ORDERING GUIDELINES: MAMMOGRAPHY AND BREAST ULTRASOUND

GENERAL INFORMATION: 1. Please make the patient aware of the following: If the patient’s previous mammograms and/or breast ultrasounds were NOT performed at Berkshire Medical Center’s Women’s Imaging Center, Fairview Hospital, or North Adams Regional Hospital/Northern Berkshire Health Center of BMC, he/she should arrange to have copies of them sent to the Women’s Imaging Center (even if the appointment is scheduled at Fairview or the Northern Berkshire Health Center). The address is 777 North Street, Pittsfield MA 01201. The radiologist will need these images for comparison. The patient should leave enough time before his/her appointment for the images to arrive at Women’s Imaging. NOT OBTAINING PRIOR EXAMS FROM AN OUTSIDE FACILITY BEFORE THE APPOINTMENT MAY RESULT IN EXTRA IMAGING OR A DELAY IN GETTING THE RESULTS.

2. There are two types of mammograms: diagnostic and screening. A diagnostic mammogram is performed if a patient is called back for additional imaging following a screening mammogram, if the patient has a palpable mass or other symptom, or if a previous finding is being followed. A screening mammogram means that the patient has no symptoms.

3. If the patient does not speak English, you must notify Central Scheduling at the time you make the appointment that an interpreter will be needed.

4. If the patient is either an in-patient or an Emergency Department patient at Berkshire Medical Center, please contact the Women’s Imaging Center at 447-2147 for information about ordering a mammogram or breast ultrasound. If an emergency breast ultrasound is needed during times that the Women’s Imaging Center is not open, the exam can be booked in the main Radiology department, but the Women’s Imaging Center MUST be notified the next business day.

PATIENT PREP FOR ALL MAMMOGRAMS:  The patient should bring a list of his/her current medications to the exam.  Patient should not wear perfumes, powders, or deodorant on the day of the exam. These substances can be seen on a mammogram and can interfere with an accurate interpretation of the exam by the radiologist.

THERE IS NO SPECIAL PREPARATION REQUIRED FOR BREAST ULTRASOUNDS

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MAMMOGRAPHY NAME OF EXAM COMMON INDICATIONS ORDERING NOTES ROUTINE SCREENING MAMMOGRAMS WMC MAMMO-DIGITAL ROUT BIL  Screening exam of both breasts  If the patient needs a diagnostic mammogram on (Bilateral Screening Mammogram) one side and a screening mammogram on the other, a bilateral diagnostic mammogram should be ordered.

WMC MAMMO-DIGITAL ROUT LEFT  Screening exam of the left breast only  If the patient needs a diagnostic mammogram on (Left Breast Screening Mammogram) the right side at the same time, a bilateral diagnostic mammogram should be ordered.

WMC MAMMO-DIGITAL ROUT RIGHT  Screening exam of the right breast only  If the patient needs a diagnostic mammogram on (Right Breast Screening Mammogram) the left side at the same time, a bilateral diagnostic mammogram should be ordered.

WMC MAMMO-DIG ROUT IMPLANTS  Screening exam of both breasts for patients  If the patient needs a screening mammogram on (Screening Mammogram Implants) with implant(s) in one or both breasts one side and a diagnostic mammogram on the other, a bilateral diagnostic mammogram for implants should be ordered.

WMC MAMMO-DIGIT SPECIAL NEEDS  Screening exam of both breasts for patients  “Special needs” refers to any patient who might (Screening Mammogram Special Needs) with special needs require extra time to complete the exam.

DIAGNOSTIC MAMMOGRAMS WMC MAMMO-DIGITAL DIAG BIL  Patient has a palpable lump in each breast or  For patients with palpable lumps, an ultrasound (Bilateral Diagnostic Mammogram) other bilateral symptoms should also be ordered (see Breast Ultrasound  Patient is being called back after a screening guidelines below). mammogram for additional views of both  If the patient needs a diagnostic mammogram on breasts one side and a screening mammogram on the  Follow-up exam for previous findings in both other, a bilateral diagnostic mammogram should breasts be ordered.

WMC MAMMO-DIGITAL DIAG LEFT  Patient has a palpable lump or other symptom  For patients with palpable lumps, an ultrasound (Left Breast Diagnostic Mammogram) in the left breast only should also be ordered (see Breast Ultrasound

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MAMMOGRAPHY NAME OF EXAM COMMON INDICATIONS ORDERING NOTES  Patient is being called back after a screening guidelines below). mammogram for additional views of the left  If the patient needs a screening mammogram on breast only the right side at the same time, a bilateral  Follow-up exam for previous finding(s) in the diagnostic mammogram should be ordered. left breast only

WMC MAMMO-DIGITAL DIAG RIGHT  Patient has a palpable lump or other symptom  For patients with palpable lumps, an ultrasound (Right Breast Diagnostic Mammogram) in the right breast only should also be ordered (see Breast Ultrasound  Patient is being called back after a screening guidelines below). mammogram for additional views of the right  If the patient needs a screening mammogram on breast only the left side at the same time, a bilateral  Follow-up exam for previous finding(s) in the diagnostic mammogram should be ordered. right breast only

