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Comprehensive Breast Imaging

All Brighton Radiologists perform screening and diagnostic mammography for the Hospital Systems with whom we partner.  Breast Interventional procedures are performed with expertise by our physicians as well.  Dr. Troy is the Head Mammographer for Brighton and Drs Torok and Nair have completed fellowship training in Women’s Imaging at UPMC Magee Women’s Hospital of Pittsburgh.  Full breast imaging services include:

  • Digital Screening Mammography
  • Digital Diagnostic Mammography and Breast Ultrasound
  • Ultrasound Guided Breast Biopsy
  • Stereotactic Breast Biopsy (available at Heritage Valley Women’s Center and Grove City Medical center)
  • Ultrasound and/or Mammographic needle and wire localization prior to surgery
  • Breast MRI, including MRI guided Biopsy (in conjunction with Heritage Valley including the Women’s Health Center)
  • Automated 3D Breast Ultrasound using Siemens ABVS unit (Heritage Valley Women’s Health Center)

Frequently Asked Questions Relating to Mammography

What is the difference between screening and diagnostic mammography? 

A screening mammogram is done on an outpatient basis, the patient has the screening study done and returns home.  A notification will follow in the US mail with the report, stating whether or not the study was normal or if the patient must return for additional views and/or ultrasound.  If a return visit is needed based on the screening mammogram result, this is scheduled as a diagnostic mammogram/ultrasound.  For the diagnostic visit, the patient stays until the radiologist has completed the workup and the patient leaves knowing the next step in management.   Other reasons for a diagnostic mammogram include patients with a new breast problem such as a lump, or patients with appropriate circumstances such as a history of recent breast cancer.

Compression is uncomfortable- why is this needed for my mammogram?

Compression is essential for two main reasons: first, it spreads dense breast tissue apart allowing underlying abnormalities such as breast masses or calcifications to be better seen.  Second, the better compression reduces the tissue thickness, which in turn reduces the radiation dose to the breast.   Compression also reduces motion.

I have heard conflicting advice about mammograms- when should these start and how often should they be done?

The American Cancer Society and the American College of Radiology recommend annual mammograms beginning at age 40.  For women with a positive family history of a first degree relative with breast cancer (mother or sister), screening should begin 10 years before the relative developed cancer.  For example, if a 30 year old women’s mother developed breast cancer at age 40, screening would begin at age 30 for the daughter.

What is “dense breast tissue”?

Breast tissue is a mix of fatty tissue (easily penetrated by xray beam) and dense fibroglandular tissue (difficult to penetrate).  Generally, for breasts that have more than 50% fibroglandular tissue, this is considered ‘dense’ which means it is more difficult to separate a mass from the dense tissue.  Both dense normal tissue and breast masses appear white on a mammogram.  Terminology on your mammogram indicating dense tissue includes “Heterogeneously Dense” (typically 50-75% of breast being dense) and “Extremely Dense” (> 75% dense). Dense breasts are an independent risk factor for breast cancer and also make breast cancer detection more difficult.  This is why additional mammogram views, ultrasound, or other tests may be needed as patients with dense tissue participate in their annual mammograms.

 What is a breast biopsy?

This is when a radiologist uses either mammogram guidance or ultrasound to direct a needle to an area of concern in the breast.  This is done on an outpatient basis with local anesthesia. For core biopsies, tissue samples are taken and a small titanium marker clip is placed at the area of biopsy.  The clip will stay in permanently if the biopsy is benign, and if biopsy yields a surgical diagnosis the clip will help direct a surgeon back to the area of interest.  The samples are reviewed by a pathologist and the pathology report is reviewed by one of the women’s imagers.

 

Imaging During Pregnancy

Brighton Radiology follows the American College of Radiology’s Practice Guideline for imaging pregnant or potentially pregnant adolescents and women with ionizing radiation.

The full written guideline can be viewed at: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Pregnant_Patients.pdf

“To maintain a high standard of safety, particularly when imaging potentially pregnant patients, imaging radiation must be applied at levels as low as reasonably achievable (ALARA), while the degree of medical benefit must counterbalance the well-managed levels of risk.”

It is the policy of Brighton Radiology that the pregnancy status of all adolescent girls and all adult women of child bearing age be determined prior to non urgent imaging. Of course, critically urgent studies can be performed without waiting for confirmation of pregnancy or the absence of pregnancy. However, the Radiologist must be informed that the pregnancy status of the patient is not known.

As with all imaging procedures, the specifics of an individual case must always be considered and may lead to the modification of even the most strongly suggested guidelines.

The Radiologist must be consulted whenever the clinician contemplates an imaging study for his/her pregnant patient.

The Radiologists at Brighton Radiology are always available to discuss the specifics of an individual case and to guide the clinician towards the most appropriate imaging procedure.