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.
Tomosynthesis “3D mammography” takes multiple x-ray images of the compressed breast using different projections and from this data reconstructs multiple stacked thin images representing the whole breast volume. These can be viewed by the radiologist one after another, allowing the whole breast to be examined slice by slice, similar to reading pages in a book. It’s the ability to evaluate the breast at different depths (slice by slice) rather than the whole breast as just a single image, which has earned the nickname “3D mammography” for tomosynthesis. This technology helps to increase the conspicuity (contrast resolution) of cancers by removing the layers of overlapping breast tissue that occur with conventional 2D mammography.
Conventional mammographic screening is the only early cancer detection strategy that has been shown in randomized trials to reduce the chance of death from breast cancer. A limitation of digital full field mammography is the superimposition of breast tissue which can obscure cancers or make normal structures appear suspicious. This reduced ability to detect breast cancers is more pronounced as breast density increases. In recent clinical trials, Tomosynthesis “3D mammography” detected on average additional 1.9 cancers per 1000 screens when used in addition to conventional mammography. To put this in context conventional digital mammography found on average 5.2 cancers per 1000 screens in the same studies. The addition of tomosynthesis to conventional mammography does increase the radiation dose to the breast by a factor of 2. The total dose however is still below the U.S. Food and Drug Administration (FDA) radiation dose limit and is similar to the dose patients received before the change from film/screen to digital mammography.
Tomosynthesis “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, for consideration. The program is tailored to the patient’s personal and familial risk factors for breast cancer, including assessed breast density.
A personalized program includes:
Annual Screening Mammography with Computer Aided Detection (CAD) with or without one of the following adjunctive imaging techniques:
- Breast Tomosynthesis (“3D mammography”)
- Bilateral Breast Ultrasound
- Magnetic Resonance Imaging (MRI) of the Breasts
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.
At present there is no specific reimbursement for 3D mammography.
Tomosynthesis “3D mammography” is currently available on the east side of town at our Wilmot Center for Women’s Imaging, 677 North Wilmot Road, and on the west side of town at our La Cholla Center for Women's Imaging, 5960 N. La Cholla Boulevard.
Tomosynthesis “3D mammography” is a new technology with great promise however, its final role in the breast imaging algorithm is yet to be determined. Though early studies demonstrate the addition of 3D mammography to conventional screening increases the number of cancers detected, more studies are required to show improved detection will translate into improved screening efficacy. At Radiology Ltd., 3D mammography is one component of our imaging armamentarium, which also includes the more established technologies including digital full field mammography, breast ultrasound and breast MRI. Our personalized screening program recommendations incorporate one or more of these imaging modalities tailored to the patient’s personal and familial risk factors for breast cancer, including assessed breast density.
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. However, if further clarification is still needed, a breast MRI or breast biopsy may be recommended.