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Breast Center

3D Mammography Guide for Providers

What is 3D mammography (tomosynthesis)?

3D mammography is a new screening and diagnostic tool designed for early breast cancer detection. During the 3D part of the exam, the X-ray arm sweeps in a slight arc over the breast, acquiring multiple images of the breast during a short scan. The individual images are then reconstructed into a series of thin, high-resolution 1 millimeter “slices” to create a three-dimensional mammogram. The radiologist can review the data one slice at a time like turning pages in a book, making it easier for them to determine if there is anything of concern.

How is 3D mammography different from a 2D mammogram?

Two-dimensional (2D) imaging may demonstrate overlapping of the breast tissue, which can conceal actual findings, or make normal tissue appear suspicious, thus causing both false-positive results and false-negative results.

By looking at the breast tissue in one millimeter slices with 3D mammography, the radiologist is able to look more closely at each individual layer of the breast tissue across multiple images and identify masses or abnormalities more accurately.

What are the benefits to 3D mammography?

Research shows:

  • Fewer call backs (15-40% less) for additional testing, which in return reduces patient anxiety and health costs.*
  • Improved imaging for dense breast tissue. This may eliminate the necessity for ordering diagnostic mammograms due to chronic dense breast tissue.
  • A 40% increase in detection of invasive breast cancers.
  • A 27% increase in detection of all breast cancers.

Who should have tomosynthesis?

Almost all patients who need a screening or diagnostic mammogram can have 3D mammography. For women with dense breast tissue, women who have breast implants or who had prior biopsy or surgery, 3D mammography can help with the examination of the breast. Exceptions may include women who are very large-breasted, pregnant or unsteady. The HCM Breast Center intends to utilize tomosynthesis for all imaging other than specialized views and the exceptions listed previously.

What should patients with dense breasts do?

Density refers to breast tissue with more glandular and connective tissue than fat. A mammogram is the only way to find out about density.

Patients can either:

  1. Speak with you, their provider. If a woman has had a prior mammogram, you will have a report on record that would indicate her breast density.
  2. Speak with their mammography provider. If a woman has had a prior mammogram, her mammography provider will have a report on record that would indicate her breast density.

Is there additional radiation?

Mammography Quality Standards Act (MQSA) dose limit set by the FDA.- 3.00 mSv

  • 2D mammogram only- 1.20 mSv

  • C-View 2D + 3D mammogram- 1.45 mSv

  • 2D and 3D mammograms- 2.65 mSv

  • Screen-Film mammogram- 1.90 mSv

  • An airplane flight from New York to Los Angeles round trip- 0.04 mSv

  • One year in Idaho of natural radiation- 6.00 mSv

  • Average background exposure for one year in the United States- 3.00 mSv

  • Living in the Colorado Plateau for one year- 4.50 mSv

Our intention at HCM Breast Center is to use C-View™ 2D +3D mammography. Once a baseline is established, we anticipate eliminating the traditional 2D imaging. Additional radiation is also avoided by the reduced number of patients we recall. (Results may vary until at least two years of 3D images are acquired).

What is C-View?

In 2013, the US FDA approved a new mode for the Hologic system, whereby the 2D image is generated from the tomosynthesis dataset directly (C-View™ 2D image), avoiding the need for a separate 2D exposure and essentially halving the radiation dose associated with a tomosynthesis procedure. Does utilizing tomosynthesis mean patients definitely won’t be called back for additional views? 3D tomography can help radiologists rule out abnormalities that may have looked suspicious in a 2D mammogram, so the likelihood patients will be called back will be less. However, there is still a chance that some patients will require additional mammographic views and/or ultrasound and MRI.

Does health insurance cover the procedure?

The Centers for Medicare & Medicaid Services (CMS) has approved a billing code for 3D mammography to become effective January 2015. Until that date, HMC Breast Center will only bill the 2D portion as it has in the past. These Medicare rates do not guarantee coverage and payment by Medicare or by private insurers. However, we expect most insurance carriers will base their reimbursement on the new rates.

Where can I find additional information?

The American College of Radiology

The American College of Obstetricians and Gynecologists

The American Cancer Society

Are You Dense Advocacy

Hologic, Inc.