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Mammography

Breast Imaging - Mammography

Detailed information for Referrers

3D Mammography Referrer Information

 

Requesting a 3D Mammogram vs 2D

3D Mammograms can be requested in the same way as 2D Mammograms and need to meet the same medicare requirements.  Since not all NCRG locations have the 3D Mammogram technolocy in place, the Mammogram done will be per the capabilities of the location. Currently this means in Lismore a 3D Mammogram is possible while in Ballina and Grafton  2D Mammogram.

If you specifically want your patient to know that they need to book a 3D Mammogram, it may be helpful to indicate this on the request form (eg  ‘3D Views’ or ‘Tomosynthesis/Tomography’).

What is a Mammogram used for?

A Mammogram is used to examine the internal structure of the breast (“Mammary Glad”) . A specialised X-Ray is obtained of the breast, and the X-Ray films are interpreted by the Radiologist.  Accurate interpretation of Mammograms requires significant experience. At North Coast Radiology Group we have a team of highly skilled Radiologists who are able to not only interpret your examination with a high degree of accuracy but also provide a collegiate environment to cross-check examinations with.

The basic theory behind mammography is that different types of tissue stop x-rays by different amounts. In particular, breast cancers tend to stop x-rays much more than normal breast tissue. Also, some forms of breast cancer contain tiny flecks of calcium, which stop x-rays very well. These abnormal densities and certain sorts of calcification are what the Radiologist searches for.

You should also be aware that sometimes the breast tissue of some women can also stop x-rays very efficiently. This means that occasionally abnormalities are hidden, or masked inside normal tissue. In particular, the breasts of younger women often appear very dense on mammograms.

You should also know that the mammogram is very good at detecting small and subtle abnormalities that develop over time. It is therefore, very important to bring previous mammograms with you. The radiologist is looking for small changes, which by themselves may be unremarkable, but may be very significant if they were not there one or two years ago.

 

 

What is 2D and 3D Mammography

North Coast Radiology Group provides both 2D and 3D Mammography services – with 3D Mammography available at Women’s Imaging at St Vincents Hospital in Lismore.

2D Digital Mammography is the most common breast imaging method used in Australia. There are some patients for whom 3D Mammogrpahy (also known as Breast Tomosynthesis) is particularly suitable for example higher-risk patients compared with 2D Mammography.

3D Mammography examinations allow the breast tissue to be examined in thin ‘layers’, typically 1mm thick. This helps see through overlapping structures that may mimic or hide lesions on a conventional Mammogram.

North Coast Radiology currently has 3D Mammogram technology at its Lismore Women’s Imaging Branch.

 

How is a Mammogram Done?

The test may be uncomfortable for some people, but should not be the cause of terrible pain. You should understand that a compression plate is placed on the breast for very good reasons: to allow x-rays to pass through a thinner region which will decrease the x-ray dose and increase the accuracy of the test, and to move different parts of the breast off other parts of the breast, thus revealing hidden structures.

In 2D Mammography, two standard views are obtained: one from the top (“cranio-caudal” or CC) and one from the side (“medio-lateral oblique” or MLO).

Depending on what is found from these two, other specialised views may be required. For example, if the radiologist wants to better look at a small area of calcification, a magnified view can be obtained. It is important that you should not be shocked or worried that other mammograms are obtained. Most of the time, the radiologist is trying to either get a better look at something, or trying to move overlapping parts of the breast away from each other. Having extra views taken is NOT necessarily a bad sign.

In 3D Mammography the x-ray arm sweeps in a slight arc over the breast taking a series of images at various angles in just seconds.

3D Mammography can also be used for highly accurate placement of localisation wire in less time making for less discomfort for the patient and a high level of accuracy.

A Mammogram examination takes about 20 minutes. The actual image capture time for 3D is just a few seconds more compared with 2D Mammography thus minimising the period of discomfort.

 

Do Men have Mammograms?

