Breast Diagnostic Services

• Bone density tests are painless, noninvasive and safe. There may be some discomfort during manipulation of the body, especially if a patient has a recent injury.
• Generally, no prior preparation is needed, but patients may be asked to stop taking calcium supplements 24 to 48 hours prior to the test.
• Because radiation is involved, it should not be performed if the patient is pregnant.

• Physician referral form
• Current medical insurance card
• Driver's license or other government-issued identification
• Wear comfortable clothing. (Avoid metal straps, buttons, zippers)

Bone densitometry scanning, also called dual-energy x-ray absorptiometry (DXA or DEXA) or simply a "bone density scan," is an enhanced form of x-ray technology that is used to measure bone loss. DEXA is today's established standard for measuring bone mineral densitometry.

An x-ray (radiograph) is a painless medical test that helps physicians diagnose and treat medical conditions. Radiography involves exposing a part of the body to a small dose of ionizing radiation to produce pictures of the inside of the body. X-rays are the oldest and most frequently used form of medical imaging.

Bone densitometry is most often performed on the lower spine and hips.

Bone densitometry is most often used to diagnose osteoporosis, a condition that most often affects women after menopause. Osteoporosis involves a gradual loss of calcium, causing the bones to become thinner, more fragile, and more likely to break.

The exam is effective in tracking the effects of treatment for osteoporosis and other conditions that cause bone loss. The test can also assess an individual's risk for developing fractures.

Bone densitometry testing is strongly recommended if you:

• Are a post-menopausal woman and not taking estrogen.
• Have a personal or maternal history of hip fracture or smoking.
• Are a post-menopausal woman who is tall (over 5 feet 7 inches) or thin (less than 125 pounds).
• Are a man with clinical conditions associated with bone loss.
• Use medications that are known to cause bone loss, including corticosteroids such as Prednisone, various anti-seizure medications such as Dilantin and certain barbiturates, or high-dose thyroid replacement drugs.
• Have type 1 (formerly called juvenile or insulin-dependent) diabetes, liver disease, kidney disease, or a family history of osteoporosis.
• Have high bone turnover, which shows up in the form of excessive collagen in urine samples.
• Have a thyroid condition, such as hyperthyroidism.
• Have a parathyroid condition, such as hyperparathyroidism.
• Have experienced a fracture after only mild trauma.
• Have had x-ray evidence of vertebral fracture or other signs of osteoporosis.

The Lateral Vertebral Assessment, a low-dose x-ray examination of the spine to screen for vertebral fractures that is performed on the DEXA machine, may be recommended for older patients, especially if you:

• Have lost more than an inch of height.
• Have unexplained back pain.
• Have had a bone densitometry scan that gave borderline readings.

Special care is taken during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection councils continually review and update the technique standards used by radiology professionals.

State-of-the-art x-ray systems have tightly controlled x-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures those parts of a patient's body not being imaged receive minimal radiation exposure.

• Food and drink: On the day of your bone densitometry scan you may eat normally. You should not take calcium supplements for at least 24 hours before your exam. 
  
  
• When to arrive: Arrive 15 minutes before your scheduled appointment time to check in and fill out any necessary forms. 
  
  
• What to wear: You should wear loose, comfortable clothing, avoiding garments that have zippers, belts, or buttons made of metal. You may be asked to remove some or all of your clothes and to wear a gown during the exam. You may also be asked to remove jewelry, eyeglasses, and any metal objects or clothing that might interfere with the x-ray images. 
  
  
• Other information: Inform your physician if you recently had a barium examination or have been injected with a contrast material for a computed tomography (CT) scan or radioisotope scan. You may have to wait 10 to 14 days before undergoing a DEXA test.

Women should always inform their physician or technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy because radiation can be harmful to the fetus. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby.

• Scanning: Bone densitometry scans are a quick and painless procedure, and usually done on an outpatient basis. You will lie on a padded table. An x-ray generator will be located below you and an imaging device, or detector, will be positioned above.

  To assess your spine, your legs will be supported on a padded box to flatten the pelvis and lower (lumbar) spine. To assess the hip, your foot will be placed in a brace that rotates the hip inward. In both cases, the detector will slowly pass over the area, generating images on a computer monitor. You must hold very still and may be asked to keep from breathing for a few seconds while the picture is taken to reduce the possibility of a blurred image.

