Digital Mammography with CAD

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Raleigh Radiology is committed to provide patients the most advanced mammography technology available. Digital Mammography with CAD (computer aided detection) is the latest tool available to detect breast cancer at early stages when it has a better chance of being cured. In clinical studies, digital mammography screening detected up to 28% more cancers than film screen mammography in women under the age of 50, premenopausal and permenopausal women, and all women with dense breast. Raleigh Radiology was the first in Wake County to offer digital mammography, and is the first fully digital mammography practice by offering this service at four convenient outpatient locations. All are accredited by the American College of Radiology and certified by the FDA. In addition, all mammography exams are read by board certified radiologist, of which many have earned additional sub specialized training in breast and women’s imaging.

Screening Digital Mammography
A screening mammogram is a low dose x-ray of the breast used to detect abnormal changes in the breast tissue. This type of routine mammogram is for women who have no signs or symptoms of an abnormality. Women are encouraged to have a baseline mammogram between the ages of 35-39, and begin annual exams at age 40. Screening mammography should be used in conjunction with a clinical breast exam performed by your physician and monthly self breast exams.

The exam is performed in an upright position, usually standing. The mammography technologist will instruct you while they place your breast tissue in the best position to achieve maximum results for your exam, and typically two views of each breast will be obtained. The breast tissue is compressed between two plates on the machine. Compression spreads apart the tissue to give the radiologist better visualization of the anatomical structures within the breast. The applied compression will be held in place only a few seconds during the exposure, and then automatically released.

Mammograms make it possible to detect tumors that cannot yet be felt, and also microcalcifications (tiny calcium deposits) that can sometimes indicate the presence of cancer. To reduce discomfort if you have sensitive breasts, schedule your mammogram in the first two weeks following your menstrual cycle when your breasts are less tender.

Upon completion of your screening exam, the mammography technologist will review the images for quality. The radiologist will interpret your exam and send the results to your referring physician or provider, and we will notify you of the outcome as well. If there is an area that raises any question for the radiologist that needs further clarification, they may recommend you return for a diagnostic mammogram.

Diagnostic Digital Mammography
A diagnostic mammogram is also a low dose xray examination of the breasts, but used to evaluate potential problems within the breast. If you have one or more of the qualifying symptoms, you may need a diagnostic mammogram, instead of a screening:

Personal history of breast cancer
New lump or mass
New breast pain that is focal (localized to a specific point or area in the breast)
New nipple inversion
Bloody discharge from the nipple
Short-term follow up recommended by a radiologist from a previous mammography examination
Screening mammogram revealed a finding that needs further investigation or clarification

With a diagnostic evaluation, the technologist usually obtains the same images as with a screening exam, but also performs special customized views under the direction of the radiologist. This may include the use of special, smaller compression paddles, the use of magnification techniques, and/or breast ultrasound to focus on the area of interest or concern. Because this exam is more customized, it often requires more images be taken (as compared to a screening study), and also means that diagnostic exams from patient to patient may not be exactly the same. Also, diagnostic mammography is not considered a preventive care service by most insurance companies, and may be subject to deductibles and co-insurance. Please contact your insurance provider with questions concerning your coverage.

Breast Ultrasound
To complete your breast imaging evaluation, the radiologist may recommend a breast ultrasound at the time of your diagnostic mammogram appointment. This is an imaging technique that uses sound waves to look at anatomical structures within the breast and can supplement a mammogram evaluation by helping the radiologist characterize the tissue he or she is evaluating. The use of ultrasound helps the radiologist to avoid recommending unnecessary surgical procedures and make a comprehensive diagnosis. While breast ultrasound is often used as a supplemental diagnostic tool, it is not an adequate screening option and should not be used to replace mammography.

Frequently Asked Questions

What is the difference between a screening & a diagnostic mammogram?

Screening: A yearly exam performed when the patient has no clinical symptom or history of breast cancer. A screening can be done on a patient with a history of breast cancer if the affected breast was removed (Mastectomy) and 5 years has passed since the Mastectomy. The recommendation for baseline screening is at 35 years of age. This can be an insurance issue so have the patient check if they are younger than 35.

