This case study explores the BreastScreen NSW virtual assessment clinic in greater southern NSW.

This virtual model of care provides women living in regional and rural areas with access to remote multidisciplinary and specialist care.

On this page

About BreastScreen NSW

Breast cancer is the most commonly diagnosed cancer in Australian women. The BreastScreen NSW program aims to detect breast abnormalities early. The program actively invites women between 50 and 74 years for screening mammogram every two years, with a follow up assessment if any abnormalities are found. The service is accessible to women age 40-49 and over 75 years.

BreastScreen NSW assessments occur at a multidisciplinary clinic. Clients have diagnostic tests including mammography, ultrasound, clinical examination and needle biopsy to assess the abnormality found at screening. BreastScreen NSW must aim to complete the follow up of clients with abnormalities within standardised nationally governed timeframes to make sure that women receive results in a timely fashion.

Outside of metropolitan areas it may not always be possible to have a suitably qualified Breast Radiologist available on site to achieve the required timeframes, while maintaining the same high-quality level of care. This was an issue that the BreastScreen NSW team wanted to address.

Trialling a virtual model of care

In 2016, BreastScreen NSW participated in a national research project, commissioned by BreastScreen Australia (BSA) and the National Quality Management Committee, to evaluate a service delivery model for virtual radiology. The research was undertaken by James Cook University.

The research project found that the virtual radiologist assessment model is safe and effective. It is clinically equivalent to the onsite assessment model in terms of cancer detection and has significantly improved timeliness to assessment and recommendation for care. This model has minimised the anxious waits for women recalled for further assessment. From the client’s perspective, there was no greater time to wait for the assessment outcome conducted under the virtual radiologist model compared to face to face assessment.

‘Since 2016 our service has improved compliance with the National Accreditation Standard for time from a screening mammogram to assessment outcome. Now more than 91% of women are assessed within 28 days of their screening mammogram. Utilizing the remote model has contributed to this result.'

Ensuring equitable access for women in regional NSW

As part of this study, BreastScreen NSW set up a virtual assessment clinic for women in greater southern NSW. The assessment radiologist is remote from the assessment clinic and has access to a reporting workstation with videoconference capability.

This image shows the sonographer at Queanbeyan conducting the ultrasound scan. The radiologist can watch the ultrasound in real time on their remote camera linked to the ultrasound machine. The sonographer and radiologist can communicate during the scan if the radiologist wants to relook at an area or ask for a specific spot on the scan.
This image shows the radiographer in Queanbeyan with the x-ray machine. Mammographic images from this machine are uploaded into the BreastScreen picture archiving and communication system (PACS) and are available to the radiologist within minutes of taking the mammogram pictures. The radiologist can then decide if additional images are required or go on to ultrasound while the woman is still in the x-ray room.

Improving experiences of care

Clients attending virtual assessment clinics have provided feedback to the greater southern service. More than 95% of women felt their assessment clinic attendance was the same as if they had attended a clinic with an onsite radiologist. Feedback regarding perceived anxiety suggested it was no different from wait times to attend regular assessment clinics and during the regular assessment clinic process.

Clients reported high satisfaction with their clinic experiences, high confidence in care being received and positive feedback regarding the support systems offered. 92% of clients were very satisfied with the virtual clinic, 8% were satisfied. The majority of clients had no preference for either the onsite or remote model, indicating their acceptance of the virtual assessment clinic model.

Patient quotes

  • ‘I felt comfortable. The facilities are great. I have had a good, positive experience.’
  • ‘It was all handled quickly. It reduced my anxiety getting an appointment for the biopsy promptly as this was my main concern.’
  • ‘I was happy with everything.’
This image shows Dr Nalini Bhola, BreastScreen NSW, Greater Southern Designated Radiologist and BreastScreen NSW Statewide Clinical Director, conducting the virtual multidisciplinary meeting with the radiographer and clinic co-ordinator in Queanbeyan. The clinical team and Dr. Bhola are able to meet frequently throughout the clinic to discuss the cases as new imaging is provided.

Table 1: BSA National Accreditation Standard 4.2.1 more than 90% of women should be assessed within 28 days of their screening attendance

CY 2015/16CY 2019/20June 1 to Dec 31, 2020
2423 women were recalled for further imaging 2893 women were recalled 11% of women recalled in 2020 were seen via the remote radiologist model
87.21% of women were assessed within 28 days of their screening mammogram 91.19% of women were assessed within 28 days of screening 91.98% of women were assessed within 28 days
It took the service 31 days to reach the standard of 90% (State average 34 days) The service reached the standard within 28 days (State average 31 days) The service reached the standard within 27 days
(State average 29 days)
92.53% of women were offered an appointment within the timeframe 96.27% of women were offered an appointment within 28 days 96.07% of women were offered an appointment within 28 days

Client acceptance of the model supports continuation of the virtual assessment clinic at Queanbeyan and expansion to other sites across the state.

The findings from this research can inform future virtual care, particularly where key health care team members are working remotely.

For more information about the BreastScreen NSW remote assessment clinic, contact: Beverlee Macdonell-Scott

File Size: 426 kb
Type: Brochure
Date of Publication: 21 April 2021
SHPN: SHPN (SRPB) 210356