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Procedures

3D Mammography

Know the Basics

In 3D mammography each breast is imaged in the same 2 positions as in conventional 2D mammography but produces 4 images for each breast– two 2D and two 3D images per breast. The 3D portion of the mammogram acquires a series of low dose images, taken in an arc over the breast.

These images are then manipulated or reconstructed by a computer software program so that the radiologist can scroll through images of the breast at one millimeter increments for the 3D images. The end result is equivalent to cutting the breast into smaller segments like a loaf of bread, whereas a 2D mammogram takes one image of the breast and superimposes every visible structure in the breast onto that single image.

It should be noted that 3D mammography is not done as a stand-alone examination to replace 2D digital mammography. 3D mammography is used in conjunction with 2D digital mammography. There is valuable information obtained from the 2D mammogram that is not as clearly seen on the 3D images. In other words, the 3D mammogram enhances the effectiveness of 2D mammography; it does not replace 2D mammography.

Is 3D mammography better than conventional 2D mammography?

Although no breast cancer screening test is perfect, 3D mammography is establishing itself as a superior examination to detect breast cancer when compared to conventional 2D mammography. The following five main points illustrate the specific advantages of 3D mammography as compared to conventional 2D mammography.

1. Fewer call backs.
A call back is when a woman is asked to return for additional imaging of the breast to further evaluate an abnormality seen on the screening mammogram. The additional imaging of the breast is referred to as diagnostic imaging. Although with 2D mammography less than 10% of women called back for additional imaging will have cancer, many women experience concern and anxiety when asked to return for additional imaging. Studies have shown that the call back rate with 3D mammography has been reduced by approximately 30% .

2. Fewer diagnostic images when a patient is called back equals less radiation exposure.
Studies have reported a decrease in the number of additional mammogram images obtained during a diagnostic mammogram examination following a 3D screening examination. Additionally, many patients called back may not require additional mammogram images to complete the evaluation. These patients are sent directly to breast ultrasound to further evaluate the abnormality noted on the screening 3D mammogram.

3. Higher cancer detection rate.
2D mammogram screening is currently the gold standard for breast cancer detection with studies showing that 2D mammography reduces the chance of death from breast cancer. However it is known that 2D mammography can miss up to 15-20% of cancers. Adding the 3D mammogram to the 2D mammogram detects approximately 30% more cancers than with 2D mammography alone.

4. Better screening exam for women with dense breast tissue.
Dense breast tissue can hide a developing cancer that would otherwise be visible on a screening mammogram in a patient with less glandular tissue and more fatty tissue. 3D mammography allows for the radiologist to see small segments of the breast at a time, more effectively finding a small breast cancer surrounded by dense glandular tissue. Fewer false positives (women called back for additional imaging who ultimately do not have cancer) and higher cancer detection rates have been shown with 3D mammography in women with dense breast tissue. Additionally, if you have received a letter notifying you of your dense breast tissue status, in most cases 3D mammography satisfies the recommendation for additional screening in women with dense breast tissue.

5. Improved visualization of architectural distortion.
Normal breast tissue has a flowing appearance due to the ligaments maintaining the architecture of the breast. When a cancer is growing (as well as a few non cancer diagnoses), the normal flowing appearance of the breast tissue is disrupted, resulting in what breast radiologists refer to as architectural distortion. Architectural distortion can be quite subtle, particularly on 2D mammography. According to a recent study 12-45% of missed breast cancers have been retrospectively noted to be areas of architectural distortion on the 2D screening exam. Approximately half of women who underwent surgery for architectural distortion were determined to have breast cancer. 3D mammography shows architectural distortion more clearly, including those not visible on 2D mammography.

Is 3D mammography safe?

3D mammography uses the same x-ray technology that is used in a 2D mammogram. There is no evidence to show that the current level of radiation exposure for annual mammograms will increase the risk of breast cancer. To put the radiation exposure in perspective, a standard 2D mammogram (4 images total of both breasts) is equivalent to about 7 weeks of radiation exposure from the environment. In other words, just 7 weeks of living on planet earth will expose you to about the same amount of radiation as you will encounter from a 2D mammogram. The radiation dose for a 3D mammogram is approximately double the radiation exposure of a 2D mammogram. Even at double the radiation exposure this is considered a low dose and well below the FDA established threshold of acceptable radiation dose. Radiology Ltd, as well as all imaging centers performing mammograms, are held to specific guidelines with frequent equipment inspections to ensure that the equipment is safe and uses the lowest radiation dose possible to produce high quality images. Bottom line, the benefits of early breast cancer detection and treatment far outweigh any theoretical harm from the low dose radiation exposure.

How 3D Mammography Works

Are 3D mammograms more expensive than traditional mammography at Rad Ltd?

The Affordable Care Act or “Obamacare” stipulates preventative care at no out-of-pocket costs on most health plans. This includes annual screening mammography from age 40. 3D mammography requires the purchase of completely new machines and software, and places increased demand on other resources including doubling the interpretation time by the radiologist. Reimbursement for this technology has not yet materialized however we anticipate will be available soon. Currently, if women do elect to have 3D mammography, this will be associated with a nominal fee.

Do you know if most insurances cover 3D mammography?

At present there is no specific reimbursement for 3D mammography.

In how many facilities is Rad Ltd offering 3D mammography?

3D mammography is currently available at the following locations:

  • Wilmot Center for Women’s Imaging
  • La Cholla Center for Women’s Imaging
  • Rincon Imaging Center

How do I get the results?

