Mammography, US and MRI in Breast Cancer Screening

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

Breast Sonography: 1.50
Patient Care: 1.00
Patient Interactions and Management: 1.00
Procedures: 0.50
Pathology: 0.50

Mammography: 2.00
Patient Care: 0.50
Patient Interactions and Management: 0.50
Procedures: 1.50
Anatomy, Physiology, and Pathology: 0.50
Mammographic Positioning, Special Needs, and Imaging Procedures: 1.00

Magnetic Resonance Imaging: 1.50
Patient Care: 0.50
Patient Interactions and Management: 0.50
Procedures: 1.00
Body: 1.00

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Thoracic Section: 2.00

Sonography: 1.50
Patient Care: 0.50
Patient Interactions and Management: 0.50
Procedures: 1.00
Superficial Structures and Other Sonographic Procedures: 1.00

Radiation Therapy: 2.00
Patient Care: 1.50
Patient and Medical Record Management: 1.50
Procedures: 0.50
Treatment Sites and Tumors: 0.50

Outline

1. Introduction
2. Breast Cancer Screening
   1. Screening Mammography
   2. Breast US Screening
   3. Breast MRI Screening
3. Imaging Features of Benign and Malignant Lesions
   1. Mammography
   2. Ultrasound
   3. Magnetic Resonance Imaging
4. Problem Solving Using Mammography, Ultrasound, and MRI
   1. Abnormal Mammogram
   2. Preoperative Staging of Newly Diagnosed Breast Cancer
   3. MRI-Directed “Second-Look” US of the Breast
   4. Postoperative Breast
   5. Evaluation of Occult Breast Cancer
   6. Palpable Breast Masses and Pain
   7. Nipple Discharge
   8. Mastitis
   9. Evaluation of the Male Breast
   10. Unusual Findings
5. Conclusions

Objectives

Upon completion of this course, students will:

1. identify the most common cancer found in women
2. recognize how much screening mammography has reduced mortality since the 1990s
3. learn the factor most responsible for reducing the sensitivity of mammography
4. know the recommended frequency of screening mammography
5. realize that limitations with mammography have led to other developments in breast imaging
6. understand attributes of ultrasound for breast imaging
7. identify which patient population benefits most by adding ultrasound imaging to screening mammography
8. know factors that cause women to be placed in a group of high-risk individuals for contracting breast cancer
9. identify the imaging modality most sensitive for occult breast cancer detection in a high-risk population
10. learn the sensitivity of the combination of screening mammography and breast MRI for the high-risk population
11. understand how repeated radiation to the chest before age 40 affects breast cancer risk
12. understand attributes of MRI for breast cancer screening
13. recognize the characteristics of malignancy on mammography
14. identify benign conditions that share mammographic features of malignancies
15. realize the main diagnostic function of breast ultrasound
16. know characteristics of cysts on ultrasound
17. know characteristics of solid masses on ultrasound
18. realize how a small, potentially malignant mass can be overlooked on ultrasound
19. understand how benign US findings following a suspicious mammographic finding affects the course of action
20. learn how to visualize breast cancer on MRI via dynamic contrast enhancement studies
21. identify MRI pulse sequences used for dynamic contrast enhancement breast exams
22. recognize dynamic contrast enhancement patterns on breast MRI exams and interpret what they mean
23. learn about differentiating benign and malignant lesions with breast MRI
24. realize the first course of action after a suspicious area is identified on a screening mammogram
25. know what findings of coarse microcalcifications on ultrasound may indicate
26. learn valid reasons to refer to breast MRI after an inconclusive mammogram
27. know when ultrasound is beneficial in evaluating the extent of breast disease
28. identify the most accurate imaging technique in the determination of the extent of breast disease in women with a new diagnosis of breast cancer
29. realize why US-guided biopsy is often preferred over MRI-guided tissue sampling
30. understand that “second look” US may not correlate with MRI breast lesion findings
31. identify normal mammographic findings in a post-lumpectomy breast
32. know what increased vascularity at the surgical site of a postoperative breast may be indicative of
33. realize how patient age affects the course of evaluation when presented with breast pain or a palpable lump
34. recognize the usual methods to evaluate nipple discharge
35. know common causes for nipple discharge
36. learn the best course of action to differentiate between mastitis and inflammatory breast disease
37. know the percentage of breast cancer found in males
38. recognize the usual diagnosis in the male referred for a mammogram
39. identify common cancers that metastasize to the breast
40. identify new technology being developed to improve early detection of breast cancer