Breast – Goals, Objectives & Reading Material

Overview

  • Rotation Location
    The UF breast imaging rotation is located at the UF Health Women’s and Diagnostic Imaging Center at Springhill (4037 NW 86 Terrace), on the north side of NW 39th Avenue, approximately 3/4 of a mile east of I-75 at Exit 390. Residents should park in the north parking lot and enter through the front or side door. The side door requires a fob and will give you access to the back door of the imaging center which requires a code. If you come in the front, the Imaging Center is to the left, past the Opus coffee shop.
  • Mammographers
    Julia Marshall, MD (Section Chief)
    Linda Armstrong, MD
    Erinn Cooke, MD
    Robert Dubuisson, MD
    Ray LaRue, MD
    Patricia Moser, MD
    Gladys Torres, MD
  • VA Mammographers
    Megan Hodge, MD (Lead Mammographer)
    Sarah Linden, MD
  • Springhill Staff
    Sharon Richardson (Office Manager)
    Jackie Hall (Lead Technologist)
    Michelle Clay (Technologist)
    Karen Thurston (Technologist)
    Cathy Jerkins (Technologist)
    Jessica Ostolaza (Technologist)
    Katlin Prevatt (Technologist)
    Pam Willis (Technologist)
    Cammie Womble (Technologist)
    Laurie Goslinga (Nurse)
    Kim Saylor (Data Entry Specialist)
    Maxine Williams (File Room)
    Cathy Mlot (Front Desk)
    Elaine Beck (Financial Representative)
  • Hospital Staff
    Sharon Williams
    Teresa Mizell

Daily Assignments at Springhill

  • Junior resident (1st mamms rotation)
    Begin with screening mammograms, but will also have the opportunity to perform diagnostic mammography, ultrasound, interventional procedures and MRI
  • Senior resident
    Screening and diagnostic mammography, ultrasound, interventional procedures and MRI

MRI guided biopsies and breast MRIs are performed at the South tower MRI unit which is at the far end of the South tower radiology department

Needle localization procedures and ultrasound markings are performed in the south tower radiology department in the room next to the fluoroscopy room

When both residents have been on the breast imaging rotation before, duties will be shared depending on the individual resident’s needs and with the attending’s approval.

Resident Requirements at Springhill

  • Arrive by 8 a.m.
  • Professional attire (no scrubs); Maintain appropriate standards of professionalism in patient sensitivity, personal behavior, respectful demeanor to others, and ethical behavior; Treat your patients as you would your sister, mother, or grandmother!
  • Check for pathology reports at least daily.
    • Review pathology and imaging with attending before finalizing addendum report. Report should include whether the pathology is benign or malignant and whether it is concordant with the imaging findings.
    • Call referring physician with biopsy results and document results and contact in addendum to the biopsy results. Benign results can be given directly to patient (after reviewing with the attending). Malignant results should be called to referring physician first. In most cases they will contact the patient. Our nurse, Laurie Goslinga, keeps track of the biopsies and results and will contact patients if requested.
  • Complete and sign all exam dictations before the end of the day.
  • Watch noon conference from the small conference room.
  • Attend breast conference at least once during the rotation. Seniors will be expected to present cases at the conference. The conference is held on Mondays at 7:15 am and is located in the Davis Cancer center conference room which is on the ground floor to the left down a hall when you enter from the north side of the building.
  • Residents are responsible for keeping track of their procedure and mammography numbers. Keep in mind you will need documentation of reviewing 240 mammograms in any 6 month period in the last 2 years of your residency.
  • Observe one mammogram.
  • Observe and practice ultrasound scanning of the breasts and be able to understand various artifacts and imaging quality issues.
  • Understand Mammography Quality Assurance standards (MQSA) for screen film and digital mammography. Know the requirements for the various components of an inspection.
  • Understand the standards for a properly positioned mammogram and the technical factors that affect image quality (physics of breast imaging).
  • Understand the differences between screening and diagnostic mammograms and be familiar with the additional views that might be used to further evaluate a finding identified at screening.
  • Be familiar with the BI-RADS lexicon for mammography, ultrasound and MRI and be able to apply it appropriately in reports. (source: BI-RADS atlas)
  • Observe the stereotactic biopsy set up, the steps that the technologist performs prior to the radiologist’s involvement.
  • During the first week of the rotation, if you are new to the breast imaging rotation, please arrange with the attending physician to perform a turkey or chicken breast phantom in order to practice US guided biopsies prior to performing the procedure on a patient.
  • During the first week of the rotation, if you are new to the breast imaging rotation, arrange to meet with Kim Saylor to go over data entry process and report format
  • Procedure resident will check the schedule of procedures daily and will contact the mammography IR attending assigned at the hospital to arrange their participation (if needed) for any of the procedures that occur in the hospital (usually the south tower). This includes MRI guided biopsies and needle localizations. The resident will be responsible for reviewing all of the patient’s imaging and records prior to the procedure. There is a web based schedule accessible from the radiology intranet. Click on the IR tab at the top of the page, Gatorlink login, Click on Schedule-Mammo on left side of page.
  • The procedure resident will check the protocol list daily and protocol any breast MRIs.

