The Carol Milgard Breast Center in Washington State

The Carol Milgard Breast Center in Tacoma, Washington was conceived from the ground up to provide women with the fastest, most effective, and most comprehensive care. Its services include digital mammography, high resolution ultrasound, dedicated breast magnetic resonance imaging (MRI), as well as a full compliment of biopsy techniques using stereotactic, ultrasound, and MRI guidance. "The mission of our dedicated staff is to provide accurate and timely diagnosis of breast disease," stated Dr. Khai Tran, the Center's medical director. "We raised the level of care for women seeking breast imaging services throughout the region."

Before the Milgard Center opened, there were numerous breast clinics in the area offering a range of screening and diagnostic breast imaging services. But, if a woman needed additional tests, she often needed to make multiple appointments and travel to multiple clinics. Some clinics utilized analog mammography, some digital mammography. Some patients received their diagnosis within a few weeks, for others, the agonizing wait between screening and diagnosis could take months.

"For years, we didn't have enough radiologists to travel to every clinic in the area, and the level of service was inconsistent," continued Dr. Tran. "On the horizon was a looming manpower shortage as many senior breast imagers were preparing for retirement and fewer people were entering the field. We needed to find a way to be more efficient with the resources we had, to provide a consistently high level of care to all patients, and to create an environment that would attract high quality breast imagers."

A dream becomes a reality

Four years ago, Dr. Tran proposed pooling the resources of the three largest providers of breast imaging solutions in the Tacoma area - Franciscan Health System, MultiCare Health System, and TRA Medical Imaging. They would consolidate several clinics to create a central hub utilizing state-of-the-art digital imaging services, and couple the hub with three satellite clinics, strategically located to provide convenient, accessible, and consistent care to all women in the area. His proposal was accepted, and after four years of planning and a $5 million grant from the Gary E. Milgard Family Foundation, the new Center opened its doors in February 2009.

"We created an entirely new breast imaging program based on the spoke-and-hub model with the Milgard Center as the hub," explained Dr. Tran. "Now, in place of eight independent sites providing the same services and buying similar equipment to compete with each other, we are collaborating and reducing the duplication of services," stated Tran. "This saves a lot of healthcare dollars and gives women, who otherwise may only have had access to analog mammography, access to high quality digital mammography, which is superior."

Marcy Parsons, program director at the Milgard Center, explained, "Women still have the option of convenient locations for screening services, but now they know their images will be read in a timely manner by the best-trained mammographers at the Milgard Center. If they need a diagnostic call back or biopsy, we can complete a woman's entire diagnostic workup and biopsy in one place."

As an added plus, radiologists no longer need to travel from clinic to clinic, so they have more time to read mammograms. "We have really high quality people in the Milgard Center, which creates an exciting work environment and lets us be competitive in hiring and attracting future mammographers," declared Tran.

The heart of the operation: a center of excellence

The heart of the Milgard Center is a large, three-story facility designed to put women at ease the moment they enter the front door. "We designed the system and flow so a woman doesn't have to wait," declared Parsons. "We recognize that a screening appointment is only one appointment in the course of a woman's day. She may come in on the way to work, or on her lunch hour. While she's at the Center we want to make the best use of her time and get the information she needs from us during the time she's here."

The first floor of the Milgard Center is dedicated solely to screening mammography. Each appointment is completed in 10 minutes or less, which includes taking new images as well as comparing the new images with the woman's past images. If the patient's previous images were analog, the Center acquires and digitizes the images prior to the appointment. The Center's goal is turn results around in 48 hours.

The Milgard Center also offers bone density screening on the first floor utilizing a Hologic Discovery™ bone densitometry system. "This fits well with our mission," explained Parsons. "And women can often have a screening mammogram and bone density test in the same appointment."

The second floor of the Milgard Center focuses on diagnostic services. "Generally, patients enter our second floor with a heightened sense of anxiety," stated Parsons. "A woman comes for a diagnostic screening because she has a concern or has been called back for additional images. With digital technology we're able to give patients immediate results from their tests."

