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« i-Mammo: The Mammogram You Never Had | Main | GRAND ROUNDS AND SICK PARROTS »



I think you are missing their numbers, and using much worse ones.
15% more, would mean that for every 100 cancers found previously, that they now find 115 cancers.
Your numbers would have 15 cancers out of 100 mammograms in addition to whatever was found originally.

Dr. Caligari

Numbers please??? All these dire consequences of government and legal involvement remain unquantified and are simply claimed to exist without any citation. Please provide numbers as to the number of closed clinics, mammographies left uninterpreted.

Interestingly, all the problems you point out if "solved" would mean more $$ for radiologists. Surprise!!!

If reimbursements from medicare are so low, STOP taking medicare patients. Since you're such a wonderful radiologist (a fact you like to harp upon), I'm sure you can make a living serving exclusively the privately insured or self-insured. Problem solved


Jhn1: Of course, you are correct, and in rereading how I phrased the 15%, it was misleading. I'll fix that in the next post. Thanks.


Reader Caligari:

Sorry. I assumed most people had read about and heard about the closing of mammography clinics and services (like NYU's outpatient women's mammography center)on the front pages of The New York Times and The Wall Street Journal, along with most of the major media. It's not a far trip on Google to find lots of references to this problem.

I can forward you the email for the emergency mammography legislative task force set up last year in Tallahassee, Florida, to deal with precisely this problem.

And congratulations on discovering my motive and seeing through this ruse of mine...about the $$, I mean. I guess it's all out in the open now. I've flayed this fish in an effort to start a groundswell that would eventually lead to a HUGE increase above the $15 per mammogram radiologists now get.

I'm thinking if I could get $18 per interpretation, I'd really be living high.

Anyway, thanks for the input. I'll try not to play that harp that seems to be so irritative.


CodeBlue ...

Don't waste the finger tips on "Dr." Caligari ... if you check out http://chaplin.nu/archives/000316.html you will see that she/he rather aggressively attacked Dr. Chaplin for his choice of medicine careers.

Reading the responses over there, I thought she/he was just anti male doctors ... but, after seeing her/him over here ... I'm thinking she's/he's just anti doctor.

Keep informing us all. You do a great job!

(PS ..if you're ever just looking for a subject ..can you do one on Arnold Chiari Malformation?)

Kate Killebrew, MD

Here, here to CBB! I'm a radiologist and I've read breast studies for years. I read that in some recent year, like 2002 or 2003, 4400 breat imaging centers CLOSED. You got that right! No one has time to double read bec. the available readers are too busy just trying the read the ones they've got. Reimbursement is terrible, fed regulations are everywhere, quality control is constant, more so than in any other type of imaging, suits and/or threats of suits are everywhere. Everything about the breast is difficult; it's difficult to image; the pathology is very difficult; you have to take a large percutaneous specimen to get a diagnosis, much larger than any other organ; mammography is unpleasant, and has to be performed every year for just ONE type of cancer, vs. a blood lab profile which can exclude many things. Women hate it. Radiologists hate reading them, for the most part. Women are frightened. The stats are misleading, by the way, in that the highest liklihood 1:9 is in the last decode of life, the 90's, when cancers are easiest to treat. Some progress slowly, some so fast that early diagnosis is useless. Frivolous suits are rampant; one woman had her diagnosis delayed by SIX WEEKS, went on to die--very aggressive tumor in a pre-menopausal woman--and her family sued and won. You have to keep numbers on the number of cases you read, the number of continuing medical credits you earn, and your true-true/true-false positive readings-your accuracy. No other branch of medicine is so stringently regulated. The work is tedious and usually does not involve much new technology. Digital is fine but very expensive, $100,000. per work station the last time I checked, and required constant maintenance by the vendors, so one must keep one's standard machines up and running for the dig. downtime. I am not sure about reimbursement for dig mammos. Other areas of imaging are far more interesting and lucrative. No easy answers in sight.


Thank you for the blog about mammograms.

I am amazed at how behind the times the medical administrative field is in using technology.

I think it good to have a set of human eyes to examine the test, and a computer as well.

Wondering, would you write something about the attempt to legalize sillicon breast implants again?
Also even the FDA's own website advises that every implant will eventually leak.
Even saline implants use sillicon for the shell.
That mammograms can cause implants to rupture.
That the temperature of the human body can cause the implant shell to degrade.

If you write about this, it will bring greater visibility to this issue.

I love your blog, I am a fan of yours since your writing about Terri Schiavo.

Thank you for all that you do.


Do silicon implants cause cancer and other diseases?


Will computer aided diagnosis increase the number of women who suffer unnecessary biopsies? What if the doctor disagrees with the computer. Must a biopsy be done to avoid possible legal action?


Did you send your grand rounds submission in to grrlscientist yet?

(just trying to help her out by plugging it where I can (grin) she needs more submissions)

So .. anyone reading this ... send your submissions for grand rounds to [email protected]
by tomrrow! She needs them! Sooner better than later.


Very interesting.



Is this a service that needs to go "cash", completely outside any insurance......with the image downloaded to another part of the world outside the reach of the tort bar?

Separate the technical part of the service, which can't leave the USA, from the professional part of the service which can now be sent anywhere on the planet?

Or, if one does not want to send outside the USA, send the image to a state that has real tort reform, get the image read there?


The only thing missing is a federal law forcing radiologists to read mammograms.

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