Breast Imaging

Contact Information:
Director: Dr. Renee Pinsky (rpinsky@med.umich.edu)
Breast Imaging contact: Dr. Renee Pinsky
Admin. Contact: Kim Desbrough (desbroug@med.umich.edu; 734-615-9016)

**Please note: The evolving nature of the COVID-19 pandemic and social distancing requires us to limit the number of individuals who can be present in the reading rooms. The Breast Imaging component may be converted to remote/online at the discretion of the Breast Imaging division if deemed necessary. What follows is a description of the rotation once reading rooms have been adapted or social distancing requirements lessen.

Welcome to Breast Imaging (BI) division. We hope you will find this to be an interesting and stimulating rotation. We have set up a number of learning objectives and if you have additional interests, please let us know. We expect that you will attend the conferences for BI during the whole month to get the most exposure. A list of conferences is below.

The reading rooms can be busy places. Please introduce yourself to the physicians, fellows, residents, US practitioners, nurses, technologists and reading room coordinators who may be present. All have something to offer and would like to be engaged.

Students are expected to adhere to the University of Michigan Medical School code of dress including a white coat and are expected to wear their identification badge at all times during their rotation. All students should always be accompanied by a physician, nurse, or technologist when interacting with patients. Conversations with patients should occur in the examination room with your supervising physician present. Professional discussions about patient management and imaging findings should only occur in designated areas.

Case Presentations

  • You are required to present a total of 2 cases at oral PowerPoint presentation (on the provided template) to Dr. Pinsky and the other student(s) in the last week of the rotation.

  • Confirm date of your presentation with Dr. Pinsky early in the 2nd week of your respective rotations. Choose 2 cases you have seen during your rotation in each of the subspecialties. These are short succinct presentations with emphasis on imaging aspects and should NOT exceed 10 minutes for 2 cases.
  • Preparing the conference entails using webpacs to import selected images. Alternatively, images can be imported from clinical workstations (PACS) using departmental RadImage or RadPix software into PowerPoint.
  • You will need help from radiology residents, fellows, or attending radiologists to get started. Review studies during the workday with any radiologist beforehand to select appropriate images. Cases should be labeled with patient initials and hospital registration number ONLY on the first slide.
  • Please use original images for your presentation, although occasionally you may use web images or illustrations to augment your presentation.
  • Kim Desbrough can assist you with using the departmental resources that are needed.
  • Each teaching file case must be fully worked up, including: history, imaging findings, diagnosis, brief differential diagnosis, and discussion of disease with focus on relevance to the imaging features. Try to include ACR appropriateness criteria pertinent to the case and BIRADS terminology in the breast imaging cases. Information from textbooks and pertinent publications as references is expected.

Grade:

Daily attendance and compiling the two (2) teaching file cases are required to pass the elective. A grade of high pass or honors can be achieved by completing additional work under the supervision of one of the breast or US radiology faculty. This may include additional teaching file cases, preparation of a case report, participation in or contribution to a research project, etc. The quality and intensity of the additional work completed will be evaluated in determining your grade. Bear in mind that extra work of poor quality may not merit a grade of high pass or honors. Similarly, a grade of high pass or honors may be achieved on the basis of an outstanding performance during the required daily clinical activities, attendance and the required case presentations.

Breast Imaging

Breast imaging patients are generally healthy patients who are being screened for breast carcinoma. Additionally, as part of the multidisciplinary Breast Care Center (BCC), a significant number of our patients undergo diagnostic imaging for palpable or clinical abnormalities or follow-up studies after treatment for cancer. They present to be evaluated for breast cancer and as such, are uniformly concerned. It is important that we respect these concerns and be professional at all times.

Educational Objectives:

General

  • Observe patient positioning, and understand the expectations and limitations in mammographic positioning.

  • Have basic understanding of radiation risk.

  • Be familiar with the current guidelines for mammography screening.
  • Be familiar with indications for diagnostic mammography, breast MRI.
  • Be familiar with the work up of a patient with a palpable lump or bloody nipple discharge.
  • Know different ways breast cancer appears on mammography and ultrasound and MRI.
  • Be familiar with the ACR BIRADS Lexicon.
  • Know the lifetime risk and risk factors for breast cancer.
  • Be familiar with breast cancer incidence and mortality rates and how have they changed over the last 40 years.
  • Be familiar with the sensitivity/specificity of the various BI modalities
  • Know the limitations of mammography.

Procedures

  • Observe a fine needle aspiration, US guided and stereotactic core biopsies and wire localization.

  • Observe breast ultrasound and understand its appropriate use.

Breast Imaging is located on B2 of the Cancer Center and the EAA Breast Imaging office. All clinic days: 8:30 a.m.- Noon (until 3 pm is optional)

The reading rooms are as follows:

Breast Imaging is located on B2 of the Cancer Center and the EAA Breast Imaging office. All clinic days: 8:15 a.m.- Noon (Mondays until 2 for BCC conference)

The reading rooms are as follows:

A/C: (CC B2-300)

A: Diagnostic Studies

C: Diagnostic cases

D: (CC-B2 101) Diagnostic cases

B: (CC-B2 350) Procedures and Screening exams

X: (CC) Procedures and Screening exams

EAA- AM Wires, PM Diagnostic cases and Screening exams

MRI (CC-B2- 358) Ask Rebecca Spaulding in BI to let you know each day when MR is being read and by whom so you can read with them)

BI Conferences

On Wednesday mornings at 7:30 a.m., we have a morning Breast Imaging Division Conference. This alternates between Path correlation, Journal club and case conferences. You are expected to attend. Path conference is held in the CC–B2 “D” reading room. The other conferences are held in the BI conference room (CC-B2-359)

The Breast Care Center Multidisciplinary Conference is held on Mondays from 12:30 - 1:30 p.m. in the CC-B1 conference room. You are expected to attend.

Appropriate reading in breast imaging would include:

  • Breast Imaging: The Requisites by Deborah Ikeda, 3rd ed. 2017
  • Breast Imaging Companion by Gilda Cardenosa 4th ed. 2017