Digital Screening and Diagnostic Mammography
What is Mammography?
Mammography, also known as a mammogram, is the examination of the breast using x-rays. Mammography is considered the most effective tool for early breast tumor detection. Most medical experts agree that successful treatment of breast cancer often is linked to early diagnosis. Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to three years before a patient or physician can feel them.
Kootenai Imaging uses 3D digital mammography. Also known as digital breast tomosynthesis, 3D mammography allows the radiologist to scroll through the breast tissue like the pages of a book. They can alter the orientation, magnification, brightness and contrast to produce images of the breast that significantly improve cancer detection. Computer-aided detection, or CAD, uses a digitized mammographic image to search for abnormal areas of density, mass, or calcification that may indicate the presence of cancer. The CAD system highlights these areas on the images, alerting the need for further analysis.
What are the advantages of 3D mammography and computer-aided detection?
- Compared to conventional mammography, 3D mammography improves visualization of the breast tissue, reduces the need for additional “callback” images, and significantly improves cancer detection.
- The superior contrast resolution of 3D mammography and its ability to manipulate images make for more accurate detection of breast cancers.
- Computer-aided detection, or CAD, obtains a second, computerized reading in the hope of finding more cancers or more accurately gauging signs of malignancy.
- Digital mammograms can be archived in various ways, easily retrieved, and copied.
How often should I have a mammogram?
Current guidelines from the American College of Radiology(ACR) recommend screening mammography every year for women, beginning at age 40. Please call your insurance company’s customer service phone number to discuss your mammography benefit limits.
The National Cancer Institute (NCI) recommends that women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and about the frequency of screening.
When should I schedule my mammogram?
Before scheduling a mammogram, you should discuss problems in your breasts with your doctor. In addition, inform your doctor of hormone use, any prior surgeries, and family or personal history of breast cancer. Generally, the best time is one week following your period. Do not schedule your mammogram for the week before your period if your breasts are usually tender during this time. Always inform your x-ray technologist if there is any possibility that you are pregnant.
How should I prepare for a mammogram?
On the day of the exam:
- Do not wear lotion, deodorant, or powder under your arms or on your breasts
- Describe any problems you’re experiencing with your breasts with your technologist
- Remove all jewelry and clothing from the waist up. You will be given a gown that opens in the front.
What can I expect during the procedure?
To image your breast, an x-ray technician will position you near the machine and your breast will be placed on a platform and compressed with a paddle. Breast compression is necessary in order to:
- Even out the breast thickness – so that all of the tissue can be visualized.
- Spread out the tissue – so that small abnormalities won’t be obscured.
- Allow use of a lower x-ray dose.
- Hold the breast still – to eliminate blurring of the image caused by motion.
- Reduce x-ray scatter – to increase picture sharpness.
The technologist will go behind a glass shield while making the x-ray exposure. You will be asked to change positions slightly between views. The process is repeated for the other breast. Routine views are a top-to-bottom and side view.
What will I experience during the procedure?
The exam takes about half an hour. The technologist will apply compression on your breast and, as a result, you will feel pressure on the breast as it is squeezed by the compressor. Some women with sensitive breasts may experience some minor discomfort. Be sure to inform the technologist if pain occurs as compression is increased. If discomfort is significant, less compression will be used.
What is a breast ultrasound?
Ultrasound uses sound waves to generate a picture of the breast tissue. No compression is necessary. Ultrasound is particularly useful in telling cysts from solid masses in the breast. Cysts are very common and totally benign; about half of all women have some cysts in their breasts at some point. Ultrasound is also very helpful in characterizing masses and lumps.
What happens if they find something in my breast?
Sometimes we do find a lesion that requires a biopsy to find out what it is. Fortunately, the vast majority of breast biopsies can be accurately performed with a needle and do not require surgery. Depending on the finding, a needle biopsy is performed, using either stereotactic (mammogram), ultrasound, or MRI guidance.
What is Breast MRI and how is it useful?
