Diagnostic Breast Imaging

Imaging is an important tool used to diagnose breast cancer, and to evaluate the stage and extent of disease in breast cancer patients. Three major types of imaging are used in this capacity: mammography, ultrasonography, and breast MRI. Based on these imaging exams, your physician may determine that no treatment is necessary or may recommend further diagnostic tests or therapy.

Diagnostic Mammogram

What is it?
If a breast problem or an abnormality is found in the images from a screening mammogram, additional images are needed. This is called a diagnostic mammogram. The images obtained during this appointment will help your doctors determine the nature and location of any suggested abnormality in your breast, the surrounding tissue and lymph nodes. Your health care provider may recommend a diagnostic mammogram and ultrasound if a lump is felt during a clinical breast exam.

How do I prepare for this exam?

If you did not have your previous mammograms at UCSF Medical Center, you must bring your previous mammogram with you. If you call the facility where it was performed, they will tell you how to obtain these images on film. If the facility offers a CD of the images, please ask them to print out film images. The radiologist compares the images from prior exams to the current exam to assist in the interpretation. In general, the UCSF Radiologist will want to compare your last five years of mammogram films to the results of the scheduled mammogram.
Do not wear talcum powder, deodorant, lotion or perfume under your arms or on your breasts. These substances can cause artifacts on your mammogram making the images harder to interpret.
Wear two-piece clothing so that you only have to remove your top and bra for the examination.
Jewelry worn should be easily and quickly removable.
You may be asked to complete a brief breast health questionnaire.

What happens and how long does it take?
Diagnostic mammography is different from screening mammography in that additional views of the breast are usually taken, tailored to the particular concern. Each breast will be imaged separately. Your breast will be placed on the special plate of the mammography equipment by the technologist and then compressed with a paddle. This compression flattens the breast and greatly improves detail so that the maximum amount of tissue can be imaged and examined. If an abnormality seen with diagnostic mammography is suspicious, additional breast imaging (with exams such as ultrasound) or a biopsy may be ordered. You will need to wait while the radiologist makes a determination about the images, in case different or additional views are needed. This examination will take approximately 30 minutes.

Who performs this exam?
A radiology technologist will obtain the images by using a digital mammography machine, the same one that is often used for a screening mammogram. A radiologist, a doctor who specializes in breast imaging, reviews the images on the computer where they can make the images smaller or larger, brighter or darker. S/he will provide an interpretation of the images. Other types of diagnostic testing may be necessary following a diagnostic mammogram.

Will my insurance cover this exam?
Most insurance plans cover this exam but you should check with your insurance carrier to be certain. If you have HMO insurance, check with your plan to make sure that UCSF Medical Center is in your provider network.

How do I schedule this exam?
Call (415) 885-7465 and press option 2 for mammography. The scheduling department is open from 7:30 am - 6:30 pm, Monday through Friday.

Where do I go to have this exam?
UCSF Mount Zion Medical Center, 1600 Divisadero Street, 2nd floor , Room H2906, San Francisco

For more information on mammography in general, and additional resources visit RadiologyInfo.org.

Breast Ultrasound Appointment

What is it?
Your health care provider may recommend a diagnostic mammogram and ultrasound if a lump is felt during a clinical breast exam or an abnormality is found in the images from a screening or diagnostic mammogram. High frequency sound waves are used to image cysts (round, fluid filled pockets inside the breast) and can often help the breast imager determine if an area is actually a cyst or a dense mass. Cysts are non-cancerous, while a mass may require a biopsy to determine if it is cancerous. The images obtained during this appointment provides a different view than is possible with mammography and will help your doctors determine the nature of any suggested abnormality in your breast.

How do I prepare for this exam?

If you did not have your previous mammograms at UCSF Medical Center, you must bring your previous mammogram with you. If you call the facility where it was performed, they will tell you how to obtain these images on film. If the facility offers a CD of the images, please ask them to print out film images. The radiologist compares the images from prior exams to the current exam to assist in the interpretation. In general, the UCSF Radiologist will want to compare your last five years of mammogram films to the results of the scheduled mammogram.
Wear two-piece clothing so that you only have to remove your top and bra for the examination.
Jewelry worn should be easily and quickly removable.
You may be asked to complete a brief breast health questionnaire.

What happens and how long does it take?
During an ultrasound examination, you will be instructed to lie on an examination table. The ultrasound technologist will cover the part of the breast that will be imaged with a gel type substance. The gel lubricates the skin and enables the transmission of the sound waves. The radiologist then holds an ultrasound transducer (this looks like a microphone) against your skin and moves it around to obtain images that can be seen on the ultrasound monitor. The transducer emits sound waves and picks up the echoes. The computer will analyze the echoes and display an image on the computer screen. You may feel slight pressure but you won't hear the high-frequency sound. This examination usually takes 20-30 minutes. There is no radiation with this procedure. In some cases, a small sterile clip will be placed into the biopsy site of the breast to mark the location in case a future biopsy is needed. This microclip is left inside the breast and causes no pain or disfigurement.

