iMammogram.com offers follow-up CAD screening for $75

iMammogram.com, a Westlake Village, CA-company, is marketing a service to analyze standard mammograms by a computer-aided detection (CAD) device at a cost of $75. This is in addition to the original x-ray.

Not all radiologists are crazy about the idea.

The company has teamed up with a California supermarket chain, which offers its customers a discount coupon for $25 off iMammogram.com's CloserLook service. iMammogram.com has also enlisted celebrity spokespersons such as comedian Whoopi Goldberg.

"When you think about how many breast cancers are missed by the naked eye, this will tell you why iMammogram is so important to me," Goldberg is quoted as saying on iMammogram's Web site.

The R2 Technology ImageChecker workstation is intended as a second reader for radiologists, directing attention to possible lesions after the physician has conducted a primary reading of the mammograms. The ImageChecker CAD system digitizes mammography films and then reads the electronic images. Pattern-matching algorithms electronically tag suspicious areas in the digital images. ImageChecker's software marks possible breast abnormalities, such as microcalcifications or mass lesions, on the display screen.

After digitizing the mammograms, iMammogram.com returns the films to the facility where the mammogram was performed, and gives the facility and the patient a paper copy of the CAD findings. The radiologist can then compare the original film to the computer analysis, paying attention to any abnormalities the computer detected.

Some radiologists, however, don't like the thought of the CAD system looking over their shoulders after they have already interpreted the mammograms.

"This is kind of a ripoff," said Dr. Elsie Levin, associate director of the Faulkner-Sagoff Breast Imaging and Diagnostic Center in Boston, which includes CAD service with all its mammograms. "If a patient comes to me and there is nothing on the mammogram to worry about, and they pull out a paper printout, her doctor is supposed to investigate further? They pay $75 (to iMammogram.com), when they could come in and get it free."

The company's founder, radiologist Larry Chespak, believes he is performing a service in pinpointing false-negative readings.

"We have two cases (iMammogram screened) where cancer was undetected and another case where the cancer was blatantly missed," Chespak said. "This is a matter of radiologists getting used to the first real application of computers in medicine."

Some radiologists agree.

"If I can pick up one or two more cases (of cancer) a year because you're looking over my shoulder, that's OK," said Dr. Frank Hartwick, president of the Delta Radiology Medical Group in Stockton, CA. "It's not that computers replace us; they augment us."

Chespak said his service is also important because smaller centers cannot afford their own CAD systems, which sell for an average of $190,000 to $229,000, depending on the software, monitor type, and capacity of the automatic film feeder.

"We're not here to prey off women's concerns about breast cancer," Chespak said. "The naysayers haven't looked deeply enough into what we're doing as a business. Yes, we're for-profit and we expect to make money, but the basic premise is that some of the other 10,000 centers (that cannot afford CAD systems) should have access to this. If they can't afford this technology, we'll make it very easy for their patients and their radiologists to have this information. It's unfair to put more cost burden on radiologists."

Hartwick said his center got into a relationship with iMammogram.com because patients started bringing the CAD printouts back to the radiologists.

"One way would have been to ignore it and hope it would go away," Hartwick said. "But patients seem to like the idea of a computer looking at the mammogram. So we called iMammogram and asked them to make the service available in our offices. We FedEx it today and get it back tomorrow. That way, we don't look at it until the CAD is done and sent back."

Radiologists' other issue with iMammogram.com seems to be that the company raises unnecessary fears in patients, causing them to doubt the original mammogram reading.

The Faulkner-Sagoff center has two ImageCheckers to digitize films and one viewer. The center's director, Dr. Norman Sadowsky, said they don't charge for the service and they don't ask for donations.

"We don't advertise it; we don't need more patients," Sadowsky said.

R2 Technology has been waiting for GE Medical Systems to obtain FDA clearance to install R2's ImageChecker CAD system on GE's Senographe 2000D, the full-field digital mammography scanner that GE sells for hard-copy reading only. R2 has a contract with GE to incorporate ImageChecker into its full-field mammography system as soon as the FDA gives its approval for soft-copy reading. GE is hoping to get that approval by the end of this year.

R2 Technology is at some pains to distance itself from iMammogram.com, even though R2's product is the primary driver of iMammogram.com's marketing.

"iMammogram and R2 are not connected in any way other than a supplier/customer relationship," said Mike Klein, R2's CEO. "We have no strategic relationship or partnership whatsoever. We have been concerned about the perception that iMammogram and R2 are somehow aligned, because iMammogram quotes our clinical studies and shows R2 products on their (Web) site. We have made it clear to iMammogram that any use or representation of R2 material, images, and data requires our advance approval."

iMammogram.com does not need FDA approval to digitize mammograms because the tests are not performed on site.

CADx Medical Systems of Montreal has developed a competing system it calls Second Look, which has not yet received FDA approval.

"I think I'm a damn good mammographer," Hartwick said. "We take pride in doing the best job we can do. I do think CAD makes us find more misses. If radiologists are offended by that, they ought to find another job."