• Length of scan: The scan is usually completed within 20 to 30 minutes.

• Instructions: You may resume normal activity immediately after your bone densitometry scan. 

• Exam results: All bone densitometry exams are interpreted by a radiologist. Under normal circumstances the reports are available electronically to the ordering physician 24-48 hours. Your referring physician will communicate these results to you.

A mammogram is an x-ray exam of the breast. It is used to detect and evaluate breast abnormalities, both in women who have no breast complaints or symptoms and in women who have breast symptoms including a lump, pain, or nipple discharge. An analog mammogram uses x-ray films to capture the image. A digital mammogram is a newer method that uses x-ray detectors and a computer to create the image.

Computer Aided Detection (CAD) is used and can be applied to mammography exams to help radiologists identify and mark regions of interest that are potentially indicative of cancer.

A screening mammogram is an exam used to detect early breast cancer in women experiencing no symptoms. Mammography plays a central part in the early detection of breast cancers because it can show changes in the breast up to two years before you or your physician can feel them. Current guidelines recommend screening mammography every year beginning at age 40. In addition, women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and about the frequency of screening.

Diagnostic mammography is used to evaluate patients with abnormal clinical findings, such as a breast lump or lumps that have been detected by the patient or her physician. Diagnostic mammography may also be used after an abnormal screening mammogram in order to determine the cause of the area of concern on the screening exam.

We take special care during x-ray examinations to use the lowest radiation dose possible while producing the best images for evaluation. National and international radiology protection councils continually review and update the standards used by radiology professionals.   State-of-the-art x-ray systems have tightly controlled x-ray beams with significant filtration and dose control methods to minimize stray or scatter radiation. This ensures those parts of a patient's body not being imaged receive minimal radiation exposure.

Although there is no radiation that reaches the uterus during a mammogram, we prefer not to perform routine mammograms on women who might be pregnant. If you are coming in because of a breast problem and you are or may be pregnant, please notify the mammographer so that we can decide the best way to evaluate your situation.

• Discussion: Prior to your mammogram, discuss any new findings, prior surgeries, hormone use, and family or personal history of breast cancer with your physician.
  
  
• What to wear: On the day of the exam, do not use deodorants, antiperspirants, powders, or ointments since these can show up and be confusing on the mammogram. Since you will need to undress from the waist up, a two-piece outfit is recommended.
  
  
• What to bring: If possible, obtain prior mammograms and make them available to the radiologist at the time of the current exam. You will be asked a number of important questions about your medical history so that we can assess your breast cancer risk.

• Preparation: You will be given a gown and asked to remove your clothing from the waist up. You will be escorted into the mammography room. If you have not had a mammogram before, the mammographer will explain the procedure. If you have any scars on your breasts, breast implants or skin irritations, particularly underneath your breast in the fold where the breast attaches to the chest, please point them out to the mammographer.
  
  
• Breast compression: It is very important that you work with the mammographer to ensure that your breast is as far into the machine as possible so that the tissues deep in the breast can be examined. Your breast will be placed on a special platform and gradually compressed with a paddle (often made of Plexiglas or other plastic).
  
  You will feel pressure on your breast as it is squeezed by the compressor. Some women with sensitive breasts may experience discomfort. If this is the case, schedule the procedure when your breasts are least tender. Be sure to inform the mammographer if pain occurs as compression is increased. If discomfort is significant, less compression will be used.
  
  Breast compression is necessary in order to:
  - Even out the breast thickness so that all of the tissue can be visualized.
  - Spread out the tissue so that small abnormalities won't be obscured by overlying breast tissue.
  - Allow the use of a lower x-ray dose because a thinner amount of breast tissue is being imaged.
  - Hold the breast still in order to eliminate blurring of the image caused by motion.
  - Reduce x-ray scatter to increase sharpness of picture.
  
