Molecular Imaging in Breast Cancer Screening

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after March 18, 2024:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 1.50
Procedures: 1.50
Pathology: 1.50

Mammography: 1.50
Procedures: 1.50
Mammographic Positioning, Special Needs, and Imaging Procedures: 1.50

Magnetic Resonance Imaging: 1.50
Procedures: 1.50
Body: 1.50

Nuclear Medicine Technology: 2.25
Safety: 0.75
Radiation Physics, Radiobiology, and Regulations: 0.75
Procedures: 1.50
Other Imaging Procedures: 1.50

Registered Radiologist Assistant: 1.50
Procedures: 1.50
Thoracic Section: 1.50

Sonography: 1.50
Procedures: 1.50
Superficial Structures and Other Sonographic Procedures: 1.50

Outline

1. Introduction
2. Primary Screening
3. Need for Supplemental Screening after DBT
4. Supplemental Screening of High-Risk Women with Dense Breasts
5. Supplemental Screening of Average-Risk Women with Dense Breasts
6. Decision Algorithm for Supplemental Screening
7. Screening Workflow and Patient Management
8. Implementing MBI in Clinical Practice
9. Case Studies
   1. Supplemental Screening for Dense/Complex Mammograms
      1. Case 1
      2. Case 2
      3. Case 3
      4. Case 4
   2. High-Risk Screening and MR Imaging Contraindications
      1. Case 5
      2. Case 6
   3. MBI Diagnostic Use for Problem Solving
      1. Case 7
      2. Case 8
      3. Case 9
   4. False Positives
      1. Case 10
      2. Case 11
      3. Case 12
10. Conclusion

Objectives

Upon completion of this course, students will:

1. know the authors’ primary imaging modality for breast cancer screening
2. know a particular patient population for which detecting breast cancer can be a challenge for mammography
3. know the expectations for routine supplemental breast cancer screening
4. understand the decision to switch from 2D digital mammography to DBT as the primary imaging modality for women presenting for breast cancer screenings
5. be familiar with the decision to continue with supplemental screening of women with dense breasts even after conversion to DBT for primary screening
6. recognize the advantages of MR imaging with IV gadolinium as a supplemental screening method for high-risk women with dense breasts
7. know why MR imaging with IV gadolinium is not suitable as a supplemental screening technique for all patients
8. identify the patient populations for which MR imaging would be recommended as an effective screening tool
9. be familiar with the guidelines supporting MR for adjunct breast cancer screening
10. be aware of the reasons mentioned in the article why MBI might be offered as an alternative imaging solution to MR as a supplemental breast cancer screening method
11. know the origins for the basis of MBI, due to incidental tracer uptake in breast tumors
12. understand why the ^99mTc-sestamibi radiotracer is not affected by anatomic characteristics such as density or surgical distortion
13. be familiar with the limitations of camera detectors in early ^99mTc-sestamibi breast imaging
14. know how the sensitivity of gamma cameras has been enhanced in recent years
15. be familiar with the relative radiation dose risk of MBI
16. know the effects of adding MBI to digital mammography versus mammography alone
17. understand how adding MBI as an adjunct breast screening technique compares to the addition of other adjunct screening techniques
18. be familiar with the ACR’s BI-RADS classifications of breast density
19. know the next screening step for women who have been objectively scored as having dense breasts on the BI-RADS scoring system
20. know which patient populations would be recommended for either MR or MBI imaging as adjunct screening after mammography
21. understand the type of density scoring provided by breast density assessment software, as compared to a radiologist’s interpretation
22. know what should be reported to the referring physician in the final mammography report
23. know this site’s screening recommendation to high-risk women with dense breasts
24. be familiar with the roles of the scheduling personnel at this site once a patient has been recommended for MBI
25. know the menstrual cycle phase when MBI is to be performed
26. know when MBI imaging should commence after radiotracer injection
27. be familiar with what should be considered for documentation in an MBI report
28. know why biennial MBI supplemental screening is recommended in non-high-risk women
29. know when positive findings at MBI should be evaluated with targeted ultrasound
30. know the roles of the various personnel when implementing MBI in clinical practice
31. be familiar with the various entities for which education was identified as being crucial to the maintenance and continuation of the clinical site’s MBI program
32. know why the patient in Case 1 was recommended for supplemental screening with MBI
33. know the aspect of MBI which reassures both radiologists and patients in cases where a mammogram is too dense for accurate interpretation and MBI is clearly negative
34. know why the patient in Case 8 was recommended for MBI
35. understand why the patient in Case 11 was recommended for supplemental screening