Mammography / Breast Imaging and Procedures

Breast radiologistsWe have passed rigorous accreditation tests in mammography, stereotactic biopsy, breast ultrasound and breast MRI. We deliver expert clinical care from our ACR-certified mammography and ultrasound technologists. All of our physicians are American Board of Radiology and Mammography Quality Standards Act certified.

If you have questions about appropriate breast cancer screening, please refer to the website

We are located at 736 Cambridge St. in the St. Margaret's building Floor 5 (ground floor). Screening mammograms are available during routine business hours, as well as on Saturdays and occasional weekday evenings. Schedule your mammogram by calling 617-789-3160.


What is a mammogram?

A mammogram is an X-ray picture of the breast. Doctors use mammograms to look for early signs of breast cancer. Mammograms currently are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt. When breast cancer is found early, many women go on to live long and healthy lives.

At St. Elizabeth’s Medical Center, all mammography is digital.


What is a 3-D mammogram?

Three-dimensional (3-D) mammography, also known as breast tomosynthesis, is a type of digital mammography in which x-ray machines are used to take pictures of thin slices of the breast and computer software is used to create 3-D images of the breasts. 3-D mammography uses very low dose X-rays. However, since it is generally performed at the same time as standard two-dimensional (2-D) digital mammography, the radiation dose is slightly higher than that of standard digital mammography but still below the allowed levels.


What is a screening mammogram?

A screening mammogram is a mammogram that is performed on a routine basis to check for breast cancer in women who do not have any signs or symptoms of breast cancer.

Screening mammograms usually involve two X-ray images of each breast. These X-ray images help to detect tumors that cannot be felt, as well as microcalcifications (tiny deposits of calcium) that sometimes indicate the presence of early breast cancer.

When should I get a mammogram?

In women with no increased risk for breast cancer, results from randomized clinical trials as well as other studies recommend annual mammograms beginning at age 40. In patients with a family history of breast cancer in a first degree relative (mother or sister), a woman should begin annual screening mammograms 10 years earlier than the age of diagnosis of her relative, or at age 40, whichever comes first. 


I have breast implants. Do I need a mammogram?

Women with breast implants should continue to have mammograms. A woman who had an implant following a mastectomy should ask her doctor whether a mammogram of the reconstructed breast is necessary. It is important to let us know about breast implants when scheduling a mammogram, as there are special techniques used when taking the images that allow for better visualization of the breast tissue.


I received a letter saying I need to come back for additional views − what does that mean?

Additional views are occasionally needed to better clarify possible abnormalities seen on screening mammography, or areas of the breast that were not adequately visualized on screening mammography. This is one use for a diagnostic mammogram.


What is a diagnostic mammogram?

A diagnostic mammogram is a mammogram that is focused specifically on a problem that the patient is having regarding her breast or to further evaluate something seen on the patient’s recent screening mammogram.  

Examples of a physical problem include a new lump, nipple discharge, skin thickening, change in size of the breast and persistent focal pain. The diagnostic mammogram takes more time to complete than a screening mammogram due to some very specialized pictures. Many times, the additional mammographic views are sufficient; sometimes a breast ultrasound is required for further evaluation.

What is a breast ultrasound?

Breast ultrasound 2A breast ultrasound is another technique that radiologists often use to evaluate the breast tissue. It uses sound waves instead of X-rays to visualize the breast tissue, which does not require any radiation.

A small plastic probe is placed on the skin of the breast with ultrasound gel and pictures are taken. This is generally painless.

Breast ultrasound can sometimes better evaluate lumps in the breast but do not show everything that mammograms depict. This is why breast ultrasound is used in addition to mammograms in certain patients.  


Who should have a breast ultrasound?

Breast ultrasoundA new breast lump is the most common indication for breast ultrasound, usually following mammography. In patients under the age of 30 with a new lump, the ultrasound may be performed without mammography. Other reasons for ultrasound include nipple discharge or infection. Ultrasound may also be done to further evaluate a finding seen on the screening or diagnostic mammogram. If there is a questionable mass seen on the breast ultrasound then a needle biospy can be performed using ultrasound to guide the tissue sampling.[clear][/clear]

Breast cystUltrasound is sometimes used along with mammograms to screen certain women, such as those with dense breast tissue as seen on a mammogram. Some studies have shown that having a yearly screening ultrasound in addition to a mammogram will show more invasive cancers than mammograms alone in women with dense breasts. But, ultrasound also shows many findings that may lead to follow-up or needle biopsy but turn out not to be cancer.


What is breast density?

