Women’s Imaging
The physicians of Professional Radiology, Inc. provide women’s imaging services at The Christ Hospital Women’s Imaging Center, The Jewish Hospital Breast Center, The Fort Hamilton Hospital Women’s Health Choice, and West Chester Medical Center Women’s Health Services. These radiologists have extensive experience interpreting screening and diagnostic mammography, MRI of the breasts, and breast ultrasound as well as performing interventional breast procedures including stereotactic, ultrasound and MRI guided breast procedures and biopsies.
The Mammographers of Professional Radiology, Inc. strive to provide the highest quality of compassionate care to every woman receiving her mammogram at each institution. All radiologists are available for consult on diagnostic mammograms. If procedures are necessary they can often be performed within a week’s time employing a seamless scheduling process. Our patient’s privacy and comfort are of utmost concern.
“Mammography has reduced morbidity and mortality of breast cancer up to 25% in the past 15 years. Although mammography is imperfect it is a useful and powerful screening method in diagnosing early breast cancer,” Elizabeth A. Weaver, MD.
About our centers
The Jewish Hospital Breast Center is located at 4750 E. Galbraith Road, Suite 111. The Medical Office Building is located across the street from The Jewish Hospital, and the phone number is 513-686-3300.
The Christ Hospital Women’s Imaging Center is located at 2123 Auburn Avenue, Suite 324 in the Medical Office Building at The Christ Hospital. The phone number 513-585-2760.
The Fort Hamilton Hospital Women’s Health Choice is located at 630 Eaton Avenue in Hamilton. The phone number is 513-867-2700.
West Chester Medical Center Women’s Health Services is located at 7700 University Drive in West Chester. The phone number is 513-298-3278.
Who is the radiologist?
Radiologists are physicians who specialize in all aspects of imaging the body. This includes exams used to diagnose abnormalities and in performing biopsies of tissues that require imaging guidance (example: biopsies of breast lesions that cannot be felt). Radiologists understand radiation safety issues and the methods by which images are acquired, which makes them uniquely qualified to interpret imaging studies and to perform image guided biopsies.
Radiologists have 4-6 years of specialized training after earning a medical degree. Those who read mammograms have additional training solely devoted to breast imaging. To maintain certification to read mammograms, the radiologist must read many mammograms a year, maintain continuing education credits pertinent to mammography and are subjected to medical audits. Statistical results are compared to local and national results.
R2 Technology
Each of our breast centers feature the R2 ImageChecker, which serves as a second set of eyes for the radiologists. This computer-aided detection (CAD) system, converts mammograms into a digital format and performs more than a billion analyses to outline suspicious areas. The system highlights possible suspicious areas on the mammogram that warrant a second review by the radiologist. Research suggests that the R2 ImageChecker can detect 23 percent more breast cancers than mammography alone. All screening mammograms and most diagnostic mammograms performed at our breast centers, including both Mobile Mammography Units, are double-read by the R2 ImageChecker.
What is a mammogram?
A mammogram is a radiographic image that gives a picture of the internal structure of the breast. There are two types of mammography: screening and diagnostic.
A screening mammogram is performed on women who have no evidence of breast disease. Using a mammography machine, a radiologic technologist obtains two views of each breast. Screening mammography is the best way to detect breast cancer early. A screening mammogram is similar to other screening exams such as a PAP smear, PSA for prostate cancer, fecal occult blood to detect colon cancer and a glucose test to detect diabetes.
Yearly screening mammography should be a routine procedure for all women ages 40 and older. Women with a strong family history (mother, sister or daughter) of premenopausal breast cancer may wish to begin screening earlier.
Diagnostic mammography is performed when a possible abnormality, such as a lump, has been found on a screening mammogram or upon clinical examination of the breast. It includes special views in order to better evaluate the abnormality. A diagnostic mammogram is read by the radiologist at the time of the exam.
What does it mean to have an “abnormal” screening mammogram?
A finding on your screening mammogram requires further evaluation to determine if it is suspicious. This evaluation usually involves specialized mammographic views. It may require physical exam, ultrasound or an MRI exam. Most of these “abnormal” findings can be resolved as benign (not cancer) on subsequent imaging. If they cannot be resolved as benign, then a follow-up study or biopsy may be recommended.
