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Providing physicians with superior breast MR images and accurate interpretations is crucial to patient management and is achieved by having qualified staff perform and interpret the exams. The ICAMRL Standards outline the training and experience requirements for the medical and technical staff working in the MR laboratory. These requirements can be located in Section 1 of the Organization standards (www.icamrl.org/icamrl/apply/standards.htm) and are summarized below.

Staff Requirements

MEDICAL STAFF

• Must be a licensed physician and certified by an ABMS-recognized board in a relevant specialty
• Must meet one of the three training and experience pathways as outlined in the Standards
• established practice
• formal training
• informal training
• Must have 15 hours of MR CME every three years (documentation required)

TECHNICAL STAFF

• RT(R) with MR credential
• RT(R) with a minimum of 1 year full time MR experience
• Imaging credential (i.e., CNMT, RDMS) with minimum 1 year full time MR experience

Continuing Education Requirements

• All medical and technical staff are required to have 15 hours of MR CME/CE every three years.

Monitoring Quality

In order to achieve accreditation, applicant laboratories must develop and implement a quality assurance program that provides:

1. an environment for patients that is safe and private
2. education about the test to include contraindications; pre-test preparation, and the associated risks involved
3. emergency care, if needed
4. infection control
5. equipment maintenance, performance measures and assessment
6. diagnostic quality images
7. quality interpretation of the images

Designation of a quality assurance committee is highly recommended to assess the administrative, technical, and interpretive aspects of the program. This assessment should evaluate the current processes and implement corrective actions when deficiencies are noted. Policies and procedures ensuring this ongoing assessment are required at the time of the laboratory’s application submission.

Policies And Procedures Requirements

• Patient and personnel safety
• Emergency procedures
• Pre-screening for ferromagnetic implants/devices, contrast sensitivity, NSF
• Infection control
• Contrast/medication administration supervision
• Quality assurance/testing of the magnet and ancillary equipment (i.e., daily, periodic, annual)
• Technical quality assessment (i.e., image quality, schedule back logs)
• Interpretive quality assessment (i.e., correlation, peer review)
• Documentation of two months of daily quality assurance

The Final Product

Representative case studies submitted by the applicant laboratory are the most significant aspect of the ICAMRL accreditation application and their evaluation is heavily weighted in the accreditation decision. Laboratories must submit three (3) case studies, one normal examination and the remaining two must demonstrate pathology. The case studies selected for review must be from within twelve months of the date of the submission of the application and should represent the laboratory’s best work. The ICAMRL does not stipulate the parameters or sequences for the cases as protocols can vary depending on the field strength and manufacturer. Applicant laboratories are required to submit the entire case study with subtractions, temporal sequences, and 3D images if acquired. The protocol parameter sheet that is included in the application must be submitted along with each case submission.

Case Studies and Final Report Requirements

• Three case studies must be submitted with the final report (1 normal, 2 demonstrating pathology)
• Cases submitted on CD must have viewer installed
• All acquired images used in the interpretation (subtractions, 3D) must be submitted (Note: screen capture on some units is acceptable)
• Final report must be comprehensive and reflect the image findings
• Final report must meet the criteria as outlined in the Standards

When used in conjunction with mammography, breast MRI can be a very useful breast cancer diagnostic tool. MRI can be used effectively to gain information about breast abnormalities detected with mammography, physical exam, or other breast imaging modalities. While breast MRI is effective in some cases, it has limitations that prevent physicians from using it as a widespread screening tool for breast cancer. Its increased cost over mammography and frequent inability to distinguish between cancerous and non-cancerous abnormalities are drawbacks. However, the American Cancer Society’s recent endorsement of MRI as a screening tool in young women at very high risk of breast cancer shows that the technology is beginning to play a more significant role in breast cancer detection.

Accreditation through the ICAMRL is one of the best ways to ensure that your breast MRI facility is providing quality patient care. Today’s health care organizations are held to very high levels of accountability, by peers, by the general public, and by Medicare and other payers. ICAMRL accreditation is a means by which laboratories offering breast MRI can evaluate and demonstrate the level of patient care they provide.

***

REFERENCES

“American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography.” Published in the March/April 2007 CA: A Cancer Journal for Clinicians (Vol. 57, No. 2: 75-89). First author: Debbie Saslow, PhD, American Cancer Society

http://caonline.amcancersoc.org/cgi/content/full/57/2/75

American Cancer Society press release, March 28, 2007

Diagnostic Imaging article, August 21, 2007

New England Journal of Medicine article, March 29, 2007

New York Times story, March 28, 2007

MSNBC segment on breast MRI, March 28, 2007