FAQs :: Women's Digital Imaging, Ridgewood NJ

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1. What is the benefit of digital mammography over conventional film screen?

Digital mammography is much faster with less radiation than film screen mammography. In addition the images can be manipulated electronically. The radiologist can magnify and optimize different parts of breast tissue without having to take an additional image again shortening procedure time and the additional radiation involved in additional views.

From a patients perspective, the machine looks just about the same. Positioning is similar as well. With the latest 2nd generation digital unit the compression paddles have been reconfigured to alleviate some of the discomfort associated with compression.

2. What is CAD and how does that help me?

CAD stands for “Computer Aided Detection”. The computer acts as a second set of eyes and a second reading following the radiologist. It has been stated to increase the early detection of breast cancer by 20%. CAD should only be used in conjunction with an experienced breast radiologist as the computer identifies many benign areas which only an experienced radiologist can dismiss as benign. This increases detection and decreases benign biopsies.

3. Is your facility ACR (American Collage of Radiology) accredited?

Yes.
WDI has received FDA, ACR, and accreditation. In addition, we passed our MQSA (Mammographic Quality and Standards Act) yearly sincing openning in 2004.

All new mammography facilities first receive their FDA approval. Following radiation and safety testing by a certified physicist, the facility receives temporary accreditation. The facility then has several months to send in images to the ACR and receive its final accreditation. WDI has hired a team, from Columbia Presbyterian Medical Center .This team includes two physicists and a technologist They perform the necessary radiation safety as well as quality control needed to obtain and maintain accreditation.

4. Do I need a breast ultrasound?

If you have a “palpable” finding such as a lump or thickening (meaning you or your doctor feels a lump), a directed or targeted ultrasound of this area may be indicated. In addition if there is a focal finding on the mammogram a directed ultrasound of that region may be warranted. Ultrasound is excellent at distinguishing fluid collections (known as cysts) and solid masses which could be either benign or malignant.

5. What is a screening breast ultrasound?

A screening ultrasound is usually performed when the breast tissue is radiographically dense. Dense tissue is a normal finding but can limit the ability of the radiologist to read the study for the following reason: breast tissue or glandular tissue as it is also called, is white on the mammogram, masses such as cancer are also white. Finding “white “cancers on a white background are extremely difficult to detect. Tumors on ultrasound are grey while the breast tissue remains white thereby increasing its visualization. The combination of dense breast tissue with a family history of breast cancer is usually the indication for a screening breast ultrasound.

A. Should I have my screening ultrasound at the time of my mammogram?

There are two ways to have the screening ultrasound done. One is at the time of the mammogram. A second option if the current mammogram is stable is to return in 6 months for what we call an “interval screening .ultrasound”. This option gives you the opportunity to be imaged twice a year so that small interval cancers can be found. If you have a strong family history of breast cancer it may be prudent to have the ultrasound at the time of the mammogram and at the 6 month interval.

6. If I have a family history of breast cancer on my father's side, does that count as significant?

Yes! Whether the history is maternal or paternal the genetic implications are the same.

7. If I am satisfied with my current mammography facility why should I change?

You may not need to! Find out if your mammogram is being read by a fellowship trained breast imager. Is the equipment state of the art? Are you called back for additional views or is the entire workup including additional views as well as breast ultrasound (if needed) performed at the time of the study? Are you given the results by the doctor with opportunity to discuss any issues of concern?

8. Does it make a difference who reads my mammogram?

Yes.
The experience, training and skill of the physician interpreting physician is as important, if not more important than the technology used. Most missed cancers on mammography are the result of a failure on the part of the radiologist to either identify or correctly interpret the cancerous abnormality. Studies have own that an experienced breast imager will detect more cancers than general radiologists.

9. How is your facility different?

Women’s Digital Imaging strives to offer a rare blend of expertise, the latest technology, compassion and quality service.

