At ABC, we offer the latest in breast imaging with 2D digital mammography and 3D breast tomosynthesis.

 

What is a mammogram?

 
An x-ray of the breast

 

What is 3D tomosynthesis? 


At the same time as the two mammograms are taken, a camera takes images of the breast - every 2 degrees - the computer reconstructs this into 1mm slices through the breast.

 

Will I get my result immediately? 


Yes - you will be taken through your images by a specialist radiologist at your appointment. 

 

Women can be concerned about:

 

  • Radiation - the dose of radiation used is very low and less than you would get in a year from natural radiation.
  • Compression - most women find the compression no more than uncomfortable. If you have had recent breast surgery, have breast implants, or found your last mammogram very uncomfortable, please discuss this with the mammographer (specialist breast x-ray technician) prior to your examination as there are ways to help you manage your discomfort.

 

Why is mammography used? 


Screening mammography is a wellness test, and may detect breast problems before you have any symptoms or concerns. It may show changes in the breast up to two years before you or your doctor can feel a breast lump. This early detection of small breast cancers is important as it enables early treatment.
Diagnostic mammography is used to assist in the diagnosis of an area of concern already identified by you or your doctor.

 

When should women undergo screening mammography? 


Regular screening mammography is recommended for all women over 40 years of age. Plus there are other recommendations:

  • Women from 40-50 years should have annual mammography.
  • Women over 50 years of age may continue to have annual mammography or opt to have two-yearly mammography. If you are unsure which applies to you, discuss this with your doctor.
  • Women who have had a previous breast cancer should have annual mammography.
  • Women who have a first degree relative (ie, their mother or a sister) who has had breast cancer should start having mammograms ten years in age before the age at which their relative was diagnosed.

 

We maintain strict processes to ensure our mammography service meets international quality standards.

You will be asked to remove your clothing from the waist up, and given a gown to wear. For ease of undressing, you may like to wear a shirt and a skirt, or trousers.


Please do not wear deodorant or talcum powder on your breasts or armpits on the day of your examination. We do however provide wipes and deodorant for your personal use. 


Discuss any breast symptoms or problems with the mammographer before the examination and bring along any previous mammography films to your appointment. 


It is important for the radiologists interpreting the mammogram to have previous studies for comparison as they compare previous films with new images to look for any areas of change. 


Please remember to also bring the referral note from your doctor.

A skilled mammographer will take at least two pictures of each breast.  Each breast is placed on the x-ray machine nand compressed with a plastic paddle.  This flattening of the breast will reduce the breast thickness and hold the breast still, which optimises image quality and reduces radiation dosage.

 

Most women would describe the compression as uncomfortable, rather than painful.  If you have found the compression painful, please discuss your concerns with the mammographer.

 

Sometimes further x-ray views may be needed to show an area of the breast more clearly.  Don't be concerned if this occurs.  An ultrasound scan may also be necessary to complete your examination.

 

In most instances having a mammogram only takes about 20 minutes.

We may in some cases also need to perform an ultrasound.

After the images are taken, you will be asked to wait until the mammographer has viewed them to see if any more are needed.

 

The Radiologist may ask if you wish to see the images and will give you your result then.

 

We are proud to be the 1st Breast Care Clinic in Auckland to offer 3D Breast Tomosynthesis.

What is a Three Dimensional (3D) mammogram? 

 

A Three-dimensional (3D) mammogram, also known as breast tomosynthesis, is a type of digital mammography in which x-ray machines are used to take many pictures of thin slices of the breast to produce a 3D image. This process is similar to how a computed tomography (CT) scanner produces images of structures inside of the body.

With a mammogram, glandular and fibrous tissue is white and fat is seen as black.
Cancers are also seen as white so they can hide in normal glandular breast tissue, particularly if the breasts are dense which is seen in our clinic population.
The 3D tomosynthesis takes images through the breast while the mammogram is taken and the computer reconstructs this into 1mm slices through the breast.
Our specialist radiologist reads this in conjunction with the state of the art 2D digital images.
This improves cancer detection and reduces the number of unnecessary biopsies.