1st Rotation Goals

  • Study breast cancer epidemiology
  • Study breast anatomy, physiology and pathology
  • Learn how to evaluate the mammogram for quality and know the technical factors, positioning, artifacts and how they impact image quality
  • Learn how to interpret and dictate a screening and diagnostic mammogram applying the Breast Imaging Reporting and Data System (BI-RADS) terminology and assessment categories
  • Learn how to manage a diagnostic work up and how to perform problem solving mammography
  • Learn how to perform and dictate a breast ultrasound
  • Learn how to evaluate the breast ultrasound for quality and know the technical factors and artifacts and how they impact image quality
  • Learn and understand the principles of ultrasound guided biopsies including the various biopsy devices- FNA, core and vacuum assisted
  • Practice ultrasound guided biopsy and observe breast ultrasound guided biopsy.
  • Learn and understand the principles of stereotactic biopsy and observe a stereotactic biopsy from the initial set up to the post biopsy mammogram.
  • Learn the appearance and management of benign breast lesions, high risk lesions, DCIS, IDC and other special types of breast carcinoma for mammography and ultrasound.
  • Learn how to correlate pathology results with imaging appearance to determine concordance and appropriate management.
  • Learn how to evaluate the young patient and the pregnant patient and be familiar with the pathologies that occur in this population of patients.
  • Learn how to evaluate the axilla and what constitutes an abnormal exam.

1st Rotation Reading Assignments

  • Solid breast nodules: Use of Sonography to Distinguish between Benign and Malignant Lesions
  • Mammographic Features of 300 Consecutive Nonpalpable Breast Cancers
  • Acceptability of Periodic Follow-up as an Alternative to Biopsy for Mammographically Detected Lesions Interpreted as Probably Benign
  • Challenges in Mammography: Part 1, Artifacts in Digital Mammography
  • Digital Mammographic Artifacts on Full-Field Systems: What Are They and How Do I Fix Them?
  • Unusual Breast Lesions: Radiologic-Pathologic Correlation
  • Breast Intervention: How I Do It
  • Stereotactic Breast Biopsy
  • Stereotactic Localization of Breast Lesions: How It Works and Methods to Improve Accuracy
  • Breast Imaging of the Pregnant and Lactating Patient: Imaging Modalities and Pregnancy Associated Breast Cancer
  • Breast Ultrasound; Thomas A Stavros: Chapter 10 (Evaluation of Cysts) & Chapter 19 (Evaluation of the Axilla); This text is available at Springhill.

