Posted by: notdeaddinosaur | October 20, 2015

How Pennsylvania is Screwing Radiologists

Here’s something new and different: Dino defending Radiologists. Oh, I’ve lit into them from time to time over the years, but we are colleagues. And a recent ruling by the Pennsylvania Governor’s office mandating that 3D mammograms, also known as tomosynthesis, be treated exactly the same as previous technology for payment purposes (ie “Free” to patients) is patently unfair to radiologists.

Some background: The current technological standard for breast cancer mammography screening consists of taking plain low-dose xray images of compressed (ouch!) breast tissue, either with film or digital technology. Usually they take two views of each breast, resulting in four pictures, which takes an experienced radiologist less than two minutes to read. Tomosynthesis is a process conceptually similar to a CT scan in that it produces a series of images of the breast that can be scrolled through to produce a “3D” mammogram. Trouble is that it takes longer to read, meaning that because time is money, 3D mammograms cost more that the old-fashioned ones. The equipment is hideously expensive as well, so of course they want to recoup those costs.

But is tomosynthesis “better”? It depends. In women with dense breasts, tomosynthesis can do a better job of distinguishing actual masses from shadows formed by overlapping tissue, which lowers the number of patients called back for extra views. This is a good thing. The problem is one of over-marketing: hospitals and medical systems have done a bang-up job selling their new technology as the latest must-have latest and greatest. Everyone’s clamoring for it. How dare anyone suggest pawning off yesterday’s technology on them! After all, “Isn’t your life worth it?” (Never mind the whole “saving your life” thing with mammography is starting to look more and more overrated.)

Now the Commonwealth of Pennsylvania is requiring that all mammograms, 3D as well as 2D, remain “free” to women.They’re not “free”, of course. Mammogram technicians and radiologists aren’t in it just for the money, but they do have bills to pay. “Free” mammograms are paid for by insurance companies, who both pass on the costs in the form of premiums to all their subscribers, and by restricting payments to radiologists and hospitals. You don’t think they’d let their profits take a hit, do you?

Ordinarily I’m a fan of our new Governor, Tom Wolf. But in this case, his new policy is unfair, and ought to be re-visited.



  1. I’m an 11 year stage 3 breast cancer survivor. I’ve never had one of those 3D mammograms. I just get the regular diagnostic mammogram. They sound like a boat load of radiation. I think I’d pass if I was offered one.

  2. Don’t quite get how it’s the Guv who’s the screwer here. If the insurers are refusing to pay more for the more expensive test, aren’t they, as usual, the bad guys?

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