MAMMOGRAPHY

WHAT IS A MAMMOGRAM? Mammography is a specific type of imaging that uses a low-dose of x-ray system to examine breasts. A mammography exam, called a mammogram, is used to aid in the diagnosis of breast diseases in women. An x-ray (radiograph) is a painless medical test that helps physicians diagnose and treat medical conditions. Radiography involves exposing a part of the body to a small dose of ionising radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging. Two recent enhancements to traditional mammography include digital mammography and computer-aided detection.

DIGITAL MAMMOGRAPHY, also called full-field digital mammography (FFDM), is a mammography system in which the x-ray film is replaced by solid-state detectors that convert x-rays into electrical signals. These detectors are similar to those found in digital cameras. The electrical signals are used to produce images of the breast that can be seen on a computer screen or printed on special film similar to conventional mammograms. From the patient´s point of view, digital mammography is essentially the same a s the screen-film system.

COMPUTER AIDED DETECTION (CAD) systems use a digitised mammographic image that can be obtained from either a conventional film mammogram or a digitally acquired mammogram. The computer software then searches for abnormal areas of density, mass, or calcification that may indicate the presence of cancer. The CAD system highlights these areas on the images, alerting the radiologist to the need for futher analysis, maybe with the use of ultrasound.

WHY IS IT NECESSARY?

Mammograms are used as a screening tool to detect early breast cancer in women experiencing no symptoms and to detect and diagnose breast disease in women experiencing symptoms such as a lump, pain or nipple discharge.

Screening mammogram
Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before a patient of physician can feel them. Screening mammography is recommended every year for women, beginning at the age of 50. Research has shown that annual mammograms lead to early detection of breast cancers, when they are most curable and breast-conservation therapies are available.

It is advised 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 the age of 40 and about the frequency of screening.

Diagnostic mammogram
Diagnostic mammography is used to evaluate a patient with abnormal clinical findings – such as a breast lump or lumps – that have been found by the woman or her doctor. Diagnostic mammography may also be done after an abnormal screening mammography in order to determine the cause of the area of concern on the screening exam.

How is the procedure performed?

During mammography, a specially qualified radiolographer will position your breast in the mammography unit. Your breast will be placed on a special platform and compressed with a paddle (often made of clear Plexiglas or other plastic). This will gradually compress your breast. Breast compression is necessary in order to:

• Even out the breast thickness so that all of the tissue can be visualised.
• Spread out the tissue so that small abnormalities won´t be obscured by overlying breast tissue.
• Allow the use of a lower x-ray dose since a thinner amount of breast tissue is being imaged.
• Hold the breast still in order to eliminate blurring of the image cause by motion.
• Reduce x-ray scatter to increase sharpness of picture.

The Radiographer will stand behind a glass shield during the x-ray exposure. You will be asked to change positions slightly between images. The routine views are a top-to-bottom view and an oblique side view. The process will be repeated for the other breast.

The patient must hold very still and may be asked to keep from breathing for a few seconds while the x-ray picture is taken to reduce the possibility of a blurred image. When the examination is complete, the patient will be asked to wait until the radiographer determines that the images are of high enough quality for the radiologist to read.
The examination process should take about 15 minutes.

HOW TO PREPARE

Before scheduling a mammogram, any new findings or problems in your breasts should be discussed with your doctor. In addition, inform your doctor of any prior surgeries, hormone use, and family or personal history of breast cancer.

The best time for a mammogram is one week following your period. Always inform your doctor and radiographer if there is any possibility that you are pregnant. Describe any breast symptoms or problems to the radiographer performing the exam. If possible, obtain prior mammograms and make them available to the radiologist at the time of the current exam.

Our radiologists will assess your mammograms while you are at our clinic, and the radiologist will discuss your results with you. In some cases, it may be necessary to do an ultrasound examination to complement the findings of the mammograms.

If our radiologist deems it necessary, he will do an ultrasound guided cytology/histology test which will be sent to our hospital for culturing and examination. Patients will be contacted regarding these results by letter.