Thursday, June 14, 2018

Mammogram : Getting it right matters

Master health checks have become very attractive for providers and patients. A set of tests are put together under various packages ranging from 600 rupees to 25,000 or called bronze, silver, gold, diamond and platinum checks!!!

A mammogram or ultrasound or both are thrown in for women depending on age.

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The films and reports are usually packaged very nicely and given to the patient. The interpretation, reporting, and discussion of the results are usually discussed by general medical or gynaecology colleagues. They may not be equipped with the decision making tools and hence the patient is left with a lot of anxiety and stress seeking second or third opinions.

What can go wrong with Mammograms?

 

1. Technology:

Using the right technology has its advantage. Digital technology, tomosynthesis, workstation that has a high resolution helps in spotting early disease. There are tools to measure breast density and computer-aided diagnosis which add to the information.

The newer machines also deliver less radiation dose and the resolution is fantastic. Like the 18 megapixel camera as against the 3-megapixel cameras of the earlier versions.

Many centres may not have all the facilities. Although this is a disadvantage, a good mammogram can still be done with older analog machines with a little attention to detail.

Older machines have to pass the QA and QC and calibrated periodically to ensure radiation dose is not exceeding the permissible limits and safety. AERB monitors these details. But seldom these are done properly.

2. Technique of performing mammogram


A. Compression: Unfortunately the test involves some breast compression which might be uncomfortable. The compression can last up to 4 to 5 seconds.
If the compression is inadequate then the image quality will suffer.

B. Positioning: The entire breast has to be included in the study. If the whole breast is not included then parts of breasts will not be imaged. There is a risk of missing details or cancer in the area which gets missed out in the image. This leads to a false negative mammogram. A missed opportunity to detect cancer. So the technologist’s role is very important in ensuring a good mammogram.

It can be very intimidating for a woman to undress in front of a stranger in a cold room for the procedure. As rule mammograms are always done by a lady technologist. A good technologist can make the entire procedure comfortable and painless for the patient.

C. Interpretation: the mammograms should be read in a room where there is very little distraction with suitable lighting. The monitors displaying the images should be medical grade monitors with resolution of at least 5 megapixels.

3.Interpretation

What the mind doesn't know the eyes cannot see.

Training to understand the normal anatomy, physiology, pathology and imaging features is important to recognize the various breast conditions.

mammography in chennai
Mammographic interpretation needs specialist radiologists. Otherwise, there is a serious risk of missing cancer diagnosis and creating false alarms. It is also important to compare with previous studies to see if there is any new change.

Diagnostic mammograms in conjunction with breast ultrasound and MRI sometimes will give all the necessary information to plan surgery.

Even in the best of health, there is a 10% probability of missing cancer, therefore mammograms should not be just another master health check. And when cancer is diagnosed mammogram provides a roadmap for further surgical planning.

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