Breast Imaging








Breast MRI
Breast Ultrasound
Special Procedures

DRC offers state-of-the-art breast care imaging which includes the region's first Digital Mammographic examination suite. We are certified by the American College of Radiology's mammography accreditation program and have been comprehensive women's imaging for many years. Our imaging expertise includes both diagnostic and screening mammography. Our facilities strive to be patient centered and are respectful of women's needs and emotional concerns regarding breast care. We strive to make patients feel comfortable while maintaining our high radiological and technological standards.

MAMMOGRAMS

A mammogram is a set of X-ray images of the breasts. Each breast is imaged in two different projections: from the top facing down, and from the side. The images are obtained by placing the breast in a special mammography machine, which is designed so that a radiation beam passes through the breast and forms an image. The breast is held in compression for each X-ray exposure to achieve the clearest possible image. DRC provides this service at the following locations: Associates in Oncology and Hematology, Battlefield Imaging, Chattanooga Outpatient Center, and Tennessee Imaging and Vein Center.

You may be wondering why a mammogram cannot be performed with the same kind of equipment used for X-rays of the chest or bones. Although the breast itself is internally made up of various kinds of tissue, those tissues have very similar densities to each other. Distinguishing among them requires a special kind of X-ray beam as well as special X-ray film/detector.

Screening and Diagnostic Mammograms

Screening mammography is performed on women without symptoms who typically are over the age of 40. The purpose is to look for any early signs of breast cancer. The majority of these mammograms show no abnormality.

Diagnostic mammography is performed to resolve a particular question related to the breast. This can be in one of several situations:

  1. If a woman has any signs or symptoms related to the breasts, such as a lump, breast pain, nipple discharge, unexplained skin changes of either breast, or new or unexplained asymmetry of the breasts
  2. If a woman has a personal or family history of breast cancer
  3. If an indeterminate abnormality is seen on a screening mammogram

Diagnostic mammography often includes extra mammographic views. These may be magnified or performed in different positions. Sometimes the breast is further examined using ultrasound (see Breast Ultrasound) or recently MRI of the breast can be done to further enhance the diagnostic study (see Breast MRI).

When Should I Get A Mammogram?

You may be referred for a mammogram by your primary care doctor or you may contact us directly. Usually, a woman has her first (or "baseline") mammogram at 40 years of age. This may be performed at an earlier age if there are any signs or symptoms, or in women with a family history of breast cancer. After the baseline mammogram, a woman should probably have a mammogram every one or two years until age 50 (the exact frequency should be discussed with her personal physician). After age 50 an annual mammogram is recommended or recently MRI of the breast can be done to further enhance the diagnostic study (see Breast MRI).

Preparation For Your Mammogram

If you've had a prior mammogram elsewhere, you'll be asked to either bring that mammogram to your appointment, or arrange for it to be sent to us. Comparing mammograms made at different times on the same person is often extremely helpful in detecting subtle changes.

On the day of your mammogram you should not use talcum powder, perfume or deodorant under your arms or breasts area. We recommend that you wear a comfortable two-piece garment. You may continue to take any medication that you normally take.

During the Exam

The mammography technologist will position your breasts. This involves compressing the breasts to obtain a clear picture of the tissues. The degree of pressure needed for optimal imaging may cause discomfort momentarily. It does not harm the breast tissues. The entire exam will take approximately a half hour.

Is Mammography Safe?

Mammography does expose you to some radiation. However, today's refined mammography equipment is designed so that this exposure is minimal and our digital mammographic suite is half that of traditional systems.


BREAST ULTRASOUND

Ultrasonography is the technique of using sound waves to create an image of part of the body without the use of radiation. It does not duplicate the information found on a mammogram but is used as a complimentary evaluation. It is particularly useful in distinguishing fluids from solids, and is therefore often used to detect cysts within the breast (cysts are small fluid-filled structures).

Most breast ultrasound exams are performed to answer a specific question which may have been raised regarding a particular area of your breast. Such questions might arise as the result of a mammogram showing an abnormality, or by examining the breast. DRC provides this service at the following locations: Battlefield Imaging, Chattanooga Outpatient Center, Diagnostic PET/CT of Chattanooga, Hutcheson Medical Center, Insight Imaging, Mobile Sonix and Tennessee Imaging and Vein Center.

Preparation

There is no preparation for a breast ultrasound exam.

