WOMEN'S IMAGING

A primary focus of the Division is to offer an integrated Women's Imaging Service at the USC Health Science Campus, that is patient focused and devoted to the diagnosis and treatment of diseases and conditions unique to women.

Indications for a Screening Mammogram

The American Cancer Society recommends that women, without symptoms, begin annual screening mammography at age 40. However, mammography may be performed earlier in women with a family history of breast cancer. Here, at the USC/Norris Breast Center, we are developing a system that requires TWO radiologists to interpret all the screening mammograms independently. Research has shown that this practice potentially improves cancer detection at the time of screening mammogram by almost 10%.

Indications for a Diagnostic Mammogram

A diagnostic mammogram is performed in women of any age with symptoms, such as a breast lump, and nipple discharge, and in patients who have a history of breast cancer. The radiologist is will review the films, obtain additional images if necessary, and discuss the findings with you and your doctor.

Indications for a Breast Ultrasound

A breast ultrasound is a very important tool, used to evaluate soft tissue masses seen on the mammogram, and to evaluate palpable breast masses. Ultrasound differentiates the cystic or solid nature of the mass. In addition, ultrasound supplements mammography in evaluating dense breasts and is the initial examination used to evaluate a palpable mass in a woman under 30 years old.

Breast ultrasound also plays a crucial role in diagnosis, since abnormalities that are seen with ultrasound can easily be sampled. Specifically, ultrasound is successfully used to guide cyst aspiration, core biopsy of solid masses, and preoperative needle or wire localization.3.4.5 Indications for a Galactogram
Galactography is a mammographic study, which involves the injection of water-soluble contrast into a duct. This study is used to evaluate spontaneous bloody or clear nipple discharge that originates from one or two ducts. It often determines the cause of bloody nipple discharge, which is not seen on the mammogram.

Indications for a Pelvic Ultrasound

Pelvic sonography is one of the best imaging techniques to evaluate gynecologic disease. Two complementary approaches are used to view the pelvic contents, which include the uterus and ovaries. The transabdominal transducer is placed on the abdominal wall and uses a full urinary bladder as a window to look at the pelvic organ. The endovaginal method may then be performed, with an empty bladder.
Ultrasound-guided interventional procedures, such as biopsies and drainage of fluids, are also performed. Pelvic pain, irregular bleeding, pelvic masses, abnormal blood tests, and response to certain drugs are some of the indications for this examination.

Indication for a Bone Densitometry Scan (DEXA)

Osteoporosis is a disease that characterized by low bone mass, which leads to increased risk of fracture. It is one of the most prevalent conditions associated with aging. Osteoporosis is easily diagnosed, and more importantly, can be prevented and treated.

DEXA is the method of choice used to diagnose osteoporosis and plays a crucial role in evaluating peri- and post-menopausal women, who are estrogen deficient. This easy, fast, precise method allows accurate follow-up of patients undergoing treatment. The clinical indications for bone densitometry include estrogen deficiency, previous fractures, prolonged steroid use, primary hyperparathyroidism, and osteopenia seen on conventional radiography.

Indications for a CT scan of the Pelvis

CT may be performed to help clarify findings on an ultrasound. In a patient with known malignancy, it can define the extent of spread of a cancer - local and distant. Post-treatment (surgical, radiation therapy) complications may also be evaluated. Palpable masses and abnormal pain are also indications for a CT. CT of the abdomen and chest may also be performed, as needed by clinical symptoms.

Indications for an MRI of the Breast

MR of the breast may be performed to help clarify findings on mammogram, ultrasound, or physical exam to evaluate for cancer or for breast implant rupture. The exams for the two indications are different.

For breast cancer evaluation, MR scan:

1. Determine extent of disease and look for other sites of involvement in the same or in the other breast in a pre-operative patient, or in a post-operative patient with surgical margins that are positive.
   
2. Find an unknown primary cancer in the breast if the axilary lymph nodes are malignant.
   
3. Differentiate between post-operative scar and tumor recurrence.
   
4. Determine response to chemotherapy.
   
5. Look for occult cancer in patients with dense breasts and with family history
   
6. Look for occult cancer in patients with implants.

Indications for an MRI of the Pelvis

Because of excellent soft tissue differentiation, MRI is an important adjunct to ultrasound in the evaluation of the female pelvis; MR is indicated in patients where ultrasound is technically sub-optimal or non-diagnostic.

MR of the pelvis should be considered before CT for the evaluation of almost all disease entities and complex congenital anomalies. MRI is useful for tumor staging and follow-up after therapy. It may also be used for preoperative planning for myomectomy. Because of consistent image reproducibility, MRI is recommended for following patients on hormonal therapy for adenomyosis and leiomyomatosis. Also, as there is no ionizing radiation, MR may be used as a problem solving modality in evaluating pregnant patients.
With newer systems, MRI is more comfortable, faster and less claustrophobic, making MRI a more desirable way to evaluate the pelvis.