Bringing Digital Mammography Technology to Outlying Areas
In Alaska, where the leading cause of death is cancer, access to the latest medical care and technology can mean the difference between life and death. "The key to saving lives is early detection," says Dr. Denise Farleigh, Medical Director of Providence Imaging Center, an independent diagnostic imaging facility in Anchorage. "The greatest challenge in Alaska is
The area's need for better access led the Imaging Center to institute their first mobile mammography screenings back in 1989, using a cargo van equipped with a Hologic Lorad Transpo unit.
The old unit, unfortunately, had begun to show its years. "It had simply run out its design life," says Dr. Farleigh. "Our mobile unit has always been very important to us, but there were some clients and sites that we had to stop visiting simply because we could not get the unit on the road."
In addition, the old system was limited in the places it could visit. The imaging unit had to be wheeled off the cargo van, and set up inside the site in a dedicated room with the power required to run the equipment. Not all sites had this kind of space available. And, during the long winter months, navigating the rolling unit across ice-choked parking lots could be a challenge.
A generous gift
Providence Imaging Center knew that if they were going to continue providing screening to the women in Anchorage and the outlying areas, they needed to replace the mobile unit. Funds had been earmarked for the purchase of a new vehicle equipped with an older screen-film Lorad system (the Center had recently upgraded their mammography equipment with the installation of three Hologic SeleniaT digital mammography systems).
Thanks to the Providence Alaska Foundation (PAF), a local non-profit group, and the generous support of the CARRS/Safeway supermarket chain, the entire cost for a new mobile unit was donated to the Imaging Center. The money had been raised through change put in collection jars by employees and customers of CARRS/Safeway. Impressively, the entire amount had been raised in only one month, October 2005, Breast Cancer Awareness Month.
The generosity of the PAF donation allowed the Center to use their funds, originally intended for a new coach, to purchase a new Selenia system for the mobile unit, thus ensuring that patients visiting the mobile coach will receive the same quality digital mammograms as the women who visit the Imaging Center in Anchorage.
"We were moving away from screen-film systems in the Imaging Center," explains Dr. Farleigh, "and having digital [on the mobile unit] makes it easier to make this transition."
Equipped with the new Selenia and R2 Computer Aided Detection system, the new mobile coach is a 34-foot self-contained mammography suite, which can be driven to a site and parked. The women simply walk in to get their exams.
Where they go
For most of the year, the majority of the screenings performed by the mobile unit are located in the Anchorage area.
When the coach is out, it makes scheduled stops at several local medical centers that are not equipped for mammography, and area businesses. In addition, the mobile unit makes scheduled visits to area schools. "If we can come to a person's place of employment," Dr. Farleigh says, "they do not have to take time off, and they can have a mammogram in the time it takes for a coffee break. Teachers especially like the convenience," she adds, "because they
don't have to find a substitute teacher for the day."
During the spring and fall, longer overnight runs are added to the schedule to allow for travel to some of the region's more remote areas. Some runs can be as long as eleven days on the road, screening women in areas that would not normally have access to mammography services.
"About every other month we send the coach on an overnight trip", says Susan Kessler, RT (R)(CV)(M)(QM)CRT, the lead technologist for the mobile unit. "We go as far as Talkeetna, up near Denali National Park - Anchorage to Talkeetna is about a two and a half hour drive. And, we go out to Eagle River and the Matanuska-Susitna Valleys. The longest trips are to Valdez and Cordova. These areas require a six hour ferry ride to access."
The mobile unit is a one-person operation; the technologist is responsible for imaging the patients well as driving the coach over the road. Ms. Kessler describes a typical trip to these remote areas. "To make the Valdez/Cordova trip," she says, "I first drive the 300 miles to Valdez, which is where the oil pipeline ends. On the way, I stop in the community of Glenallen, and spend a day seeing patients there. When I arrive in Valdez, I spend three to five days there
performing screening exams. Then it's a 6 hour trip on the ferry to spend three days in Cordova, then another 6 hour ferry ride back to the mainland to the town of Whittier, and then 75 miles back to the Imaging Center."
During one recent trip to Valdez/Cordova, over 200 women received screening mammograms.
The importance of convenience
According to Ms. Kessler, the mobile mammography coach makes access to life saving technology possible. "Some women have never had screening mammograms before," she says, "or if they did, they do not have them regularly, because getting to Anchorage is a huge deal for many of them. It's a long trip, and if the mobile system was not available, they would skip their exams."
"It's a long trip, and if the mobile system was not available, they would skip their exams."
"When our mobile program first began," Dr. Farleigh says, "we discovered that as many as one third of our patients had never had a mammogram before. The reason given was almost always because of convenience and access. Our mobile unit has eliminated those reasons as an excuse for not having a mammogram."
Serving the underserved
According to Ms. Kessler, the mobile unit makes it possible to see women who normally might never have had the chance to receive a mammogram. "We are definitely seeing an underserved part of the population. Some of these women live way out; in small cabins. some of them don't have running water. It's a huge effort to get to Anchorage to get an exam.and yet, because of this unit, these women can get the latest in breast imaging technology."
"We are definitely seeing an underserved part of the population. Some of these women live way out; in small cabins. some of them don't have running water. It's a huge effort to get to Anchorage to get an exam.and yet, because of this unit, these women can get the latest in breast imaging technology."
In addition, through a combination of state and private programs that provide breast and cervical cancer screenings to the working poor, the mobile unit of Providence Imaging Center can see women who are uninsured and in danger of falling through the cracks.
"We visit sites where we see almost exclusively this population," explains Ms. Kessler. "One day, a woman who had been living in a homeless shelter came in for her screening mammogram. She would not have been able to get one if it had not been for this unit." Ms. Kessler adds, "All day, every day, patients tell me, 'Thank you so much for bringing this here. I might not have had my mammogram without PIC making is to simple."
Dr. Farleigh points out the importance of having the system on the road. "In an underserved population, you will always see a significant number of cancers in the previously unscreened. You would not have found these cancers if the unit had not been able to make its way to these sites."
Naturally, operating a traveling mammography unit in the northern most state in the union has its challenges, mostly weather related. Because of the extreme conditions often found in Alaska, the unit must be protected from the elements at all times.
Ensuring that the digital detector on the Selenia system does not get too hot or too cold is the work of two on board diesel generators operating the heating units for the exam area. "During one trip out to Glenallen," recalls Ms. Kessler, "the temperature dipped to - 30° F. I had the back up generator on the whole drive to and from Glenallen to keep the exam area temperature stable. The heaters kept everything nice and toasty."
Hope for the future
The new mobile mammography coach means that the Imaging Center can once again return to the sites and locations that had been previously discontinued due to the unreliability of a very old mammography unit. Says Ms. Kessler, "Because of the condition of the old system, we had tapered off the mobile services, and reduced the schedule of on site visits. Now that we have the new system.our goal is to have the unit out and running five days a week, year round."
For the women of the Anchorage area, that's very good news.