During the Exam

During the exam, you lie on a stretcher and a small amount of gel is placed on the part of the breast to be examined. A small device called a "transducer" is then used to carefully examine the area. Several images are usually taken to document the findings. When the technologist has finished the examination, the images are shown to the Radiologist who may also perform a brief ultrasound scan to confirm the findings. The exam takes approximately a half hour.


BREAST MRI

Magnetic Resonance Imaging (MRI) is a diagnostic tool that produces detailed images of the human body without the use of X-rays. These images are created using a large magnet, radio waves and a computer system to process the data. Procedures using MRI are painless and involve no ionizing radiation.

DRC provides state-of-the-art MRI equipment including both high-field traditional magnets as well as low-field open magnets for extra comfort. In addition, we offer the region’s first high-field open magnet at our Battlefield Imaging location. Recently, we installed a new 3T open high-field magnet at Chattanooga Outpatient Center.  Therefore, DRC is able to provide the best quality imaging study while maximizing patient comfort.

Preparation

Most MRI exams require no preparation. However, for some types of scans you may be asked to not eat or drink for 4 hours prior to your test. Your doctor's office will let you know if this is necessary.

You should take any medication you would normally take as directed by your doctor. Please let your technologist know what medications you are currently taking. If you are taking medications to relax you, please have someone with you to drive you home after your MRI.

Note:

If you have had recent exams to diagnose this same or a similar problem at another facility, it would be helpful for the radiologist to see those exams. If available, please bring prior studies with you.

Oral Sedation for Claustrophobia

DRC provides the option of oral sedation for patients who have claustrophobia or who feel they will be too uncomfortable to tolerate the exam. Typically, alprazolam (Xanax) is the medication used unless otherwise requested. At the time of scheduling please let us know that you or your patient would like to take advantage of this program. The Radiology nurse will contact the patient prior to the exam to discuss sedation options, to take a detailed medical history, and to discuss dietary restrictions. They will also confirm that the patient will arrange to be escorted for the entire procedure time. The patient will need to arrive one hour before their scheduled exam time. Upon completion of the exam the nurse will go over written discharge instructions. The patient should not plan to do any work or activity that requires them to be alert for the duration of that day. The patient will be discharged home with their escort.

Before the Exam

When you arrive for your exam you will be asked to complete a questionnaire about your previous medical history and the reason for the visit. A technologist will then review this information with you and answer any questions you might have about the MRI. You will then be escorted to a dressing room to change from street clothes to a hospital gown and allowed to lock your possessions in a locker (if at all possible please leave valuables at home).

After the technologist discusses the exam with you and answers any questions that you might have, you will be escorted into the scan room.

During the Exam

After the technologist discusses the exam with you and answers any questions that you might have, you will be escorted into the scan room. There, you will be positioned, reclined, on a special cushioned table that will move you through the scanner during your exam. A special piece of equipment called a surface coil, which is like a radio antenna, may be placed on the part of your body to be imaged.

The technologist will then leave the room. However, at all times, the technologist can both see and hear you and you will be given a call button in the very unlikely case of an emergency.

MRI sequences will then begin. The exam consists of several different sequences that vary in length and the type of sound they make. The technologist will tell you how long each sequence will be and will remind you to lie as still as possible. Some MRI exams have a few short sequences during which you will be asked to hold your breath. These "breath holds" last from 10 to 20 seconds.

Patients in the scanner will be aware of a "knocking" noise. This is the sound of the magnet working to generate images. Should the noise be bothersome, a technologist can provide you with earplugs.

Patients should expect to be in the scanner between 40 minutes to an hour and one half. After the exam, the technologist will help you off the table and escort you back to the locker area where you can change back into your clothes.

Getting Your Results

The exam images will first be viewed by a Radiologist, a physician specializing in analyzing these exams. Our Radiologists will review the results of your MRI scan with your doctor who will then explain them to you. Your doctor should have access to your exam results within 24 hours.

Is MRI Safe?

MRI poses no known risk to most patients if appropriate safety guidelines are followed. However, for some patients, MRI may be inadvisable. You should tell your doctor if you have or believe that you might have any of the following:

  • Brain aneurysm clips

  • Cardiac pacemaker

  • Are or maybe pregnant

  • Implanted medication pumps

  • Implanted nerve stimulating devices

  • Intrauterine device (IUD)

  • Any other surgically implanted or metallic object in your body

For the safety of staff and patients the MRI environment needs to remain free of metal objects. Here are some examples of what must be removed before entering the scan room:

  • all jewelry including watches

  • eyeglasses

  • removable metallic dental work

  • hairclips and hairpins

  • hearing aids

  • keys

  • coins

  • wallets and credit cards

Will It Hurt?

