DOCSLIB.ORG

Evaluation of Nipple Discharge E. Jane Karimova, MD September 11, 2018, 7:00Pm ET

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Evaluation of Nipple Discharge E. Jane Karimova, MD September 11, 2018, 7:00Pm ET Evaluation of Nipple Discharge E. Jane Karimova, MD September 11, 2018, 7:00pm ET SAM Questions 1. 42 year old woman with no significant family history of breast or ovarian cancer with a recent onset of bilateral spontaneous milky nipple discharge. She was prescribed risperidone 3 months ago. Her screening mammogram from 2 years ago is normal. What is the best next imaging step? A. Screening mammogram B. Diagnostic mammogram C. Targeted ultrasound of the subareolar breasts bilaterally D. Contrast‐enhanced breast MRI E. Galactography Answer: A Rationale: Screening mammogram is the best answer. This patient developed physiologic nipple discharge, defined as bilateral, originating from multiple ducts, white or green in color and milky in appearance, often nonspontaneous. Physiologic nipple discharge is not associated with breast cancer and no special imaging work up is needed (choices 2‐5 are incorrect). This patient is due for a screening mammogram; therefore, answer 1 is correct. Causes of physiologic nipple discharge include hypothyroidism, pituitary adenoma, pregnancy, and medication side effects. Medications associated with physiologic discharge include hormonal preparations, psychotropic, antihypertensive, and antiemetic drugs, and the H2 receptor antagonist group. This patient, who recently started taking risperidone, a psychotropic medication, likely experiences a side effect of the new medication and should be managed clinically. References: Hirose M, Nobusawa H, Gokan T. MR ductography: comparison with conventional ductography as a diagnostic method in patients with nipple discharge. Radiographics. 2007 Oct; 27 Suppl 1:S183‐96. doi: 10.1148/rg.27si075501. Review. Gray RJ1, Pockaj BA, Karstaedt PJ. Navigating murky waters: a modern treatment algorithm for nipple discharge. Am J Surg. 2007 Dec;194(6):850‐4; discussion 854‐5. 2. 20 year‐old woman with an average risk of breast cancer development and spontaneous clear discharge from a single orifice on the left nipple. What is the best next step? A. Screening mammography B. Diagnostic mammography C. Targeted subareolar ultrasound of the left breast D. Breast MRI E. Galactography Answer: C Rationale: Targeted ultrasound is the best answer. This young woman has pathologic nipple discharge, characterized as unilateral, non‐spontaneous, and from a single orifice. Imaging work‐up starting with ultrasound is appropriate. Breast cancer is rare in women of average risk younger than 30 with the probability of 1 in 1681 at 20 years. Because of the theoretically increased radiation risk of mammography and the low incidence of breast cancer in this age group, diagnostic workup should start with ultrasound instead of mammogram in women younger than 30. Diagnostic mammography is the wrong answer. If the initial US reveals suspicious findings, mammography may be indicated. Similarly, screening mammogram, breast MRI, and galactography are also not appropriate as the first imaging step. Reference: ACR Appropriateness Criteria® Evaluation of Nipple Discharge. Lee, Su‐Ju et al. Journal of the American College of Radiology, Volume 14 , Issue 5 , S138 ‐ S153. 3. 42 year old woman with new onset of spontaneous bloody right nipple discharge. No recent screening mammogram. What is the best initial imaging study? A. Diagnostic mammogram B. Screening mammogram C. Ultrasound D. MRI E. Galactogram Answer: A Rationale: Diagnostic mammogram is the best choice. In patients 40 years or older with pathologic nipple discharge mammography is the first‐line imaging modality unless the patient is pregnant or had a recent (<6 months) screening mammogram. In these cases work up can start with US (choice 3). MRI and galactogram (choices 4 and 5) are usually not appropriate as the initial examination, but may be used when initial work‐up is negative. Reference: ACR Appropriateness Criteria® Evaluation of Nipple Discharge. Lee, Su‐Ju et al. Journal of the American College of Radiology, Volume 14 , Issue 5 , S138 ‐ S153. 