10. There has been a lot of publicity about MRI of the breast. Who should have this examination?

Breast MRI is an exciting new modality to image breast tissue. MRI uses a computer, magnetic field and radio waves instead of x-rays to produce images of the soft tissues of the body. MRI has emerged as a new technique in the evaluation of breast disease. When used with mammography MRI can provide valuable information for the detection and characterization of breast disease. MRI does not replace mammography; it’s an additional technique that provides additional information. The expense of MRI limits it as a screening tool in the general population. Breast ultrasound is another tool which complements mammography. Together with mammography the sensitivity of detecting breast cancer increases.

The following are currently accepted indications for breast MRI:

• Diagnosis of breast implant rupture
• Surgical Planning
• Staging of breast cancer and treatment planning
• Post surgical and radiation follow-up
• Monitoring high risk patients with a non radiation alternative

WDI does not currently perform breast MRI however can recommend you to a quality convenient location. We will help facilitate scheduling your appointment as well getting timely results.

11. I am always told that my breast tissue is very dense, and that I need an ultrasound. Why don’t I skip the mammography altogether and go straight to the ultrasound?

Ultrasound does not replace the mammogram. Mammography is still the “gold standard”. Mammography detects calcifications which are rarely identified on Ultrasound as well as subtle density changes and changes in breast tissue “architecture”. Breast ultrasound performed in conjunction with mammography in women with dense breast tissue significantly raises the sensitivity of detecting early breast cancer.

12. I’ve been told that too many biopsies are recommended due to “screening ultrasound”. Why should I bother having it done?

In inexperienced hands normal tissue and benign lesions can be misinterpreted as suspicious masses. When breast ultrasound is performed by an experienced breast imager these “benign findings” are either followed with short term follow-up ultrasound or dismissed entirely. Of course, as with mammography there will be benign lesions which may have to be biopsied. There must be a certain number of “benign biopsies” on order to detect tiny malignancies (which is what we want to detect early!).

13. My breasts are extremely tender especially around the time of my period. Can I have a mammogram or ultrasound at this time?

For you comfort it is best to have these studies performed when your breasts are not tender (especially the mammogram which compresses your breast). If you think you can tolerate the compression, then you can have your exam performed as it will not interfere or affect your study.

14. What are calcifications?

Calcifications are calcium deposits found within the breast tissue. These deposits can be identified by mammography. They are extremely common and are frequently due to non-cancerous causes. Calcifications are not related to or caused by dietary intake of calcium. They can, however, be an early sign of breast cancer and should be analyzed carefully by your radiologist. There are two main types of calcifications:

• Macrocalcifications. These calcifications are usually large and round. They are ordinarily recognized as benign (non-cancerous) and need no additional testing.

• Microcalcifications. These calcifications are smaller and may be numerous. They can be random or clustered and may vary in size and shape. The radiologist may request additional mammography views for further evaluation. For example, magnification views (enlargements) may provide more detailed information. There are several kinds of microcalcifications. Three frequently noted types are as follows:

• Benign. These microcalcifications can be identified clearly as benign (non-cancerous) by an experienced radiologist and need no further work-up.

• Indeterminate. Such calcifications are not clearly benign or malignant and need additional work-up. (See evaluation below).

• Malignant. These microcalcifications are almost always related to malignancy and a biopsy should be performed.

15. I’ve been told that breast cancer is not painful. If I have a painful mass should I assume that it’s fine?

Most breast cancers are not painful however there are always exceptions to the rule. If you have a mass never assume it is a benign cyst even if you have a history of breast cysts. Have your physician evaluate you. She/He may ask you to have a breast ultrasound and a possible mammogram first. At WDI we will try to make a same day appointment for a woman worried about a breast mass. Most often these “masses” prove to be benign.

16. At what age should I start having mammograms? How often?

American College of Radiology (ACR) recommends baseline mammography between age 35 and 40. If you have a family history of breast cancer, you may need to start earlier. For example, if your mother had be at age 40 you should start your mammogram at age 30.

17. Do I need to retrieve my old films and records?

If you have had prior studies at another facility, it is well worth your effort to bring them with you on the day of your appointment. Breast imagers look for subtle changes in tissue patterns of the breast which could signify an early developing cancer. These findings often are not appreciated without the benefit of film comparison.

