Washington Radiology Associates (WRA), a large private practice radiology group serving the Washington D.C. area, performed a high volume of breast tomosynthesis screenings this year. Not many imaging centers or hospitals can say that. Breast tomosynthesis was only just approved by the Food and Drug Administration in February 2011 and it's not yet covered by most health insurance.

But Patrick Waring, WRA's administrator, believed in the technique from the get-go. Doctors at the imaging center who are screening with the 3-D imaging method, like Ingrid Ott, said breast tomosynthesis has found cancers that would have been missed in 2-D. Waring said tomosynthesis is especially beneficial to women with dense breasts because the multi-slice technology can detect lesions hidden by overlapping tissue.

"We've seen a 30 percent drop in call backs," said Waring. "We see right where the lesion is and often times women go straight to ultrasound."

Waring spoke about integrating tomosynthesis into his practice at AHRA's annual conference in Orlando, Fla. The event, held Monday night, was sponsored by Hologic, which manufactures the 3-D digital mammography system.

Easy does it

Waring said that WRA integrated the technology slowly, starting gradually with one machine at one site last August. But after patients started requesting the screening and the radiologists on staff became equally enthusiastic, WRA eventually upgraded all 15 sites. Along the way, patients were educated through marketing materials, technologists were trained and all 27 radiologists on WRA's staff came on board.

For patients and technologists, the procedure is seamless. But for radiologists, Waring said the learning curve is usually greater. Initially with the new technology, it took WRA radiologists double what it would normally take to read an exam (so a two-minute reading now took four minutes). But after some practice, they were able to cut it down to three minutes. Doctors have also had to adjust to switching back and forth from Hologic's workstation and their own. But soon, Waring said these two will be integrated.

Perhaps the most pressing issue is reimbursement. Since there's currently no billing code for tomosynthesis, WRA provided it for free at the onset. After more patients started requesting it, the group began charging $50 for the procedure. Most WRA patients can afford this so it didn't do much to turn people off.

"Almost half of our patients are opting to pay for 3-D mammography," said Waring.

Other hospitals and imaging centers who offer tomosynthesis might bill it under an unlisted code (which may or may not mean reimbursement) or they may ask patients to sign a waiver to claim responsibility of the bill if reimbursement is rejected. Others don't bill at all. Hologic says they have the clinical evidence needed for the reimbursement approval process, and they are still waiting on published studies, which WRA doctors are leading. Hologic is also working to reduce the radiation dose of the scan, which is only slightly higher than 2-D.

"In the next few years, it may be the standard of care," said Waring.

Correction: An earlier version of this article did not directly attribute the statements about breast tomosynthesis' usefulness in the second paragraph. We apologize for our error.

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