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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