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FHDI: Breast MRI
The advanced breast imaging studies performed at First Hill are designed to provide you and your doctor important information about your medical status, as well as to help improve your decision making on your treatment options.
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These exams fall into two basic categories:
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Detection of breast cancer and assessment of its extent |
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Diagnostic examination of silicone breast implantS |
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These studies are done on an outpatient basis, using magnetic resonance (MR) imaging and very high-resolution ultrasound. No X-rays are used, and there are no known health risks associated with these diagnostic methods.
This site addresses most issues about these exams. Please study it carefully, and if you have further questions at any time, please ask us.
When is advanced breast imaging used?
Unlike the X-ray mammography used for routine breast screening, these exams are only appropriate in special circumstances, to provide additional, complementary, diagnostic information.
We encourage your doctor to speak with our radiologists to determine whether these examinations are indicated for your care.
Cancer exams
Diagnosis -- Magnetic resonance (MR or MRI) and ultrasound imaging are increasingly employed to improve the diagnosis and assessment of the size and extent of known breast cancer. They are also used when breast cancer is suspected, but other breast imaging studies have been inconclusive.
These exams are for patients whose therapy decisions are likely to be significantly affected by the information provided.
Three other roles of advanced breast imaging are for biopsy, staging and monitoring.
Biopsy -- For patients who do not have a proven diagnosis, the next step after diagnostic imaging is to obtain a tissue sample (biopsy) for the pathologist to examine. Although there are many effective procedures for this, the one we offer is ultrasound-guided needle biopsy.
Staging -- When cancer has already been diagnosed, our imaging methods are often used for "staging". To determine the extent of the tumor.
Staging defines:
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The size and local extent of tumor |
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The presence or absence of tumor in adjacent lymph nodes |
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The presence or absence of distant metastatic tumor in bones, liver, etc. |
Monitoring -- Similar studies are also used to monitor a tumor's response to chemotherapy.
Silicone implant exams
MR and ultrasound are also used for silicone breast implants, to determine whether the implants are ruptured and to define the extent of leakage that may have occurred.
Please note that the imaging method for implants is NOT designed to diagnose or to rule out cancer; contrast injections are not administered.
MRI of the breast
The MR study of the breasts for cancer uses contrast material which is injected into a vein. The images produced are three-dimensional and have high resolution and clarity.
Although this test is relatively new in this country, it has been used in Europe since about 1986. While breast MR is capable of detecting tumors as small as four or five millimeters (the size of a pea), the overall accuracy of the test is still being studied. Our physicians are highly experienced and pioneered this technique in the Northwest; beginning in January 1992.
Precautions -- There are circumstances under which MR imaging should not be done, and other which call for precautions. Before your exam, you will be asked if you are pregnant or if you have any metal in your body. You must tell us if you have a cardiac pacemaker, cerebral aneuryism clips, an insulin pump, or other infusion pump, cochlear (inner ear) implant, neurostimulator, Copper-7 IUD or any other metal in the body, especially your eyes.
Preparing for the exam -- No advanced preparation is required. Eat normally and take medication as usual.
For non-urgent exams for possible cancer, we recommend the MR exam be done at around 10 days from the first day of your menstrual period, if possible.
What to expect -- Please remove any metal objects which could be affected by the magnet (such as jewelry, watch, dentures, and hearing aids). You will also change into comfortable clothing that we will provide.
An intravenous tube will be placed in your arm, and you will be positioned on your stomach. Your breasts will rest in a special "breast coil" which receives the signal from the area being studied.
During the examination, it is crucial that you not move, or the MR image will be blurred. The quality of your MR study depends entirely on your ability to hold extremely still for 15 to 20 minutes.
During the exam, you will be given a small IV injection of a contrast agent which is FDA approved and considered very safe; most patients do not feel it at all. This material rarely produces reactions, and when they occur, they are milder than iodine-based contrast used for CD scans and kidney X-rays.
Throughout the exam, you will hear a rhythmic thumping sound and may feel a slight vibration, but there should be no other physical sensations.
While the space in the MR machine is adequate, some people feel uncomfortable in it. If you have difficulty being in a confined area, please call us in advance to discuss it.
Occasionally a patient will need a moderate oral sedative to be comfortable in the MR scanner. If this is the case, you will need to bring someone to drive you home.
Ultrasound
In many cases, additional breast and lymph node diagnostic information is obtained using high-resolution ultrasound, which can help further clarify the nature of breast or lymph node lumps.
Ultrasound is also used to accurately guide biopsies. Additionally, it is used to place markers prior to surgical biopsy or lumpectomy. For the latter, ultrasound enables, precise placement of a thin localization wire into a lump which leads the surgeon to the mass.
Precautions and preparation -- There are no precautions or preparation requirements.
What to expect -- Ultrasound produces pictures with a small beam of high-frequency sound waves.
You will be asked to change some of your clothing and wear a hospital gown. A warm gel will be applied to your skin and removed afterwards.
If you are having a biopsy or placement of a localization wire, a local anesthetic is administered.
Results
We will send films of your study and a written report to your doctor. You and your doctor can then discuss the results and how they apply to your medical care.
Billing
Your examination is billed as a medical diagnostic procedure. We are preferred providers for most medical plans, and we will bill your insurance plan. Many plans require pre-authorization for these procedures. Ultimately, you are responsible for payment.
For any portion not paid by your insurance, we accept cash, personal checks, Visa and MasterCard.
The medical staff
Our staff physicians, led by Bruce A. Porter, M.D., are board-certified radiologists whose research into oncology imaging has been published extensively. Their work has led many referring physicians to regard our center as a specialized regional cancer imaging center.
Our support staff is among the best. Everyone here is committed to making your visit comfortable and efficient.
We invite you to call with any questions, comments or concerns.
Other helpful resources for learning about breast cancer include:
American Cancer society
www.cancer.org
National Cancer Institute
www.nci.nih.gov
National Alliance of Breast Cancer Organizations (NABCO)
www.nabco.org
National Coalition for Cancer Survivorship
www.canceradvocacy.org
National Consortium of Breast Centers, Inc. (NCBC)
www.breastcare.org
The Susan G. Komen Breast Cancer Foundation
www.breastcare.org
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