Yes, Men can and often do have Mammograms. Men may have “lumps” in the breast, as women do. Most often, as with women, these lumps are not cancer, but caused by hormonal changes in the body. Rarely, a male breast lump may be malignant. One percent of all breast cancers occur in men.

No perfume, deodorant, lotions (eg moisture cream) or talcum powder as this can show up on the x-ray and impact the accuracy of the image

Finally, wear a two piece outfit that allows you to continue to wear the bottom section (eg trousers or skirt) but for ease of examination allows the top section (shirt) to be removed. This will assist with providing privacy and warmth.

If you experience significant breast discomfort during your menstrual period, it may be best not to schedule your mammogram during this time. One week after you period is best, unless the examination is urgent.

Eat and drink normally, and continue to take you usual medications.

It is very important to bring previous films to your appointment – even if your previous Mammogram was done by us. This is to support a thorough analysis of your examination.

The Government uses rules to determine if rebates offered by Medicare and the Department of Veterans Affairs can be accessed by patients. For patients to be eligible for a Medicare rebate the following information must be present and stated on the referral.

 

Requirements

Requesting doctors must include relevant clinical indications/history for all mammography (2D and 3D)  procedures otherwise patients are not eligible for a Medicare rebate.
For patients to be eligible for a Medicare rebate you must include your reasons to suspect malignancy in the breasts because of:

  • The past occurrence of breast malignancy in the patient or in a member of the patient’s family when a blood relative; or
  • Symptoms or indications of malignancy found on an examination of the patient by a medical practitioner.

A mammogram which has ‘routine’ or ‘screening’ written on it, will not quality for a Medicare rebate.

For 3D Mammograms examinations, the same Medicare eligibility rules apply. When booking a Mammogram appointment it is helpful to indicate which Mammogram (2d or 3d) is being requested as not all branches have the same Mammogram technology in place and it will affect which branch the appointment is booked at.

FAQ in relation to Breast Implants and Mammograms

This information was sourced from BreastScreen and a link to this further information on Mammograms is provided within the Links Section of this page.

 

Is Mammographic screening safe for women with implants?

Mammographic screening is generally safe for women with implants.  There is an extremely small chance that the pressure placed on the implant by the mammography machine could cause the implants to rupture or break.  In women who have implants which have already ruptured or started to leak, it is possible that having a mammogram could increase the amount of silicone or saline (depending on the type of implant) spreading into the breast tissue.

In some women with implants, very small amounts of silicone or saline (depending on the implant) pass through the pores of the implant shell. This is sometimes called ‘bleeding’ of the implant. At present it is not known whether mammography increases ‘bleeding’ of implants.  There is a small chance that mammography will change the shape of the breasts by dispersing the fibrous capsule that often grows around the implant. The breast may feel softer after mammography. However, it cannot be guaranteed that both breasts will be affected equally.

 

How much radiation is used?

Because of the extra views required, women with implants will experience more exposure to radiation during mammography than women without implants.

 

Is it painful?

The process of taking the mammogram may involve some discomfort as the implant may need to be pushed aside to expose the maximum amount of breast tissue. Most women find the discomfort does not last for very long.

 

Is Mammographic screening effective in detecting breast cancer in women with implants?

Mammographic screening is not 100% effective.  Mammograms may be less effective for some women with implants because the implant can obscure some of the breast tissue.”

Additional Resources include:

General Mammography Information- Information supplied by Inside Radiology

Information for Women with Implants – Information supplied by Breast Screen

Service Availability

Mammography
Ballina, Chatswood, Grafton, Mammo, Ryde, Women’s Imaging
Ballina
BMD, CT, Interventions, Mammo, MRI, NCR, OPG, X-Ray
Chatswood
CRR, CT, Interventions, Mammo, MRI, OPG, Screening, Ultrasound, X-Ray
Grafton
BMD, CT, CVI, Interventions, Locations, Mammo, MRI, OPG, Screening, Ultrasound, X-Ray