introduction to breast imaging breast rad lab directions: please answer all the questions prior to...
TRANSCRIPT
Introduction to Breast ImagingBREAST RAD LAB
Directions: Please answer all the questions prior to interactive conference.
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Outline
Screening
BI-RADS Categories
Diagnostic
Procedures
MRI
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Screening
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Screening Mammography
• What is screening mammography?
• What are the current American Cancer Society recommendations regarding screening mammography?
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Screening Mammography
• What are the standard views for screening mammography?
• How many views of each breast?
• Does the radiologist read the study while the patient is in the department?
• What happens if there is a finding on the study that requires additional views?
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Screening Mammography
• Please draw a screening study.
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Screening Mammography
• What is the radiologist looking for on a mammogram (i.e. what are signs of breast cancer)?
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What view? Anatomy?
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What muscle?
What is white?
What is dark?
What view? Anatomy?
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Lateral or medial?
What is white?
Lateral or medial?
What is this
What is dark?
BI-RADS Lexicon & Categories
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BI-RADS
BI-RADS
• What does BI-RADS stand for?
• What is the purpose of BI-RADS?
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BI-RADS Lexicon
• There are 4 terms to describe breast composition:
The breast are almost entirely __________
There are __________ areas of fibroglandular density
The breasts are __________ , which may obscure small masses
The breasts are __________ , which lowers the sensitivity of mammography
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BI-RADS Lexicon
Masses
Masses are described by the shape, margin, and density.
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BI-RADS Lexicon
The 3 ways to describe the shape of a mass are __________ ,
__________ , and __________.
The 5 ways to describe the margin of a mass are __________ , __________ , __________ , __________ , and __________.
The 4 ways to describe the density of a mass are __________ ,
__________ , _________ , and __________.
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BI-RADS Lexicon
Calcifications
Calcifications are described as being typically benign or suspicious morphology. Calcifications are also described in terms of distribution.
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BI-RADS Lexicon
• What are the 9 descriptors for typically benign calcifications?
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BI-RADS Lexicon
• What are the 4 descriptors for suspicious morphology?
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BI-RADS Lexicon
• What are the 5 distribution descriptors?
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BI-RADS Lexicon
• Draw a right CC view with pleomorphic calcifications in a linear distribution, vascular calcifications, and skin calcifications.
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BI-RADS Lexicon
• Draw right and left MLO views with large rod-like calcifications.
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BI-RADS Lexicon
• Draw a right MLO view with fine linear or fine linear branching calcifications in a segmental distribution.
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BI-RADS Categories
• BI-RADS Category 0 - ?
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BI-RADS Categories
• BI-RADS Category 1 - ?
• BI-RADS Category 2 - ?
• BI-RADS Category 3 - ?
• BI-RADS Category 4 - ?
• BI-RADS Category 5 - ?
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BI-RADS Categories
• BI-RADS Category 6 - ?
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Diagnostic Imaging
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Diagnostic Imaging
• How is diagnostic imaging different from screening?
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Diagnostic Imaging
• What are some examples of special diagnostic views?
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Diagnostic Imaging
• What are examples of indications for diagnostic imaging?
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What are these?
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Procedures
Ultrasound core needle biopsy
Stereotactic core needle biopsy
MRI guided biopsy
Wire localization
Ductogram
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Procedures
• Image guided core needle biopsies
– Invasive?
– Cost effective?
– Decreases number of surgeries for malignant lesions?
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What is this?
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Procedures
Ultrasound Guided Core Needle Biopsy• When do we recommend an ultrasound guided biopsy?
• Is it an outpatient procedure?
• Who does the procedure?
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Procedures
Stereotactic Core Needle Biopsy• When do we recommend a stereotactic biopsy?
• Is it an outpatient procedure?
• Who does the procedure?
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Procedures
MRI Guided Core Needle Biopsy• When do we recommend an ultrasound guided biopsy?
• Is it an outpatient procedure?
• Who does the procedure?
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Procedures
Wire Localization• When are wire localizations performed?
• What type of imaging guidance is used?
• Who performs the procedure?
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Procedures
Ductography• What are the indications for a ductogram?
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Breast MRI
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Breast MRI (American Cancer Society)
• ACS recommends annual screening breast MRI (based on evidence)
– Who is in this category?
• ACS recommends annual screening breast MRI (based on expert consensus)
– Who is in this category?
• There is insufficient evidence for or against MRI screening
– Who is in this category?
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Breast MRI
• Recommendation against MRI screening
– Lifetime risk < ?
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Question
• 54-year-old woman with a lump in her right breast. Her last mammogram was 6 months ago. Her mammogram was negative. What should study should be ordered?
• A. Screening mammogram
• B. Diagnostic mammogram
• C. MRI
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Question
• You are working up left breast calcifications. You recommend a biopsy. What BI-RADS category do you assign?
• A. Category 3
• B. Category 0
• C. Category 4
• D. Category 2
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Question
• You are able to see the calcifications on the mammogram. What type of biopsy will you recommend?
• A. Ultrasound guided
• B. Stereotactic biopsy
• C. Wire localizaton
• D. Recommend an MRI prior to any biopsy
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Thank you!
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