WMC MAMMO-DIG DIAG IMP BIL  Patient has bilateral implants and has a  For patients with palpable lumps, an ultrasound (Bilateral Diagnostic Mammogram Implant(s)) palpable lump in each breast or other bilateral should also be ordered (see Breast Ultrasound symptoms guidelines below).  Patient has implant(s) and is being called back  If the patient needs a diagnostic mammogram on after a screening mammogram for additional one side and a screening mammogram on the views of both breasts other, a bilateral diagnostic mammogram for  Follow-up exam for patient with implant(s) for implants should be ordered. previous finding(s) in both breasts

WMC MAMMO-DIG DIAG IMP LEFT  Patient has implant(s) and has a palpable lump  For patients with palpable lumps, an ultrasound (Left Breast Diagnostic Mammogram Implant) or other symptom in the left breast only should also be ordered (see Breast Ultrasound  Patient has implant(s) and is being called back guidelines below). after a screening mammogram for additional  If the patient needs a screening mammogram on views of the left breast only the right side at the same time, a bilateral  Follow-up exam for patient with implant(s) for diagnostic mammogram for implants should be previous finding(s) in the left breast only ordered.

WMC MAMMO-DIG DIAG IMP RIGHT  Patient has implant(s) and has a palpable lump  For patients with palpable lumps, an ultrasound (Right Breast Diagnostic Mammogram Implant) or other symptom in the right breast only should also be ordered (see Breast Ultrasound  Patient has implant(s) and is being called back guidelines below). 3

MAMMOGRAPHY NAME OF EXAM COMMON INDICATIONS ORDERING NOTES after a screening mammogram for additional  If the patient needs a screening mammogram on views of the right breast only the left side at the same time, a bilateral  Follow-up exam for patient with implant(s) for diagnostic mammogram for implants should be previous finding(s) in the right breast only ordered.

WMC MAMMO-DIGIT DIAG SP NEEDS  Special needs patient has a palpable lump or  “Special needs” refers to any patient who might (Diagnostic Mammogram for Special Needs other symptom in one or both breasts require extra time to complete the exam. Patient)  Special needs patient is being called back after  For patients with palpable lumps, an ultrasound a screening mammogram for additional views should also be ordered (see Breast Ultrasound of one or both breasts guidelines below).  Follow-up exam for special needs patient for previous findings in one or both breasts

BREAST ULTRASOUND EXAM COMMON INDICATIONS ORDERING NOTES WMC US BREAST LEFT  Patient has a palpable lump or other symptom  A clock-face location MUST be provided for all in the left breast only palpable areas.  Patient is being called back after a screening  An approximate distance from the nipple is mammogram for additional views of the left extremely helpful. breast only  It must be noted if the patient has implants  Follow-up exam for previous finding(s) in the left breast only

WMC US BREAST RIGHT  Patient has a palpable lump or other symptom  A clock-face location MUST be provided for all in the right breast only palpable areas.  Patient is being called back after a screening  An approximate distance from the nipple is mammogram for additional views of the right extremely helpful. breast only  It must be noted if the patient has implants  Follow-up exam for previous finding(s) in the right breast only

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BREAST ULTRASOUND EXAM COMMON INDICATIONS ORDERING NOTES WMC US BREAST BILATERAL  Patient has a palpable lump or other symptom  A clock-face location MUST be provided for all in each breast palpable areas.  Patient is being called back after a screening  An approximate distance from the nipple is mammogram for additional views of both extremely helpful. breasts  It must be noted if the patient has implants  Follow-up exam for previous findings in both breasts

WMC US SCREENING BREAST LEFT  As a supplement to mammography, to screen  Please note if the patient has implants for occult cancers in certain populations of  Not all insurance plans cover ultrasound breast women (such as those with dense screening exams; therefore, the patient will be fibroglandular breasts who are also at elevated asked to sign a financial waiver form at the time of risk of breast cancer or with newly suspected the exam. The patient may wish to contact her breast cancer) who are not candidates for MRI insurance provider prior to the exam to determine or have no easy access to MRI if the service is covered.

WMC US SCREENING BREAST RIGHT  As a supplement to mammography, to screen  Please note if the patient has implants for occult cancers in certain populations of  Not all insurance plans cover ultrasound breast women (such as those with dense screening exams; therefore, the patient will be fibroglandular breasts who are also at elevated asked to sign a financial waiver form at the time of risk of breast cancer or with newly suspected the exam. The patient may wish to contact her breast cancer) who are not candidates for MRI insurance provider prior to the exam to determine or have no easy access to MRI if the service is covered.

WMC US SCREENING BILAT  As a supplement to mammography, to screen  Please note if the patient has implants for occult cancers in certain populations of  Not all insurance plans cover ultrasound breast women (such as those with dense screening exams; therefore, the patient will be fibroglandular breasts who are also at elevated asked to sign a financial waiver form at the time of risk of breast cancer or with newly suspected the exam. The patient may wish to contact her breast cancer) who are not candidates for MRI insurance provider prior to the exam to determine or have no easy access to MRI if the service is covered.

WMC US AXILLA – RIGHT  Patient has a palpable lump or other symptom in the right axilla 5

BREAST ULTRASOUND EXAM COMMON INDICATIONS ORDERING NOTES  Identification and evaluation of axillary lymph nodes in patients with breast cancer

WMC US AXILLA – LEFT  Patient has a palpable lump or other symptom in the left axilla  Identification and evaluation of axillary lymph nodes in patients with breast cancer

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