Technical standards and practice parameters - MRI, mammo, US

Question 1

screening MRI of the contralateral breast in patents with newly diagnosed breast ca detects cancer in what percent of patients?

Answer 1

3-5%

Question 2

in what percent does MRI detect occult cancer in the ipsilateral breast, in a patient with newly diagnosed cancer?

Answer 2

12-27%

Question 3

in what time frame is recurrence seen in a patient that has undergone mastectomy, and where is the recurrence usually seen?

Answer 3

within 5 years in the skin or subcutaneous tissue around the scar

Question 4

should screening mammo be performed in the residual tissue after a patient has undergone mastectomy?

Answer 4

no

Question 5

how should gad be administered in breast MRI?

Answer 5

0.1 mmol/kg bolus with 10 ml saline flush

Question 6

what are the ACR slice thickness recommendations for breast MRI?

Answer 6

3 mm or less

Question 7

what are the ACR recommendations for in plane axial resolution in breast MRI?

Answer 7

1 mm or less to decrease volume averaging

Question 8

what is the best sequence to evaluate axillary nodes on MRI?

Answer 8

non enhanced T1 without fat saturation

Question 9

in what subset of patients is MRI most useful to evaluate for extent of ipsilateral disease?

Answer 9

in patients with ILC or with dense breasts

Question 10

what is the recurrence rate per year in patients that have undergone surgery and radiation?

Answer 10

1-2% per year usually in the same quadrant

Question 11

what percent of patients get fat necrosis after BCT?

Answer 11

1/3 to 1/2

Question 12

in what types of tumors is MRI best for evaluating response to treatment?

Answer 12

ER negative/Her2+ and those that are more aggressive. MRI is not as good for ER/PR+ and Her 2- tumors.

Question 13

what are the high risk lesions?

Answer 13

lobular neoplasia, papilloma, ADH, flat epithelial atypia, radial scar

Question 14

what are the ACR parameters for breast US transducer?

Answer 14

high resolution, real time linear array broad bandwidth with center of frequency at leas 12MHz or more

Question 15

what is the upgrade rate of DCIS to invasive cancer?

Answer 15

20-25%

Question 16

how soon does a health care provider have to be notified of a bi rads 4 or 5? how soon does the patient have to be informed?

Answer 16

within 3 days of the interpretation. patient has to be informed within 5 days

Question 17

the average dose of a single CC view of a 4.2 cm compressed breast that is half fat and half FGT should not exceed?

Answer 17

3 mGy

Question 18

MQSA requires that facilities have audit outcomes on what Bi Rads? ACR recommends what?

Answer 18

MQSA requires Bi rads 4 and 5 audits. ACR recommends Bi rads 0,4,5.

Question 19

what can facilities refer to for information on their audit outcomes compared to other facilities?

Answer 19

ACR national mammography database provides benchmarking for outcomes data

Question 20

what should lightbox luminance be?

Answer 20

3000 cd/m2

Question 21

what should ambient light in mammo reading room be?

Answer 21

20-45 lux

Question 22

mammo grids mut fit which size receptors?

Answer 22

18X 24 and 24X30

Question 23

how much magnification should mag mammo produce?

Answer 23

1.4-2.0

Question 24

what are the grid ratios for contact mammography?

Answer 24

3.5:1 and 5:1

Question 25

what size monitors are used in digital mammo?

Answer 25

2K X 2.5K or 5 megapixel

Question 26

what is the technique for ductography?

Answer 26

identify single pore of discharge, 30G cannula tip is placed on the duct, when cannula is in the duct inject 0.2-0.3 mL of contrast - once contrast is in, get magnification CC and ML mammograms of the retroareolar breast

Question 27

what is artifact that can mimic filling defects in ductography?

Answer 27

air bubbles

Question 28

if filling defect is indented on ductogram, what can be done to localize?

Answer 28

place clip during diagnostic ductogram or do wire localization on day of surgery

Question 29

what is the T staging of breast ca?

Answer 29

T1: less than 2 cm, T2: 2-5 cm, T3: greater than 5 cm, T4: any size with invasion to chest wall or skin, T4d: Inflammatory breast cancer

Question 30

what is the N staging of breast ca?

Answer 30

N0: no regional LN, N1: ipsilateral moveable axillary nodes, N2: ipsilateral fixed axillary nodes, N3: ipsilateral supraclav or infraclav or ipsilateral intramammary nodes

Question 31

what is the M staging of breast ca?

Answer 31

MX: mets can’t be assessed, M0: no distant mets, M1: distant mets

Question 32

what is stage 4 breast cancer?

Answer 32

M1 (any T, any M)

Question 33

what artifact is seen on US of implants?

Answer 33

reverberation artifact is seen in the near field - but can tell its artifact bc it spans the same depth as breast tissue and can still see deeper structures

Question 34

what is the salad oil sign of rupture?

Answer 34

rupture of double lumen implant - see saline from inner lumen within silicone which is the outer lumen