Frequently Asked Questions

Why do you have to do a spinal tap under Xray guidance?

Spinal taps are performed under x-ray fluoro guidance because it enables the radiologist to be more precise. This translates into a less complicated and less uncomfortable exam for the patient.

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Why do I have to wait four hours after a procedure before I can leave?

You are monitored after any procedure in which we have utilized medication for sedation (moderate sedation) to ensure that medication effects have worn off and you are alright from the procedure performed. Once it has been determined you are in good shape for discharge, the radiology team will let you go home. Some procedures performed without moderate sedation will allow you to go home sooner and some procedures using moderate sedation may necessitate you staying longer for observation. Details will be explained to you prior to the procedure.

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Why do I have to have someone with me after a procedure?

To make you more comfortable during your procedure you may receive medicine through an IV. The medication will decrease pain and give you a sedated feeling. You will be kept after the procedure for 2 -4 hours and major effects of the drugs have usually subsided when you are released. Someone will be required to transport you home since reaction time may be decreased and some drowsiness could remain.

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Why does it hurt so bad to have an injection for lymph node “mapping”?

One of the most vital pieces of information the surgeon needs to know when performing surgery on a breast with proven cancer is to which lymph nodes in the armpit does the breast drain. There is always one main “sentinel” node that receives most of the drainage of the fluid from the tissues of the breast. It is this lymph node that may contain cancer cells if the breast cancer has already spread beyond the local site.

In order to find this lymph node, the radiologist injects a radioactive substance (extremely low levels of radiation by the way) into the skin of the breast. The tiny lymphatic vessels in the skin pick up the radioactive particles and carries them to the lymph nodes. The surgeon uses a probe that picks up the radiation in the lymph nodes to locate the lymph node at surgery.

These lymphatic vessels are located within the substance of the skin itself. Therefore, the injection must be made directly into the thin layer of the skin of the breast around the nipple in four injections or one injection directly beneath the nipple. Injecting this tiny amount into the skin is painful because of the location of the injection directly into the skin and not beneath it. In fact, if it doesn’t hurt, it wasn’t done properly. And, it is impossible to deaden the skin before the injection as such an injection would alter the drainage pattern.

A patient may request a lidocaine patch from their surgeon to place on the breast/nipple area the night before the injection and that will help with the pain. Also, placing ice on the breast a few minutes before the injection helps.

Once the injection takes place, the pain is gone and is only momentary. This link, https://www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet, tells a patient everything they need to know about this procedure.

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Why can’t I have a screening breast ultrasound instead of a mammogram?

Mammography is the only breast cancer screening tool known to reduce deaths from the disease. Screening ultrasound without a mammogram misses breast cancer. It is especially inferior to mammography at diagnosing the early most treatable stages of breast cancer, such as DCIS.

It may be useful as an adjunct to mammography in the presence of dense breast tissue. However, it is important to note that adding ultrasound to mammography also substantially increases false positives (the likelihood of needing more follow up exams and biopsies, which ultimately prove to not represent cancer). Additionally, screening ultrasound has not been scientifically proven to reduce mortality from breast cancer.

There is not any data to support the use of ultrasound for average-risk women with nondense breasts.

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Don’t mammograms increase my risk for breast cancer?

The short answer is no, but not having a mammogram increases your odds of getting diagnosed with breast cancer at a later, harder to treat stage. The median size of breast cancer diagnosed with regular screening is 1.0 to 1.5 cm. The median size of breast cancer detected by physical exam is 2.0 to 2.5 cm in size.

Mammography uses low energy ionizing x-rays at low radiation doses to create an image. The risk of radiation from a mammogram causing breast cancer is far lower than the likelihood of mammography detecting breast cancer for women aged 40 years and older. The average dose from a standard 4 view mammogram is 0.4mSV. To put that number in perspective, people in the US are typically exposed to an average of about three mSv of radiation each year from background sources such as natural surroundings. The radiation dose a woman receives with a screening mammogram is about equal to the dose received over seven weeks from natural surroundings or background radiation. Another way of looking at it is the radiation dose from a mammogram is a little more than from a chest x-ray, but much less than the exposure from at CT scan.

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Don’t mammograms rupture breast implants?

Currently, screening mammogram is the most important diagnostic tool for detecting early breast cancer. It is recommended for all women ages 40 or older to have yearly screening mammogram, regardless of having breast implant or not.

The risk of implant rupture during  mammography is a very common question  and concern of patients with breast implants. Unfortunately there is not enough clear scientific data on this issue.  Although some complaints of ruptured implant during mammography have been reported, but no one knows whether the rupture was truly caused by compression during mammography or mammography exacerbated the already ruptured implants. A study by FDA scientist Dr. S. Lori Brown and colleagues describes adverse events that were reported to the FDA related to breast implants and mammography screening. The authors found 66 adverse events that were reported as either occurring during the mammogram or involving breast implants interfering with the mammogram. Forty-one reports of either silicone and saline breast implants pertained to ruptures that were suspected as happening during mammography. These are the cases reported over several years from probably millions of mammograms performed on patients with breast implants in that time period. It has been previously reported by the FDA that all implants will eventually break. The risk of breast implant rupture is known to increase as the implant ages. A study by Holmich and colleagues suggested that during the first ten years a woman has implants, most implants do not break, between 11-20 years most will break, and by the time they are more than 20 years almost all have broken. Also, patients should be aware that other breast imaging modalities, such as ultrasound or MRI, are only complimentary to the mammography and cannot substitute screening mammograms.

Therefore, to answer this question, there is potentially a slim risk of implant rupture during mammography. This risk can be minimized by informing the technologist regarding breast implants at the time of mammogram. A modified technique is used for mammography of breasts with implant.

Considering the low risk of potential implant rupture caused by compression during mammography and the crucial role of mammography in early diagnosis of the breast cancer- which unfortunately is a common disease- the current guidelines encourage women with breast implants to have regular mammograms.

For more information, please see the web references provided below.

• http://breastimplantinfo.org/breast-implants-mammography/
• https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/mammograms-for-women-with-breast-implants.html
• https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm064406.htm

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Why doesn’t my doctor just operate on me instead of having the radiologist drain fluid off of me with CT guidance?

Minimally invasive procedures which rely on CT or ultrasound image guidance are now the standard of care for draining most fluid collections in the body.  These procedures use only small needles, wires, and catheters to access and drain fluid through a small hole in the skin and are much faster and less risky than open surgery.  Radiologists performing these procedures administer only mild to moderate sedation, so the patient also avoids having to undergo general anesthesia, which has its own risks.  As such, image guided drainage performed by your radiologist is much safer and faster than surgery and is therefore the procedure of choice in most cases.

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Is a radiologist a doctor or a technologist?

A radiologist is a medical doctor who is an imaging expert with special training in interpreting medical images and performing procedures using imaging guidance.

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How many years of training does a radiologist have?

There is some slight variability dependent on the individual and their sub-specialty, but generally 9-12 years of training after college. This includes 4 years of medical school, a 1 year internship in medicine or surgery, and 4 years of residency training in radiology. Some radiologists elect to pursue an additional 1-2 years of fellowship training in a radiology sub specialty of their choosing after residency.

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