Diagnostic: An exam done when a patient has a specific new finding or is being followed at the recommendation of either the radiologist or a surgeon. A diagnostic can also be ordered for any patient with a history of breast cancer. A diagnostic mammogram is always done on patients who had a lumpectomy and on patients who have had a mastectomy within the past 5 years. A diagnostic mammogram includes the same four standard views as a screening mammogram; in addition, it includes other specialized views. It will be seen by the radiologist while the patient is still in the office.
When and how will the patient get results?

A letter will be mailed to the patient within 30 days giving the final assessment results as mandated by the FDA. A delay can occur when comparison films are not available at the time of service. If the patient is required to return for additional imaging, they are notified by phone.
Why does your office need my previous mammogram films?

One of the most important parts of mammography is proving stability over time. This is done by having the radiologist compare the old exam with the new exam to exclude subtle differences in the breast tissue. The actual mammography films are needed for this, not just the report.
Does the patient have to have an order for a six month follow up even though it was recommended by the Radiologist?

Yes. The radiologist can only recommend that the patient have a follow up appointment. The referring physician still has to provide an order for this procedure to be done.
Does a 6 month follow up need to be a bilateral or unilateral mammogram?

The patient should have a bilateral mammogram only once per year unless there is a clinical finding in both breasts. If a patient has a bilateral mammogram with a finding in one breast, the six month follow up should only be of the affected breast. The patient should then return after another six months for a yearly bilateral mammogram. Baseline mammograms should be bilateral so the radiologist can compare for symmetry of breast tissue.
Should a patient under 30 years old with a breast lump, have a mammogram or breast ultrasound?

In general, patients under 30 with a breast lump should have an ultrasound first. The mammogram will be determined by the radiologist based on the ultrasound findings. In most patients under 30, the breast tissue is very dense and difficult to image effectively. Patients over 30 should have a bilateral mammogram and the need for ultrasound will be determined by the radiologist based on the mammographic findings. Breast ultrasound is used for a specific finding, usually a palpable lump or a mammographic abnormality and is not indicated for screening.
Once a patient has a diagnostic or abnormal mammogram, do their future mammograms always need to be diagnostic?

No. The radiologist will investigate clinical symptoms and will follow any mammographic and/or sonographic findings until they can say that it is either benign or needs to be biopsied. If the patient has a biopsy that is benign, they can return to having screening mammograms at their surgeon’s discretion.
Can a patient have a screening ultrasound if they do not like having mammograms?

Unfortunately, no they cannot. mammograms and ultrasounds image breast tissue differently. Not everything that is seen on a mammogram can be seen on an ultrasound. The standard of care dictates that mammography is the imaging modality of choice for breast cancer screening. Other modalities are used only when there is a clinical indication.
If a patient has implants or had breast reduction, is it ordered as a screening or diagnostic?

It is up to the referring physician to decide weather it is a diagnostic or screening mammogram.

Neil A. Ramquist, MD

Diagnostic Radiologist

Medical Director of Diagnostic Imaging at Rex Hospital
BS, MD, University of California at Davis
Chief resident in radiology, Bowman Gray School of Medicine
Member, American College of Radiology
Member, Radiological Society of North America
Native of Wisconsin

Expertise in mammography, CT, and ultrasound
Joined Raleigh Radiology in 1981

Donald G. Detweiler, MD

Diagnostic Radiologist

President, Raleigh Radiology Associates
Medical Director, Raleigh Radiology Blue Ridge, Cary, Breast Center, and Cary Women's Imaging Center
Chairman, Rex Classic - 2000
President, Medical Staff Rex Hospital - 1995
BS, Duke University
MD, Emory University
Fellow and resident in diagnostic radiology, University of North Carolina Medical Center
Native of Illinois

Expertise in mammography, CT, and ultrasound
Joined Raleigh Radiology in 1982

W. Kent Davis, MD

Neuroradiologist and Breast Imaging and Intervention Radiologist

Medical Director, Raleigh Radiology Cedarhurst, Clayton, Wake Forest, and Brier Creek
Former President of Raleigh Radiology
BS, Duke University
MD, University of North Carolina at Chapel Hill
Internship in internal medicine, Union Memorial Hospital, Baltimore
Resident in radiology, Duke University Medical Center
Fellowship in neuroradiology, Duke University Medical Center
Certificate of Added Qualifications in Neuroradiology awarded by American Board of Radiology
Member, American Society of Neuroradiology
Native of North Carolina

