临床应用的教育。增加放射科医生在有针对性的教育干预中的作用可能有助于提高认识，并导致更合理地利用资源。
