Radiology



	Film vs. Digital Mammography: a traditional fil mammogram on the left, compared to a sharper, more detailed digital mammogram of the same breast, at right. Radiology Digital Mammography One of the distinctions of the Wray Community District Hospital is that it offers Digital mammography. This technology converts X-rays to electronic images of the breast, which can be viewed, optimized and stored on a computer. In a recent study, digital mammography was better than traditional film mammography in detecting breast cancer in women under 50 and with dense breasts. Digital mammograms mean: Quicker mammograms, since there's no need to wait for film images to be developed Images can be viewed instantly by the technologist and radiologist Images can be easily transferred electronically with no loss of image quality Computer-assisted optimization helps radiologists detect micro-calcifications that might be missed on traditional film mammograms The American College of Radiology recommends annual screening beginning at age 40. Women who are considered higher risk may need to begin mammography earlier, usually is recommended to begin screening with mammography at 5-10 years earlier than the age of diagnosis of the family member How does digital mammography differ from traditional film mammography? A digital mammogram takes less time to perform and typically involves a lower radiation dose to the patient. It also gives us the ability to optimize the image; very similar to the way you optimize a digital photograph. Images are stored electronically. In addition, images can be interpreted remotely, so second opinion interpretations may become easier. Is digital mammography better at detecting cancers? Recent studies indicate a higher cancer detection rate of digital mammography in certain patients, including those with dense breasts, those under 50 years old, and those who are pre- or peri-menopausal. How do you know if you are at high risk for breast cancer? High risk factors for breast cancer include: Family history of breast cancer, two or more first degree relatives with breast cancer; especially if they were diagnosed when pre-menopausal Personal history or family history of the breast cancer gene BRCA 1 or BRCA 2 Personal history of radiation therapy to the chest between the ages of 10 and 30 years Lifetime risk of breast cancer scored at 20%-25% or greater based on one of several accepted risk assessment tools that look at family history and other factors. This category often requires consultation with a genetic counselor who can assess breast cancer risk using various computer models. If something suspicious is found on a mammogram, what is the chance that it might be breast cancer? Approximately 10% of screening mammograms are called back for additional imaging evaluation, which involves diagnostic mammography views and/or ultrasound. Of those that are called back, only about 10% of those require biopsy (90% are either explained as benign findings or simply require short-term follow-up). Of those that are biopsied, only about 30% actually are cancer. Another way to put this is that out of 1,000 screening mammograms performed, approximately 5 patients will be found to have cancer. What happens if something suspicious is found on my mammogram? If there is a suspicious finding on your mammogram, you will typically need to have additional views and/or ultrasound performed. Your doctor or nurse will contact you to discuss this and schedule your next appointment. Additionally, if warranted by the radiologist, treatment may include ultrasound-guided core biopsy, stereotactic breast biopsy, cyst aspiration, needle localization and surgical consultation, or MRI-guided biopsy. Breast ultrasound as well as diagnostic mammography is available at Wray Community District Hospital. We will make every attempt to schedule and perform these procedures as soon as possible, so that our patients do not have to endure a long wait to find out whether or not they have breast cancer. When is an ultrasound recommended, and how does it differ from a mammogram? Ultrasound is used: To evaluate any palpable breast lesion To evaluate masses, distortions, or asymmetries found on mammography To evaluate findings identified on breast MRI Ultrasound forms images of the breast utilizing sound waves, not X-rays. No compression is required; a warm gel is placed on the skin and an ultrasound probe is rubbed over the skin to obtain the image Ultrasound can often show abnormalities, which might go undetected on mammography due to extremely dense breast tissue. Ultrasound is used most commonly in conjunction with mammography, not as a replacement for mammography What is the difference between a screening mammogram and a diagnostic mammogram Screening mammography is performed in asymptomatic patients -- patients who have no clinical signs or symptoms of breast cancer. Two views of each breast are obtained and are checked for technical adequacy by the technologist. These are interpreted later by the radiologist with results sent to the patient by mail. Screening mammograms are usually read within the same day unless we need to obtain prior mammograms for comparison taken at a different facility. Diagnostic mammography is performed in symptomatic patients -- patients who have signs or symptoms of breast cancer such as a palpable lump, nipple discharge, skin changes, etc. We also perform diagnostic mammography in patients with a past history of breast cancer, for follow-up of an abnormal screening mammogram, or for short-term follow-up of probably benign findings. These studies begin with the typical mammography views, with additional views and ultrasound obtained as deemed necessary by the radiologist.