2D Image1

 

Cancer visible on the right 3D mammogram but not the left 2D mammogram.

Why are we using this technology?

• Increases the cancer detection rate
• Reduces false negative mammogram results especially in women with dense breast tissue
• Reduces the recall rate
• Reduces unnecessary biopsies
• Provides a 3D image to the surgeon.

What about the radiation dose?
 

We have installed dose reduction software so that the total radiation is 30% less than with conventional mammography.

Is it comfortable?

The new technology uses less compression and takes about 20 seconds longer to take the image than standard film mammography.

The modern design has patient comfort in mind.

 

You will be asked to remove your clothing from the waist up, and given a gown to wear. For ease of undressing, you may like to wear a shirt and a skirt, or trousers.


Please do not wear deodorant or talcum powder on your breasts or armpits on the day of your examination. We do however provide wipes and deodorant for your personal use. 


Discuss any breast symptoms or problems with the mammographer before the examination and bring along any previous mammography films to your appointment. 


It is important for the radiologists interpreting the mammogram to have previous studies for comparison as they compare previous films with new images to look for any areas of change. 


Please remember to also bring the referral note from your doctor.

A skilled mammographer will take at least two pictures of each breast.  Each breast is placed on the x-ray machine and compressed with a plastic paddle.  This flattening of the breast will reduce the breast thickness and hold the breast still, which optimises image quality and reduces radiation dosage.

 

Most women would describe the compression as uncomfortable, rather than painful.  If you have found the compression painful, please discuss your concerns with the mammographer.

 

Sometimes further x-ray views may be needed to show an area of the breast more clearly.  Don't be concerned if this occurs.  An ultrasound scan may also be necessary to complete your examination.

 

In most instances having a mammogram only takes about 20 minutes.

 

We may in some cases also need to perform an ultrasound.

After the images are taken, you will be asked to wait until the mammographer has viewed them to see if any more are needed. 

 

The Radiologist may ask if you wish to see the images and will give you your result then.

 

Also known as ultrasound biopsy or ultrasound-guided injection, ultrasound-guided breast biopsy is an accurate way to take samples of tissue from within the breast that are visible on ultrasound but may not be able to be felt by you or your doctor.

An ultrasound probe is placed over the site of the lump and the radiologist, using local anaesthesia, places a specialised spring biopsy needle into the mass. Tissue specimens are then taken for examination by a pathologist.

A radiologist places a very fine wire marker into the breast to localise (or mark) a specific area of the breast, this was identified as needing further investigation on your mammogram

Why is this necessary?


This procedure is performed prior to the surgeon removing a small abnormal area in your breast. The abnormality can be seen on your mammogram (breast x-ray), but is unable to be felt by your doctor, making it difficult to locate it for removal. The marker makes removal easier.

This procedure will take 40 to 60 minutes. Please wear a shirt and trousers, or skirt, and bring someone with you to take you to the surgical clinic or hospital, where you are likely to go straight after the localisation procedure. Bring a suitcase of personal effects for your stay in the surgical ward. Your surgeon will indicate how long you will need to stay in the surgical unit after the surgery.

There are two stages to this procedure: localisation and excision. We will perform the localisation in our clinic, and you will travel to the hospital for the excision, or removal, of the lump.

Localisation

A mammographer and a radiologist will explain the procedure to you. You will have an initial mammography image taken of your breast. After the radiologist has seen this film, the mammographer will sit or lie you by the mammography machine. When you are in position your breast will be compressed. You will be in this position for a while, so let the mammographer know if the position or pressure is too uncomfortable.

The radiologist will prepare the area with liquid skin wash.

After local anaesthetic has been injected, a fine needle will be inserted into the breast and placed near the area that the surgeon wants to locate. X-rays from both the side and the top of the breast will be taken to check the positioning of this needle.

When the needle is correctly located, a fine wire will be threaded through the needle and the needle withdrawn. This piece of wire will stay in the breast to mark the area for the surgeon.

