Women's Imaging

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

Welcome to the Women’s Imaging Elective with rotations in the Breast Imaging (BI) division and Ob-Gyn Ultrasound. 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. You will have a 2 week block in each subspecialty. We expect that you will attend the conferences for both BI and US 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 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 4 cases as oral PowerPoint presentation (on the provided template) to Dr. Pinsky or Wasnik and the other student(s) in the last week of the rotation. You will be informed about the date and location for your presentation in the third week. (Kim Desborough will schedule this).
  • 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 15 minutes for 4 cases (you may lose points for longer presentations).
  • 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 Desborough 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 four (4) 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 teaching files.

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 behave professionally.

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, US and 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 wire localization, fine needle aspiration, and US guided and stereotactic core biopsies.
  • 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:
A/C: (CC B2-300)

A: AM procedures and PM diagnostic studies

C: Diagnostic cases
D: (CC-B2 101) Diagnostic cases
B: (CC-B2 350) 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 1:00 – 2:30 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

Introduction: US

The focus of this rotation is Ultrasound including Ob- GYN and general abdominal US which are performed both at University hospital as well as several off sites. The inpatient and outpatient studies are read in the main Radiology department in the US-1 and 2 reading rooms (UH-B1- G403 Main US RR). Studies are also performed on inpatients and in the ED which are read in Main US. Your primary assignment is in US-2 but you should observe the pertinent studies in Main US as well. Just let the Main faculty or fellow reading that day know that you would like to see the Ob-Gyn cases (this is also an opportunity to go into the room while the technologist is scanning to see the study performed).

General:

  • Be familiar with the basic physics of Ultrasound.
  • Be familiar with the indications for Abdominal US and OB US in each trimester an
  • Be familiar with ED indications for Pelvic US and findings in the W/U of pelvic pain with and without a positive pregnancy test.
  • Be familiar with fetal measurements and growth assessment.
  • Be familiar with assessment of fetal anatomy and abnormalities.
  • Be familiar with issues in US of multiple gestations.
  • Be familiar with work up of abdominal and pelvic symptoms (ie bleeding, pain, mass, etc…) and US findings.
  • Observe a sonohysterogram

US Conferences: US Conference is held at 7:30 AM on alternating Tuesday mornings in UH- 2C108. Please check with Amy regarding date of conferences during your rotation.

Appropriate reading would include:
Ultrasound-

Diagnostic Imaging: Abdomen and Pelvis by Federle et al

Diagnostic Ultrasound: Abdomen and Pelvis by Kamaya et al