Mammography

A mammography exam, called a mammogram, is a specific type of X-ray image used to aid in the early detection and diagnosis of breast diseases. Three recent advances in mammography include digital screening mammography, computer-aided detection, and breast tomosynthesis. For more information, mammographysaveslives.org is a valuable online resource on mammography.

Annual screening mammography starting at age 40 results in the greatest mortality reduction, the most lives saved and the most life years gained (LYG). This is why the American College of Radiology and Society of Breast Imaging recommend regular mammography in women 40-and-older (including 40-49). For more information, please visit endtheconfusion.org.

Dr. Carroll is a fellowship trained breast radiologist with Arizona State Radiology. Follow her blog >"The Mammo Press - A Patient's Guide to Breast Imaging and Radiology" for discussion of commonly asked questions concerning breast imaging and radiology.

Digital 3-D Mammography/
Tomosynthesis

Currently available at:
Sierra Vista Diagnostics
Mount Graham Regional Medical Center

Breast tomosynthesis, also called three-dimensional (3D) breast imaging, is a new state of the art mammography imaging procedure. It utilizes X-ray technology that moves in an arch motion over the breast and takes an array of pictures from many angles. The information is sent to a computer, where it is assembled to produce highly focused, clear, three-dimensional images of the breast.

How Is a Tomosynthesis Procedure Performed?

The digital breast tomosynthesis procedure is very similar to standard screening mammogram exams. We make every attempt to make the procedure as comfortable for you as possible.

The standard 30-minute exam includes:

  • You will be given a hospital gown in place of your shirt.
  • You will be asked to lower your gown, and your breast will be placed in the scanner.
  • The screening unit will apply compression to hold your breast in position.
  • You will be asked to hold your breath while the images are captured.
  • The process will be repeated for the other breast.
  • After the exam you will be able to return to your normal activities.

Preparing for Your Tomosynthesis Procedure

The digital breast tomosynthesis procedures require minimal preparation. For your comfort, and the best imaging results we recommend the following:

  • The best time for a mammogram is 1 week following your period.
  • Avoid scheduling your mammogram for the week before your period, as your breasts are usually tender during this time.
  • Always inform technologist if there is any possibility that you are pregnant.
  • Do not wear deodorant, talcum powder, or lotion under your arms or on your breasts on the day of the exam.

Digital Screening Mammography

Digital screening mammography replaces the typical X-ray film with a specialized detector to capture the images digitally. The digital image can be seen on a computer monitor or printed. A standard digital screening mammogram captures two different views of each breast for review by your radiologist.

Diagnostic Mammography

Diagnostic mammography uses similar technology to screening mammography. The diagnostic mammogram captures multiple different views of the breast in question.

They aid your radiologist in further evaluation of a specific problem, including:

  • Breast lump
  • Breast pain
  • Nipple discharge
  • Patients with a history of breast cancer
  • To thoroughly evaluate an area of concern identified from the screening mammogram

Computer-Aided Detection (CAD) for Mammography

Computer–Aided Detection for mammography is a unique imaging system that uses the image obtained from a mammogram to help the radiologist analyze suspicious areas found during the exam. The CAD software identifies possible areas of abnormal density, mass, or calcification that may indicate the presence of cancer. The interpreting radiologist will use this information, in conjunction with their specialized breast imaging training to determine if additional imaging is needed.

How Is a Mammogram Performed?

The typical mammogram takes approximately 30 minutes. We strive to make the scan as pleasant as possible. Please let us know if you are uncomfortable during the exam, and describe any breast symptoms to the technologist performing the exam.

We understand that breast compression may be uncomfortable, however the compression is absolutely necessary to obtain the best possible image for the radiologist to evaluate for subtle changes that may represent a new breast cancer.

The typical exam includes:

  • You will be asked to replace your shirt with a hospital gown.
  • You will be asked to lower your gown, and your breast will be placed on a special platform in the screening unit.
  • The screening unit will gradually compress your breast.
  • You will be asked to hold your breath while the image is captured.
  • You will be asked to change positions between images.
  • The process will be repeated for the other breast.
  • After the exam you will be able to return to your normal activities.

Preparing for Your Mammogram

Preparation for your mammogram is minimal. We recommend the following tips to make the exam as comfortable as possible:

  • Avoid scheduling your mammogram for the week before your period, if your breasts are usually tender during this time.
  • The best time for a mammogram is 1 week following your period.
  • Always inform technologist if there is any possibility that you are pregnant.
  • Do not wear deodorant, talcum powder, or lotion under your arms or on your breasts on the day of the exam.