2nd Rotation Goals

  • Learn the various components of quality control through reading as well as by observing the technologists as they perform the various QC responsibilities
  • Learn the differences between film screen and digital mammography and the principle of tomosynthesis
  • Knowledge of the components and desired goals of the medical audit for breast cancer detection
  • Learn the Mammography Quality Standards Act (MQSA) requirements
  • Learn the quality determinants of breast MRI including positioning, image processing, technique and artifacts
  • Learn how to interpret a breast MRI and dictate a report using BI-RADS lexicon.
  • Observe and perform MRI guided biopsy
  • Learn the appearance and causes of benign and malignant male breast disease and how to evaluate the male patient with symptoms
  • Learn how to perform wire localizations with mammography, ultrasound and MRI
  • Learn how to evaluate the specimen radiograph
  • Learn about galactography (indications and technique), cyst aspiration and fine needle aspiration. Observe and perform if possible

2nd Rotation Reading Assignments

  • Performance Benchmarks for Diagnostic Mammography
  • Performance Benchmarks for Screening Mammograms
  • BI-RADS Atlas – Follow up and outcome monitoring: The Basic Clinically Relevant Audit. Section IV, pp 23-66. The atlas is available at Springhill
  • Pearls and pitfalls in breast MRI
  • BI-RADS- MRI: A Primer
  • Patterns of Enhancement on Breast MR Images: Interpretation and Imaging Pitfalls
  • Positioning in Breast MR Imaging to Optimize Image Quality
  • Imaging Features and Management of High-Risk Lesions on Contrast Enhanced Dynamic Breast MRI
  • MR Imaging Assessment of the Breast after Breast Conservation Therapy: Distinguishing Benign from Malignant Lesions
  • Radiologic and Pathologic Findings in Breast Tumors with High Signal Intensity on T2-weighted MR Images
  • Patterns of Nonmasslike Enhancement at Screening Breast MR Imaging of High-Risk Premenopausal Women
  • Background Parenchymal Enhancement at Breast MR Imaging: Normal Patterns, Diagnostic Challenges, and Potential for False-Positive and False-Negative Interpretation 
  • Breast MR Imaging Artifacts: How to Recognize and Fix Them
  • Recognizing and Interpreting Artifacts and Pitfalls in MR Imaging of the Breast
  • Recognizing Artifacts and Optimizing Breast MRI at 1.5 and 3 T
  • Breast MRI: Image Quality, Artifacts and Quality Control
  • Mammographic Appearance of Male Breast Disease
  • Primary Breast Cancer in Men: Clinical, Imaging, and Pathologic Findings in 57 Patients
  • Ductography: How To and What If?

1st and 2nd Rotation Physics Goals

By the end of the first two rotations the resident should have studied the following physics pertaining to breast imaging:

  • Mechanism of obtaining and optimizing film-screen or digital mammograms
    • Target/filter combinations
    • Use of a grid
    • Reduction of scatter
    • Radiation dose
  • Adjustment of mammogram techniques for specific cases such as thin breasts or implant
  • Mechanism of obtaining and optimizing breast US images
  • Mechanism of obtaining and optimizing breast MRI images
  • Recognizing, understanding, and correcting artifacts in breast imaging (mammography, US and MRI)
  • Workstation display of digital mammograms
    • Required equipment parameters
    • Image processing
  • Computer assisted display software for breast MRI, including the role of dynamic imaging

Physics Resources

3rd Rotation Goals

The resident will use the third rotation to reinforce skills that have been acquired during the first two rotations, review at least 240 examinations if not already completed, attend and present at breast conference and participate in teaching the junior residents. Residents on their third rotation will be expected to be involved in the more complicated procedures and imaging and will be responsible for becoming proficient in same.

Other Resources

Additional Resources are available on the X-drive in the Breast Imaging Rotation folder including:

  • Reading assignments from Breast Imaging: Expert Consult Series (Bassett et al). Three copies of the text are available at Springhill and can be checked out for the month. This book is sometimes available at Amazon for a very low price from other sellers (<$70).
  • Steps for reading breast MRI (provided by Dr. Sarah Linden)
  • PowerPoint presentations including:
    • Breast Interventional Procedures (Provided by Dr. Elizabeth Vorhis)
    • Breast Pathology (provided by Dr. Ray LaRue)

 

 

 

Department of Radiology
College of Medicine
University of Florida
PO Box 100374, Gainesville, FL 32610-0374

Phone: (352) 265-0291
Fax: (352) 265-0279
PACS Support: (352) 265-0526