4. 45 year old woman with new onset of unilateral spontaneous bloody nipple discharge. Initial workup with mammogram and ultrasound was nonrevealing. What is the best next step? A. Cytological evaluation of the discharge B. Galactogram or breast MRI C. Central duct excision Answer: B Rationale: Galactogram (or ductogram) is performed after the secreting duct is cannulated and a small volume (0.1‐1.5 ml) of water‐soluble iodinated contrast material is injected. Mammogram is then taken in two projections. Although galactography can be time‐consuming and technically challenging, it was reported to localize 76% of otherwise occult malignant and high‐risk lesions (ref. Morough). MRI can also be very helpful when conventional imaging fails to demonstrate the culprit lesion. MRI has higher sensitivity and specificity than US and ductography for lesion detection and may be a useful alterative to ductography (ref.: Orel, Lubina, Manganaro). An additional advantage of MRI is the ability to perform MRI‐guided needle biopsy of a suspicious finding. Answer 1 is incorrect. Cytology of nipple discharge is not indicated as it has been proven neither sensitive nor specific (ref Gray). Answer 3 is not the best answer out of the offered choices. Although duct excision is the gold standard diagnostic and therapeutic approach for patients with pathological nipple discharge when imaging does not disclose the culprit lesion, non‐directed central duct excision may miss multiple or peripheral lesions. Preoperative imaging with ductography ‐guided operations or any other surgical procedure with image guidance of the lesion are more likely to have a specific underlying lesion identified than patients who underwent central duct excision alone. Therefore, if patient can tolerate, MRI or galactogram would be helpful prior to surgery. References: Morrogh M1, Park A, Elkin EB, King TA. Lessons learned from 416 cases of nipple discharge of the breast. Am J Surg. 2010 Jul;200(1):73‐80. doi: 10.1016/j.amjsurg.2009.06.021. Epub 2010 Jan 15. Orel SG, Dougherty CS, Reynolds C, Czerniecki BJ, Siegelman ES, Schnall MD. MR imaging in patients with nipple discharge: initial experience. Radiology. 2000;216(1):248‐254. Lubina N, Schedelbeck U, Roth A, et al. 3.0 Tesla breast magnetic resonance imaging in patients with nipple discharge when mammography and ultrasound fail. Eur Radiol. 2015;25(5):1285‐ 1293.Nakahara H, Namba K, Watanabe R, et al. A comparison of MR imaging, galactography and ultrasonography in patients with nipple discharge. Breast Cancer. 2003;10(4):320‐329. Manganaro L, D'Ambrosio I, Gigli S, et al. Breast MRI in patients with unilateral bloody and serous‐bloody nipple discharge: a comparison with galactography. Biomed Res Int. 2015;2015:806368. 5. What are contraindications to galactography? A. Severe allergy to iodinated contrast material. B. Debilitating anxiety. C. History of prior surgery disconnecting the duct orifices from the underlying ducts. D. Abscess or diffuse mastitis. E. All of the above. Answer: E Rationale: All of the above. Although no significant contrast reactions have been reported following ductography, severe allergy to contrast material should be considered a contraindication. Mental disorder or debilitating anxiety might preclude patient cooperation for the procedure. History of surgery disconnecting the nipple orifices from the ducts will make the procedure unsuccessful (ref. Slawson). Galactography should not be performed in patients with mastitis or breast abscess, as the inflammation may become more severe (ref. Tabar). References: Slawson SH1, Johnson BA. Ductography: how to and what if? Radiographics. 2001 Jan‐Feb;21(1):133‐50. Tabár L, Dean PB, Péntek Z. Galactography: the diagnostic procedure of choice for nipple discharge. Radiology. 1983 Oct;149(1):31‐8. .