The wire has a small hook at the end that keeps it secure. When the localisation procedure is completed, the end of the needle is secured onto your skin with tape. You can put on your bra or, if you prefer, just wear a shirt or top. The wire will stay in place with normal movement - but you shouldn't swing your arm vigorously.

MRI combines the use of a very strong magnet, radio waves and a computer system to provide detailed images of internal structures and soft tissue structures. The level of detail seen with an MRI is extraordinary compared with any other imaging modality.

Electrical pulses are used to vary the direction and strength of the magnetic field, causing temporary magnetic realignment of atoms and molecules within your body. The machine's powerful computers can recognise the changes in the atoms as typical of organs and other structures within the body, building up a picture of the body parts. 


What is MRI used for?

MRI is an imaging option for examining the breast. It is the most sensitive for the detection of breast cancer. It is used in breast disease to determine the size and number of breast lesions, to examine the other breast and or surveillance in women with a strong family history of breast cancer. MRI requires specialised equipment and expertise, and allows evaluation of some body structures that may not be as visible with other imaging methods.

Please phone us for an appointment. The receptionist will give you:

  • Instructions on where to go for your MRI scan
  • A list of safety questions
  • Information about the preparation needed before your scan - this may include a period without food, and / or the need for an injection of contrast medium
  • Information about how to arrange "prior approval" from your medical insurance company for your MRI - this means you can send them the invoice for payment, rather than pay first and then claim.
  • Discuss the requirements if ACC funding this examination.

Some MRI scans require an injection of contrast medium. This shows up on the MRI images, and enables the radiologist to identify some organs or internal structures more clearly. It causes no complication in the vast majority of people who have it.

Because the strong magnetic field will affect any metallic object implanted in the body, MRI staff will ask whether you have a artificial joint (eg, hip replacement), heart pacemaker (or artificial heart valve), implanted device (eg, intrauterine device, IUD) or any metal plates, pins, screws or surgical staples in your body. In most cases, surgical staples, plates, pins and screws pose no risk during MRI if they have been in place for more than four to six weeks.

You will be asked if you have ever had a bullet or shrapnel in your body, or ever worked with metal. If there is any question that you may have a metal fragment embedded in your soft tissue, you may be asked to have an x-ray to detect if this is the case. Tooth fillings and dental braces are usually not affected by the magnetic field, but discuss the braces with the radiologist.

As MRI may result in local heating of the skin around tattoos and permanent eyeliner please discuss these with the MRI Radiographer.

If you are particularly anxious about having an MRI, a friend or relative is welcome to come with you to the MRI scanning room. It is safe for them to be in there as there are no x-rays used. This person will also need to complete the questionaire about metallic implants etc.

You will be asked to remove hair clips, jewellery, glasses, hearing aids, and any removable dental plates. If there is a chance you could be pregnant, please let the staff know.

The MRI machine is basically a large cylinder-shaped magnet. A specially trained MRI radiographer will position you on a couch that will then move into the donut-shaped cylinder for image capture. You will have to remain very still during the scanning process. If you have difficulty lying flat, or suffer from claustrophobia, please inform the radiologist prior to the examination.

The radiographer will go behind a partition to operate the scanner. He or she is able to talk to you via a two-way intercom during the scan and will let you know what is happening. If you have any questions, please don't hesitate to ask at any time, even during the MRI scan.

The MRI machine makes a loud banging noise (from the coil movement) while scanning. You will be provided with earplugs or headphones to reduce any discomfort from the noise. Please bring along a favourite CD if you’d like us to play this during the scan.

An MRI  procedure takes between 30 and 60 minutes.

Once the images are recorded, the images and report will be sent to your referring doctor.

You may eat and drink normally. There are no after affects from this MRI.

Why do some women need an ultrasound as well?

There may be a need to perform a breast ultrasound in addition to the mammogram.  The reason for this will be explained to you. Note- there is an additional cost involved.

