Clinical Excellence

If you haven’t heard about three-dimensional (3D) mammography yet, read on! Also known as tomosynthesis, 3D breast imaging is the most up-to-date breast screening technology available to women today. 

“Tomosynthesis takes multiple images of each breast,” says Emily Ritchie, MD, a radiologist and women’s imaging specialist with Sentara RMH Medical Center. “As a result, it provides a more accurate study than traditional imaging techniques.”

That greater accuracy means patients don’t need to be called back for additional imaging—and possibly biopsies—as often as with two-dimensional (2D) imaging. 

“That’s a huge advantage when it comes to patients’ time and anxiety levels,” Dr. Ritchie adds. 

Multiple studies have demonstrated the superiority of tomosynthesis over 2D mammography. One study showed a 38% drop in recall rates and an 11% drop in biopsy rates.

Cancer detection is also better with 3D mammography. In addition to seeing cancer more easily, 3D mammograms also allow radiologists to spot tumors sooner than ever before. Early detection, of course, is especially effective in treating breast cancer.

“There’s about a 20-30% relative increase in accurate cancer detection,” says C. Scott Pease, MD, a radiologist at Sentara Martha Jefferson Hospital. “So 3D mammography offers fewer false positive exams and seems better at finding cancers than 2D imaging alone.” 

In fact, 3D tomosynthesis has been one of the most significant advances in the field since mammography was first used to screen women for breast cancer in 1969.

How Tomosynthesis Works

A standard 2D mammogram consists of flat X-ray pictures of each breast taken at two different positions, yielding two images for each breast. 

Digital 3D breast tomosynthesis, on the other hand, provides hundreds of additional images, giving radiologists 3D views into the breast tissues that aren’t possible with a 2D mammogram.

During a tomosynthesis exam, low-dose X-ray exposures are taken during a brief compression of the breast, as the X-ray source moves incrementally around the breast.

“The technique produces scans that almost look like a short movie,” says Dr. Pease. “Viewing breast tissue in this way reduces ‘artifacts’ caused by normal tissue overlap, which helps reduce recall rates and false alarms.”

The 3D exam also allows radiologists to better detect certain early tissue changes associated with breast cancer—particularly architectural distortions of the breast tissue. 

From the patient’s perspective, the 3D and 2D procedures are actually very similar, except that during tomosynthesis the machine moves to capture more images, and the procedure takes one to two seconds longer. A tomosynthesis scan also requires more time for a radiologist to review, Dr. Pease notes.

Sentara Martha Jefferson has offered tomography since 2014, and Sentara RMH has had the technology since the winter of 2015.

Approximately 70-80% of Sentara RMH patients opt for 3D mammography, according to Dr. Ritchie, and most women opt for it at Sentara Martha Jefferson, too. 

When it was first introduced, 3D mammography wasn’t accepted by some insurance companies, and it was only partially covered by others. 

“Now, almost all insurance companies are on board,” says Dr. Ritchie. 

Medicare and many insurance providers cover the full cost of 3D mammography; other insurance providers cover most of the cost but leave a portion for the patient to pay, she adds.

Who Benefits from 3D Mammography?

“All women can benefit from having a tomosynthesis exam,” says Dr. Ritchie. “We strongly recommend it for women who have previously had breast cancer.” 

Tomosynthesis may be particularly beneficial for women who are at high risk of developing breast cancer, including those with dense breast tissue or a family history of breast cancer.

Being high-risk means that a woman’s chance of developing breast cancer is greater than average, but it does not mean she will definitely get cancer, Dr. Pease notes. When a woman knows she is at high risk, she can make more informed decisions about her health care, including screenings and prevention methods. 

Both Sentara RMH and Sentara Martha Jefferson offer high-risk breast programs aimed at giving women the tools they need to make these important decisions. Depending on a woman’s particular needs, these tools may include more frequent examinations and adding other imaging technologies, such as MRI or ultrasound. 

Why Choose Sentara?

For women who opt to get their mammograms done at Sentara RMH or Sentara Martha Jefferson, there are many advantages. 

“Our compassionate mammography technologists really strive to perform the best imaging,” says Dr. Pease. “I’m always impressed by our staff’s professionalism—their desire to do their best and adapt to new technologies.”

Quality audits at Sentara Martha Jefferson have bested published national data by the Breast Cancer Surveillance Consortium and compare well to those of published academic papers, he adds.

Both Sentara hospitals use current Hologic tomosynthesis equipment that features radiation dose-reduction techniques. The staff and equipment comply with quality measures established by the American College of Radiology and the U.S. Food and Drug Administration. 

Getting mammograms done at the same location, year after year, adds consistency, says Dr. Ritchie, enabling radiology teams to compare mammograms with ultrasound or MRI images to look for correlations. If callback imaging or biopsies are needed, scheduling can be done quickly and easily. 

“When outside imaging centers do the mammograms, Sentara radiologists must request the previous images and reports to review, which can add time to the process,” she explains. 

Another advantage is having the patient’s entire breast care team in one place, allowing radiologists, breast surgeons and nurse practitioners to consult together easily about the best treatment options.

At Sentara RMH, both 2D and 3D digital mammography services are available at the Funkhouser Women’s Center and on the Mobile Health Services Van. At Sentara Martha Jefferson, the same mammography services are available at the Outpatient Centers at Proffitt Road and Pantops, and at the Health Services Center at Spring Creek. 


Mammogram Screening is Safe—Even During the Pandemic

With all of the COVID-19 safety protocols in place at Sentara RMH Medical Center and Sentara Martha Jefferson Hospital, there is no reason to postpone, procrastinate or delay when it comes to getting your annual mammogram. 

“We always put our patients’ safety first,” says Emily Ritchie, MD, a radiologist at Sentara RMH. “Our team strongly believes that part of patient safety is making sure everyone has access to health care, even in a pandemic.” 

The protocols being practiced at both hospitals meet or exceed the guidelines for COVID-19 in healthcare settings, including those recommended by the Centers for Disease Control and Prevention, the World Health Organization, and the U.S. Food and Drug Administration. 

Patients are prescreened for COVID-19 before their appointments—and, in fact, anyone entering the hospital or clinic is screened with a no-touch thermometer for possible COVID-19 symptoms. 

Physical distance is required in the waiting rooms, and the number of patients in the office at any one time is limited. Hand sanitizer and masks are provided to all patients and guests. 

All staff members wear masks and other necessary protective equipment. Imaging technicians wear masks, sterile gloves and other protective equipment. All surfaces and equipment are wiped down between patients. 

Common areas are also cleaned regularly between each use, with a focus on high-touch surfaces such as chair armrests, doorknobs, hand scanners and pens.

Both hospitals provide their staff members with detailed checklists of cleaning requirements so that nothing is overlooked. 

“Breast cancer can be a deadly disease, but it’s usually curable when caught early by a screening mammogram,” says Dr. Ritchie. “So ensuring that our patients have safe access to our life-saving services during the pandemic is our top priority.” 

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