Load more

Recommended publications
  • Evicore Breast Imaging Guidelines
    CLINICAL GUIDELINES Breast Imaging Guidelines Version 2.0 Effective September 1, 2021 eviCore healthcare Clinical Decision Support Tool Diagnostic Strategies: This tool addresses common symptoms and symptom complexes. Imaging requests for individuals with atypical symptoms or clinical presentations that are not specifically addressed will require physician review. Consultation with the referring physician, specialist and/or individual’s Primary Care Physician (PCP) may provide additional insight. CPT® (Current Procedural Terminology) is a registered trademark of the American Medical Association (AMA). CPT® five digit codes, nomenclature and other data are copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in the CPT® book. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein. © 2021 eviCore healthcare. All rights reserved. Breast Imaging Guidelines V2.0 Breast Imaging Guidelines Abbreviations for Breast Guidelines 3 BR-Preface1: General Considerations 5 BR-1: Breast Ultrasound 8 BR-2: MRI Breast 10 BR-3: Breast Reconstruction 12 BR-4: MRI Breast is NOT Indicated 13 BR-5: MRI Breast Indications 14 BR-6: Nipple Discharge/Galactorrhea 18 BR-7: Breast Pain (Mastodynia) 19 BR-8: Alternative Breast Imaging Approaches 20 BR-9: Suspected Breast Cancer in Males 22 BR-10: Breast Evaluation in Pregnant or Lactating Females 23 ______________________________________________________________________________________________________
    [Show full text]
  • Biopsy Needles and Drainage Catheters
    Needles & Accessories | Catheters & Accessories Dilation & Accessories Spinal & Accessories | Implantable & Accessories Product Catalog ISO 13485 & ISO 9001 Certified Company Rev. 01 - 2019/03 About ADRIA Srl. Adria is a worldwide leader in developing, manufacturing and marketing healthcare products. The main focus is on Radiology, Oncology, Urology, Gynecology and Surgery . Adria' s corporate headquarter is based in Italy, it is ISO Certified and products are CE . marked. Adria was incorporated more than 20 years ago in Bologna , where the corporate headquarter and production plant is located. Adria is leader in developing and manufacturing healthcare products and keeps the status to be one of the first companies aimed to develop single patient use biopsy needles and drainage catheters. Over the time, thanks to the experience of specialized doctors and engineers , Adria product range and quality have been progressively enhanced, involving and developing the spine treatment line. Nowadays Adria has a worldwide presence . Reference markets are France, Spain, Turkey and products are distributed in more than 50 countries, through a large and qualified network of dealers. Since far off the very beginning, many things have changed, but Adria' s philosophy and purpose have always remained unchanged: helping healthcare providers to fulfill their mission of caring for patients. Table of Contents Needles & Accessories …………………………………………….....…...3 Catheters & Accessories ……………………….………………..…...…...18 Dilation & Accessories ……………………………………………...…...25 Spinal & Accessories ……………………………………………...…...30 Implantables & Accessories……………………………………………...…...35 Needles & Accessories HYSTO SYSTEM Automatic Biopsy Instrument……………………….……….…….. 4 HYSTO SYSTEM II Automatic Biopsy Instrument…………………….……….……...5 SAMPLE MASTER Semi-Automatic Biopsy Instrument…………………………….. 6 HYSTO-ONE Automatic Reusable Biopsy Instrument & MDA Biopsy Needle ....... 7 HYSTO-TWO Automatic Reusable Biopsy Instrument & MDS Biopsy Needle…...
    [Show full text]
  • Breast MRI: New and Abbreviated Protocols
    Breast MRI: New and Abbreviated Protocols Christopher Comstock M.D. Department of Radiology Memorial Sloan-Kettering Cancer Center Topics • What is our goal? • Current status of screening • How do we change screening • Abbreviated Breast MRI (AB-MR) • EA1141 AB-MR Trial • Multiparametric Breast MRI Beyond the scope of this talk! • The debate over screening the benefit of mammography, particularly for women in their forties. What is Our Goal? • Decrease breast cancer mortality • Reduction in the morbidities associated with surgery and chemotherapy • Finding breast cancers at a smaller size and earlier stage leads to a reduction in mortality and the use of less aggressive therapies Reservoir of Breast Cancer Present in 1000 Women Being Screened • Is it 30, 40, 50, 60 or more breast cancers per 1000 women? • Depends on risk of population • Detection level (size and stage) depends on modality and frequency of screening Reservoir of Breast Cancer Present in 1000 Women Being Screened Tomo plus WBUS The Dissemination of Medical Technologies into Clinical Practice • Innovations medical in technology and quality of information are the sole driving force in the acceptance and adoption of new technologies • The dissemination of medical technologies depends on the social, political and ideological context into which they are introduced Much Can Be Learned From the History of Mammography • Despite improvements in technology, mammography languished from 1930s to 1970 – 1930-1950 Stafford L. Warren, Jacob Gershon-Cohen and Raul Leborgne – 1950s Improved techniques, Robert Egan • The production of better data alone did not eliminate the role that economics, authority and ideology played “TO SEE TODAY WITH THE EYES OF TOMORROW” A HISTORY OF SCREENING MAMMOGRAPHY.