All radiologists are located on the second floor and read all mammograms taken at the Milgard Center as well as those taken at the satellite clinics. Patients in the satellite clinics receive access to the same digital imaging technology, the same radiologists, and the same 48-hour turn around time as patients visiting the Milgard Center. "We're not just elevating the level of care within the Milgard Center, but we're improving the workflow for the community to ensure we're delivering results in a timely fashion for all our sites," declared Tran.

Digital technology raises the level of care

"Digital technology is a key platform in elevating the level of patient care and making it more accessible," explained Dr. Tran. The Milgard Center has six Hologic Selenia^® digital mammography systems, three for screening mammograms and three for diagnostic mammograms. Five additional Selenia systems are located in the satellite clinics for screening mammograms.

In addition, the Milgard Center has two Hologic ATEC^® (Automated Tissue Excision and Collection) systems for stereotactic and MR guided biopsies. "Image quality is the singular factor that truly impacts patient care," agreed Tran. "Digital technology allows us to see more during the test. The analogy I often use in comparing analog to digital is like putting on your glasses and seeing things for the first time."

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"Our radiologists had the opportunity to evaluate other digital systems and selected Hologic because of its superior image quality and the efficiencies it allows us to build into our workflows," explained Parsons.

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"Plus, digital technology allows us to communicate in a very seamless way so images can be sent from one place to another and stored reliably without loss in quality," continued Tran. "Now, you can have your mammography done 40 miles or 400 miles away on a digital mammography unit and send those images electronically to the Center to be interpreted. Every step along the way, from screening through diagnostic and additional testing, digital technology enables us to send things along quicker, so there's generally less waiting around."

All mammography rooms at the Milgard Center utilize Hologic Selenia TechMate™ workstations so technologists can view the digital images without leaving the room or interrupting the exam. "The technician stays in the room, which really puts patients at ease," explained Parsons. They can recall and compare past imaging studies at a moment's notice, magnify and manipulate images, and respond immediately to positioning or exposure issues as they compare new and previous images.

In a screening environment, if something suspicious presents during the exam, the digital technology enables the technician to alert the breast radiologist to take a look at the image almost immediately. "All this information is a tool our technologists need to do their job," explained Parsons. ''The ability to manipulate images and do what we need to do at the time of the exam has decreased the number of callbacks."

Digital technology enables the Milgard Center to use the high-quality images in different forums for ongoing patient care. Dr. Tran and his colleagues use the technology in the Center's private consultation rooms to show images when meeting with patients who need additional tests. "That's probably the one thing in the Milgard Center that has received the most immediate and positive response from patients, because I don't have to show them analog films anymore. I can magnify images on a 30-inch monitor and show them everything they need to see including MRI. That is a huge plus and patients love it."

The Milgard Center also uses the digital images in their weekly conferences where surgeons, oncologists, and radiologists review cases to enhance training opportunities.

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"With digital technology and high definition video technology we can display images in a way we were not able to before and that helps our clinicians do a better job making decisions for the patients," explained Tran.

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A Model for the Future

"The patients and the community are absolutely thankful they have a state-of-the-art center and the satellite clinics in their backyard, where they can get everything done," Tran continued. "They can get their screenings, and if necessary, go on a callback and get their diagnostic exam, ultrasound or biopsy in the same location and, often on the same day. That really shortens the time it takes for a diagnosis. They no longer need to go from one place to another, to another."

As it moves forward, the Milgard Center plans to extend its digital screening services to women in outlying areas possibly with mobile screening. "We also would like to bring women back into our community who went elsewhere for their breast imaging before we opened the Milgard Center. Now, we hope to instill a sense of confidence and show our community that we have the right tools and the right people to provide absolutely cutting-edge breast care right here in Tacoma," stated Dr. Tran.

Concluded Dr. Tran, "As we move into a new era of healthcare where we have limited resources, it will be essential to collaborate, so we can better afford cutting-edge technologies that can often be very expensive. It is our hope that the Milgard Center's success will be a model for other areas of the country, as well as other types of services. This kind of collaboration is the future. This is the recipe to provide better healthcare at lower cost."