By Robert G. Sullivan, Esq.
In a previous article, I discussed the importance of screening and diagnostic mammographies. What is equally important to a patient is the selection of a professional and reputable radiology facility for these critical studies.
A patient should never assume that all radiology facilities are the same. Like many things in the United States, radiology has become a big business. Many radiology practices operate at multiple locations, staffing a growing number of offices with technicians and radiologists who may not always be the best qualified to interpret mammography films.
Today, there are fellowships in radiology for doctors to become specialists in breast imaging. Simply stated, some radiologists have this specialized training and others do not.
A patient should be aware that not having this additional expertise, however, does not mean that these less qualified radiologists are prevented from interpreting mammographies. Fellowships are not mandated by state licensing regulations. Although federal law has minimum requirements a doctor must satisfy before being allowed to read mammography films, these criteria do not make eligible doctors the best qualified to do so.
A patient should always find out if her mammography facility has a radiologist on staff, certified in breast imaging, who will read her study. In addition, a patient should always ask if the mammography center has a radiologist present at all times, even when she is going for a screening mammography. Screening mammographies are sometimes “shipped” to an outside radiologist to interpret. Other facilities have a radiologist who will report at scheduled times to review a large number of films. These practices can result in unnecessary delays in the review of a mammography.
Having a radiologist present, at all times, means that, most likely, a patient’s films will be read, at least as an initial screening, before she leaves the office. If she needs any further studies, they may be ordered by the radiologist, and performed right away. These radiologists are also trained and educated in performing needle biopsies that can be done at the facility when indicated.
A patient should also find out if the newest radiology equipment is being used. “Digital mammography” is now replacing standard x-ray mammography. From the patient’s perspective, a digital mammogram is the same as a standard film-based mammogram. Compression of the breast, the time the patient must stay in one position, and the amount of radiation needed to create clear images remain identical to conventional x-rays. However, while standard film mammography images can take several minutes to develop, digital mammography provides the image on the computer monitor in less than a minute.
Digital mammography can also be manipulated to correct for under or over exposure after the exam is completed, a feature that may eliminate the need for repeat mammograms in any given year. The magnification, orientation, brightness, and contrast of the mammogram image may also be altered after the exam is completed to help the radiologist more clearly see certain areas of the breast.
Please remember that you need to be an active participant in the process of your mammography exams. Make sure your doctor gives you an accurate referral for the study, indicating any complaints you have or findings he/she may have made upon examination. Do not assume a negative mammography rules out any cancer. If your doctor can feel an area of abnormality, even if it is not seen on mammography, you need to see a surgeon. Always review the prescription your doctor gives you for a mammography. If you have a complaint, make sure your doctor noted it on the form, and you are being sent for a diagnostic, not a screening, mammography. Be very honest and open in filling out the mammography questionnaire, and tell the mammography technician about areas of concern. Make sure she writes it down. Check out the facility you are going to. Research the doctors, equipment and types of services that it can provide. Finally, if you are over 40, don’t miss a yearly screening mammography. This now routine study can mean the difference between timely diagnosis, treatment and survival or death.