Breast imaging

Diagnostic 2D & 3D Mammography (Tomosynthesis)

A mammogram is a specialised X-ray of the breasts performed on a dedicated machine, used for both screening and diagnostic purposes. Screening mammography is recommended for women over 40 who have no symptoms, enabling the early detection of abnormalities that might not be physically noticeable. If you experience symptoms like pain, tenderness, a lump, thickening, skin changes, dimpling, or nipple discharge, your doctor may recommend diagnostic imaging, typically including mammography and possibly an ultrasound, especially if you are over 40. At San Radiology & Nuclear Medicine, our subspecialist radiologists in breast imaging will provide a detailed report to your doctor, including breast density measurements, comparisons to any prior imaging, and an assessment of any breast pathology. They will also correlate your symptoms or signs with the imaging results and will coordinate further care if necessary with our Breast Care Nurse and San Breast Surgeons. Our team is here to assist you in every step of your mammography experience. To access these imaging services, you’ll need a referral from your GP or specialist to ensure you receive the appropriate care tailored to your needs.

What is 2D and 3D Mammography?

The patient experience for both 2D and 3D mammograms is similar, with breast compression required during image capture. However, 3D mammography, or tomosynthesis, offers significantly greater diagnostic accuracy. In a 2D mammogram, two images of each breast are taken from different angles, resulting in four images. 3D tomosynthesis captures multiple images, creating detailed slices of the breast that the radiologist can scroll through, reducing the risk of abnormalities being hidden by overlapping breast tissue. For most initial evaluations, we routinely perform both 2D and 3D imaging, with some exceptions for women with breast implants or reconstructed breasts. This comprehensive approach ensures the highest quality of care and the most accurate diagnosis. One of our expert radiologists will interpret your mammogram and guide further investigations if needed, which may include additional imaging like ultrasound, contrast mammography, or MRI. This process will be discussed with you and your doctor.

How Is a Mammogram Performed?

A specially trained radiographer will position your breast in the mammography unit and apply gentle compression using contoured plastic paddles. While this can be uncomfortable, it only lasts for about 25 seconds per breast. Our Siemens Revelation machine offers enhanced diagnostic accuracy through wide-angle imaging, although this slightly increases the compression time. The machine optimises compression to the ideal level, improving comfort for many women.

Why Is Compression Necessary?

Breast compression is essential for obtaining the best images during mammography. It flattens the breast to a uniform thickness, minimises movement (which can cause blurring), and reduces the radiation dose. We understand the discomfort that can be associated with this process and strive to minimise it while ensuring the best possible image quality.

Preparing for Your Mammogram

For those still menstruating, schedule your mammogram during the week after your period starts when your breasts are least tender. If you have breast implants, please inform us when booking, as the exam will take a bit longer. On the day of your mammogram, avoid wearing deodorant or talcum powder, as these can interfere with the images. Wear a shirt with a skirt, shorts, or trousers to make it easier to remove only your top. If you’ve had prior breast imaging, bring those studies and reports with you.

How Long Does a Mammogram Take?

The imaging itself is quick, with each exposure lasting about 25 seconds. We typically allow 20 minutes for the entire appointment, including filling out a questionnaire, changing, having your mammogram, and having the images reviewed by a radiologist. Occasionally, additional views may be needed, which could extend your appointment time.

Risks and Complications of Mammography

Mammography is a safe, well-tolerated procedure performed on millions of women each year. While rare, some women may experience tenderness, bruising, or skin irritation under the breasts. Women with a history of breast surgery or radiotherapy may find the compression more uncomfortable, and there is a small risk of rupturing breast implants. Mammography involves a low dose of radiation. However, the benefits of early detection and treatment of breast cancer far outweigh the minimal risks associated with this radiation. The dose varies depending on breast size and the number of images needed. The risk of developing breast cancer from mammography radiation is no greater than from natural background radiation over a year of normal life.

Breast Ultrasound

For women under 40, a breast ultrasound is often the first imaging test used to investigate symptoms. For those over 40, it’s commonly performed alongside a mammogram. Unlike mammograms, ultrasounds use high-frequency sound waves instead of X-rays, offering different and complementary information about the breast.

How Is a Breast Ultrasound Performed?