    [Show full text]
  • Breast Elastography – Ultrasound Or Magnetic Resonance
    Medical Policy Joint Medical Policies are a source for BCBSM and BCN medical policy information only. These documents are not to be used to determine benefits or reimbursement. Please reference the appropriate certificate or contract for benefit information. This policy may be updated and is therefore subject to change. *Current Policy Effective Date: 7/1/21 (See policy history boxes for previous effective dates) Title: Breast Elastography – Ultrasound or Magnetic Resonance Description/Background In the United States, about 1 in 8 women will develop invasive breast cancer over the course of her lifetime. In 2020, is it estimated that there will be over 280,000 new cases of invasive breast cancer diagnosed in women and over 2,600 new cases of invasive breast cancer in men.1 Breast cancer is the most common cancer in women worldwide.2 Mammography remains the generally accepted standard diagnostic test for breast cancer screening and diagnosis. The incidence of breast cancer has led to research on new diagnostic imaging techniques for early diagnosis. Elasticity is the property of a substance to be deformed in response to an external force and to resume its original size and shape when the force is removed. In evaluation of superficial tissue such as skin, breast or prostate, manual palpation can distinguish normal tissue from stiffer tissue. Elastography is a noninvasive technique that evaluates the elastic properties, or stiffness of tissues, and its application for diagnosing breast cancer is based on the principle that malignant tissue is less elastic than normal, healthy breast tissue. Elastography has been investigated as an additive technique to increase the specificity of ultrasound and magnetic resonance imaging.
    [Show full text]
  • Evaluation of Nipple Discharge
    New 2016 American College of Radiology ACR Appropriateness Criteria® Evaluation of Nipple Discharge Variant 1: Physiologic nipple discharge. Female of any age. Initial imaging examination. Radiologic Procedure Rating Comments RRL* Mammography diagnostic 1 See references [2,4-7]. ☢☢ Digital breast tomosynthesis diagnostic 1 See references [2,4-7]. ☢☢ US breast 1 See references [2,4-7]. O MRI breast without and with IV contrast 1 See references [2,4-7]. O MRI breast without IV contrast 1 See references [2,4-7]. O FDG-PEM 1 See references [2,4-7]. ☢☢☢☢ Sestamibi MBI 1 See references [2,4-7]. ☢☢☢ Ductography 1 See references [2,4-7]. ☢☢ Image-guided core biopsy breast 1 See references [2,4-7]. Varies Image-guided fine needle aspiration breast 1 Varies *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 2: Pathologic nipple discharge. Male or female 40 years of age or older. Initial imaging examination. Radiologic Procedure Rating Comments RRL* See references [3,6,8,10,13,14,16,25- Mammography diagnostic 9 29,32,34,42-44,71-73]. ☢☢ See references [3,6,8,10,13,14,16,25- Digital breast tomosynthesis diagnostic 9 29,32,34,42-44,71-73]. ☢☢ US is usually complementary to mammography. It can be an alternative to mammography if the patient had a recent US breast 9 mammogram or is pregnant. See O references [3,5,10,12,13,16,25,30,31,45- 49]. MRI breast without and with IV contrast 1 See references [3,8,23,24,35,46,51-55].
    [Show full text]
  • Screening Automated Whole Breast Ultrasound
    Screening Automated Whole Breast Ultrasound Screening Automated Whole Breast Ultrasound Stanford now offers screening automated whole breast ultrasound (SAWBU) at our Stanford Medicine Cancer Center Palo Alto location. This is an optional test that can be used as a supplement to screening mammography in women with mammographically dense breasts. It can find cancers that cannot be seen on mammograms due to overlap with dense breast tissue. Stanford uses automated whole breast technique, a new method developed for accuracy and efficiency. Who is a candidate for SAWBU What will happen during the How is SAWBU exam is examination? SAWBU examination? different? This is an optional test to supplement You will lie on your back, and gel will Screening automated screening mammography in women be applied to your breast. whole breast ultrasound who: uses sound waves (no radi- A large ultrasound handpiece will be • Undergo routine screening with ation) to create 3D pictures placed on the breast, and the system mammography. of the breast tissue, using will automatically take a “sweep” • Have no current signs or a new automated method that obtains ultrasound images of symptoms of breast cancer. developed for accuracy and the tissue from top to bottom. The • Have mammographically dense efficiency. handpiece will be repositioned to take (heterogeneously or extremely other “sweeps” to include all of the It can find cancers that dense) breasts. breast tissue. cannot be seen on mam- • Are not at “high risk" undergoing mograms alone due to supplemental screening with An exam of both breasts takes less overlap with dense breast breast MRI. Screening ultra- than 20 minutes to obtain.
