RSNA Program Expands Breast Imaging Training
Global Learning Center experience in Indonesia informs model published in Radiology: Imaging Cancer
When RSNA brought its Global Learning Center to Cipto Mangunkusumo National Referral Hospital – Faculty of Medicine Universitas Indonesia (FKUI/RSCM) in Jakarta in 2023, the goal was to address a clear need for breast imaging training in Indonesia.
Three years later, the initiative has produced more than local gains: It helped establish the country’s first comprehensive breast radiology training curriculum and generated a model now described in Radiology: Imaging Cancer for other low-resource settings seeking to expand breast imaging capacity.
For Windu C. H. N. Suryaningrat, MD, a radiologist at the facility in Jakarta who was completing the final year of her residency when the program began, the need was immediate and familiar. “We were mostly learning about ultrasound and mammography, because those were the examinations we encountered most often,” Dr. Suryaningrat recalled. “Breast MRI was still rarely performed, so our exposure to the modality during residency was very limited.”
Now in practice, Dr. Suryaningrat said one of the most frustrating limitations she has experienced is that breast localizations and image-guided biopsies are typically performed by surgeons. That separation can make it difficult for radiologists to follow cases through diagnosis.
“Because surgeons do the biopsy, they get the pathology anatomy results,” Dr. Suryaningrat said. “As radiologists, we don’t get the chance to correlate between the image finding and the pathology to see the result of these risk cases.”
The arrangement also reflects a broader need for stronger multidisciplinary cooperation among the teams involved in breast cancer care, she noted.
For a low-to-middle-income country where women typically present with breast cancer already in the advanced stages of disease, the implications of these knowledge and practice gaps are clear and unfavorable.
Building a Curriculum for Local Needs
For the RSNA volunteer team who partnered with the host team at FKUI/RSCM to develop and deploy the GLC initiative, the conditions signaled an opportunity to introduce new systems and skills that would position radiologists to expand their scope of practice and, ultimately, improve patient outcomes. The goal was not only to strengthen breast imaging expertise in Indonesia, but also to develop a collaborative training model that could guide similar efforts after the GLC initiative officially ended in 2025.
To get there, the team began with a comprehensive needs assessment to identify Indonesia’s specific training gaps and clinical needs. Similar GLCs had been implemented in other locations, including Tanzania, giving the team a foundation to build from.
“It’s great to look at what the GLC accomplished in other countries,” said Stefanie Woodard, DO, associate professor and section chief of breast imaging and intervention at the University of Alabama at Birmingham. “What worked, what didn’t work?”
At the same time, every site is unique, making it difficult to take one program and apply it wholesale elsewhere. “The cultures are different; the capabilities are different; the facilities are different; the equipment is different and the level of baseline knowledge is different,” explained Dr. Woodard, who served on the volunteer team as a faculty member for the GLC.
Lessons learned from earlier projects, combined with the needs assessment and input from local physicians such as Dr. Suryaningrat, helped lay the foundation for a tailored solution.
What took shape was Indonesia’s first comprehensive breast radiology training curriculum, rolled out in phases over a three-year period.
“First, it was about providing the tools and developing a program for breast-specific training,” Dr. Woodard said. “Then, it was about introducing skills to create a dialogue between the surgeons and the radiology group to increase the procedural training.
The next step, she said, was to support multidisciplinary collaboration so radiology could play a larger role in breast cancer care.
“It was about forming these multidisciplinary collaborations where they can have more team discussion and involve radiology more in breast cancer care,” Dr. Woodard said.
The potential benefits were significant: improved diagnostic accuracy, earlier detection, reduced need for surgical biopsies, standardized treatment and improved care coordination.
Education was delivered in multiple formats, including dozens of didactic lectures, case-based discussions and procedural labs. Sessions also included reflection questions designed to gauge knowledge gains and encourage participants to consider strategies for applying new skills in practice.
Dr. Suryaningrat said even the earliest coaching under the GLC was valuable, particularly as radiologists worked to build US-guided or image-guided biopsy skills. “If we can do the biopsy, the placement or localizing in our department or as radiologists, we can get to the definitive diagnosis—whether it’s malignant or benign—in a shorter period of time,” she said.
Dr. Woodard said the program’s impact was evident in lab observations and in quiz scores before and after education sessions. “The learning was bi-directional, not one-way,” Dr. Woodard said. “It wasn’t like one group teaching the other. It definitely was a collaboration.”
For the RSNA volunteer team, she said, the experience offered its own value. “The educational benefits I received from it are unmatched,” she said. “You’ll never have such a great learning opportunity as you do when you’re learning completely different ways of doing things.”
Extending the Model Beyond the GLC
The Radiology: Imaging Cancer paper, led by Dr. Woodard, documents how the team developed and implemented the curriculum, including the sessions, topic organization and lessons learned from the three-year effort.
“It’s sort of our template for a reproducible action plan,” Dr. Woodard said. “It’s really helpful to have this publication to show people how we set the training program up.”
“By listing the topics and curriculum structure, the article gives other teams concrete information they can adapt to their own settings,” she said. “If you’re looking for a syllabus, you could use some of these.”
Although the GLC has completed, its impact continues through expanded knowledge sharing. Dr. Woodard said radiologists from hospital systems beyond FKUI/RSCM joined educational sessions by videoconference, extending the reach of the program beyond the primary site. Several trainees also went on to continue related work with U.S.-based teams as a direct result of the program.
Dr. Suryaningrat, now fully immersed in her faculty role, is eager to pass along what she learned to her own students. Because her facility rarely sees real cases involving image-guided biopsy, the curriculum now includes a requirement for yearly training in US-guided biopsy under faculty trained in the technique.
“I had the opportunity through RSNA to do an observership at Emory University,” she shared. “At that time, I got the chance to see many cases from the U.S. stereotactic and MRI procedural perspective. I hope that in the future, after I provide training to my residents, they can do the same in their hospitals.”
For More Information
Access the Radiology: Imaging Cancer editorial, “A Global Partnership to Address Breast Cancer Challenges in Indonesia through a Breast Radiology Training Program.”
Read previous RSNA News stories on global health: