Embedded Files
For any inpatient Breast ultrasound requests, see this page: link
Remember, you must use a dedicated Mammo viewing monitor/screen, to interpret Mammos!
Remember, you must use a dedicated Mammo viewing monitor/screen, to interpret Mammos!
'Non Diagnostic Error' in NBI/UV? FIX
BREAST ON CALL (POST BIOPSY PATIENTS)
All breast biopsy/procedure patients will be given the reading rooms as contact information for any after hour questions
Please see below Dr. Margolies instructions handling the phone calls
In the rare event that a breast biopsy patient calls after hours, please have them hold pressure. If seems extreme, there is always the ED and of course the resident should call the attending who did the procedure. If that person does not answer, please call the person who is doing procedures the next day at that site or a related site. Please see attached Mammo attending contact information at the bottom of this page.
Locations
Locations
During the week prior to your mammo rotation, you will receive an email with your schedule including your daily assignments (procedures/diagnostics/screens).
During the week prior to your mammo rotation, you will receive an email with your schedule including your daily assignments (procedures/diagnostics/screens).
If you are on procedures or diagnostics, please report to your designated site and check in with your assigned attending each day you are on the rotation.
If you are on procedures or diagnostics, please report to your designated site and check in with your assigned attending each day you are on the rotation.
If you are on screens, you will not have a designated attending; please report to your designated site and check in with any attending and let them know that you are assigned to read screens that day.
If you are on screens, you will not have a designated attending; please report to your designated site and check in with any attending and let them know that you are assigned to read screens that day.
MAMMO SOUTH
MAMMO SOUTH
Mount Sinai Union Square (DUS/PACC)
Mount Sinai Union Square (DUS/PACC)
Faculty representative: Dr. Abramson
Attending Extension: 44-8873
Resident Reading Room:
Phone extension: 44 - 6224
Location:
10 Union Square East
Mammo suite, 4th floor, Suite 4L
New York, NY 10003
Mount Sinai Chelsea (MSC)
Mount Sinai Chelsea (MSC)
Faculty representative: Dr. Lisa Abramson
Resident Reading station:
Location:
325 West 15th Street
1st floor, Mammography Suite
New York, NY 10011
MOUNT SINAI 787 (JB)
MOUNT SINAI 787 (JB)
Faculty representative: Dr. Lisa Abramson
Location:
787 11th Ave (Entrance is next to the Jaguar dealership)
7th floor, Mammography Suite
New York, NY 10019
HOURS:
HOURS:
8:00 AM – until attending dismissal
MULTIDISCIPLINARY CONFERENCES
MULTIDISCIPLINARY CONFERENCES
MS Union Square (DUS)
Multidisciplinary breast conference every Monday 8:00 - 9:00 AM
Hiatus during summer (starts back up after Labor day)
Residents on rotation should attend
NYRS
One day dedicated to breast during annual conference
The New York Breast Imaging Society (NYBIS)
5 CME lectures per year and the lecture schedule
Mount Sinai Hospital
Goldwurm Auditorium
1425 Madison Avenue at 98th street)
6:00 - 8:00 pm
NYBIS would love to have more resident involvement and each year we elect a resident liaison
ROTATION REQUIREMENTS / LEARNING OBJECTIVES
ROTATION REQUIREMENTS / LEARNING OBJECTIVES
First Day: Rotate with the Mammo and US techs to understand how they perform the studies
Keep up with the assigned reading list provided by attendings
Understand benign and positive mammogram and ultrasound findings (How you learn what's relevant to screening and diagnostic examinations)
Review MRI cases as an R3 or R4
Radexam for each breast rotation at the end of each rotation block
End of rotation evaluation (phone call to discuss resident performance and also receive feedback for what could be improved)
VIRTUAL MAMMO RESOURCES
VIRTUAL MAMMO RESOURCES
ROTATION GUIDE
ROTATION GUIDE
Junior residents (R1, R2s)
Junior residents (R1, R2s)
Read the BI-RADS atlas
Mammo section at minimum but ideally mammo and sono sections before starting first week
Read MRI section by second rotation
Watch a mammo being performed
Scan as much as possible real time
Spend time with the tech watching them scan and then scan after tech finishes while tech presents case to attending
*counts towards 75 required ultrasounds to graduate
Introduce yourself to the patient & ask her permission to scan while tech & attending are checking
Preview the screens
Decide if you want to give a BI-RADS 0, 1 , or 2
Then observe attending read out
Once you’re comfortable with the dictation software, you can start pre-dictating as well
Observe procedures
Once you see a few, put sterile gloves on so you can get familiar with the equipment
Ie. try firing the biopsy gun before attending uses it to biopsy
Reminders for Procedure Days - All years
Reminders for Procedure Days - All years
Review the patient's chart prior to the procedure
Check biopsy markers that the patient currently has
Take notes after the procedure and offer attendings to call patients with results if you are able to
Review and take notes on additional findings that you are not currently biopsying but may require future follow-up
Pay attention to how attendings get consent and try doing it for future cases
Senior residents (R3, R4s)
Senior residents (R3, R4s)
Screening numbers: need 240 in six months
Diagnostic cases
Procedures under supervision
MRIs
MQSA REQUIREMENTS
MQSA REQUIREMENTS
In order to immediately begin independent interpretation of mammograms following a residency program, medical residency graduates of 2014 or later must:
Have interpreted 240 mammographic examinations under direct supervision within any 6-month period during the last two years of the medical residency. (That is, for newly graduating medical residents, the interpretation of the 240 exams may be during any 6-month period during the last 2 years of the residency program, as opposed to the last six months of the residency program, as was previously required.)
Have completed 3 months of formal training in the interpretation of mammograms and in topics related to mammography (including instruction in radiation physics specific to mammography, radiation effects, and radiation protection).
Have completed a minimum of 60 category I hours of documented medical education in mammography (including instruction in the interpretation of mammograms, basic breast anatomy, pathology, physiology, technical aspects of mammography, and quality assurance and quality control in mammography), with at least 15 of the category I hours having been acquired within the 3 years immediately prior to the date that the physician qualified as an interpreting physician.
All years
All years
Before starting the rotation, please configure your UV settings to match these screenshots:
Before starting the rotation, please configure your UV settings to match these screenshots:
https://drive.google.com/drive/folders/1R_nclRnjM6_7jV1vyeOt7EPwZxaElL-w?usp=sharing
https://drive.google.com/drive/folders/1R_nclRnjM6_7jV1vyeOt7EPwZxaElL-w?usp=sharing
Keep a list of the cases you give a “0” to so you can track cases that attending may change more easily in your nuance list
Track the ones that attending also agrees to give a BI-RADS 0 and follow up the outcomes--great way to learn
EPIC access is essential
Consults are a great way to learn: pre-dictate with attending supervision/guidance
Consent cases for procedures AFTER you have been oriented and observed
Be sure you know what procedure you are consenting for and have confirmed with the procedure attending that getting consent is appropriate
Consent: “Imaging guided biopsy of left/right breast with tissue marker” or “Imaging guided localization of left/right breast”
Time out form-> more specific: “Stereotactic/Ultrasound/MRI guided biopsy/localization Right/Left breast calcifications/mass/clip [LOCATION] with tissue marker”
Ask about medication and metal allergies, blood thinners/bleeding issues
Procedures are all done under sterile conditions, minimal risk of infection & bleeding, plenty of local anesthesia (lidocaine) will be given (may feel a “pinch & burn”). After breast is numb, will feel pressure but should not feel anything sharp. If feel something sharp, let us know
For MRI biopsies: let patient know there is a possibility (about 10%) biopsy will be cancelled if the area cannot be reproduced (i.e. doesn’t enhance)
Marking clips are placed to mark all biopsies – if patient is refusing tissue marker get attending. (bottom line is that we will not do biopsy without marker but detailed discussion should be done by fellow or attending)
Unless you are fluent in another language and have hospital approval to consent in that language, get consent by phone with the assistance of a translator from Pacific interpreters. Write the interpreter’s name and ID# on the consent form. It will have to be dictated onto the report.
Post procedure instructions
Shower after 24 hours
No soap, lotions, etc on steri-strip. Steri-strip should fall off in 5 days. If not, can remove it on 6th day
Limit overhead motion or anything that moves the breast for 24-48 hours
Tylenol as needed for pain
Ice 15 min on, 15 min off for first day
Wear a sports bra/tight bra after procedure and it may be more comfortable to sleep in it the first night
Soreness and bruising expected post procedure
TECHNICAL TIPS
TECHNICAL TIPS
IKONOPEDIA
IKONOPEDIA
Make sure you're on a Mammo reading station
Login to "UV or NBI" (not WFM!)
Also, login to Ikonopedia (web based application)
1st time logging in?
Enter @mountsinai.org email address & click "Forgot Password" to reset
Email is case sensitive (all lower case)
Enter findings on Ikonopedia Scn Mammo tab
MAKE SURE YOU CLICK "PRE-SIGN" at on the "Report" screen (screenshot here), and NOT from the main page drop-down, or else it will not count for your numbers!!!
To view your screening numbers for ACGME (takes up to 24 hours to update - it is updated at 2am every night.)
Cogwheel > Analytics > Select date range > "Resident Exam Counts, Personal" > Click Generate
If your Mammo hanging protocol doesn't load on UV PACS ("Non-Diagnostic View"), correct this by opening navigator, right click on images to "navigator options", go to "Mammography Viewer", Check box "enable step protocol" and clock "apply"
GE UV MAMMO FILTERS & TRACKING PATIENTS
GE UV MAMMO FILTERS & TRACKING PATIENTS
These can also be found at this link (as above): https://drive.google.com/drive/folders/1R_nclRnjM6_7jV1vyeOt7EPwZxaElL-w?usp=sharing
MS DUS
MS DUS
PH TODAY
Study Description: PH
Modality: MG
Date of exam: Today
Exam status: Arrived, Verified, Transcribed
PH US TODAY
Study Description: PH US today
Modality: US
Date of exam: Today
Exam status: Arrived, Verified, Transcribed
PH US BIOPSY
Study Description: PH ULTRASOUNDBREAST
Modality: US
Date of exam: Last 7 days
Exam status: Arrived, Verified, Transcribed
SCREENERS 7 DAYS
Study Description: PH Mammography Screening
Modality: MG
Date of exam: Last 2 weeks
Exam status: Arrived, Verified, Transcribed
MRI BREAST
Study Description: PH MRI breast
Modality: MR
Date of exam: Today
Exam status: Arrived, Verified, Dictated
MS 787
MS 787
Study Description: JB
Modality: MG, US
Date of exam: Today
Exam status: Arrived, Verified, Transcribed
MS Chelsea
MS Chelsea
BC TODAY
Study Description: BC
Modality: US, MG
Date of exam: Today
Exam status: Arrived, Verified, Transcribed
BOOKS
BOOKS
BI-RADS Atlas, 5th edition (Available on Google Drive MSBISLW@gmail.com)
Ikeda, Breast Imaging: The Requisites
Cardenosa, Breast Imaging Companion
Tabar and Dean, Teaching Atlas of Mammography
Cardenosa, Breast Imaging (Core Curriculum series)
Dershaw, Imaging-guided Interventional Breast Techniques
Morris and Liberman, Breast MRI: Diagnosis and Intervention
Stavros AT. Breast ultrasound. Philadelphia, Pa: Lippincott Williams & Wilkins, 2003
Shah and Mandava, Breast Imaging: A core Review
INTERNET TEACHING FILES
INTERNET TEACHING FILES
MRI Biopsy Technique
OTHER RESOURCES
OTHER RESOURCES
BI-RADS book available on Google Drive MSBISLW@gmail.com
ACR Appropriateness Criteria (Breast section)
(BI-RADS terminology may be outdated)
To enlarge the above Algorithm images, right click on the image --> Open image in new tab!
To enlarge the above Algorithm images, right click on the image --> Open image in new tab!
ATTENDING ON CALL
ATTENDING ON CALL
There is a breast imaging attending on call who is available to answer patient questions and concerns at all times
The attending on call is listed on the on call schedule
Page updated
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