As a Vice President at Advanced Health Education Center, one area under my charge is helping mammography facilities fulfill the requirements assigned by accreditation bodies after a negative film check validation report or failure. As a woman with personal experience in mammograms with spot films, stereotactic breast biopsy and breast ultrasound, I understand the experience from the patient perspective.
If you take a look at the FDA MQSA Scorecards (stats) from February 2017 to February of 2019, you will see a decrease in the number of facilities doing mammography, and an increase in digital and DBT units. There is a decrease in Level One violations down from 2017 to 2019 by 8.5%. Level Two violations increased by 5.3% from 2017 to 2019. Level Three violations went down 6% to zero as they combined Level Three with Level Two. Facilities with no deficiencies went down 4.4%. Women getting mammograms increased by 32,000 from 2017 to 2019, which is consistent with overall US Census growth. The Scorecard data is one method of validating what is changing in mammography.
In assisting facilities with problems in accreditation, I see small facilities that don’t do many mammograms per day struggle to evaluate images to submit for their accreditation film checks. (Squirrel: Why do we still call them “film” checks?) Top that off with the difficult time they have finding a mammographer for their smaller usually rural site.
Larger facilities with smaller satellite also fail film checks at the smaller sites. That triggers training for the entire staff of mammographers, because they are all under the facility license. I hear the cries of frustration from managers that are fairly knowledgeable about the MQSA requirements, but are frustrated keeping up with accreditation. I’ve seen hundreds of Film Check Validation Reports and Failure Reports delineating insufficient mammograms.
There is no question in my mind that if the MLO PNL is not within 1 cm of the CC’s PNL, you will fail your film check or if you don’t compress breast tissue enough, you will miss critical pathology. And on and on……. So why are facilities turning in poor images? The biggest reason is lack of enough mammograms to have image choices. Another reason is women are getting bigger! Sorry, but it’s true. Mammographers are using multiple images to get the entire breast in view with proper compression, and yet they can’t turn in more than four images for film check validation. More patients are in wheelchairs making mammography a super-challenge. This is where I hear the cries of mammographers. They have good points! Perfection is requested and adequacy is difficult.
As a mammography patient, I want a warm gown and robe in a cushy environment with a smiling mammographer that looks like she loves her job. More importantly, I want a mammographer that acts like she loves her job, works fast, and is competent. Being a technologist, I know what to expect, so I’m an easy patient. However, I have had mammograms and a stereotactic biopsy where I could definitely find inadequacies in the services of the mammographer or radiologist. If the patient thinks the technologist is incompetent, it’s not good. The customer won’t come back. Period. Most people don’t understand the procedure or why mammographers have to smash their breast into a pancake. But great communication can make that technologist a hero! It’s the little things that make a mammographer a champion, such as; properly marking images, skin tags, nipples, etc.; or using a Bella Blanket to keep from tearing patient’s skin.
Accreditation for mammography is not going away. Large breasted patients and patients in wheelchairs are not going away. Patient centered care is not going away. Mammography can really only tolerate great mammographers. Mammography is not for every technologist or radiologist. I’m fortunate to have worked with hundreds of facilities with amazing staff members that really care about their patients. My Quality Management background helps me appreciate those mammographers and radiologists who deserve a crown. That’s my perspective. How do you feel about mammography and accreditation? I’d love to hear from you in our blog.
Lesa Mohr, BSRS, RT (R)(QM)(BD)
Follow this link for more info about AHEC’s Mammography Training and Consulting Services