The Dubin Breast Center offers comprehensive breast imaging services that include state-of-the-art, low-dose digital mammography such as 3D mammography (tomosynthesis), and high-resolution breast ultrasound. We perform minimally invasive procedures, including biopsies, using ultrasound and mammographic guidance and stereotactic techniques. Mount Sinai’s Radiology Associates coordinates breast MRI services.
Our breast imaging facility provides patient-focused care in a warm environment designed for comfort and privacy. We designed the center with you in mind. Ultrasound rooms, for example, are equipped with music systems and specially designed examination tables. Patient navigators are available to guide patients throughout the Center. If you need a routine breast screenings, we may take you to the Center for Advanced Medicine, where we perform state-of-the-art imaging studies in an expedited fashion.
For Your Imaging Appointment
- Be sure to ask your doctor to fax an order/prescription for your imaging exam prior to your arrival or plan on bringing a copy to your visit.
- If you have prior imaging, please bring a copy to your visit (preferably on disc in dicom format) or have them sent prior.
- Arrive 30 minutes prior to your table time to allow for registration.
- Do not wear any powders or deodorant.
- For more information regarding image-guided breast biopsies, please see attached.
Quick and accurate diagnosis is key to developing an effective individualized treatment plan. To make sure we have all the information we need to determine precisely what is going on, we offer a comprehensive array of breast imaging services. Sometimes we need to use more than one imaging modality to gain all the data we need. Our state-of-the-art procedures include the following:
A mammogram is an X-ray exam of the breast. After age 40, we recommend women receive screening mammograms every year to check for any changes in the breasts (such as indications of cancer). If you have a lump or other symptom, or a change in your screening mammogram, we may use diagnostic mammograms to obtain more information.
To perform a mammogram, we compress your breast between a plastic plate and a digital detector, which helps to spread the tissue apart. This process ensures there will be little movement, that the image will be clear, and that the mammogram can be performed with lower X-ray dose. While this compression can be uncomfortable, it lasts for a few seconds only, and it is a necessary step to producing a good mammogram image. Our technicians will work with you to try to limit the discomfort as much as possible.
To optimize breast cancer detection, all mammogram exams done at Mount Sinai are digital. At the Dubin Breast Center, 3D mammograms are also available.
We perform breast ultrasounds to evaluate any problems that may have been found during a screening, diagnostic mammogram, or physical examination. We may also perform these as an adjunct to a screening mammogram, particularly for women with unusually dense breasts.
To perform this test, a technician holds an instrument to your skin, which transmits sound waves through the breast. The computer picks up the echoes from these sounds waves and transforms them into a black and white image that it displays on the screen. This examination is painless and does not expose you to any radiation.
Breast Magnetic Resonance Imaging (MRI)
An MRI scan uses magnets and radio waves (instead of X-rays) to produce highly detailed, cross-sectional images of the breasts. We may use a contrast material called gadolinium, which we inject into your arm before or during the exam. This contrast makes it easier for us to see the breast tissue details.
Bone scans detect areas of abnormal bone growth due to fractures, tumors, infection, or other diseases of the bone. We may also do a bone scan after we detect a bone tumor, to see how your body is responding to treatment.
We use bone scans are performed when we suspect that breast cancer has metastasized (spread), including a lymph node that tests positive for cancer.
What Can I Expect?
- No preparation is necessary.
- We will inject a radioactive tracer into your vein and allow it to circulate for at least two hours to permit absorption by the bone.
- We will ask you to drink fluids during these two hours.
- After the two hours, we will ask you to empty your bladder and to remove all external metal objects such as jewelry, watches, and piercings.
- You will lay flat on the imaging table.
- You can breathe normally but must lie still while we are taking pictures. The scan will last approximately 30 minutes, unless additional images are needed.
You can expect to spend about three to four hours in the Nuclear Medicine department, start to finish, for this procedure.
Multiple-gated acquisition (MUGA)
We perform multiple-gated acquisition (MUGA) scans in the Nuclear Medicine are to evaluate your heart. A MUGA scan takes many pictures to create a moving picture of your heart pumping, so we can evaluate how well your heart pumps and moves your blood around your body. We call this measurement an ejection fraction (EF) because the blood is ejected from your heart.
WE typically perform a MUGA scan before you start chemotherapy to make sure your heart is functioning well enough to withstand chemotherapy. We will likely repeat these scans after you begin receiving chemotherapy and then from time to time to make sure your heart continues to function well. Sometimes we may need to adjust your chemotherapy dose.
What Can I Expect?
- In preparation for your scan, avoid drinks containing alcohol or caffeine (coffee, tea, or soft drinks) for several hours before the test.
- We will ask you to remove metal objects from your chest area such as jewelry or piercings.
- A nuclear medicine technologist will start the procedure by giving you a small injection into a vein in your arm of a medication that attaches to your red blood cells. This prepares the cells for the radioactive injection 30 minutes later. This radioactivity “tags” or “labels” the red blood cells so that we can watch them using the gamma camera for scanning.
- You will lie flat on the imaging table. Breathe normally but lie still. We may need to take additional pictures if you move during the scan.
- We will place three electrodes on your chest like with an EKG.
- We will move the gamma camera very close to your chest to take the pictures.
- The scan usually takes an hour, unless we need to take additional pictures.
