The Netherlands, second only to Belgium, grapples with the highest per capita incidence of breast cancer1 globally.
In response to this alarming statistic, the country has implemented rigorous screening protocols, specifically targeting those at heightened risk. Furthermore, they are pioneering the use of innovative strategies and technologies to combat this pervasive health issue.
The standard screening protocol typically involves ultrasound and mammography examinations. However, if any suspicious findings emerge, a subsequent MRI is needed due to its superior diagnostic capabilities. Regrettably, mammography can be particularly challenging for patients with dense breast tissue. Furthermore, the waiting period between the initial screening and the follow-up MRI can induce additional psychological stress and anxiety for the patient. To realize a faster and optimized screening approach, Dr. Ritse Mann and his team at Radboud University Medical Center (Radboudumc) envisioned a dedicated facility for MRI breast screening only. They soon found themselves grappling with complex questions such as:
- How can a non-existent department be designed, tested, and evaluated without incurring substantial upfront costs?
- Is it feasible to use MRI as an efficient screening tool?
- Can MRI achieve, or perhaps even surpass, the throughput levels of mammography, which currently stands at six patients per hour?
Consequently, Radboudumc reached out directly to our Facility Design and Consulting experts, seeking their assistance and guidance.
How it all started – from the idea to a digital twin
Ritse Mann and his team conceived an initial concept for an MRI screening facility, a proposal that was subsequently deliberated in the Dutch parliament.2 The project received funding from ZonMW, an organization committed to promoting innovation in healthcare. The Siemens Healthineers team was approached toward the end of 2021 to discuss and further develop the initial concept for the MRI breast screening department. After numerous intensive brainstorming sessions to identify beneficial technologies for the project and strategies to maximize its potential, the team decided to employ workflow simulation. This approach would allow them to test various scenarios against a range of Key Performance Indicators (KPIs).
Building the digital twin
The Siemens Healthineers consulting team visited the Radboudumc facilities in the Netherlands, gathering valuable insights into local working methods and data. This information formed the foundation for creating an optimal digital twin. In collaboration with several key experts, four primary action areas were identified, focusing on:
- Technology & equipment
- Layout
- Scanning protocols
- Workflow
Initially, the team reviewed and selected the best available technology for MRI breast screening, which was determined to be a 3T Prisma and an 18-channel breast coil. A new generation contrast agent injector and a dockable table were introduced to enhance staff efficiency. The Facility Design and Planning Services (FD) team devised two innovative layouts for the new MRI screening facility. The first layout, more traditional in nature, incorporated changing rooms and was designed in line with current workflows and resources, serving as a baseline. Wanting to maximize the benefits of the dockable tables, the second layout was given special attention. Using a novel design, the room layout would be able to accommodate up to four dockable tables and would always ensure a unidirectional patient flow. A collaborative group from R&D, Consulting, and FD conducted tests with a dockable table to further refine this second layout. In doing so, they balanced efficiency and staff experience, ensuring that neither aspect compromised the other.
In collaboration with the Oncology pre-development team, scanning protocols were optimized using AI-based reconstruction techniques, specifically Deep Resolve. This approach enabled the shortest possible scan duration while still maintaining optimal diagnostic image quality for screening. To further optimize the workflow, staff roles and responsibilities were redefined, and tasks were executed in parallel wherever feasible.
Ultimately, all these concepts were incorporated into the workflow simulation, serving as the digital twin of the new MRI breast screening facility. Various layouts, along with a diverse combination of parameters such as staff numbers, dockable tables, and changing rooms, were tested across multiple scenarios. Key Performance Indicators (KPIs) such as waiting times, throughput, and staff and room utilization were monitored during the simulation. These metrics were instrumental in evaluating and comparing the outcomes of each scenario.
Results & Potential Future Impact
The objective of matching the throughput levels of conventional mammography was not only achieved, but significantly surpassed. In the baseline scenario, only 4.1 patients could be examined per hour for each scanner. However, the innovative scenario that incorporated four dockable tables and three radiographers managed to scan an impressive 6.9 patients per hour per MR, all while maintaining the same levels of staff utilization.
Impressed by the simulation results, the Radboudumc team is currently examining the cost-benefit ratio at both micro and macroeconomic levels to further promote the idea of using MR as a screening modality for breast cancer. To foster a constructive dialogue within the scientific community based on quantitative data, a paper was authored by Radboudumc PhD student Lejla Koko, with team members from Siemens Healthineers as co-authors. The paper was published in the journal Investigative Radiology.