Who should run breast clinics, surgeons or radiologists?

The role of radiologist in the changing world of healthcare: a White Paper of the European Society of Radiology (ESR)

Radiology as a specialty has been enormously successful since its beginnings, moving over time from an adjunct to clinical decision-making to a crucial component of multidisciplinary patient care. However, this increased centrality of radiology and reliance on our services carries within it dangers, prominent among them being the danger of our being viewed as deliverers of a commodity, and the risk of our becoming overwhelmed by increasing workload, unable to interact sufficiently with patients and referrers due to pressure of work. With this White Paper, the Board of Directors of the European Society of Radiology (ESR) seeks to briefly explain the position of the radiologist in the modern healthcare environment, considering our duties and contributions as doctors, protectors, communicators, innovators, scientists and teachers. This statement is intended to serve as a summary of the breadth of our responsibilities and roles, and to assist radiologists in countering misunderstanding of who we are and what we do.

Utilization of breast MRI and breast MRI-guided biopsy in clinical practice: results of a survey in Québec and France

Background

To investigate the practice regarding breast MRI exams and breast MRI-guided biopsies in two countries with different health care systems, France and Québec. A 12-item questionnaire was distributed online among radiologists from France and Québec, attempting to determine: demographic characteristics and breast MRI diagnostic and MRI-guided practices (indications, workload, availability, and waiting time assessment).

Results

One hundred and seventy radiologists (France, 132 respondents (28.5%); Quebec, 38 respondents (35.2%)) participated in the survey, most of them based in non-academic centers. Thirty-eight percent of Quebec and 2.3% of French radiologists did not perform breast MRI in their daily practice. Nearly 50% of French and Quebec respondents interpreted 1–10 breast MRI exams per week. Decision-making factors of preoperative MRI were similar in both countries (pathology, age, and breast density), with a heavier emphasis placed on the surgeon’s opinion in Quebec (47.8% versus 21.8% (p = 0.009)). Quebec demonstrated a higher waiting time than France (1–2 weeks in 40% versus less than 1 week in 40%). MRI-guided breast biopsies (less than 5 MRI-guided biopsies per week) were being performed by a minority of the respondents (36% in France and 43% in Québec).

Conclusion

Most of radiologists performing breast MRIs work in non-academic institutions in both countries. Waiting time is higher in Quebec, but most of preoperative breast MRIs are performed within 3 weeks in both countries. The surgeon plays an important role in recommending preoperative MRI in Quebec. MRI-guided breast biopsies are not widely available in both countries.

Imaging-led symptomatic breast clinics: a case for direct access to radiology

Radiologists play a pivotal role in patient management in modern hospital medicine and more so with regard to breast imaging. The diagnosis of breast pathology hinges predominantly on mammography and ultrasound imaging. With reduced clinician confidence in clinical examination alone, virtually all patients with breast symptoms are being referred for imaging. The traditional 'one-stop' clinics are victims of their own success and demand outstrips availability. This article makes a case for imaging-led breast clinics to increase efficiency, reduce duplication of work and cost, and increase throughput of patients.