A breast ultrasound is conducted by trained sonographers or radiologists, with subspecialist expertise in breast imaging at San Radiology & Nuclear Medicine. The procedure involves applying gel to the breast to eliminate air gaps between the skin and the ultrasound device (transducer) for clear imaging. The sonographer then moves the transducer over the breast to capture images. You’ll lie on an examination bed with your arm above your head, and you may be asked to roll slightly to one side. The examination typically takes about 30 minutes. In some cases, a radiologist may review the images or perform part of the exam to assess specific areas in real-time.

Preparation for Your Breast Ultrasound

For comfort, wear a shirt with a skirt, shorts, or trousers, so you only need to remove your top and bra. If you’ve had prior breast imaging, bring those images and reports with you to the appointment.

Contrast Enhanced Mammography (CEM)

Contrast mammography is an advanced imaging technique that enhances traditional mammograms with an X-ray dye injection. This method helps investigate issues not fully resolved by standard mammograms or ultrasounds, assess the extent of known cancers, and improve diagnostic accuracy, especially in women with dense breasts or specific symptoms.

How is a Contrast Enhanced Mammogram Performed?

A nurse or radiographer will first insert a small cannula into a vein in your arm for the contrast dye injection. Imaging starts about two minutes after the injection, with both breasts being imaged in 8 minutes. The process involves two mammograms per breast, taken at different energy levels to highlight the contrast dye. The exam takes about 30 minutes. The injectable contrast agent is iodine-based, similar to what's used in CT scans. You may feel warm or experience a metallic taste, but these sensations are usually temporary. The dye is cleared from your body through urine, so drinking fluids post-exam is important.

Preparation for Your Contrast Enhanced Mammogram

Wear a shirt with a skirt, shorts, or trousers for comfort, as you’ll only need to remove your top and bra. Avoid deodorant or talcum powder, as these can interfere with imaging. If you have prior breast imaging, bring those reports with you.

Risks and Complications of Contrast Enhanced Mammography

Contrast mammography is generally safe but has potential risks, including discomfort from the injection, allergic reactions, or kidney function impact for those with existing conditions. Our experienced team are prepared to manage any reactions and ensure your safety.

Breast MRI

Breast MRI is a sophisticated imaging technique that uses powerful magnets and radiofrequency pulses to create detailed images of the breast, without using ionising radiation. This makes it particularly valuable for certain patient groups. Breast MRI is recommended for women at high risk for breast cancer, such as those with a strong family history or genetic mutations like BRCA1 or BRCA2. It is also the preferred imaging method for women who have received chest irradiation for lymphoma, as it avoids additional radiation exposure. It is also a fantastic screening tool for women who want ‘piece-of-mind' there is nothing suspicious that needs further investigation.

When Is Breast MRI Used?

Breast MRI is used in various clinical situations:

Screening: Rapid Sequence Breast MRI ideal for women with a heightened risk of breast cancer due to genetic factors or family history but are typically asymptomatic. It offers valuable information with reduced scan time, making it efficient for both initial and follow-up imaging. Rapid Sequence MRI can be referred by GPs and Specialists however there are no Medicare rebates for this examination type.

Cancer Evaluation: MRI helps assess the extent of cancer within the breast tissue and evaluate abnormal lymph nodes. This comprehensive scan captures detailed images of the breast tissue in multiple phases, including dynamic contrast enhancement and delayed phases. It provides a thorough view of the breast and is typically used for initial evaluations and detailed assessments.

Implant Assessment: MRI is useful for detecting ruptures in breast implants and identifying areas obscured by implants on other imaging tests.

How Is a Breast MRI Performed?

During a breast MRI, you will lie face down on a padded bed that resembles a massage table. . MRI is very noisy so you will be provided with headphones to protect your hearing and music can also be played. The examination will take 20-30 minutes. A contrast injection is usually required and is administered through a small cannula in your arm or hand. Our team of radiographers will thoroughly explain the examination and remain in constant communication throughout.

Preparation for Your Breast MRI

Hormones can influence the appearance of breast tissue. If the test is not urgent and you are still menstruating, schedule your MRI during the first half of your menstrual cycle when hormonal influences on breast tissue are less pronounced. If you are on HRT, discuss with your doctor whether pausing it before the exam could be beneficial, as it can affect image interpretation.