Expertise in head, neck, and spine imaging; breast imaging and breast intervention
Joined Raleigh Radiology in 1990

Andrew B. Weber, MD

Vascular & Interventional Radiologist

BS, University of Pennsylvania
MD, Temple University Medical School
Internship in surgery, York Hospital
Chief resident, Duke University Medical Center
Former Chief, Rex Hospital Radiology
2009 Chairman, Rex Hospital Open
Rex Corporate Counsel
Native of Pennsylvania

Expertise in vascular/interventional radiology and MR angiography
Joined Raleigh Radiology in 1992

Julia K. Taber, MD

Women’s Imaging Radiologist

Vice President of Medical Staff Officers & Committees of Rex Hopsital
BS, Brown University
MD, Duke University Medical School
Internship in internal medicine, New York Hospital
Resident in diagnostic radiology, Duke University Medical Center
Fellowship in mammography and pediatric radiology, Duke University Medical Center
Member, Society of Breast Imaging
Member, American Institute of Ultrasound in Medicine
Women’s Imaging Radiologist

Expertise in breast imaging, breast intervention, and pediatric radiology

Joined Raleigh Radiology in 1993

Gregory C. Hinn, MD

Musculoskeletal Radiologist

Medical Director, Musculoskeletal Imaging at Rex Hospital
Medical Director, MRI at Rex Hospital
BA, University of North Carolina at Chapel Hill
MD, Bowman Gray School of Medicine at Wake Forest University
Resident in radiology, University of Virginia Health Sciences Center
Fellowship in diagnostic and interventional musculoskeletal radiology, University of Virginia Health Sciences Center
Musculoskeletal radiologist for the North Carolina State University Athletic Department.
Raised in North Carolina

Expertise in musculoskeletal imaging with bone and joint intervention
Joined Raleigh Radiology in 1995

Gregory A. Bortoff, MD, PhD

Abdominal Imaging Radiologist

Director of Raleigh Radiology Recruiting
BS, Cornell University
MD, PhD, State University of New York Health Science Center at Syracuse
Resident in radiology, Wake Forest University Baptist Medical Center
Fellowship in abdominal imaging, Wake Forest University Baptist Medical Center
Member, Radiological Society of North America
Member, American Roentgen Ray Society
Native of New York

Expertise in abdominal imaging, including MRI, MRA, ultrasound, oncologic imaging, and PET/CT
Joined Raleigh Radiology in 1999

Jennifer S. Van Vickle, MD

Abdominal Imaging Radiologist

Medical Director of Ultrasound at Rex Hospital
BA, University of Chicago, M.Div and Th.M, Duke University
MD, Duke University Medical Center
Internship in internal medicine, Duke University Medical Center
Resident in diagnostic radiology, Duke University Medical Center
Fellowship in abdominal imaging and mammography, Duke University Medical Center
Native of Missouri

Expertise in breast imaging, breast intervention, abdominal and pelvic imaging, including CT, ultrasound, and MRI
Joined Raleigh Radiology in 2002

Gintaras E. Degesys, MD

Musculoskeletal & Abdominal Imaging Radiologist

BA with high honors, Kenyon College
MD, University of Cincinnati College of Medicine
Internship and chief resident, Northwestern University
Fellowship in interventional and abdominal imaging, Duke University Medical Center
Certificate of Added Qualifi cations in Vascular and Interventional Radiology awarded by American Board of Radiology
Native of Ohio

Expertise in musculoskeletal imaging, breast intervention, and abdominal imaging and intervention
Joined Raleigh Radiology in 2002

Laura O. Thomas, MD

Abdominal Imaging Radiologist

Director of Rex Breast Care Center at Rex Hospital
Radiologist Recruiter
BA, Princeton University
MD, Duke University Medical School
Internship in internal medicine, UNC Hospitals
Chief resident, Duke University Medical Center
Fellowship in women’s and abdominal imaging, Duke University Medical Center
Native of Missouri

