Breast Imaging

Breast imaging exams can use a variety of technologies, including x-ray based mammography, sound-based ultrasound, and magnetic-based MRIs. Furthermore, when suspected irregular growths require lab analysis to determine what type of cells are involved, computerized x-ray or ultrasound technologies provide images to guide needle biopsies that extract the cells for examination. The following paragraphs describe the procedures as they are performed at Santa Fe Imaging.

Digital Mammography

What is Mammography?

One of the best known of breast imaging exams, mammography uses x-rays and specially-designed equipment to provide diagnostic images of breast tissue. It is considered the most effective tool for early breast tumor detection, and most medical experts agree that successful treatment of breast cancer often is linked to early diagnosis. Mammography plays a particularly important part in early detection of breast cancers because it can show changes in the breast up to two years before a patient or physician can feel them.

SFI uses digital mammography, which allows the radiologist to alter orientation, magnification, brightness and contrast to produce images of the breast that can be seen on a computer screen. Computer-aided detection, or CAD, then uses a digitized mammographic image to search for abnormal areas of density, mass, or calcification that may indicate the presence of cancer, and CAD highlights these areas for analysis.

What are the advantages of digital mammography?

• TIME: Conventional screening mammography generally takes 10-15 minutes, while digital mammography images are usually taken in less than 5 minutes.
• CLARITY: The superior contrast resolution of digital mammography and its ability to manipulate images provide precise data that facilitates earlier and more accurate detection of breast cancers.
• The CAD advantage: Computer-aided detection, or CAD, obtains a second, computerized reading in the hope of finding more cancers or more accurately gauging signs of malignancy.
• ACCESS: Digital mammograms can be archived in various ways and are easily retrieved, and copied as medical practitioners evaluate treatment.

How often should I have a mammogram?

Current guidelines from the American Cancer Society (ACS), the American Medical Association (AMA) and the American College of Radiology (ACR) recommend screening mammography every year for women, beginning at age 40. 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 should I expect during this exam?

To image your breast, a technologist 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:

• Spread out the tissue - so that small abnormalities won't be obscured.
• Allow use of a lower x-ray dose.
• Even out the breast thickness - so that all of the tissue can be visualized.
• 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?

A Screening Mammogram takes about 5 minutes; a Diagnostic Mammogram around 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 compression paddle. 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.

Diagnostic Mammogram

Diagnostic mammograms are specialized mammograms designed to solve a particular problem. The radiologist designs each exam in order to answer the particular question at hand.

Reasons to have a diagnostic mammogram:

• Question arising from a screening mammogram
• Breast symptom such as a lump, focal breast pain or nipple discharge
• Follow-up exams
• Personal history of breast cancer

How is a Diagnostic Mammogram different from a screening mammogram?

In addition to the four views obtained in a screening mammogram, there are many specialized views that are possible to further investigate a finding. The most common view is called a "spot compression magnification" view. This is a magnified view of a particular area of the breast. The radiologist may also want to do an ultrasound for another view.

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.

Breast MRI: Magnetic Resonance Imaging of the Breast

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 a question about how extensive the disease is. Medical indications (reasons) for breast MRI are evolving, and are the subject of many studies around the country.

Breast Biopsy

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 biopsied. Once the area has been located, the radiologist numbs the area with a local anesthetic, and 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 can be as accurate as a surgical biopsy and are performed on an outpatient basis, taking less than 40 minutes 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 48 hours.

MRI-Guided Breast Biopsy:

We can perform a standard needle biopsy in the MRI suite if a lesion is detected only on a Breast MRI exam, and this can be performed in under an hour.