Mammography Exam

This chapter covers what patients should do before the exam, what the technologist asks during the history intake, and why each piece of history matters. Many exam items test a single pre-exam instruction or ask which history item should change how the exam is performed.

Instructions are usually given when the appointment is scheduled and repeated at check-in.

Wear a two-piece outfit so only the top must be removed.

Bring prior mammograms or provide the names and locations of facilities where prior breast imaging was done, so the facility can request them.

If breasts are tender before menses, schedule about 7 to 10 days after the start of the menstrual period.

Tell the scheduler or technologist about breast symptoms, implants, prior surgery or biopsy, pregnancy or breastfeeding, and any physical limitation.

Lactating patients should nurse or pump shortly before the exam to reduce breast density and discomfort.

If a patient arrives wearing deodorant, she is given wipes (or soap and water) to clean the axilla and breast thoroughly before imaging. Most facilities keep cleansing wipes in the dressing area for this purpose.

Clinical Scenario: During image review the mammographer notices clusters of tiny bright specks along the axillary skin line on both MLO views. The patient confirms she applied antiperspirant that morning. The mammographer has her clean the skin and repeats the affected views per facility protocol, then notes the reason on the requisition. The radiologist decides whether any remaining specks need further evaluation; the technologist does not decide the specks are "just deodorant" and leave it at that if the patient denies using products.

The history form and the technologist's interview give the radiologist context. A finding that is expected after surgery may be suspicious in an unoperated breast. Key elements:

Patient History Elements and Why They Matter

The technologist asks open questions ("Have you noticed any changes in either breast?") followed by specific ones ("Any new lump, nipple discharge, skin change or pain in one spot?"). Symptoms are documented on a breast diagram with clock position, distance from the nipple and laterality. Section 2 covers the clinical history in more depth.

Every patient of reproductive age is asked about the possibility of pregnancy per facility policy. Screening mammography is generally postponed during pregnancy. A pregnant or lactating patient with a symptom is usually evaluated first with ultrasound; diagnostic mammography may still be performed when the physician decides it is needed, because the dose to the uterus from a mammogram is extremely small. The technologist does not make that decision independently; she notifies the radiologist.

Comparison with prior mammograms is one of the most powerful tools the radiologist has. It shows whether a finding is new, growing or stable, and stability over time supports a benign assessment. If priors exist at another facility, the technologist documents where they are, and the facility requests them. When priors are needed before a final assessment, the radiologist can issue an incomplete assessment (need prior mammograms for comparison) and finalize after they arrive. Under MQSA, patients have the right to have their original images (or copies, as appropriate) transferred to another facility or provider on request.

Exam Tip: If an item asks what most improves the accuracy of a screening interpretation for a patient with prior mammograms elsewhere, the best answer is obtaining those prior images for comparison, not adding extra views.

No deodorant, powder, lotion or perfume on the exam day; residue can mimic calcifications.

Schedule sensitive patients about 7 to 10 days after the start of menses; lactating patients nurse or pump first.

History covers symptoms, surgery, biopsies, implants, personal and family history, hormones, pregnancy and prior imaging.

Document symptoms on a diagram with laterality, clock position and distance from the nipple.

Prior images are requested and compared; the radiologist may defer a final assessment until they arrive.

Pregnancy questions are asked per policy; screening is deferred, and the radiologist decides on diagnostic imaging.