Breast Imaging Ordering Guidelines

Patricia L. Scheifly Breast Health Center Mammography – Hacienda Heights 12393 Washington Blvd 1850 S. Azusa Ave., Suite 88 Whittier, CA 90606 Hacienda Heights, CA 91745 P: 562.907.0667 P: 626.225.4905 F: 562.789.4411 F: 562.789.4411 TDD: 562.696.9267 . TDD: 562.696.9267

Screening Mammography Diagnostic Mammography Breast Ultrasound Only Breast MRI

***If ordering a diagnostic mammogram in eHR or ***If ordering an ultrasound in eHR or  Patient is currently Request for Breast Imaging Services form, Request for Breast Imaging Services form,  Evaluation of Implant integrity asymptomatic Ultrasound of the same breast should not be ordered Mammogram of the same breast should not separately. be ordered separately. . No new problems  BILATERAL Diagnostic Mammogram with . This exam is done without . No pain Ultrasound if needed contrast and only evaluates the The patients below should begin with implant(s). . No mass/thickening . Patient is currently symptomatic ultrasound only with diagnostic . No spontaneous clear . If the referring provider would - Male patients (20 years and older) mammogram if needed. or bloody nipple also like the breast tissue

discharge - Female patients (30 years and older) evaluated, “Evaluation for breast

. No skin changes cancer exam must be ordered” . Patient has had breast cancer with lumpectomy  Females: Symptomatic Clinical notes/problems must . Patient has had a bilateral also specify that the implant  Patient has never been . Patient presents with clinical breast problem of integrity should also be diagnosed with breast one breast and is due for her annual exam mammogram within the last 3 cancer within months at one of the facilities listed evaluated. 2 months above (Whittier or Hacienda

Heights).  Evaluation for Breast Cancer  UNILATERAL Diagnostic Mammogram with . Patients that are 29 years of age or *Creatinine levels within 6 weeks Ultrasound if needed younger should begin with may be required ultrasound . Patient is symptomatic

. Patient has had breast cancer with mastectomy . This exam will evaluate the  Males: Symptomatic breast tissue. This exam is done . Patient has had a mammogram in the last . Patients that 19 years of age or with and without contrast. 10 months and is now presenting with a new younger should begin with symptom. ultrasound . If the patient has both breasts, please order a bilateral breast  Abnormal Mammogram & Short Term  Abnormal Mammogram & Short exam regardless if symptom is Follow-up only on one side. Term Follow-up

. If the radiologist’s report recommends: “Diagnostic mammogram (Special Views) . If the radiologist’s report . If the patient has had a and/or ultrasound” recommends: “Ultrasound and/or mastectomy, please order a mammogram” unilateral exam. - Order unilateral or bilateral “mammogram with ultrasound if needed “ - Order the “ultrasound with (refer to last imaging report). mammogram if needed” (refer to last imaging report).

NOT PART OF THE MEDICAL RECORD Revised 6.2016