Risks of a Breast MRI

There are no specific risks to breast MRIs, however all patients undergoing any MRI examination will need to be thoroughly screened for any implants or devices that are not MRI conditional. Please alert your referring doctor and our bookings team to any devices or implants you have, so we can determine your suitability for this examination. There is a small risk of a reaction to the MRI contrast. The MRI team will discuss this with you at the time of your examination, however if you have had a previous reaction to MRI gadolinium-based contrast, please advise your referring doctor and our team at time of booking.

Breast Lymphoscintigraphy

Breast lymphoscintigraphy is a diagnostic procedure used to identify the first lymph nodes that drain lymphatic fluid from a breast tumor. This is crucial for guiding surgeons on which lymph nodes might need to be removed and examined during breast surgery.

How is a Lymphoscintigraphy Performed?

Upon arrival, you will be evaluated by a Nuclear Medicine Physician who will review your medical history, medications, and allergies. You will receive up to four small injections of a radioactive tracer around the breast area. These injections are generally well-tolerated with no side effects. After the injections, you will massage the area for 10 minutes to enhance lymphatic flow. A series of images will then be taken with a gamma camera, first for about 20 minutes, and a second set approximately 2 hours later, which will take around 45 minutes. The sentinel node will be marked on your skin to assist the surgeon during your operation. The entire process typically lasts 3-4 hours. We recommend you wear comfortable clothing and bring a book to read or music to listen to.

Preparation for Your Lymphoscintigraphy

No special preparation is needed. Please bring any relevant imaging studies and reports, as they are necessary for the Nuclear Medicine Physician’s review. If you have other exams scheduled for the same day, inform our staff so we can coordinate the order of your tests. Post-Procedure:

Risks of a Lymphoscintigraphy

The radiation exposure from this test is minimal, similar to a couple of chest X-rays. There are no specific precautions required after the procedure, as the radioactive tracer naturally decays over time. In cases where the sentinel node is not visible, surgeons can use alternative methods to locate affected lymph nodes.

Preoperative Hookwire Localisation

Hookwire localization is a procedure used to guide the removal of an abnormality in the breast that cannot be felt. A fine wire with a small hook is inserted into the breast under imaging guidance to mark the abnormal area for accurate surgical removal, helping to minimize scarring and deformity.

How is a Preoperative Hookwire Localisation Performed?

A hookwire is inserted into the breast tissue on the day of surgery, using ultrasound or mammography (2D or 3D tomosynthesis) based on the imaging modality that best visualises the region of interest. A radiologist, radiographer or sonographer, and nurse will assist with the procedure. Imaging is used to identify the area. If ultrasound is used, you will lie on your back with your arm out to the side. If mammography is used, you will be positioned on a special chair with your breast compressed. The skin is cleaned and numbed with a local anesthetic. A needle with the hookwire is inserted to place the hooked tip into the breast tissue. The wire remains in place, with part of it taped to the skin. The area is marked for surgical reference. The procedure typically takes 30 to 45 minutes, depending on the type of imaging used. You will be transferred to the operating theatre where the surgeon will remove the abnormal area and the hookwire. A diagram, report, and images will be provided for surgical reference.

Preparation for Your Hookwire Localisation

Avoid using deodorant or talcum powder on the day of the procedure. Notify us if you are on blood-thinning medications.

Risks of a Hookwire Localisation

Hookwire localisation is very safe with minimal risks. Rare complications include wire movement, which can affect surgical accuracy, and very rarely, significant migration of the wire beyond the breast. Other risks such as bleeding and infection are extremely rare. This procedure helps ensure precise removal of the abnormal area, enhancing surgical outcomes and minimising potential complications.

Core Biopsy/Vacuum Assisted Core Biopsy (VAB)

A core breast biopsy, with or without vacuum assistance, is a safe and minimally invasive procedure used to collect a tissue sample for analysis. It helps diagnose abnormalities found in breast imaging or physical examinations without the need for more invasive surgical biopsy methods. A core breast biopsy involves using a needle to extract a small tissue sample from a suspicious area in the breast. This procedure is usually performed to investigate a lump or abnormality detected through mammography, ultrasound, or MRI. The results aid in determining whether the abnormality is benign or if further action, such as surgery, is needed.

What are the Two Types of Core Biopsies?

A Core Biopsy utilises a smaller needle and is a bit quicker with less bruising. It typically involves taking 1 to 5 samples. A Vacuum-Assisted Core Biopsy uses a larger needle with suction to collect multiple samples, usually ranging from 1 to 20, and is preferred for certain types of abnormalities.

