Breast Imaging Faqs
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Future of Breast Elastography
Future of breast elastography Richard Gary Barr1,2 1Department of Radiology, Northeastern Ohio Medical University, Rootstown, OH; 2Southwoods Imaging, Youngstown, OH, USA REVIEW ARTICLE Both strain elastography and shear wave elastography have been shown to have high sensitivity https://doi.org/10.14366/usg.18053 pISSN: 2288-5919 • eISSN: 2288-5943 and specificity for characterizing breast lesions as benign or malignant. Training is important for Ultrasonography 2019;38:93-105 both strain and shear wave elastography. The unique feature of benign lesions measuring smaller on elastography than B-mode imaging and malignant lesions appearing larger on elastography is an important feature for characterization of breast masses. There are several artifacts which can contain diagnostic information or alert to technique problems. Both strain and shear wave elastography continue to have improvements and new techniques will soon be available for Received: September 21, 2018 clinical use that may provide additional diagnostic information. This paper reviews the present Revised: January 4, 2019 Accepted: January 4, 2019 state of breast elastography and discusses future techniques that are not yet in clinical practice. Correspondence to: Richard Gary Barr, MD, PhD, Keywords: Breast; Elasticity imaging techniques; Strain; Shear wave; Strain ratio; Southwoods Imaging, 7623 Market Street, Youngstown, OH 44512, USA Breast neoplasms Tel. +1-330-965-5100 Fax. +1-330-965-5109 E-mail: [email protected] Introduction The use of palpation to determine the stiffness of a lesion has been used since the time of the ancient Greeks and Egyptians [1]. Stiff, non-mobile lesions of the breast have a high probability of being malignant. -
Breast Scintimammography
CLINICAL MEDICAL POLICY Policy Name: Breast Scintimammography Policy Number: MP-105-MD-PA Responsible Department(s): Medical Management Provider Notice Date: 11/23/2020 Issue Date: 11/23/2020 Effective Date: 12/21/2020 Next Annual Review: 10/2021 Revision Date: 09/16/2020 Products: Gateway Health℠ Medicaid Application: All participating hospitals and providers Page Number(s): 1 of 5 DISCLAIMER Gateway Health℠ (Gateway) medical policy is intended to serve only as a general reference resource regarding coverage for the services described. This policy does not constitute medical advice and is not intended to govern or otherwise influence medical decisions. POLICY STATEMENT Gateway Health℠ does not provide coverage in the Company’s Medicaid products for breast scintimammography. The service is considered experimental and investigational in all applications, including but not limited to use as an adjunct to mammography or in staging the axillary lymph nodes. This policy is designed to address medical necessity guidelines that are appropriate for the majority of individuals with a particular disease, illness or condition. Each person’s unique clinical circumstances warrant individual consideration, based upon review of applicable medical records. (Current applicable Pennsylvania HealthChoices Agreement Section V. Program Requirements, B. Prior Authorization of Services, 1. General Prior Authorization Requirements.) Policy No. MP-105-MD-PA Page 1 of 5 DEFINITIONS Prior Authorization Review Panel – A panel of representatives from within the Pennsylvania Department of Human Services who have been assigned organizational responsibility for the review, approval and denial of all PH-MCO Prior Authorization policies and procedures. Scintimammography A noninvasive supplemental diagnostic testing technology that requires the use of radiopharmaceuticals in order to detect tissues within the breast that accumulate higher levels of radioactive tracer that emit gamma radiation. -
Breast Imaging H
BREAST IMAGING H. Lee Moffitt Cancer Center and Research Institute Rotation Director: Margaret Szabunio, M.D. General Goals : On this rotation, the resident will learn to interpret screening mammograms and to perform diagnostic mammography and ultrasound examinations of the breast. The resident will learn to formulate appropriate differential diagnoses and recommendations for various breast pathologies. The resident will also learn mammographic, ultrasound and MR breast biopsy techniques. Daily Work : The resident rotation begins after morning conference has concluded. In this rotation the resident shall learn BIRADS nomenclature and become proficient in using the PENRAD system for reporting. The resident will also learn the difference between screening and diagnostic mammography and how to perform a diagnostic work-up. (S)he will become familiarized with mammographic positioning and technique and quality assurance including MQSA and ACR requirements. The resident will learn to interpret mammographic images and the use of additional mammographic views for problem solving. (S)he will learn when and how to employ sonography in patient evaluation. The resident is REQUIRED to attend Thursday morning breast interdisciplinary conference. Preparing and reviewing cases for this conference is highly recommended. The resident will assist with and perform needle localizations, breast biopsy and cyst aspiration procedures using mammographic, stereotactic and sonographic techniques for each. The resident is expected to identify proper indications and contraindications for each procedure and how to identify and manage complications. The resident is expected to understand and complete informed consent for image guided breast procedures. On occasion, the resident may observe or assist with ductography procedures. Opportunity to observe and assist with MR guided breast procedures may also be available. -
Understanding Cost & Coverage Issues with Diagnostic Breast Imaging
Understanding Cost & Coverage Issues with Diagnostic Breast Imaging JANUARY 2019 The following report represents key findings from The Martec Group’s primary and secondary research efforts. The team was instructed to explore the cost and coverage issue with breast diagnostic imaging in order to equip Susan G. Komen with the information necessary to strategize efforts at the state and federal levels. TABLE OF CONTENTS: I. A Brief Summary of Findings ................................................................................................................... 3 II. Project Background ..................................................................................................................................... 3 III. Study Objectives ........................................................................................................................................... 3 IV. Research Methodology .............................................................................................................................. 3 V. Patient Perspective ...................................................................................................................................... 4 VI. Health/Insurance Professional Perspective ...................................................................................... 5 VII. Cost Analysis .................................................................................................................................................. 6 VIII. Study Conclusions ....................................................................................................................................... -
