1. Introduction to Breast Imaging BREAST RAD LAB Directions: Please answer all the questions prior to interactive conference. 1

2. Outline Screening BI-RADS Categories Diagnostic Procedures MRI 2

3. Screening 3

4. Screening Mammography What is screening mammography? What are the current American Cancer Society recommendations regarding screening mammography? 4

5. Screening Mammography What are the standard views for screening mammography? How many views of each breast? Does the radiologist read the study while the patient is in the department? What happens if there is a finding on the study that requires additional views? 5

6. Screening Mammography Please draw a screening study. 6

7. Screening Mammography What is the radiologist looking for on a mammogram (i.e. what are signs of breast cancer)? 7

8. What view? Anatomy? 8 What muscle? What is white? What is dark?

9. What view? Anatomy? 9 Lateral or medial? What is white? Lateral or medial? What is this What is dark?

10. BI-RADS Lexicon & Categories 10

11. BI-RADS What does BI-RADS stand for? What is the purpose of BI-RADS? 11

12. BI-RADS Lexicon There are 4 terms to describe breast composition: The breast are almost entirely __________ There are __________ areas of fibroglandular density The breasts are __________, which may obscure small masses The breasts are __________, which lowers the sensitivity of mammography 12

13. BI-RADS Lexicon Masses Masses are described by the shape, margin, and density. 13

14. BI-RADS Lexicon The 3 ways to describe the shape of a mass are __________, __________, and __________. The 5 ways to describe the margin of a mass are __________, __________, __________, __________, and __________. The 4 ways to describe the density of a mass are __________, __________, _________, and __________. 14

15. BI-RADS Lexicon Calcifications Calcifications are described as being typically benign or suspicious morphology. Calcifications are also described in terms of distribution. 15

16. BI-RADS Lexicon What are the 9 descriptors for typically benign calcifications? 16

17. BI-RADS Lexicon What are the 4 descriptors for suspicious morphology? 17

18. BI-RADS Lexicon What are the 5 distribution descriptors? 18

19. BI-RADS Lexicon Draw a right CC view with pleomorphic calcifications in a linear distribution, vascular calcifications, and skin calcifications. 19

20. BI-RADS Lexicon Draw right and left MLO views with large rod-like calcifications. 20

21. BI-RADS Lexicon Draw a right MLO view with fine linear or fine linear branching calcifications in a segmental distribution. 21

22. BI-RADS Categories BI-RADS Category 0 - ? 22

23. BI-RADS Categories BI-RADS Category 1 - ? BI-RADS Category 2 - ? BI-RADS Category 3 - ? BI-RADS Category 4 - ? BI-RADS Category 5 - ? 23

24. BI-RADS Categories BI-RADS Category 6 - ? 24

25. Diagnostic Imaging 25

26. Diagnostic Imaging How is diagnostic imaging different from screening? 26

27. Diagnostic Imaging What are some examples of special diagnostic views? 27

28. Diagnostic Imaging What are examples of indications for diagnostic imaging? 28

29. What are these? 29

30. Procedures Ultrasound core needle biopsy Stereotactic core needle biopsy MRI guided biopsy Wire localization Ductogram 30

31. Procedures Image guided core needle biopsies –Invasive? –Cost effective? –Decreases number of surgeries for malignant lesions? 31

32. What is this? 32

33. Procedures Ultrasound Guided Core Needle Biopsy When do we recommend an ultrasound guided biopsy? Is it an outpatient procedure? Who does the procedure? 33

34. Procedures Stereotactic Core Needle Biopsy When do we recommend a stereotactic biopsy? Is it an outpatient procedure? Who does the procedure? 34

35. Procedures MRI Guided Core Needle Biopsy When do we recommend an ultrasound guided biopsy? Is it an outpatient procedure? Who does the procedure? 35

36. Procedures Wire Localization When are wire localizations performed? What type of imaging guidance is used? Who performs the procedure? 36

37. Procedures Ductography What are the indications for a ductogram? 37

38. Breast MRI 38

39. Breast MRI (American Cancer Society) ACS recommends annual screening breast MRI (based on evidence) –Who is in this category? ACS recommends annual screening breast MRI (based on expert consensus) –Who is in this category? There is insufficient evidence for or against MRI screening –Who is in this category? 39

40. Breast MRI Recommendation against MRI screening –Lifetime risk < ? 40

41. Question 54-year-old woman with a lump in her right breast. Her last mammogram was 6 months ago. Her mammogram was negative. What should study should be ordered? A. Screening mammogram B. Diagnostic mammogram C. MRI 41

42. Question You are working up left breast calcifications. You recommend a biopsy. What BI-RADS category do you assign? A. Category 3 B. Category 0 C. Category 4 D. Category 2 42

43. Question You are able to see the calcifications on the mammogram. What type of biopsy will you recommend? A. Ultrasound guided B. Stereotactic biopsy C. Wire localizaton D. Recommend an MRI prior to any biopsy 43

44. Thank you! 44