Why might my doctor recommend a 6 month follow-up exam for an abnormal finding?
A six-month follow-up may help to avoid unnecessary biopsies.
Almost all women have lumps, calcifications or abnormal densities on their mammograms. The radiologist assesses the risk that these may be cancer based on their appearance, the patient’s age, clinical history, use of estrogen, family history, and whether or not the abnormality has changed compared with prior mammograms. This is why it is so important to have your previous mammograms available.
After thorough assessment, if the radiologist finds no suspicious features, he/she may recommend a follow-up study in 6 and 12 months to make sure the area doesn’t change. This is a well-researched, widely practiced, and acceptable method to deal with “probably benign” abnormalities.
What is the chance that an abnormality followed at 6 and 12 months is really a cancer?
This does happen, but it is uncommon. These “probably benign” findings have been well-researched. For example, in a research study involving thousands of women being followed for probably benign masses, only 1.7% were ultimately found to be cancer. These were diagnosed because they grew on the follow-up studies and were eventually biopsied. One-third of these had grown at the six month study, 1/3 did not show growth until the 12 month study, and 1/3 did not show growth until the 24 month study. Because “benign” appearing cancers are usually the slow-growing variety, these patients still presented with early stage cancers (same prognosis as if biopsied initially).
The six-month follow-up practice is used to prevent many unnecessary biopsies.
How much should I worry if a biopsy is recommended?
Because radiologists want to detect cancer at an early stage when it is most curable, they may recommend a biopsy of a lesion that does not fit into the ?benign? or ?probably benign? category. Most of the abnormalities that are biopsied are not cancer but they do not have enough ?benign? features to allow them to be followed. For example, microcalcifications may be difficult to classify as benign by mammography. Many calcifications that are biopsied are shown to be benign (70-80%).
Types of breast biopsies:
- Cyst aspiration—uses a small needle to draw fluid out of a cyst (fluid pocket). This is recommended if a cyst is atypical in appearance or symptomatic.
- Core needle biopsy (also called Mammotome biopsy, stereotactic biopsy, ultrasound biopsy)—this procedure is used to sample cells from an abnormality in the breast. It uses local anesthetic and does not require being put to sleep. It does not require stitches. The biopsy samples the abnormality but does not completely remove it. If the core biopsy result is benign then no surgery is indicated. If it is suspicious or malignant, then the lesion would need to be removed surgically.
Why not just remove the area surgically?
If the core biopsy is benign, the patient does not need to undergo an unnecessary operation. Even if the core biopsy is malignant, then the patient and her surgeon can plan the most appropriate surgery to avoid unnecessary trips to the operating room.
- Excisional biopsy—this involves surgery to remove the area of concern. An excisional biopsy may be more appropriate in some circumstances than a core biopsy. Your radiologist or referring physician will help make this determination.
What if my biopsy shows cancer?
The key is to diagnose the cancer early and to receive appropriate treatment. The earlier the stage that breast cancer is diagnosed, the greater likelihood the cancer will be curable. Your referring physician or one of our physicians can help you choose a surgeon.
Should I have a lumpectomy or mastectomy?
The answer depends on the size, type and location of the cancer. Other factors that come into play include your breast size, lifestyle issues, and your ability to undergo radiation therapy.
What about sentinel node biopsy?
The best indicator for long-term survival is whether or not the axillary nodes contain tumor cells. The most accurate method to assess the nodes for tumor cells is to very thoroughly examine the first draining node or “sentinel node”. Your surgeon may or may not sample additional lymph nodes based on your individual circumstances. Before your sentinel node biopsy, a small amount of radioactive substance will be injected into the breast around the tumor. This will help the surgeon to find the first draining node in the operating room. This node will be delivered to the pathologist for special examination.
What is digital mammography?
Comparing digital mammography to traditional film mammography is exactly like comparing a regular camera to a digital camera. The images are acquired in the same way through breast compression, but the data is stored electronically instead of being stored on film.
Full-field digital mammography transfers images to a computer so they can be electronically enhanced. Digital mammography allows the radiologist to focus on areas of concern, which enhances readability and interpretations of the images, and may reduce patient recalls for additional views. The compression and positioning are the same as for conventional film mammography.
