Breast Imaging

A mammogram is an x-ray of the breast that allows a radiologist to evaluate the anatomy of the breast and detect cancer before it can be felt by you or your physician. It is safe and uses low radiation dose, similar to the amount of radiation you would receive on a cross-country flight in the US. Screening mammography is important because earlier detection of breast cancer allows for easier treatment, improved outcomes and reduced breast cancer deaths.

Tomosynthesis is essentially a 3D mammogram of the breast which allows for improved ability to detect cancer early. It is the standard of care in our health system.

The American Cancer Society (ACS) and American College of Radiology (ACR) recommend all average risk women begin screening mammograms starting at the age of 40. This should then be continued annually for the rest of your life or as long as you are able.

New American College of Radiology (ACR) guidelines call for women over the age of 25 to be assessed for high lifetime risk of breast cancer, particularly black and Ashkenazi Jewish women. This will determine whether breast screening examinations should be performed earlier than age 40. Women with lifetime risk greater than 20%, genetics based increased risk or exposure to chest radiation at young ages are recommended to undergo annual screening MRI beginning at age 25-30 or annual mammography between age 25-40 depending on the type of risk.

Your screening mammogram will be performed by a certified radiologic technologist (RT) who has undergone special training to obtain high quality images of the breast and works closely with the radiologist who interprets the images. The technologist will position your breast on the plate of a machine that provides gentle compression and obtains the radiographic images of the breast. The compression is important to spread out the tissue, reduce radiation dose and reduce blurring of the image. You should expect at least two pictures of each breast with the machine in different positions for a standard screening mammogram. The examination usually takes about 15-30 minutes.

Please avoid wearing deodorant, skin powders or perfumes. Please remove jewelry and nipple piercings if able.

Please bring prior imaging if performed at an outside institution. Mammography is optimally performed when comparison images are available to detect subtle changes over time.

A diagnostic mammogram is an x-ray of the breast that often targets a specific area of concern with extra magnification or compression. It is similar to a screening mammogram but often targets a specific area of concern with extra magnification or compression views to help the radiologist discern whether there is a true abnormality in the breast. Usually this will require more images than a screening mammogram to help the radiologist troubleshoot the area of concern. Occasionally, the interpreting radiologist will ask for additional images even after some images have already been obtained. This can take up to 30 minutes.

Breast ultrasound involves a small handheld probe which emits sound waves to make images of the tissue within the breast. This requires a sonographer or radiologist passing a probe over the skin in the area of interest and obtaining images on a screen for review.

A sonographer and sometimes a radiologist will roll an ultrasound probe on the skin over the area of interest and obtain images on a screen. There will be a thin layer of gel between the probe and your skin to allow for clear imaging. There is no radiation exposure with an ultrasound examination.

A breast MRI uses a large bore magnet to create highly detailed images of the breast tissue. It is used in conjunction with conventional breast imaging (mammogram and ultrasound) for detailed evaluation of breast health.

The actual scan time is usually around 15-30 minutes. The appointment slot may be booked for longer, however. Please arrive 30 minutes before your appointment check in.  You will be lying face down on a table with your breasts placed though openings in the table where the special breast magnet sits. Your sternal region should be padded.

Breast MRI requires contrast material called Gadolinium injected through an IV. This helps make certain problems such as cancer or infection/inflammation stand out against the background breast tissue so the radiologist can see them more clearly and make an accurate diagnosis. The benefits of contrast use typically outweigh any risks, though we assess your individual risk prior to giving the contrast. If MRI is being performed only to assess silicone implants, then contrast will not be required.

Breast MRI is performed for patients that meet specific criteria. This includes high risk patients, complex cases, and sometimes for those with dense breast tissue.

ABUS is a machine that is placed over the breast and obtains 3D ultrasound images of the entire breast. It is FDA approved, noninvasive, painless and involves no radiation. It is used as a supplemental screening tool in conjunction with mammography in patients with dense breast tissue. It has been shown to improve detection rates for breast cancer when used with mammogram.

You will be lying flat on your back which will allow your breast tissue to spread out evenly. The technologist will place a sponge under your hips to achieve adequate positioning. Ultrasound gel will be applied to the breast and nipple. A curved transducer device will be placed on one breast which will feel like gentle compression. Imaging will be obtained over approximately 40 seconds. The transducer will then be moved multiple times (usually at least three different positions per breast) and additional sets of images will be obtained. This will be repeated for the other breast. The entire procedure should take around 15 minutes. The radiologic technologist will be with you throughout the procedure.

ABUS can be considered in asymptomatic patients with dense breast tissue. The screening mammogram will inform the patient whether they have dense breast tissue. The need for ABUS should be a discussion between the patient and their provider.