Our Point of View

Apr 24 2008

Kaiser Permanente Comments on Mammography Quality in Northern California Facilities

A recent Northern California TV news story on the Mammogram Quality Standards Act, the federal law that sets standards for mammography machines and the staff that operate them, may raise unwarranted concerns about mammogram quality. We want to reassure our members that we are committed to satisfying the MQSA at all times, with a rigorous quality assurance process that includes stringent oversight and double-checks, staff training, and meticulous data and feedback systems for the 422,000 mammograms we perform in Northern California each year.

The news story reported on citations at Kaiser Permanente and non-Kaiser Permanente facilities in Northern California, but it is important to note that no citation that Kaiser Permanente has received would directly impair patient safety, nor affect our ability to diagnose a patient. Rather, the citations under the Mammogram Quality Standards Act related to record-keeping about the equipment used and completion of training for use of the equipment and were not about patient diagnoses or care. Of course, we take all citations extremely seriously and work to correct them promptly.

The story referred to a Level 1 citation at our Novato facility, which was nearly five years ago and was due to a recordkeeping matter. No problems were found with our mammography equipment or staffing, or with the quality of the mammograms produced. No mammograms needed to be repeated, and our service to patients was not interrupted.

We encourage women concerned for any reason about their mammogram to contact their physician. And, we want to assure women who have mammograms at Kaiser Permanente that their films are checked by two sets of experts using mammogram machines that are fully certified and licensed by the federal government, the state of California, and the American College of Radiology. Our State-certified mammography technologists examine each image to ensure image quality; radiologists then check the images for possible tumors or other medical conditions. Kaiser Permanente radiologists order re-tests if there is any problem with the image.

Mammography is just one of many tools used by KP to detect breast cancer as early as possible. We correlate diagnoses with personal and family risk factors, physical exams, ultra sound and MRI procedures that go beyond just mammography. We use the latest technology for breast imaging and employ breast specialists in each Northern California medical facility to ensure we are using the latest treatment protocols. These are some of the reasons why Kaiser Permanente is well-known for its excellence in early breast cancer detection and treatment.

The following statement from Dr. Susan Kutner, Kaiser Permanente surgeon and Chair, Kaiser Permanente Northern California Breast Care Task Force, was provided to KNTV Channel 11:

"As they pertain to Kaiser Permanente, it is essential to place MQSA citations in context for accuracy and to avoid sensationalism and unnecessary alarm on this topic. MQSA does not oversee diagnoses and patient care.

"Kaiser Permanente provides high quality state-of-the art breast care for women in Northern California. No MQSA citation that Kaiser Permanente has received would have directly impaired patient safety, nor affected our ability to diagnose a patient. MQSA inspectors test each mammography unit. If MQSA inspectors deem that a violation would impair public safety, that mammography center is shut down immediately and the public is notified. That has never occurred at Kaiser Permanente.

"Moreover, Kaiser Permanente operates its own internal electronic tracking system for all 422,000 mammography images we generate each year. This tracking system enables us to assess the completeness and quality of each film, and notify patients in a timely fashion for follow-ups and subsequent services. This is a safety net for Kaiser Permanente patients above and beyond MQSA requirements.

"That said, we are not satisfied when we receive any notices, and we take immediate action to correct any findings.

"Our own rigorous quality assurance processes, which are more strict than most imaging centers in the state, include stringent oversight and double-checks, staff training, and meticulous data and feedback systems:

• We conduct quality control checks daily and document the passing score of these results. We respond to any findings as soon as possible with corrective actions.
• We carry out regular internal audits adhering to MQSA standards, machine inspections and film quality, and conduct spontaneous readiness drills.
• We have MQSA inspections every year.
• The state and federal government certify each of our 116 mammography units.
• Every three years our films are reviewed for their quality by the American College of Radiology Certified Image Review Process.
• Our mammography technologists and radiologists participate in regular training and required continuing education programs.
• There are at least three levels of supervision and oversight in our mammography centers, as well as a Breast Care Tracking System Committee at each KP medical center that reviews and audits mammogram outcomes with the chief of mammography and the medical center's radiologists.

"Along with our rigorous quality assurance processes, Kaiser Permanente has set stringent targets and high performance expectations regarding screening for breast cancer. We are committed to making screening as accessible as possible. Our members have access to digital mammography (45 of our 116 units are digital), six Breast MRI Centers, breast ultrasounds, and stereotactic biopsies, and they can schedule a mammogram without a referral by going online or through their physician."