Breast Ultrasound Accreditation Program Requirements
Breast Ultrasound Accreditation Program Requirements OVERVIEW ........................................................................................................................................................................... 1 MANDATORY ACCREDITATION TIME REQUIREMENTS .......................................................................................................... 2 PERSONNEL QUALIFICATIONS ..................................................................................................................................... 2 INTERPRETING PHYSICIAN .................................................................................................................................................... 2 SONOGRAPHER/TECHNOLOGIST ........................................................................................................................................... 5 EQUIPMENT ......................................................................................................................................................................... 5 QUALITY CONTROL .......................................................................................................................................................... 6 ACCEPTANCE TESTING ......................................................................................................................................................... 6 ANNUAL SURVEY ................................................................................................................................................................ -
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]. -
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. -
Evaluation of the Quantitative Accuracy of a Commercially-Available Positron Emission Mammography Scanner
The Texas Medical Center Library DigitalCommons@TMC The University of Texas MD Anderson Cancer Center UTHealth Graduate School of The University of Texas MD Anderson Cancer Biomedical Sciences Dissertations and Theses Center UTHealth Graduate School of (Open Access) Biomedical Sciences 8-2010 EVALUATION OF THE QUANTITATIVE ACCURACY OF A COMMERCIALLY-AVAILABLE POSITRON EMISSION MAMMOGRAPHY SCANNER Adam Springer Follow this and additional works at: https://digitalcommons.library.tmc.edu/utgsbs_dissertations Part of the Diagnosis Commons, Equipment and Supplies Commons, and the Other Medical Sciences Commons Recommended Citation Springer, Adam, "EVALUATION OF THE QUANTITATIVE ACCURACY OF A COMMERCIALLY-AVAILABLE POSITRON EMISSION MAMMOGRAPHY SCANNER" (2010). The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences Dissertations and Theses (Open Access). 64. https://digitalcommons.library.tmc.edu/utgsbs_dissertations/64 This Thesis (MS) is brought to you for free and open access by the The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences at DigitalCommons@TMC. It has been accepted for inclusion in The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences Dissertations and Theses (Open Access) by an authorized administrator of DigitalCommons@TMC. For more information, please contact [email protected]. EVALUATION OF THE QUANTITATIVE ACCURACY OF A COMMERCIALLY- AVAILABLE POSITRON EMISSION MAMMOGRAPHY SCANNER -
What You Should Know About Breast Cancer Screening
Cancer AnswerLineTM WHAT YOU SHOULD KNOW ABOUT BREAST CANCER SCREENING Women should speak to their health care provider about their risk of breast cancer and whether a screening test is right for them, as well as to review the risks and benefits of screening. The purpose of screening is to find disease early; THE AMERICAN CANCER SOCIETY’S ideally before symptoms appear. Almost all diseases, RECOMMENDATIONS: including cancer, are easier to treat in an earlier • Women between 40 and 44 have the option to stage as opposed to an advanced stage. start screening with a mammogram every year. Women 45 to 54 should get mammograms every While experts may have different opinions regarding • year. when to begin mammography screening and at what frequency, all major U.S. organizations, • Women 55 and older can switch to a mammogram including the American Cancer Society, the every other year, or they can choose to continue National Comprehensive Cancer Network and the yearly mammograms. Screening should continue U.S. Preventive Services Task Force continue to as long as a woman is in good health and is recommend regular screening mammography to expected to live 10 more years or longer. reduce breast cancer mortality. Breast cancer • All women should understand what to expect mortality rates have continued to decrease in the when getting a mammogram for breast cancer United States due to advances in screening and screening—what the test can and cannot do. treatment over the last 20 years. These recommendations apply to asymptomatic Breast cancer screening is broken down into women aged 40 years or older who do not have different classifications based the patient’s age, level preexisting breast cancer or a previously diagnosed of risk (how likely they are to get breast cancer), and high-risk breast lesion and who are not at high risk strength of the recommendation. -
Commercial Reimbursement and Utilization for Invenia ABUS (Automated Breast Ultrasound)
Commercial Reimbursement and Utilization for Invenia ABUS (Automated Breast Ultrasound) Background interpreting physician, referring physician/Health Care Provider (HCP), and patient.6 Specifically, the MQSA encourages education More than one-half of women younger than 50 years old and and outreach to patients from medical/scientific organizations, approximately one-third of women 50 years and older have industry, and interpreting physicians. In addition, outreach to dense breasts in the US.1 Higher breast density is associated referring physicians is encouraged from professional organizations with decreased mammographic sensitivity and specificity and and Continuing Medical Education (CME) providers.6 increased breast cancer risk.2 Due to the shortcomings of mammography in this population of women, an individualized Despite widely available options for additional screening and multimodal screening approach is recommended to improve the legislation mandating density inform, uptake and adoption of early detection of breast cancer. No clinical guidelines explicitly supplemental screening has lagged. In addition to knowledge recommend use of supplemental breast cancer screening on gaps, one study identified reimbursement uncertainties (e.g. women with dense breasts,3 but as of March 2018, 33 states have billing, coding and coverage) as a key factor for slow uptake. In enacted legislation requiring that breast density, in addition to 2015, the CPT® codebook was updated to include two new codes mammography results, be reported to women undergoing such for breast ultrasound, CPT 76641 and 76642, for complete and procedures; additional states have introduced or are currently limited exams, respectively.7 These codes replaced CPT 76645. working on legislation.4 Most states require specific density The new and old codes alike do not differentiate the technology inform language distinguishing dense (i.e., BI-RADS® C and D) used to perform an exam (handheld vs. -
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. -
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.