To obtain the your prior study, call the outside facility where you had your prior study and request that the films be made available for you to sign out in person or for mailing directly to WDI. The facility will require a signed release form. The outside facility will provide this to you.

18. What is osteoporosis?

Osteoporosis is a silent, progressive disease characterized by decreased bone density and increased bone fragility with a consequent susceptibility to fracture. Up to 1.5 million fractures a year are attributed to osteoporosis. Osteoporosis is a complex, multifactoral disease that may progress silently for decades. There may be no symptoms until fractures occur. Osteoporosis use to be considered an inevitable consequence of aging. Today, there are new techniques for early detection an increasing treatment options.

19. I’ve seen bone density studies offered all over the place even the mall. Why should I go to your facility?

As with all our imaging studies, we use the very latest state of the art technology. The Lunar Prodigy Advance is extremely accurate and measures the density in both hips (many measure only one hip). In addition our machine has the capability to do a lateral view of the thoracic-lumbar spine (see below).

20. What is the benefit of examining the lateral spine?

The latest technology for bone densitometry is imaging the spine in a side view (lateral view) in addition to the standard frontal view. This allows the radiologist to evaluate for compression fractures of the spine. Compression fractures of the spine can cause false negative bone density readings without the lateral view. This is important because patients with spinal compression fractures are at a much higher risk for osteoporosis and future fracture risk. Lateral views also help to determine if osteoarthritis is present.

21. Why would I need to have a pelvic ultrasound?

There are many indications for pelvic ultrasound: pelvic pain, irregular bleeding, and postmenopausal bleeding. To evaluate benign masses of the uterus (fibroids) and ovarian masses. In addition ultrasound is useful in early pregnancy to evaluate fetal viability and to exclude life threatening tubal pregnancies (ectopic pregnancy).

A. Why do I need both a tranabdominal and endovaginal pelvic ultrasound?

The Tran abdominal ultrasound utilizes the full bladder as a “window” to look at the pelvis. This gives the “big picture” of all the pelvic organs. The endovaginal scan gives a more limited but detailed image of the uterus and the ovaries. Most of the times both types of scans are needed to fully evaluate the pelvic organs.

22. If I have excessive menstrual bleeding, bleeding between periods, or postmenopausal bleeding what could cause this?

Abnormal or excessive bleeding also known as dysfunctional bleeding is overwhelmingly due to benign causes such as hormonal fluctuations, thickening of the uterine lining (endometrial hyperplasia), benign polyps of the uterine lining. Rarely, dysfunctional bleeding can be caused by a malignancy. This is why your gynecologist may recommend a pelvic ultrasound.

23. In addition to blood tests and pelvic ultrasound how else can “dysfunctional bleeding” be evaluated?

There is a relatively noninvasive exam which can be performed at the radiologist office using ultrasound. It is called SONOHYSTEROGRPHY. It involves the injection of saline into the uterine cavity to evaluate

The lining of the uterus (also known as the endometrial lining). Results can show a normal lining, a single or multiple benign polyps, endometrial hyperplasic and rarely endometrial carcinoma. These different findings can help the gynecologist formulate a plan for treatment.

24. Do you take my insurance?

WDI participates with Medicare and will process all insurance claims directly for Medicare patients.

For all other patients with private insurance, the Practice is “fee for service”. This means that you will be asked to pay for your breast imaging study at the time of your visit. We will provide you with all the necessary paperwork for you to submit to your insurance carrier for direct reimbursement. WDI is considered an “out of network” provider and your reimbursement will depend on your out of network screening mammography spending account. Some insurance carriers have “WELLCARE” policies which covers an out of network screening mammogram. To date, most patients with out of network benefits who have met their deductible have been reimbursed between 80-100%. The best way for a patient to know what reimbursement to expect is to contact the insurance carrier directly. If you need help finding out information about your insurance coverage, please call our office. The staff will be happy to help you in any way they can.

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