A breast ultrasound may be required if you have dense breast tissue. In younger women breast tissue is often more dense, and a mammogram may not show as much detail.

 

What is an ultrasound?

A breast ultrasound uses sound waves to make a picture of the tissues inside the breast.  A breast ultrasound can show all areas of the breast, including the area closest to the chest wall, which is hard to study with a mammogram.  Breast ultrasound does not use x-rays.

A breast ultrasound is used to see whether a breast lump is filled with fluid (a cyst) or if it is a solid lump.  An ultrasound does not replace the need for a mammogram, but it is often used to help check dense breasts and to check areas of interest demonstrated on a mammogram.

A small handheld unit called a transducer is gently passed back and forth over the breast.  A computer turns the sound waves into a picture on a TV screen.  The picture is called a sonogram or ultrasound scan.

A specially trained radiologist will perform the breast ultrasound. A chaperone is available if a male radiographer is on duty.

What to bring?

  • Referral letter from your GP
  •  Old mammogram films if you have any stored at home.  If you have been to Auckland Breast Centre in the last 5 years you do not need to bring your old films.

 

How long will the appointment take?

  • It is good to allow 30mins- 1 hour for the appointment.  Please note that acute patient appointments may take longer.
  • Unexpected delays can occur.  If there is a delay that affects your appointment time, our reception team will advise you as soon as possible so you can choose to make another booking if you are unable to wait.

 

What you need to do beforehand

 

  • If you have breast implants please tell our reception team at the time of making your appointment so that we can allow extra time for your appointment.
  • If you always have a breast ultrasound- please let us know at the time of making your appointment so that time can be booked for this also.  Please advise if you are unsure if you have had an ultrasound and we will check your medical records.
  • Please let us know if your last mammogram was completed by another provider and we will source the previous images so that our Radiologist can compare the pictures (this is very important).
  • Remove all deodorant, perfume and do not use talcum powder.
  • We provide a range of antiperspirants for you to use and we have wet towels for the removal of any products you may have used that day.
  • It is a good idea to wear skirt or trousers (rather than a dress) for comfort.

 

What to expect at this appointment

  • You will be welcomed by our reception team who will collect your form and ask you to take a seat in our waiting room.
  • A female clinical assistant will take you to the change area where you will change into a gown (opens at the front).
  • When you are ready and comfortable, the radiographer (also known as a mammographer) will take x-rays of each breast.  Each x-ray only takes a few seconds.  The radiographer will check that the pictures are not blurry and that all of your breast tissue is shown on the x-rays.
  • At Auckland Breast Centre we use 3D mammography technology called Tomosynthesis.  Tomosynthesis delivers high-quality images resulting in more reliable diagnoses and will take 20 seconds per breast at the same time as the mammogram.  While the mammogram is being taken, each breast will be compressed between two flat plates on the x-ray machine.
  • Compressing the breast only lasts for a few seconds.
  • Some women may experience discomfort; however if you experience pain during the mammogram you should let the radiographer know.
  • Please advise your radiographer if you have sensitive breasts or breast implants.
  • Your radiographer will work with you to make sure that the mammogram is as comfortable as possible.

 

What happens next?

 

  • After your mammogram, you will return to the waiting area while our x-rays will be reviewed onsite by a specially trained radiologist.  Your previous x-rays will be compared to your new ones.
  • The radiologist will show you the images and advise you of the findings.
  • Your GP will also receive a copy of your results within a week. You may ask for a copy of the report to be sent to you as well for your records.
  • You will be recalled for routine mammogram in one year.  Less than 1% of women who attend regular breast screening are found to have breast cancer.

 

Payment options and insurance

  • Payment is required on the day as we do not offer an account service.
  • Please note that if you are required to have a breast ultrasound there will be an extra charge.
  • If you have private medical insurance you may wish to ring your insurer and obtain prior approval or you can claim using your receipt.
  • Please bring your prior approval number with you on the day - at the end of your the procedure an invoice will be given to you to post to your insurer. (Payment is expected from your insurer within 4 weeks of the mammogram appointment).