How is a Core Biopsy Performed?

The biopsy is guided by ultrasound, mammography, or MRI, depending on which imaging technique best visualises the abnormality. After cleaning the skin and applying a local anesthetic, a small incision (2-4mm) is made to insert the biopsy device. For core biopsies, the needle makes a clicking sound as it takes samples. For vacuum-assisted biopsies, the needle rotates and uses suction to collect tissue. The procedure involves positioning you and your breast for optimal imaging. For ultrasound, you may lie on your back or side. For mammography, you might sit or lie on your side. MRI-guided biopsies require lying on your stomach.

Preparation for Your Core Biopsy

Avoid using deodorant or talcum powder on the day of the procedure. Notify us if you are on blood-thinning medications.

Risks of a Core Biopsy

Expect some bruising, which can be managed with ice packs and pain relievers like Panadol. Avoid strenuous activities for 24-48 hours. Minor risks include bleeding, bruising, and rarely infection. Follow aftercare instructions to minimise complications.

Fine Needle Aspiration (FNA) Biopsy

A fine needle aspiration (FNA) breast biopsy is a safe, minimally invasive procedure used to collect a small sample of breast tissue cells for analysis. It helps diagnose issues found in breast imaging or physical exams without the need for more invasive surgical methods. FNA uses a thin needle to collect individual cells or small clusters. It typically results in less bruising and is preferred if you are on blood-thinning medications. Your doctor may recommend an FNA biopsy if you or they notice a lump or change in your breast, or if a radiologist suggests it after reviewing mammography, ultrasound, or MRI results. The biopsy aims to identify the cause of any abnormal findings and guide further treatment.

How is an FNA Performed?

The procedure is carried out by a radiologist, pathologist and a sonographer. The biopsy is performed with ultrasound guidance to locate the target area. The skin is cleaned, and a local anesthetic is administered. A small incision (2mm) is made if needed. A thin needle is used to collect 1 to 5 samples. The procedure takes about 30 minutes, and a marker clip may be inserted if necessary. Firm pressure is applied to the biopsy area for about 5 minutes before a dressing and ice are applied.

Preparation for Your Core Biopsy

Avoid using deodorant or talcum powder on the day of the procedure. Notify us if you are on blood-thinning medications.

Risks of FNA Bruising may occur and can last up to a few weeks. Use ice packs and Panadol for comfort. Avoid strenuous activities for 24 hours. Minor risks include bleeding, bruising, and very rarely, infection or other complications. Follow aftercare instructions and contact us if you experience any unusual symptoms.

Breast Tissue Marker (Clip) Insertion

A tissue marker is a very small object that is inserted into the breast either at the time of a biopsy, or to mark a previously diagnosed abnormality. There are a number of different types of markers available and the radiologist uses the marker clip most suitable for your particular requirements. There are different materials used in the various markers that are available and the markers come in a variety of shapes. Different shapes are useful if there are multiple areas to be marked in the same breast.

What are Tissue Markers Used For?

Biopsy Tracking: A marker helps identify the exact location of a biopsy site, making it easier to track in future imaging and prevent repeated biopsies. Pre-Surgical Planning: If chemotherapy is given before surgery, a marker helps locate and manage the area of cancer or abnormal lymph nodes, particularly for neoadjuvant treatment pathways.

Imaging Guidance: Markers make it easier to visualize abnormalities on mammograms if initial ultrasound findings are not clearly visible on mammography.

How is an Breast Tissue Marker Insertion Performed?

You will be positioned for imaging guidance, which is typically ultrasound or mammography, depending on which provides the clearest view of the area. The skin is cleaned with an antiseptic solution and local anesthetic is injected into the area where the marker will be placed. The marker is inserted using a thin, specialised needle guided by imaging. This ensures precise placement in the targeted area. The procedure is usually quick, taking about 15-30 minutes. A small dressing is applied to the insertion site. If necessary, a gentle mammogram may be performed to confirm the marker position. Markers typically do not need removal unless surgical intervention is required. If surgery is planned, the marker may be removed or localized with a hookwire.

Risks of Tissue Markers

Allergic Reactions are rare, but if you have allergies to metals like nickel or titanium, or materials used in markers, inform our team before your procedure. Minor bruising is possible, often due to the biopsy rather than the marker itself. Infection is very rare, and we take extensive precautions to prevent it.