Expertise in breast imaging, breast intervention, abdominal imaging, oncologic imaging, and PET/CT
Joined Raleigh Radiology in 2003

John G. “Jay” Alley, Jr, MD

Neuroradiologist

Chief of Radiology at Rex Hospital
BA, University of North Carolina at Chapel Hill
Post-Baccalaureate Premedical Program, Columbia University, New York
MD, University of North Carolina School of Medicine
Co-chief resident in diagnostic radiology, University of North Carolina Hospitals
Fellowship in neuroradiology, University of North Carolina Hospitals
Native of North Carolina

Expertise in neuroradiology, PET/CT, oncologic imaging and abdominal imaging
Joined Raleigh Radiology in 2004

Todd J. Roth, MD

Abdominal Imaging Radiologist

Vice Chief of Radiology at Rex Hospital
BS, University of Texas, Austin
MD, University of Texas Health Sciences Center, San Antonio
Residency, Baptist Medical Center, Wake Forest University, Winston-Salem
Fellowship in abdominal imaging, Baptist Medical Center, Wake Forest University
Native of Kansas

Expertise in abdominal and pelvic MRI, CT, and ultrasound
Joined Raleigh Radiology in 2004

Steven R. Carter, MD

Musculoskeletal Radiologist

BS, University of Virginia
MS, Medical College of Virginia
MD, Medical College of Virginia
Internship in internal medicine, MCV
Chief resident, diagnostic radiology, Emory University
Fellowship in musculoskeletal imaging, Emory University
Member, American Roentgen Ray Society, American College of Radiology, Radiological Society of North America
Musculoskeletal radiologist for the Carolina Hurricanes
Native of Richmond, Virginia

Expertise in musculoskeletal radiology
Joined Raleigh Radiology in 2005

Joshua B. Mitchell, MD

Musculoskeletal Radiologist

BA, University of Virginia
MD, University of Tennessee College of Medicine
Internship, Medical University of South Carolina
Chief resident, Medical University of South Carolina
Fellowship in musculoskeletal radiology, University of Florida
Member, Society of Skeletal Radiology
Member, American College of Radiology
Member, American Roentgen Ray Society
Member, Radiological Society of North America
Member, Association of University Radiologist
Member, North Carolina Medical Society
Native of Chattanooga, Tennessee

Expertise in musculoskeletal imaging
Joined Raleigh Radiology in 2007

Jeffrey Browne, MD

Musculoskeletal Radiologist

Medical Director of CT for Rex Hospital
BS, Boston College
MD, University of Connecticut School of Medicine
Internship, St. Raphael’s Hospital
Residency, Duke University Medical Center
Fellowship in musculoskeletal radiology, Duke University Medical Center
Member, American College of Radiology, Radiological Society of North America and American Roetgen Ray Society.
Native of Connecticut

Expertise in musculoskeletal imaging
Joined Raleigh Radiology in 2008

Michael C. Hollingshead, MD

Neuroradiologist

Medical Director of Neuroimaging at Rex Hospital
BA, University of North Carolina at Chapel Hill
MD, University of North Carolina at Chapel Hill
Internship, University of North Carolina at Chapel Hill
Residency, University of North Carolina at Chapel Hill
Fellowship in neuroradiology, University of North Carolina at Chapel Hill
Certificate of added Qualifications in Neuroradiology awarded by American Board of Radiology
Member, American Society of Neuroradiology, American College of Radiology,Radiological Society of North America
Native of Massachusetts

Expertise in neuroradiology
Joined Raleigh Radiology in 2008

Jason R. Harris, MD

Vascular and Interventional Radiologist

BS, Brigham Young University
MD, Harvard Medical School
Internship, Newton-Wellesley Hospital, Newton, Massachusetts
Residency, Massachusetts General Hospital, Boston, Massachusetts
Fellowship in vascular and interventional radiology, Duke University Medical Center
Member, American College of Radiology, Society of Interventional Radiology
Native of California

Expertise in vascular and interventional and musculoskeletal radiology
Joined Raleigh Radiology in 2008