Who performs this exam?
The radiologist, a doctor who specializes in breast imaging, will obtains the images and reviews these and the mammogram images to make a determination as to whether further testing is needed. S/he will provide an interpretation of the images. Other types of diagnostic testing may be necessary following a diagnostic mammogram.

How do I schedule this exam?
Call (415) 885-7465 and press option 1 for ultrasound. The Scheduling Department is open from 7:30 am - 6:30 pm, Monday through Friday.

Where do I go to have this exam?
UCSF Mount Zion Medical Center, 1600 Divisadero Street, 2nd floor , Room H2906, San Francisco.

For more information on breast ultrasonography for patients including links to resources visit RadiologyInfo.org.

Breast MRI

What is it?
Magnetic resonance imaging (MRI) is used to measure the extent of breast cancer after it is diagnosed and the response to treatment, screening women who have dense breast tissue and/or are at high risk for breast cancer. It is a non-invasive procedure that doctors can use to determine what the inside of the breast looks like without having to do surgery or flatten the breast (as in a mammogram).It is a highly sensitive tool that can be used in addition to mammography and ultrasound. This exam involves injecting a medication called gadolinium into the bloodstream, which helps to identify and observe the character of lesions in the breast. This exam produces hundreds of images of the breast which are reviewed by a Radiologist who specializes in MRI. Because the test uses strong magnetic fields, please tell your doctor if you have any metal in your body. You will be given an MRI screening form to check for any potential sources of metal that may be a contraindication to MRI. If you complete this form ahead of time, please remember to bring it with you to your MRI appointment.

How do I prepare for this exam?

If you did not have your previous mammograms or other breast imaging at UCSF Medical Center, you must bring your previous images with you. If you call the facility where they were performed, they will tell you how to obtain these images on film. If the facility offers a CD of the images, please ask them to print out film images of any mammograms. Prior MRI and ultrasound images should be brought on a CD-ROM in "DICOM" format. The Radiologist will compare the images from prior exams to the current exam to assist in the interpretation. In general, the UCSF Radiologist will want to compare your last five years of mammogram films to the results of the scheduled MRI.
Wear two-piece clothing so that you only have to remove your top and bra for the examination.
Avoid wearing jewelry to your MRI appointment. Jewelry worn will need to be removed prior to entering the MRI scanner.
You may be asked to complete a brief breast health questionnaire.
Read more about preparing for your MRI imaging procedure on the UCSF Radiology & Biomedical Imaging patient MRI prep page.

What happens and how long does it take?
MRI uses powerful magnetic fields and radio waves to create images and is able to achieve views in any plane and from any orientation, unlike mammography which requires repositioning of the breast for each view. Each exam produces hundreds of images of the breast(s) which can be viewed in three dimensions and which are then read by a Radiologist specialized in breast imaging. MRI does not use ionizing radiation (x-rays). During the examination, a contrast material called gadolinium is injected into a vein in your arm. The contrast material will be taken up by the breast tissue to produce clearer images for the Radiologist to interpret. You will lay face down on the table of the MRI machine with both breasts hanging freely into a cushioned recess containing the signal receiver (also known as the breast coil). The Technologist will be able to see you and control your positioning through a window. The entire bed on which you are lying will be advanced into the opening of the magnet (a tube-like machine that looks like a giant donut--open at both ends). The machine makes loud knocking noises while obtaining the images, and you will be given earplugs to minimize the noise. You will be asked to lie still for up to 15 minutes at a time while the computer acquires the images. The total examination is made up of several scans, usually 5-15 minutes in length and you will usually be in the magnet for 40-60 minutes. You will be asked to arrive 30 minutes prior to your scheduled appointment to ensure adequate preparation time (safety screening, changing, obtaining intravenous access) for the examination.

Who performs this exam?
An MRI technologist will obtain the images. The radiologist, a doctor who specializes in breast MRI, reviews these images and any other types of breast images to create an interpretive report. Other types of diagnostic testing may be necessary following an MRI.

Will my insurance cover this exam?
You should check with your insurance carrier to be certain of the circumstances that may be required to cover the cost of a breast MRI. Your doctor will indicate the reason for the examination on the order. If you have HMO insurance, check with your plan to make sure that UCSF Medical Center is in your provider network.

How do I schedule this exam? Call (415) 885-7465 and press option 1 for MRI. The scheduling department is open from 7:30 am - 6:30 pm, Monday through Friday.

Where do I go to have this exam? 1600 Divisadero Street, 1st floor , Room A142, San Francisco.

For more patient information on MRI imaging of the breast, visit RadiologyInfo.org.

Photograph: Mammogram and MRI Breast Images. Source: Mitchell D. Schnall, M.D., Ph.D. University Of Pennsylvania.