Breast Imaging Division Meeting – July 8th



|Mammography Imaging Procedure Manual |

|[pic] |Procedure Name |Diagnostic Mammography |

| |Revision Date |April 2019 |

| |Effective Date |April 2019 |

Breast Imaging Division Protocols for Technologists:

1. Palpable Mass

a. Women under the age 30 - Ultrasound, unless BRCA gene positive

b. ANY AGE who is BREAST FEEDING – Ultrasound, unless BRCA gene positive

c. Women age 30 and older – Diagnostic mammogram with spot compression magnification views in the CC and MLO projections of the site of palpable concern. Place a metallic BB on the palpable area.

c. Special Case: Males under the age of 18 – Ultrasound

d. Special Case: Males age 18 and older – Diagnostic mammogram with spot

compression magnification views in the CC and MLO projections of the

site of palpable concern. Place a metallic BB on the palpable area.

2. Focal Pain:

a. Women under the age of 30 – Ultrasound

b. Women age 30 and older – Diagnostic mammogram with spot compression magnification views in the CC and MLO projections of the site of concern. Place a metallic BB on the focal area of pain.

3. Focal bilateral pain (NO MASS)

a. Women under the age of 30 - Ultrasound. NOTE: It is reasonable for the radiologist to talk with the patient and send/refer her to the breast clinic.

b. Women age 30 and older – Diagnostic mammogram with spot compression magnification views in the CC and MLO projections of the sites of concern. Place a metallic BB on the focal areas of pain.

4. Diffuse Pain (NO MASS): Screening mammogram.

-If the patient is under 40, it is reasonable for the radiologist to talk with the patient and send/refer her to the breast clinic.

5. Nipple Discharge: Spontaneous bloody, clear, brown or black

-Diagnostic mammogram with retroareolar spot compression magnification views in the CC and MLO projections of the side(s) of discharge

*If the patient has expressed-only bloody discharge, please discuss with the radiologist.

6. Lumpectomy (for Cancer) Patient: ASCO guidelines

- 6- month unilateral diagnostic mammogram with spot compression magnification views in the CC and MLO projections of the lumpectomy site

- 12- month bilateral diagnostic mammogram with spot compression magnification views in the CC and MLO projections of the lumpectomy site

( Yearly diagnostic mammogram with spot compression magnification views in the CC and MLO projections of the lumpectomy site

7. Calcifications:

*Always perform spot compression magnification views of calcifications in the 90

and CC projections*.

-If the patient is having her 1st 6 –month, 2nd 6 -month follow-up, and final 12-month follow-up of probably benign calcifications, always perform a diagnostic mammogram with spot compression magnification views of calcifications in the 90 and CC projections. Goal: Calcification stability for 2 years.

8. Tissue visible laterally on CC -> Acquire XCC views on all patients regardless if screening or diagnostic study.

9. New Palpable Area & Recent Mammogram

a. Had a mammogram within 3 months ( Talk with the Radiologist.

b. Had a mammogram > 3 months ago ( Diagnostic unilateral/bilateral mammogram with spot compression magnification views in the CC and MLO projections of the site of concern. Place a metallic BB on the area of palpable concern.

10. Tram/Latissimus Flap: Not routinely imaged. Mammogram in the CC and MLO projections only if the patient requests the flap to be imaged OR if there is an order from her doctor.

*If the patient has an area of palpable concern involving her flap, please perform a diagnostic mammogram with spot compression magnification views in the CC and MLO projections of the palpable site of concern. Place a metallic BB on the area of palpable concern.

11. BI-RADS 3 Follow-Up: Perform a diagnostic mammogram with spot compression magnification views in 2 projects for all BI-RADS 3 cases: mass, asymmetry, calcifications. 1st 6 –month, 2nd 6 -month, and final 12-month follow-up. Goal: Lesion stability for 2 years.

12. Special Cases: Inpatients, DOC, male and emergency room patients are always diagnostic cases. Depending on the patient’s status and clinical presentation, she/he may be a diagnostic mammogram, diagnostic mammogram and ultrasound or an ultrasound only---abscess, the patient cannot tolerate a mammogram, or depending on the patient’s age.

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