  
• Scanning: You will be asked to change positions slightly between images. Routine views are a top-to-bottom view and an oblique side view. The process will be repeated for the other breast. The mammographer will walk behind a wall or into the next room to activate the x-ray machine. The x-ray beam will remain on for a few seconds at most. You may hear a whining noise that persists even after the x-ray is turned off. This is just a mechanical part of the tube that spins at high speed and does not stop immediately even though no more x-rays are being produced.

• Instructions: When the examination is complete, you will be asked to wait until the mammographer determines that the images are of high enough quality for the radiologist to read.
  
  
• Exam results: All Breast Imaging exams are interpreted by a radiologist. Under normal circumstances the reports are available electronically to the ordering physician 24-48 hours. Your referring physician will communicate these results to you.

There is no special preparation required in advance of your biopsy procedure. You may want to wear loose clothing for comfort. You may eat or drink what you normally do and perform you typical daily activities before arriving for your breast biopsy.

You should inform your doctor in advance of any medications you are currently taking whether prescription or over-the-counter. This includes aspirin, ibuprofen, blood thinners such as Coumadin, natural herbs, Vitamin E and other vitamins. Your doctor may advise you that some of these medications must be temporarily stopped several days prior to your biopsy.

Your biopsy will be performed in an outpatient setting. The entire procedure takes place in five steps:

1. Numbing of the breast with medicine
2. Imaging the breast to identify the biopsy area
3. Inserting a small needle into your breast to retrieve the tissue samples
4. Remove the small amount of tissue
5. Placing a small marker to identify the biopsy site

After you have been properly positioned for your biopsy, your breast will be imaged and the area to be biopsied located. Your skin will be cleansed with antiseptic and numbed. Sometimes, a very small nick is made to help the biopsy needle enter the breast with ease. You may feel some pressure, but most women report no pain.

The biopsy procedure will take a very short time. Multiple tissue samples will be collected. A final set of images may be taken and your physician may place a small marker at the biopsy site for future reference to identify the exact location of the biopsy. The marker is made of titanium and poses no health or safety risk. You will not be able to feel or notice the marker after placement.

Q: How much of the breast tissue or lump will be removed?
A: Physicians will only take the necessary amount of tissue samples.

Q: How long will the biopsy take?
A: Biopsy times vary. Typically, taking a total of one hour from the time you enter the exam room to the time you leave. The actual biopsy time is less than one minute.

Q: Will I have a scar?
A: Most women do not experience any permanent scarring.

Q: Will I experience any pain during the procedure?
A: You might feel a slight sting or pinch when the numbing medication is being inserted into the breast. Numbing the breast prior to the biopsy causes the rest of the procedure to be pain free.

Q: What possible side effects should I know about?
A: Your breast may be slightly tender and you may experience some mild bruising at the biopsy site: however, most women can resume normal daily activities the day after the procedure. Consult your physician for post-procedure care. 

On the day of your procedure, you will be asked to undress and put on a gown to wear. The technologist will position you face down on a specially designed table with your breast placed through an opening in the tabletop. The tabletop will be raised and the physician and technologist will perform the procedure from beneath the table.

Your breast will be slightly compressed and held in a fixed position to ensure the accuracy of the procedure. X-ray images will be taken, and special software will map the exact location where tissue samples will be taken.

The skin over the biopsy area will be cleansed with a special disinfecting soap, and numbed with a local anesthetic injected into the breast with a small, thin needle. A small incision will be made and the biopsy instrument will be inserted. You may feel some slight pressure during this time. As the samples are taken, you may hear a 'click' from the biopsy device. Several samples will be taken to ensure the most accurate diagnosis possible.

When the procedure is completed, a sterile gauze and an ice pack will be applied over the incision to minimize swelling and bleeding. Before you leave, a simple pressure bandage and some sterile strips will be placed over the incision. Stitches are not required for this procedure.

Once you receive instructions concerning the care of the biopsied area, you will be free to dress and go home.

There are several things you can do to make your procedure easier and more efficient.

• Discuss any medication you are taking with your physician. You may be asked to discontinue the use of blood-thinning medications, including aspirin and aspirin-like products, a number of days prior to your biopsy procedure.
• Wear clothing that is comfortable and easy to remove.
• Avoid the use of deodorant, underarm powders or creams before the procedure. They may interfere with the quality of the images taken during your procedure.
• Eat a light meal before your procedure.