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Breast imaging is a specialized field of diagnostic imaging that focuses on visualizing the anatomy of human breasts. It is an effective tool to characterize and detect breast diseases, the most common one being breast cancer. Several imaging modalities are used to diagnose breast disorders, such as mammography, ultrasound, etc., which will be discussed in the upcoming sections. Breast imaging is also used as a supportive tool in surgical or interventional procedures.
Listed below are the common sites of complications that can be observed using breast imaging:
Breast parenchyma
Breast ductal system
Breast dermal layer
Nipple-areolar complex
Axillary and regional lymph nodes
Breast fat and subcutaneous tissue
Vascular and lymphatic structure
Implant-related structure
Some of the common breast imaging modalities are listed below:
Mammography
Digital Breast Tomosynthesis (DBT / 3D Mammography)
Contrast-Enhanced Mammography (CEM)
Stereotactic Mammography
Ductography (Galactography)
Breast Ultrasound
Ultrasound Elastography
Breast MRI
Diffusion-Weighted Imaging (DWI)
MRI Spectroscopy (MRS)
Breast-Specific Gamma Imaging (BSGI)
Positron Emission Mammography (PEM)
Based on the clinical condition or the disease, the radiation dosage varies, although it must be administered within the prescribed limits only.
Asymptomatic Patients:
In asymptomatic patients, radiological breast imaging tests are performed as screening tests rather than for detecting a specific condition. In such cases, the radiation dose is kept at the minimum, and image views are limited.
Palpable Lump/Mass:
These complications are generally detected by mammography. To reduce the radiation dosage, lumps/masses are also detected by a combination of mammography and ultrasound. By combining mammography procedures with ultrasound, radiologists can put forth a diagnosis without any additional views.
Malignancies:
When there is a strong suspicion of breast cancer, unlike screening tests, the priority is to detect the malignancy, even if the radiation dose must be slightly increased. A full work-up is required to observe the extent of the tumor in the body, which can increase the radiation dose. Additionally, multiple mammographic views would be required to observe the dimensions of the tumor.
Several factors affect the radiation dose involved in breast imaging techniques. These factors include:
Patient-Related Factors:
These include the anatomical dimensions of the patients, such as breast thickness, density, size, and compression. The radiation dose will also depend on the patient’s ability to tolerate compression. Poor compression tolerance will demand a higher dose of radiation.
Technique-Related Factors:
The amount of radiation dose is also dependent upon the type of breast imaging done and the technique used to perform it. It is made up of several factors, such as compression quality, number of views, use of magnification or spot compression, etc. In case the procedure involves contrast enhancing, the radiation dose becomes higher.
Equipment-Related Factors:
Lastly, the dosing also depends on the type of equipment used for imaging. The detector efficiency (digital vs film-screen), target-filter combination (Mo/Mo, Mo/Rh, W/Rh), automated exposure control (AEC) settings, tube voltage (kVp) and current (mAs), and tomosynthesis acquisition parameters collectively contribute to the radiation dosage in breast imaging procedures.
Although the breast imaging methods using radiological methods generate high-quality images, the radiation exposure needs to be at the minimum level. Some measures to optimize the radiation dose during breast imaging procedures are:
Use of digital mammography and tomosynthesis.
Incorporating to principle of automatic exposure control (AEC) to optimize dosing.
Only using a limited, required number of views to reduce the amount of dose.
Making sure there is adequate breast compression.
Using synthetic 2D images instead of separately capturing 2D image planes.
For patients, it is necessary to strictly follow the patient cleaning guidelines.
Avoid repeated imaging when it's not necessary.
Take special precautionary measures for young, pregnant women and other high-risk patients.
Maintain proper compliance with the national and international prescribed standards for radiation doses.
Conduct random testing and regular radiologist training.
Listed below are common procedures used in breast imaging:
Mammography:
This is the most widely used procedure in breast imaging. Mammography can be further divided into two types—screening and diagnostic. Screening mammography is a routine test, which is performed in the absence of any symptoms. It consists of two standard views, which are craniocaudal (CC) and mediolateral oblique (MLO). The screening mammography is useful in detecting masses, architectural distortions, and microcalcifications.