Eventually, when facilities have the capability to manage this data, digital mammography will be more convenient for the physician. Full-field digital mammography may be more sensitive for the detection of cancer in women with dense breasts, such as younger women or older women on HRT. However, at this time, there is no proof that digital mammography is better than film mammography. Currently, a large national study is underway to determine whether film and digital mammography detect the same number of cancers or if one method is better than another. The data should be available in the next 3-5 years. Eventually when the cost comes down, a digital mammogram will be more convenient than conventional mammography.
Digital mammography is available at The Christ Hospital and The Jewish Hospital Breast Center, and Fort Hamilton Hospitals.
Should I have a breast MRI?
Magnetic resonance imaging (MRI) is a specialized test that is very useful to evaluate the breast in certain circumstances. However, it is not recommended for routine screening the breast for cancer. In some patients who are at extremely high risk for developing breast cancer, MR screening may be considered. Mammography is the only proven test to detect early breast cancer. MR should only be performed in conjunction with mammography. It is an expensive test, and should only be used for specific indications, such as implant rupture, detecting cancer recurrence at a lumpectomy site, and it may have some benefit in staging tumors.
Why can’t I just have a breast ultrasound instead of a mammogram?
Breast ultrasound is a very useful tool in certain circumstances. However, it does not detect microcalcifications, which are the earliest sign of breast cancer. Ultrasound fails to detect many cancers and detects many lesions which are proven to be benign on subsequent biopsy. Therefore, it is not a “sensitive” test and is not “specific.” The data acquired from an ultrasound exam needs to be evaluated in conjunction with the mammographic findings.
Mobile Mammography
In an effort to make screening mammography accessible to as many women as possible, TJH Mobile Mammography Dates and Locationsalso provides mammograms via three Mobile Mammography vans. The vans provide screening mammography throughout the tristate at places such as shopping centers, retirement homes, grocery stores and places of employment. The mobile units, which offer the R2 ImageChecker, provide the same high-quality mammograms that are provided at both hospital breast centers.
What is a DEXA exam?
Full-body DEXA exams are offered at our hospital imaging centers. Bone densitometry, using DEXA (dual-energy X-ray absorptiometry), safely, accurately and painlessly measures bone density and the mineral content of bone. DEXA is the most widespread, non-invasive test for the detection of osteoporosis, and is the best way to identify individuals who are at increased risk for future fractures. Based on your test results, your physician can suggest treatment options from exercise and lifestyle changes, nutritional supplements or medication. The goal of diagnosis and treatment is to prevent fractures.
Am I at risk?
Your chances of developing osteoporosis are greater if you are female and answer “yes” to any of the following questions:
- Are you…?
- Light skinned
- Thin or small framed
- Approaching or past menopause
- Milk intolerant or have a low calcium intake
- A cigarette smoker or drink alcohol in excess
- Taking thyroid medication or steroid-based drugs for asthma, arthritis or cancer; this includes individuals suffering from hyper-thyroidism and hyper-parathyroidism
- Do you have…?
- A family history of osteoporosis
- Early, natural or surgical menopause (i.e. hysterectomy)
- Long term steroid use (for conditions such as asthma and arthritis)
- Chronic intestinal disorders (i.e. malabsorption syndrome, post-gastrectomy)
- Rheumatoid arthritis
- A sedentary lifestyle
How to prepare for your DEXA exam
Unless otherwise instructed, eat normally the day of your exam, but avoid taking calcium supplements for at least 24 hours prior to your appointment. Wear loose, comfortable clothing. Sweat suits and other casual attire without zippers, buttons or metal objects are preferred.
You should not have had a barium study, radioisotope injection, oral or intravenous contrast material from a CT scan or MRI within seven days prior to your DEXA test.
Our breast centers offer the latest in imaging technology and highly qualified staff. For more information about women’s health and the services offered at these centers including the R2 ImageChecker, Digital Mammography, and Mobile Mammography please visit the Heatlh Alliance women’s health web page at www.ehealthforwomen.com .
Professional Radiology also provides treatment options for many conditions that afflict women including uterine fibroids, varicose veins and vertebroplasty.
For more information about women’s health, please view these sites.
Women’s Health
Osteoporosis
Fibroids
Fibroid Embolization
American College of Radiology