MRI is a technique using a very strong magnet and radio waves to pick up signals from the breast tissue. We use state-of-the-art equipment including a dedicated bilateral breast surface coil. The patient lies face-down within the scanning field for approximately 25 minutes. The primary way that abnormal tissue stands out on MRI is because it gets more blood flow than the remaining tissue. We can detect blood flow by taking images before and after infusion of an intravenous substance (gadolinium) that is easily seen on MRI. Breast MRI is most useful in detecting breast cancer and evaluating the integrity of implants. Breast MRI is often employed in patients with a known breast cancer in whom there is concern about how extensive the disease is. Annual screening breast MRI is also recommended for women with a greater than 20% lifetime risk of developing breast cancer. Women are encouraged to discuss their individual risk with their healthcare provider.
Who reads the Breast MRI exams?
Radiologists who are specifically trained in MRI of breast-related diseases will interpret the study. We also utilize a special computer-assisted detection (CAD) program designed for the processing and interpretation of Breast MR Images. Because we utilize breast imaging specialists, we can achieve maximal integration of breast imaging studies so that the patient achieves the best possible care.
How is a Breast Biopsy done?
Stereotactic-Guided Breast Biopsy – The stereotactic table is specially designed so that you can lie face down with one breast positioned through a hole in the table. Two digital x-ray images are taken from different angles, allowing the radiologist to precisely localize the area to be biopsied. Once the area has been located, the radiologist numbs the area with a local anesthetic, then, uses computer guidance for precise needle placement and collection of small tissue samples.
Ultrasound-Guided Breast Biopsy – The radiologist uses ultrasound to locate the area for biopsy and to direct the needle used in collecting breast tissue samples.
Both methods are as accurate as a surgical biopsy and are performed on an outpatient basis, taking less than an hour to perform and requiring no stitches. Furthermore, the patient can resume normal, non-strenuous activities immediately after the procedure is done. The samples are sent to the pathology lab for analysis. Results are usually available within 3 business days.
MRI-Guided Breast Biopsy
An MRI-guided breast biopsy is a non-radiation, minimally invasive technique used to gather tissue samples from a breast MRI abnormality. Sometimes these abnormalities turn out to not be a problem. If there is a potential problem, early detection is essential and increases treatment options and the likelihood of successful recovery.
What will the procedure be like?
An MRI-guided breast biopsy can take from 45-75 minutes. During this time, you will be lying still on your stomach on a scanning table and your breasts will hang through a depression in the table. Just as with a breast MRI, radio frequencies and a strong magnet are used in conjunction with contrast material to create highly detailed pictures of the breasts. As the procedure begins, you will hear a variety of muffled thumping and beeping sounds that will last for several minutes.
After the initial series of images has been taken, it is likely that you will be given a contrast fluid, intravenously, through a small IV catheter. Additional images will then be taken.
Once the abnormality is located, a radiologist will clean the area and inject a local anesthetic into the skin and deeper tissues to numb the area. A very small skin incision – approximately 1/4 inch – will be made.
The radiologist will then use imaging techniques to locate the abnormality and extract several tissue samples to be sent to and interpreted by a pathologist. After the tissue is removed, a small metallic marker will be placed. This marker is a reference point for the future and confirms that the area of concern has been biopsied. Following your procedure, you will have a mammogram to document the position of the marker.
Some women experience minor discomfort during this procedure. Others experience no discomfort at all.
A ductogram, also called a galactogram, is a test done if you are having persistent nipple discharge from a single duct, and your mammogram is normal. A tiny tube is inserted into the duct and a tiny amount of iodine contrast dye is injected into the duct. Several mammogram pictures are then obtained, with the ducts outlined by the iodine contrast dye. This shows whether there is anything inside the duct which could be producing the discharge. Most women report that this is not painful. When the duct is filled with fluid, you may feel a cramping sensation similar to what many women experience with their menstrual cycle.
Osteoporosis Screening (DEXA)
What is DEXA?
DEXA, performed using x-ray, is an exam used to measure bone loss. It is the established standard for measuring bone mineral density (BMD).
How should I prepare for a DEXA?
You can eat normally on the day of your exam. Please wear loose, comfortable clothing and avoid anything that has zippers, belts, buttons, or anything made of metal. You may be asked to remove your jewelry, eye glasses and any other metal objects before the exam. You may also be asked to remove your clothing and put on a gown.
Should I get a bone density screening exam?
Your physician should determine whether a DEXA is appropriate for you. If you have concerns about your bone density, please talk to your primary care physician about which test is best for you.
Who interprets the results?
A board certified radiologist will analyze the images and send a signed report to your primary care or referring provider, who will share the results with you.