Diagnostic mammography is performed to detect the cause of the symptoms observed. In addition to the two views mentioned above, diagnostic mammography also includes spot compression, magnification, and true lateral views. This method is effective in the detection of shape. Margin, density of lesions, and distribution of calcifications.
Digital Breast Tomosynthesis:
Digital breast tomosynthesis is also known as 3D mammography. This is an advanced version of mammography, where thin sectional images are initially generated using conventional mammography. It has reduced overlapping in the images compared to conventional mammography. This method is used to detect lesions, margins, and tumors. Digital breast tomosynthesis is typically used in combination with standard mammography.
Breast Ultrasound:
A breast ultrasound is a complementary imaging tool used in combination with the mammograms. It is used to assess palpable lumps and as a guidance tool for interventional procedures. This imaging technique is typically used in the observation of solid vs cystic nature of lesions, lesion margins and internal echo patterns, posterior acoustic features, axillary lymph nodes, etc.
Other Breast Imaging Methods:
Apart from the above-mentioned procedures, other breast examination methods are:
->Breast MRI
->Ductography
->Contrast-Enhanced Mammography (CEM)
->Elastography
A number of breast diseases and complications can be detected using the above-discussed imaging procedures. These include:
Invasive ductal carcinoma (IDC)
Mucinous (colloid) carcinoma
Medullary carcinoma
Invasive lobular carcinoma (ILC)
Tubular carcinoma
Metaplastic carcinoma
Paget disease of the nipple
Multifocal and multicentric breast cancer
Recurrent breast carcinoma
Lobular carcinoma in situ (LCIS)
Ductal carcinoma in situ (DCIS)
Phyllodes tumor (benign and borderline)
Hamartoma
Lipoma
Adenoma
Fibroadenoma
Atypical lobular hyperplasia (ALH)
Usual ductal hyperplasia
Radial scar / complex sclerosing lesion
Simple breast cyst
Complicated cyst
Complex cystic mass
Fibrocystic breast disease
Apocrine metaplasia
Duct ectasia
Acute mastitis
Chronic mastitis
Breast abscess
Granulomatous mastitis
Subareolar mastitis
Cellulitis of the breast
Intraductal papilloma
Papillomatosis
Duct ectasia
Pathologic nipple discharge
Paget disease of the nipple
Common breast radiological breast imaging procedures are generally tightly regulated and well below the unsafe dosage levels. However, it is important for patients to be informed about the potential risks of radiation use. These risks are discussed below:
Ionizing radiation causes DNA damage, which may slightly increase the risk of developing cancer. This is caused due to repeated exposure over a period of several years and not one time
Younger women are at a higher risk of developing breast cancer, as breast tissues are more sensitive to radiation.
In pregnant women, although fetal exposure to radiation is avoided, it can cause complications, despite the low risk.
In contrast-enhanced procedures, some patients might have an allergic reaction to the contrast agents.
Teleradiology decries the practice of remote analyses and interpretation of radiological images by the radiologists. Breast imaging is a vast field that requires high subspecialty expertise. As there is a lack of on-site subspecialists for breast image analysis on-site, teleradiology enables patients access to such specialists remotely. It is also helpful in case the patient needs a double review of the images. Remote reporting also reduces the turnaround times, which is highly crucian in abnormal results and suspicious lesions.
Given below are the steps involved in breast imaging reporting at Statim Healthcare:
The radiological breast examination is conducted on-site at the hospital/healthcare institution.
The obtained images are transferred to the remote radiologist at Statim who is selected based on the case requirement.
The radiologist (who might be a subspecialty expert) analyzes the images to determine the etiology or detect any abnormalities.
These images are correlated with the patient data to accurately predict any changes.
After the observation is completed, the radiologist prepares a diagnostic report which includes analysis procedure, reference ranges, results, conclusions, recommendations, etc.
A preliminary report is created for emergency/STAT cases. At times, the results can be verbally communicated if immediate clinical action is required.
These reports are then electronically signed and sent to the institution via the hospital PACS/RIS or a secure delivery system.