Massachusetts General Hospital Imaging provides mammography on the main campus and at our community locations. No matter which facility you choose, we place priority on making the imaging process comfortable, safe and successful.
Breast Tomosynthesis: Our Standard Protocol
Pioneered at Mass General, breast tomosynthesis is a breakthrough in mammography that can offer better cancer detection, fewer call backs and greater peace of mind.
Mammography at Mass General
A mammogram is an X-ray performed by a trained professional called a mammographer who properly positions and compresses the breasts (crucial for high-quality images) and checks the images immediately for quality. It is performed both as a screening test and as a diagnostic exam.
- Recommended annually for women 40 and over and earlier in some cases
- Takes about 15 minutes
- Results sent to you and your doctor
- Used when a closer look is needed or a specific clinical issue exists
- Takes longer than a screening mammogram and may include using ultrasound to get another view
- Results communicated to you following the exam; a multidisciplinary team coordinates next steps if needed
Mammography in DepthWhat is a mammogram?
A mammogram is a special type of X-ray that is tuned to detect breast abnormalities. It is used to detect and evaluate breast abnormalities, both in women who have no breast complaints or symptoms, and in women who have breast symptoms (problems such as a lump, pain, or nipple discharge).
All screening mammograms at Mass General Imaging use breast tomosynthesis, which takes multiple images of the entire breast. It is performed with conventional digital mammography using the same scanner.
Computer Aided Detection (CAD) can be applied to mammography exams to help radiologists identify and mark regions of interest that are potentially indicative of cancer. Mass General Imaging utilizes CAD in all of its mammography locations.
Screening mammogram vs. diagnostic mammogram
A screening mammogram is an exam used to detect early breast cancer in women experiencing no symptoms. Mammography plays a central part in early detection of breast cancers because it can show changes in the breast up to two years before you or your physician can feel them. Current guidelines recommend screening mammography every year beginning at age 40. In addition, women who have had breast cancer and those who are at increased risk due to a genetic history of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and about the frequency of screening.
Diagnostic mammography is used to evaluate a patient with abnormal clinical findings, such as a breast lump or lumps that have been found by the woman or her doctor. Diagnostic mammography may also be done after an abnormal screening mammogram in order to determine the cause of the area of concern on the screening exam.
Safety and mammograms
Patient safety is our top priority. We pay special attention to using the lowest radiation dose during an exam to produce the best images for evaluation. As part of this commitment, we invest in the latest equipment so that our fleet of scanners consistently delivers the lowest possible dose of radiation.
Our state-of-the-art systems have tightly controlled X-ray beams with significant filtration and dose control methods to minimize radiation and ensure that the parts of a patient's body not being imaged receive minimal radiation exposure.
Although no radiation reaches the uterus during a mammogram, we prefer not to perform routine mammograms on women who might be pregnant. If you are coming in because of a breast problem and you are or may be pregnant, please notify the mammographer so that we can decide the best way to evaluate your situation.
All Mass General facilities for mammography are licensed and accredited by the American College of Radiology, the FDA and the Radiation Control Program of the Commonwealth of Massachusetts Department of Public Health.
What should I expect BEFORE my mammogram?
- Discussion: Prior to your mammogram, discuss any new findings, prior surgeries, hormone use, and family or personal history of breast cancer with your doctor.
- What to wear: On the day of the exam, do not use deodorants, antiperspirants, powders, or ointments since these can show up and be confusing on the mammogram. Since you will need to undress from the waist up, a two-piece outfit is recommended.
- What to bring: Please bring your current insurance card. If possible, please also obtain prior mammograms and make them available to the radiologist at the time of the current exam. You will be asked a number of important questions about your medical history so that we can assess your breast cancer risk.
What will I experience DURING my mammogram?
- Preparation: You will be asked to remove your clothing from the waist up and will be given a gown. You will be escorted into the mammography room.
The mammographer who performs your exam is a highly trained individual who is board certified in breast imaging studies. She can answer most of your questions, but if she cannot, then she can ask one of the radiologists who specialize in mammography.
If you have not had a mammogram before, the mammographer will explain the procedure. If you have any scars on your breasts, breast implants or skin irritations, particularly underneath your breast in the fold where the breast attaches to the chest, please point them out to the mammographer.
- Breast compression: It is very important that you work with the mammographer to ensure that your breast is as far into the machine as possible so that the tissues deep in the breast can be examined.
Your breast will be placed on a special platform and gradually compressed with a paddle (often made of clear Plexiglas or other plastic).
You will feel pressure on your breast as it is squeezed by the compressor. Some women with sensitive breasts may experience discomfort. If this is the case, schedule the procedure when your breasts are least tender. Be sure to inform the mammographer if pain occurs as compression is increased. If discomfort is significant, less compression will be used.
Breast compression is necessary in order to:
- Even out the breast thickness so that all of the tissue can be visualized.
- Spread out the tissue so that small abnormalities won't be obscured by overlying breast tissue.
- Allow the use of a lower X-ray dose because a thinner amount of breast tissue is being imaged.
- Hold the breast still in order to eliminate blurring of the image caused by motion.
- Reduce X-ray scatter to increase sharpness of picture.
- Scanning: You will be asked to change positions slightly between images. Routine views are a top-to-bottom view and an oblique side view. The process will be repeated for the other breast. The mammographer will walk behind a wall or into the next room to activate the X-ray machine. The X-ray beam will remain on for a few seconds at most. You may hear a whining noise that persists even after the X-ray is turned off. This is just a mechanical part of the tube that spins at high speed and does not stop immediately even though no more X-rays are being produced.
- Length of exam: Your mammogram should take about 30 minutes.
What should I expect AFTER my mammogram?
- Instructions: When the examination is complete, you will be asked to wait until the mammographer determines that the images are of high enough quality for the radiologist to read.
- Exam results: All mammograms are read by Mass General radiologists from the Division of Breast Imaging. Our team of specialized breast radiologists are board certified in general radiology and fellowship trained with additional specialization in breast imaging procedures.
Rapid results are essential not only for your peace-of-mind but also for your physician to begin planning your treatment immediately, if necessary.
The combination of MR imaging and mammography can provide a cost-effective way of improving life expectancy for women who have an increased risk of breast cancer, according to a study authored by Mass General Imaging radiologist Janie M Lee.
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Across four locations, Mass General Imaging has 50 breast imaging technologists who guide women through mammograms every day. Read their advice for your first mammogram...or your twentieth.
A large-population study found that breast tomosynthesis is associated with better performance for breast cancer screening.
Each radiologist at Mass General Imaging is a specialist in a particular area of the body. Department of Radiology Chairman Emeritus James H. Thrall, MD, explains how patients benefit from the additional specialty training our physicians have completed.
Learn more about breast tomosynthesis in this podcast featuring Mass General staff radiologist and Harvard Medical School instructor Phoebe Freer, MD. Courtesy of Harvard Medical Labcast, March 2012, Harvard Medical School Office of Communications and External Relations