Breast Ultrasound

A breast ultrasound uses sound waves to take images of internal structures in the breast. The breast ultrasound exam provides valuable information for your radiologist. Currently, breast ultrasound is used to follow up on abnormal mammogram results and to further evaluate a specific problem in the breast including a palpable finding, focal breast pain, or nipple discharge.

Breast ultrasound can also be used to guide radiologists during a breast biopsy. The ultrasound imaging technique provides real time moving images allowing for accurate positioning of the biopsy needle in the area of concern.

A breast ultrasound can also be used to perform an ultrasound-guided breast biopsy. The ultrasound imaging technology assists the radiologist during the biopsy procedure.

How Is a Breast Ultrasound Procedure Performed?

The breast ultrasound examination usually takes 30 to 60 minutes to complete. The procedure is painless and noninvasive. You may return to your normal activities after the exam.

Your technologist will guide you through the ultrasound exam, which generally involves:

  • Changing into a hospital gown
  • Reclining on an exam table
  • Having a clear gel applied to your breast

The handheld wand is then gently moved through the gel as an image is displayed on a computer monitor in real-time.

Preparing for Your Ultrasound Procedure

We strive to make your ultrasound as pleasant as possible. Please let us know if you have any questions or concerns. Minimal preparation is needed for your breast ultrasound procedure.

A few helpful hints include:

  • Please discuss any symptoms or problem areas with your technologist before the exam begins.
  • You may eat and drink as normal.
  • You should continue to take your medications.

Breast MRI

Breast Magnetic Resonance Imaging (MRI) provides detailed images of the breast to assist radiologists in the diagnosis and treatment of breast disease. The images will be viewed on a computer monitor and evaluated by the radiologist using breast MRI specific software, including Computer-Aided Detection (CAD) to assist the radiologist in interpreting the MRI examination.

In addition, breast MRI is often used in conjunction with other imaging modalities, such as mammography or ultrasound to make a final diagnosis.

Breast MRI is most often used as:

  • An additional screening option for women who are at high risk for developing breast cancer
  • For further evaluation of a biopsy proven cancer
  • Monitoring the treatment response for women undergoing chemotherapy prior to surgery to remove a known cancer

A breast MRI can also be used to perform an MRI-guided breast biopsy. The MRI imaging technology assists the radiologist during the biopsy procedure.

How Is a Breast MRI Performed?

A breast MRI procedure takes approximately 60 minutes, and will require the use of a contrast agent.

Generally, a breast MRI follows this process:

  • You will be given a hospital gown.
  • An intravenous (IV) line will be started in the hand or arm for injection of the intravenous contrast.
  • You will be positioned, face down on a mobile bed, with your breasts positioned through cushioned openings.
  • The bed will then be moved into the magnet of the MRI machine.
  • During the scanning process, a loud clicking noise will be heard.
  • It will be very important for you to remain very still during the examination, and you may be asked to hold your breath for a few seconds during imaging.
  • Once the scan has been completed, the table will slide out of the scanner and you will be assisted off the table.

Preparing for Breast MRI Procedure

There is limited preparation for your breast MRI procedure.

  • You do not need to fast.
  • You should continue medications.
  • Please remove any metal objects.
  • Women should always inform their technologist if there is any possibility of pregnancy.

Please inform your doctor or the technologist if you have any of the following that may prevent you from undergoing an MRI exam:

  • Pacemaker
  • Aneurysm clips
  • A history of working with metal
  • Implanted drug infusion device
  • Metallic plates, pins, screws, or other implants (usually do not cause a problem if they have been in place more than 4 to 6 weeks)

Ultrasound-Guided Breast Biopsy

An ultrasound-guided breast biopsy utilizes ultrasound technology to guide the radiologist to collect tissue samples from an area of concern within the breast. The ultrasound technology allows the radiologist to view a real-time image of the lesion and the biopsy needle to ensure a sample is collected from the appropriate location. This minimally invasive procedure is performed using a local anesthetic, and most patients can resume their normal activities following the procedure.

Stereotactic (X-ray Guided) Breast Biopsy

A stereotactic breast biopsy utilizes a digital mammography X-ray machine to pinpoint the location of the mammographic abnormality. The radiologist uses the location coordinates to insert the needle through the skin, advance it into the area of concern (often calcifications), and remove small tissue samples for evaluation. Additional images are obtained to ensure the needle reached the targeted biopsy area. This minimally invasive procedure is performed using a local anesthetic, and most patients can resume their normal activities following the procedure.

MRI-Guided Breast Biopsy

An MRI-guided breast biopsy is a minimally invasive breast biopsy technique that utilizes MRI imaging to identify areas of suspicious breast tissue, and collect a small sample using a needle. The use of MRI imaging helps to pinpoint the exact location of the suspicious tissue and confirms the radiologist is at the specified location to collect the tissue sample using a needle.