No. MRI imaging is not painful. However, for some, lying still can be slightly uncomfortable; minimizing movement is necessary to obtain the best possible pictures. As in photography, a shifting subject will result in a picture that is blurry.


SPECIAL PROCEDURES:

Wire Localization

If a very small abnormal area is found during a mammogram, a wire may be inserted as a guide for a surgeon who may, at a later time, perform a biopsy of that area.

Aspiration

Aspiration or drainage of cysts or breast abscesses is usually performed by the Radiologist, using ultrasound guidance.

Core Biopsy

A special needle is used to obtain small samples of tissue from a particular area within the breast for histologic diagnosis. It may be performed mammographically on a special table designed specifically for this purpose, or on a stereotactic table, or with ultrasound guidance.

The above breast imaging Special Procedures can be performed by DRC at: Battlefield Imaging, Chattanooga Outpatient Center, Hutcheson Medical Center, and Tennessee Imaging and Vein Center.

Making an Appointment

When you call, we'll ask you for basic information such as your Social Security number. We'll ask you what type of test you need to schedule, and will schedule you for the best possible time. If you need to reschedule your exam, you can call us back and we'll be happy to arrange a better time for you.

When you call to schedule your exam, we'll also give you important information about preparing for the exam. If your doctor has scheduled the exam for you, and you have questions regarding the preparation or the procedure itself, you can call the imaging department where your procedure is being performed (please refer to our 'Locations' page for exact phone numbers).

Your physician will have several tasks to perform:

Complete the necessary paperwork to order the test (similar to writing a prescription for medication)

Fax, mail, or place the order in our computer system

Call us to schedule a test for you or have your physician call us directly

Obtaining Your Images

Exam Image Availability

DRC's state-of-the-art PACS technology offers you immediate access to the images of your radiologic exam. No longer does your physician have to wait to have copies of your films made. Although we can still print your X-ray on film for you with just 24 hours notice, your physician can now review your exam images immediately via the Internet. We offer safe and secure web access for your physician through Specialty Networks. Your privacy and HIPAA compliance is assured.

Images on a CD

If your physician prefers, the digital images from your study can be written to a CD-ROM, giving him/her a permanent record that can be accessed easily and quickly via a computer. CDs hold multiple studies and take up significantly less space than the traditional film in the brown envelope. A 24-hour notice is also requested to create this digital record for you.

Versatile Image Viewing Options

Internet access to your studies for your doctor is available immediately after your pictures are taken. Copies of your images can be obtained on a CD or on film with 24 hours notice.

Both Internet and CD viewing offer your physician the ability to digitally adjust your images in ways not possible with traditional X-ray film. Using the computer, the image can be made lighter or darker or zoomed for better visualization of a particular portion, for example. Your physician can fine-tune the images to accommodate his or her preferences.

Obtaining Copies of Your Images

To receive a CD or film copies of exam images, please follow these steps:

1. Call the location where your examination was performed (please refer to the locations page). Please provide your name and other identifying information along with the study being requested. With 24 hours notice, we can either create a CD-ROM or print a film for you. Our representative at the imaging center will provide you with the times available to pick up the exam.

2. To protect your privacy, please be sure to bring a picture ID when you pick up your CD/films, you will have to sign a Medical Images Release form when receiving your CD/films. If anyone else picks up your CD/films for you, please be sure to give him or her your written authorization to release your information to him or her.

3. If you would like us to send a copy of your study to a physician outside the DRC system, we will need a signed release from you along with the study you would like sent and the receiving doctor's name and address. You can fax or deliver us that release in the form of a signed letter at the fax number listed on the locations page. Please allow us plenty of time to send your films.

Any Costs

Currently the first set of films is provided at no cost to the patient. There is no charge for CD-ROM's and, of course, the Internet is always free.

LOCATIONS

For the convenience of our patients, we offer Imaging Scans at several DRC locations:

Assoc. in Oncology & Hematology
Battlefield Imaging
Chattanooga Outpatient Center
Tennessee Imaging & Vein Center