Positron Emission Tomography/Computed Tomography (PET/CT) scans take 3D images of your body that help to detect whether the cancer has spread (metastasized). This scan is sensitive and can find these changes earlier than other types of scans, while the cancers are still highly treatable.
If you have a lymph node that is positive for cancer your doctor will order a PET/CT scan to see if the cancer has spread anywhere else in the body.
What Can I Expect?
- Tell the scheduler if you are breast feeding or there is a chance you are pregnant.
- Do not eat or drink anything for four hours before your procedure time. This includes gum, lozenges, and hard candies.
- Do not drink alcohol or caffeinated beverages (tea, coffee, soda), or smoke 24 hours before the procedure.
- Your doctor will advise you about taking your prescription medications before the scan. You should only take these medications with a small sip of water. If you take insulin, the scheduling secretary will schedule your scan after lunch to ensure that you took your insulin six hours before the scan.
- On the day of the scan bring your insurance information, a prescription from your doctor, and a copy of any previous PET/CT scans that were done including the report.
- Wear warm, comfortable, metal-free clothing (no zippers or snaps).
- Upon arrival, a nurse will ask you about your medicines, allergies, and health history.
- We will ask you to remove clothing or jewelry that could interfere with the scan such as belts, earrings, shirts with snaps or zippers, bras, and glasses.
- A nurse will put an intravenous line in your arm so that we can inject a radioactive material. We will wait briefly for the material to circulate throughout your body before we begin scanning. It is important that you rest comfortably and quietly during this time.
- You will lie on a padded exam table which moves into a large opening in the scanner. You must lie still during the exam. The scan takes 20 to 30 minutes.
- Plan on spending two to three hours in the imaging center. Scan times can vary.
We perform a breast biopsy to remove a sampling of cells from a suspicious area of your breast. Examining these cells under a microscope helps us determine your diagnosis.
A radiologist who specializes in breast imaging will lead the team performing your biopsy. We will give you a local anesthesia so that you remain wake but do not feel any pain. Then we will make a small incision and extract tissue samples. We will place a tissue marker in the spot where we removed the tissue, followed by a post mammogram image so we can see the marker. One of our dedicated breast pathologists will examine the tissue sample under a microscope. You can expect to receive your results within one to two business days.
Before the procedure you will sign consent form and discuss the procedure, risks, benefits, and alternatives to the procedure as well as relevant details about your medical history. We will ask you to state your name, date of birth, and which side of your body we are going to biopsy.
We regularly conduct several types of breast biopsies, including the following:
- Stereotactic breast biopsy involves use of a special mammography machine, together with ionizing radiation to guide the radiologist’s instruments to the location of the growth.
- Ultrasound-guided breast biopsy uses ultrasound imaging to show us the location of the growth.
- Magnetic resonance imaging-guided breast biopsy uses magnetic resonance imaging (MRI) to guide us to the location of the growth.
When we place a thin wire or a radioactive seed into your breast to help the surgeon locate the area that needs to be removed, we call it breast localization. An experienced radiologist places this item, using an imaging device (such as a mammogram, ultrasound, or magnetic resonance imaging) for guidance.
We cannot always feel every breast abnormality during a physical exam. Sometimes, we can only detect an abnormality on a mammogram, ultrasound, or magnetic resonance imaging (MRI) scan because the abnormality is small or located deep in the tissue. The wire or seed acts as a guide to assist your surgeon in finding the concerning area.
We generally place the wire in your breast on the day of surgery, right before your surgical procedure, though we can place it up to five days beforehand. The seed is radioactive but contains only a very small amount of radioactive material.
What Can I Expect?
Do not apply deodorant, lotions, or talc to your skin before coming to the hospital. The procedure itself will involve the following steps:
- We will take a few images to determine the best angle at which to introduce the needle or seed.
- We will clean your skin and inject a numbing agent into your breast.
- We will introduce a needle into your breast.
- We will insert a wire or seed into your breast through the needle.
- Once the wire or seed is correctly positioned, we will remove the needle.
- We will take additional images to confirm correct placement.
- Following a wire procedure, we will escort you to the operating room.
- Following a seed procedure, you will be able to go home. There are no activity restrictions. If you have a surgical procedure after the seed procedure, there may be restrictions due to that surgery.
A state-of-the-art procedure called seed localization is improving patient satisfaction at The Dubin Breast Center of the Tisch Cancer Institute at Mount Sinai. If you are undergoing a lumpectomy, we will guide a tiny radioactive seed into your breast and implant it at the site of the tumor. The seed allows surgeons to better target and remove small breast cancer tumors. This procedure is only available at a few centers in the country since its implementation involves significant coordination between a specialized team of breast surgeons and operating room (OR) personnel, radiologists, nuclear medicine physicians, and pathologists.
Prior to the development and implementation of seed localization, we could only target small tumors with a procedure called needle localization. In this pre-surgical procedure, we would guide a wire to the site of the tumor using advanced imaging technology. Because the wire protrudes from the skin, this procedure was always performed on the day of surgery and remained in place until we remove it during the surgery.
Breast Seed Localization Procedure
With seed localization, we can implant the seed before your surgery, so you do not have to arrive at the hospital hours before surgery, as with needle localization. Using local anesthesia in an exam room, we guide the seed into position using a pre-loaded needle and then implant it at the site of the tumor. When you return, one and five days later, to have the tumor removed, we will use a GPS navigator that detects radioactivity to locate the seed and remove the tumor. No radioactivity remains within the breast once the tumor and seed are removed.