Breast density is related to how much glandular breast tissue (white on mammograms) versus fatty tissue (black on mammograms) there is in a particular woman’s breast. On a mammogram the more glandular tissue there is in a woman’s breast, the whiter the mammogram will look, and this can hide small masses. There are a few different ways to measure density on a mammogram, but no one method has been agreed upon by doctors. Breast density is not based on how your breasts feel during your self-exam or your doctor's physical exam. Breast density can be inherited, so if your mother has dense breasts, it's likely you will, too.

Research has shown that dense breasts:

  • Can be six times more likely to develop cancer
  • Can make it harder for mammograms to detect breast cancer


What is a breast MRI?

Breast MRIBreast magnetic resonance imaging (MRI) is an imaging test that creates detailed pictures of the breasts. Although breast MRI is not regularly used for breast cancer screening, it may help detect breast cancer in its earliest stage for some women who are at high risk for developing the disease. A breast MRI is not a replacement for mammography for high risk women. Instead, it should be used as a complementary screening tool. This is because although an MRI may be more likely to find cancer than mammography, it often misses some earlier cancers that mammography easily detects. For women with an average risk of breast cancer, mammography is still the standard method for diagnosing early-stage breast cancer

Other uses of breast MRI include pre-treatment planning when a patient has been diagnosed with invasive cancer, evaluation of breast implants, evaluation of chemotherapy response prior to surgery, and rarely to better evaluate the breasts when mammogram and ultrasound have not answered the question.


What are the different types of breast biopsy procedures?

There are multiple different types of breast biopsies. The most common type of breast biopsy is a core-needle biopsy where small tissue samples are taken using a special needle. A less frequent type of breast biopsy is a fine needle aspiration  where only a few cells are sampled with a needle. The type of breast biopsy you may have depends on how the abnormality is seen best.

Fine needle aspiration biopsy:
In fine needle aspiration biopsy, the doctor (a radiologist or surgeon) uses a very thin needle attached to a syringe to withdraw  a small amount of tissue from the suspicious area. This tissue is then examined by a pathologist under a microscope. The needle used for fine needle aspiration biopsy is thinner than the ones used for blood tests and local anesthetic is used for pain control.

If the area to be biopsied can be felt, the doctor locates the lump or suspicious area and guides the needle there. If the lump can’t be felt, the doctor might use ultrasound to watch the needle on a screen as it moves into the mass. This is called an ultrasound-guided biopsy.

Core needle biopsy:
A core needle biopsy is much like a fine needle aspiration biopsy. A slightly larger needle is used to withdraw small cylinders (or cores) of tissue from the abnormal area in the breast. A core needle biopsy is most often done with local anesthesia (you are awake but your breast is numbed). This procedure takes longer than a fine needle aspiration biopsy, but it’s more likely to give a clear result because more tissue is evaluated. A core needle biopsy can cause some bruising, but usually does not leave scars inside or outside the breast.

The radiologist can use ultrasound, X-ray, or MRI to guide needle placement depending on how best the area is seen. If the area is felt by your doctor, the needle may be guided by feeling the lump.

Stereotactic core needle biopsy:
A stereotactic core needle biopsy uses X-ray equipment and a computer to guide the needle to its target. This is often done to biopsy suspicious microcalcifications (tiny calcium deposits) or a mass when it cannot be felt or seen on ultrasound. For these procedures, the skin is numbed and a vacuum-assisted needle is used to take multiple core tissue samples. This is done as an outpatient and no stitches are required.

Breast MRI ScanMagnetic resonance imaging (MRI) guided biopsy:
An MRI guided biopsy is performed when a suspicious area is seen only on MRI. The patient is positioned face down in the MRI machine, in the same position as for the breast MRI, and the MRI pictures help to guide the needle to its target. A vacuum-assisted core biopsy needle is used for this type of biospy as well. This is also an outpatient procedure with local anesthetic for pain control.

Biopsy markers:
After the doctor has taken out all of the tissue samples needed, a very small, safe marker or clip may be put in your breast at the biopsy site. These clips are tiny, surgical-grade, metal devices that show up on mammograms and are used to mark the biopsy site. The clip cannot be felt and should not cause any problems. It is used to mark the area in case changes show up on future mammograms.

Wire localization:
The surgeon may request a procedure called wire localization to mark a mass or calcifications for surgical excision. For wire localization, the breast is numbed with a local anesthetic and the radiologist inserts a thin, hollow needle into the breast while targeted mammograms are used to guide it to the suspicious area. The needle/wire is left in place to guide the surgeon to the abnormal area.

Your surgeon will tell you how to care for the biopsy site and what you can and can’t do while it heals.