    [Show full text]
  • Shear Wave Elastography As an Early Indicator of Breast Cancer in A
    ISSN: 2378-3656 Altunkeser and Arslan. Clin Med Rev Case Rep 2019, 6:259 DOI: 10.23937/2378-3656/1410259 Volume 6 | Issue 3 Clinical Medical Reviews Open Access and Case Reports CAse RepoRt Shear Wave Elastography as an Early Indicator of Breast Cancer in a Breastfeeding Patient: A Case Report and Literature Review Ayşegül Altunkeser and Fatma Zeynep Arslan* Check for Department of Radiology, Konya Training and Research Hospital, University of Health Science, Turkey updates *Corresponding author: Fatma Zeynep Arslan, MD, Konya Training and Research Hospital, University of Health Science, Hacı Şaban Mah, Meram Yeni Yol Caddesi, No: 97, PC: 42090, Meram, Konya, Turkey, Tel: 0506-438-24-30, Fax: 0-332- 323-67-23 our hospital complaining from pain in the right breast. Abstract In the young patient with no history of cancer in the Shear wave elastography (SWE) is a relatively new and family; The patient was breasfeeding and labaratuary highly effective method to reveal mechanical features of tissue by demonstrating quantitative elasticity value. The findings were normal. On physical examination, a hard morphological features including margin of the lesion, ori- mass was palpated in her right breast. A hypoechoic entation, shape and border are considered in differentiation mass lesions was sonographically detected on the right of breast lesions on USG. It is a known fact that malignant breast in a diameter with 31 × 24 mm (Figure 1). SWE lesions are usually palpated as a hard mass in the physi- cal examination. A qualitative broad information can obtain was performed to obtain additional information about about the tissue elasticity by integrating SWE examination mass lesion.
    [Show full text]
  • Breast Imaging Faqs
    Breast Imaging Frequently Asked Questions Update 2021 The following Q&As address Medicare guidelines on the reporting of breast imaging procedures. Private payer guidelines may vary from Medicare guidelines and from payer to payer; therefore, please be sure to check with your private payers on their specific breast imaging guidelines. Q: What differentiates a diagnostic from a screening mammography procedure? Medicare’s definitions of screening and diagnostic mammography, as noted in the Centers for Medicare and Medicaid’s (CMS’) National Coverage Determination database, and the American College of Radiology’s (ACR’s) definitions, as stated in the ACR Practice Parameter of Screening and Diagnostic Mammography, are provided as a means of differentiating diagnostic from screening mammography procedures. Although Medicare’s definitions are consistent with those from the ACR, the ACR's definitions of screening and diagnostic mammography offer additional insight into what may be included in these procedures. Please go to the CMS and ACR Web site links noted below for more in- depth information about these studies. Medicare Definitions (per the CMS National Coverage Determination for Mammograms 220.4) “A diagnostic mammogram is a radiologic procedure furnished to a man or woman with signs and symptoms of breast disease, or a personal history of breast cancer, or a personal history of biopsy - proven benign breast disease, and includes a physician's interpretation of the results of the procedure.” “A screening mammogram is a radiologic procedure furnished to a woman without signs or symptoms of breast disease, for the purpose of early detection of breast cancer, and includes a physician’s interpretation of the results of the procedure.