After your study, the images will be evaluated by one of our board-certified radiologists with expertise in breast imaging. A final report will be sent to your doctor or healthcare provider, who can then discuss the results with you in detail.

If an abnormality is found on your screening mammogram, you will be contacted to return for a diagnostic mammogram, which usually consists of both additional X-ray images and a breast ultrasound. The diagnostic mammogram is necessary for clarification and in most cases confirms that the abnormality found on the screening mammogram is benign (non-cancerous). However, if further clarification is still needed, a breast MRI or breast biopsy may be recommended.

Reports are also available on the MyRAD Patient Portal

Breast Imaging Team

Matthew L. Bell, M.D.

  • Specialties:
    Breast Imaging, General Radiology
  • Education:
    B.S. – University of California at Irvine, 1996
    M.D. – Medical College of Wisconsin, 2001
  • Internship:
    Transitional, Aurora Health Care/St. Luke’s Medical Center (Milwaukee), 2002-2003
  • Residency:
    Diagnostic Radiology, Aurora Health Care/St. Luke’s Medical Center (Milwaukee), 2003-2007
  • Fellowship:
    Cross-Sectional Imaging, University of Arizona, 2007-2008
  • Board Certifications:
    ABR 2007

With Radiology Ltd. since 2008

Danielle M. Carroll, M.D.

  • Specialties:
    Breast Imaging, General Radiology
  • Education:
    B.S. University of Arizona, 1997
    M.D. University of Arizona, 2007
  • Internship:
    Tucson Hospital Medical Education Program, 2007-2008
  • Residency:
    Diagnostic Radiology, University of Arizona, 2008-2012
  • Fellowship:
    Breast Imaging, University of Arizona, 2012-2013
  • Board Certifications:
    ABR 2012

Marcus J. Dill-Macky, M.D.

  • Specialties:
    Breast Imaging, General Radiology
  • Education:
    M.B.B.S. – University of Western Australia, 1988
    M.D., 2006
  • Internship:
    Transitional, Royal Perth Hospital (Australia), 1988
  • Residency:
    Diagnostic Radiology, Western Australia Radiology Training Scheme, 1993-1998
  • Fellowship:
    Body Imaging, University of Toronto, 1998-1999; MRI, Monash Medical Centre (Melbourne, Australia), 1999
  • Board Certifications:
    MRCP 1992; FRANZCR 1998; RCPSC 2006; ABR 2006

Assistant Professor in Medical Imaging, University Health Network and the Mount Sinai Hospital (Toronto), 2002-2007
With Radiology Ltd. since 2007

Christine N. Eppelheimer, M.D.

  • Specialties:
    Breast Imaging, General Radiology
  • Education:
    B.S. - University of Arizona, 2006
    M.D. - University of Arizona, 2010
  • Internship:
    Internal Medicine, Banner Good Samaritan Medical Center (Phoenix), 2010-11
  • Residency:
    Diagnostic Radiology, St. Joseph’s Hospital and Medical Center (Phoenix), 2011-14; Mt. Sinai Beth Israel (New York), 2014-15
  • Fellowship:
    Body and Breast Imaging, North Shore University Hospital (Manhasset, NY), 2015-16
  • Board Certifications:
    ABR 2014

Robert F. Rauch, II, M.D.

  • Specialties:
    Breast Imaging, General Radiology, Interventional Radiology
  • Education:
    B.A. – Northwestern University (Evanston, Illinois), 1974
    M.D. – Case Western Reserve University (Cleveland), 1978
  • Internship:
    Internal Medicine, Good Samaritan Hospital (Phoenix), 1978-1979
  • Residency:
    Diagnostic Radiology, University of California at San Francisco, 1979-1982
  • Fellowship:
    Ultrasound/CT, Duke University, 1982-1983
  • Board Certifications:
    ABR 1982; CAQ Interventional Radiology 1997, 2007

With Radiology Ltd. since 1984

Paul R. Strautman, M.D.

  • Specialties:
    Breast Imaging, General Radiology, Pediatric Radiology
  • Education:
    B.S. – University of Arizona, 1978
    M.D. – University of Arizona, 1985
  • Internship:
    Transitional, Good Samaritan Medical Center (Phoenix), 1985-1986
  • Residency:
    Diagnostic Radiology, University of Arizona, 1986-1990
  • Fellowship:
    Interventional Radiology, Brown University, 1990-1991
  • Board Certifications:
    ABR 1990

With Radiology Ltd. since 2010

Marisa H. Borders, M.D.

  • Specialties:
    Breast Imaging
  • Education:
    B.S. - Pepperdine University, 1995
    M.D. - Pennsylvania State University College of Medicine, 2000
  • Internship:
    Internal Medicine, St. Joseph's Hospital, 2000-2001
  • Residency:
    Diagnostic Radiology, University of Arizona, 2001-2005
  • Fellowship:
    Breast and Body Imaging, University of Arizona, 2005-2006
  • Board Certifications:
    ABR 2005

Meet Dr. Marcus Dill-Macky
Tucson physician

Dr. Dill-Macky joined Radiology Ltd. in 2007 and is the Medical Director of Breast Imaging. He is committed to providing exceptional patient care, and views 3D mammography as a valuable adjunctive tool in the fight against breast cancer. 3D mammography was adopted by Radiology Ltd. as part of a comprehensive new approach to personalized screening for breast cancer. Each of our screening patients now receives a personalized breast screening program, designed by our radiologists. The program is tailored to the patient’s personal and familial risk factors for breast cancer.