It’s fairly common for Kitsap Peninsula residents to drive across the Tacoma Narrows Bridge or take the ferry across the water for medical services — even though in many cases they are available locally — but one Kitsap practice is seeing the reverse commute. Poulsbo-based InHealth Imaging (www.inhealthimaging.com) has been popular with the Seattle crowd recently, thanks to its cutting-edge thyroid-cancer screening.
Dr. Manfred Henne, the founder and managing member at the independent practice, began offering a new type of fine needle aspiration (FNA) analysis for thyroid nodule assessment about two months ago. Henne was the first radiologist in Western Washington to offer the Afirma thyroid FNA test, in partnership with San Francisco-based research company Veracyte.
Fine needle aspirations are performed on thyroid nodules (lumps) in order to obtain biopsy samples. When the results come back as indeterminate, a second biopsy is usually performed. When final results are still indeterminate (which is about 15 percent of the time), physicians recommend the thyroid to be removed — but only 15-20 percent of the removed tumors actually turn out malignant.
Henne said the Afirma analysis has a 95 percent or better predictive rate. “The result is, you have fewer repeat fine needle aspirations and eliminate repeat biopsies,” he said. The analysis also eliminates the need for unnecessary diagnostic surgery, he added.
One of Henne’s patients had an FNA performed three times, with the results indeterminate each time. The patient learned about the new test after researching options, and Henne felt it was something he wanted to offer. The FNA procedure is not much different from the traditional — he simply has to assemble the specimen in two different vials, one to be used for biopsy and the other for molecular analysis. The DNA analysis is looking for specific genes involved in thyroid malignancy — it measures the activity level of 142 genes — and classifies the tumor as either benign or suspicious for cancer.
Dr. Bryan Haugen, head of the Veracyte trial at University of Colorado-Denver, told the International Thyroid Congress last September that the initial tests showed the analysis had a false negative rate of four percent, the same rate of the false-negative and false-positive from biopsy results. In the fall, about 50 medical sites throughout the country conducted further clinical trials, and results are expected to be published soon.
Staying on the Cutting Edge
Kelle Kitchel-Cooper, director of development at InHealth Imaging, said the Afirma test has been sought after by patients from the Seattle area, including software company executives looking for the most current options. But this is not the first time Henne has been on the cutting edge, especially as a solo practitioner. His diagnostic and preventative imaging services range from MRIs, MRAs (including 3-D reconstruction MRA) and CTs to ultrasounds, nuclear medicine and osteoporosis screening, but he also offers special procedures such as CT-guided pain management, the only radiologist on the Kitsap and Olympic peninsulas to do so. In addition to upgrading a lot of its technology, InHealth Imaging also implemented a Picture Archiving Computer System (PACS) that allows all physicians to log in remotely to see their cases instantly.
In a couple of months, Henne will be at the forefront again. InHealth Imaging is in the process of adding a three-dimensional mammography system. The technology, called Selenia Dimensions system and manufactured by Hologic, was approved by the Federal Drug Administration in February. It was pioneered at Massachusetts General Hospital, and Henne’s practice is the first one to adopt the technology in Puget Sound and possibly on the entire West Coast.
Dr. Elizabeth Rafferty, who led the implementation of the system at MGH, was quoted as saying, “Like flipping through the pages of a book, the radiologist is able to look at one page at a time instead of seeing the whole breast reduced to a single frame, as is the case with standard mammography.”
Three-dimensional mammography, known as tomosynthesis, uses a procedure similar to the traditional mammogram and it doesn’t cost extra. But the radiologist can see the tissue in detail that wasn’t possible before, in one-millimeter slices at a time; this results in less need to come for additional views as well as in more precise diagnosis.
“It’s really devastating to miss a breast cancer diagnosis as a radiologist. I learned over the years it’s not benefitting the patient population to wait on the technology to be widespread,” Henne said. “I don’t want to wait until they ask me to do it, I wanted to bring it to the community now.”
Growing Practice
Born in Germany, Henne received a doctorate degree in physics (and had several patents) prior to going to medical school. The change in careers was the result of his desire to work outside of a lab and connect physics with medicine while helping prevent illness. He moved to the United States for a radiology residency and later completed a fellowship in radiology as well. He founded his practice on the Kitsap Peninsula 12 years ago.
InHealth Imaging, which has a total of about 25 staff, also has offices in Silverdale and at North Kitsap Urgent Care and is open seven days a week including after hours to accommodate working professionals. A new location will be added on Bainbridge Island in April or May. In the meantime, the main office, at North Kitsap Medical Center, is beginning a renovation to add more space along with a component focused on wellness and education.
Henne said he wanted to have an independent practice because he likes working in a small setting. The disadvantage is that he has added risks — he has to sign a personal guarantee, for example, when he invests into new equipment, some of which costs more than $1 million. But he compares his work to that of a chef who has his own restaurant instead of working for someone else — adding cutting-edge equipment being one example, because he doesn’t have to go through a board or other decision makers to implement it.
Kitchel-Cooper said the main advantage is structuring the business so it’s patient-centric. Besides using the latest technology, Henne offers another unusual option: Any patient is welcome to meet with him after imaging to discuss the results instead of waiting to talk to his or her physician.
She noted that many of the services are less expensive at InHealth because there is no additional “facility fee” charged by imaging labs that are affiliated with a hospital. The office also has a dedicated line for patients to call and find out the complete cost of a procedure (since the fees cannot be publicized).
“You really don’t have to take the ferry anymore (for services),” she said. “…I think healthcare here is as good as in Seattle, and there’s more personalized care.”