    [Show full text]
  • Ultrasound, Elastography and MRI Mammography
    EAS Journal of Radiology and Imaging Technology Abbreviated Key Title: EAS J Radiol Imaging Technol ISSN 2663-1008 (Print) & ISSN: 2663-7340 (Online) Published By East African Scholars Publisher, Kenya Volume-1 | Issue-2 | Mar-Apr-2019 | Research Article Ultrasound, Elastography and MRI Mammography Correlation in Breast Pathologies (A Study of 50 Cases) Dr Hiral Parekh.1, Dr Lata Kumari.2, Dr Dharmesh Vasavada.3 1Professor, Department of Radiodiagnosis M P Shah Government Medical College Jamnagar, Gujarat, India 2Resident Doctor in Radiodiagnosis Department of Radiodiagnosis M P Shah Government Medical College Jamnagar, Gujarat, India 3Professor, Department of Surgery M P Shah Government Medical College Jamnagar, Gujarat, India *Corresponding Author Dr Dharmesh Vasavada Abstract: Introduction: The purpose of this study is to investigate the value of MRI in comparison to US and mammography in diagnosis of breast lesions. MRI is ideal for breast imaging due to its ability to depict excellent soft tissue contrast. Methods: This study of 50 cases was conducted in the department of Radiodiagnosis, Guru Gobinsingh Government Hospital, M P Shah Government Medical College, Jamnagar, Gujarat, India. All 50 cases having or suspected to have breast lesions were chosen at random among the indoor and outdoor patients referred to the Department of Radiodiagnosis for imaging. Discussion: In the present study the results of sonoelastography were compared with MRI. The malignant masses were the commonest and the mean age of patients with malignant masses in our study was 45 years, which is in consistent with Park‟s statement that the mean age of breast cancer occurrence is about 42 years in India3.
    [Show full text]
  • Diagnostic Accuracy of Shear Wave Elastography for Prediction of Breast Malignancy in Patients with Pathological Nipple Discharge
    Open Access Research BMJ Open: first published as 10.1136/bmjopen-2015-008848 on 22 January 2016. Downloaded from Diagnostic accuracy of shear wave elastography for prediction of breast malignancy in patients with pathological nipple discharge Xiaobo Guo,1 Ying Liu,1 Wanhu Li2 To cite: Guo X, Liu Y, Li W. ABSTRACT Strengths and limitations of this study Diagnostic accuracy of shear Objectives: Pathological nipple discharge (PND) may wave elastography for indicate malignant breast lesions. As the role of shear ▪ prediction of breast Diagnostic accuracy of shear wave elastography wave elastography (SWE) in predicting these malignant malignancy in patients with (SWE) for detecting malignancy of patients with pathological nipple discharge. lesions has not yet been evaluated, we aim to evaluate PND has rarely been studied. BMJ Open 2016;6:e008848. the diagnostic value of SWE for this condition. ▪ For the first time, this study tested diagnostic doi:10.1136/bmjopen-2015- Design: Prospective diagnostic accuracy study accuracy of a synthesised measurement of quali- 008848 comparing a combination of qualitative and quantitative tative and quantitative measures of SWE for measurements of SWE (index test) to a ductoscopy detecting malignancy in patients with PND. ▸ Prepublication history for and microdochectomy for histological diagnosis ▪ Limitations include the fact that the weight of this paper is available online. (reference test). each measurement in the synthesised score was To view these files please Setting: Fuzhou General Hospital of Nanjing military assigned evenly and the surgeon was not visit the journal online command. blinded. (http://dx.doi.org/10.1136/ Participants: A total of 379 patients with PND were bmjopen-2015-008848).
    [Show full text]
  • ACR Practice Parameter for Performance of Contrast Enhanced
    The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. Revised 2018 (Resolution 34)* ACR PRACTICE PARAMETER FOR THE PERFORMANCE OF CONTRAST- ENHANCED MAGNETIC RESONANCE IMAGING (MRI) OF THE BREAST PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care1.
    [Show full text]
  • ACR Practice Parameter for the Performance of Whole-Breast
    The American College of Radiology, with more than 30,000 members, is the principal organization of radiologists, radiation oncologists, and clinical medical physicists in the United States. The College is a nonprofit professional society whose primary purposes are to advance the science of radiology, improve radiologic services to the patient, study the socioeconomic aspects of the practice of radiology, and encourage continuing education for radiologists, radiation oncologists, medical physicists, and persons practicing in allied professional fields. The American College of Radiology will periodically define new practice parameters and technical standards for radiologic practice to help advance the science of radiology and to improve the quality of service to patients throughout the United States. Existing practice parameters and technical standards will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice parameter and technical standard, representing a policy statement by the College, has undergone a thorough consensus process in which it has been subjected to extensive review and approval. The practice parameters and technical standards recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice parameter and technical standard by those entities not providing these services is not authorized. 2019 (Resolution 34)* ACR PRACTICE PARAMETER FOR THE PERFORMANCE OF WHOLE- BREAST ULTRASOUND FOR SCREENING AND STAGING PREAMBLE This document is an educational tool designed to assist practitioners in providing appropriate radiologic care for patients. Practice Parameters and Technical Standards are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care1.
    [Show full text]