ROTATIONS‎ > ‎

MAMMO



LOCATION & TIME

HOURS:
LOCATION

MOUNT SINAI WEST/BRODSKY AND MOUNT SINAI ST. LUKE'S
  • Faculty representativeDr. Karen Lee
  • Schedule:
    • Monday, Wednesday, Friday:  West
    • Tuesday, Thursday:  SL
  • Location:
    • Radiology Associates West (Brodsky)
      • 425 West 59th Street, 6th floor
      • Suite 6C, New York, NY 10019 
      • 212-523-8333 
    • Mount Sinai St. Luke's
      • 1111 Amsterdam Avenue
      • 3rd floor, New York, NY 10025
      • 212-523-4000 
MOUNT SINAI UNION SQUARE (DUS, PACC)
  • Faculty representative: Dr. Ami Shah
  • Extension: 44-8873
  • Location
    • 10 Union Square East
    • 4th floor, Suite 4L
    • New York, NY 10003 
MOUNT SINAI CHELSEA
  • Faculty representativeDr. Lisa Abramson
  • Location
    • 325 West 15th Street
    • 1st floor, Mammography Suite
    • New York, NY 10011

ROTATION REQUIREMENTS / LEARNING OBJECTIVES

  • First Day: Rotate with the Mammo and US techs to understand how they perform the studies

  • Keep up with the assigned reading list provided by attendings
  • Understand benign and positive mammogram and ultrasound findings (How you learn what's relevant to screening and diagnostic examinations)
  • Review MRI cases as an R3 or R4
  • Radexam for each breast rotation at the end of each rotation block
  • End of rotation evaluation (phone call to discuss resident performance and also receive feedback for what could be improved)

TRACKING PATIENTS IN RIS AT MS DUS

  1. Log in to Centricity RIS with user name and password
  2. Click on Tracking from the top row of headings at the top of the page
  3. Organization : “PH” 
  4. Track by: “Resource Group” 
  5. In the box next to “Resource Group” type in “PDM” 
  6. Auto Refresh (1 min): select “On” 
  7. Click on SEARCH button… this will bring up the list of all the scheduled patient’s at MSDUS for that day 
    • Organize the list in order of appointment time by clicking on Sched Date
    • Alternatively, clicking on Arrive, will show patients in order of arrival time so you can track who is actually here in the department 
    • Once the technologist starts a study, a time stamp will show up under Begin


GE UV MAMMO FILTERS

MS DUSNYRAMS Chelsea
PH TODAY

Study Description: PH

Modality: MG

Date of exam: Today

Exam status: Arrived, Verified, Transcribed

 

PH US TODAY

Study Description: PH US today

Modality: US

Date of exam: Today

Exam status: Arrived, Verified, Transcribed

 

PH US BIOPSY

Study Description: PH ULTRASOUNDBREAST

Modality: US

Date of exam: Last 7 days

Exam status: Arrived, Verified, Transcribed


SCREENERS 7 DAYS

Study Description: PH Mammography Screening

Modality: MG

Date of exam: Last 2 weeks

Exam status: Arrived, Verified, Transcribed

 

MRI BREAST

Study Description: PH MRI breast 

Modality: MR

Date of exam: Today

Exam status: Arrived, Verified, Dictated

NYRA

Study Description: NY

Modality: MG

Date of exam: Today

Exam status: Arrived, Verified, Transcribed

BC TODAY

Study Description: BC

Modality: US, MG

Date of exam: Today

Exam status: Arrived, Verified, Transcribed

 


** See PDF below on how to create filters in GE UV

IKONOPEDIA


MULTIDISCIPLINARY CONFERENCES

MS Union Square (DUS)
  • Multidisciplinary breast conference every Monday 8:00 - 9:00 AM 
    • Hiatus during summer (starts back up after Labor day)
  • Residents on rotation should attend

Annual Mount Sinai conference 
  • October 1-3, 2018
  • Excellent topics from some of the leaders in the field
  • Course syllabus

NYRS
  • One day dedicated to breast during annual conference


The New York Breast Imaging Society (NYBIS)
  • 5 CME lectures per year and the lecture schedule 
  • Mount Sinai Hospital 
    • Goldwurm Auditorium
    • 1425 Madison Avenue at 98th street)
    • 6:00 - 8:00 pm
  • NYBIS would love to have more resident involvement and each year we elect a resident liaison
  • NYBIS current resident liaisons
  • Please contact Karen Lee for more information about joining NYBIS

ROTATION GUIDE

Junior residents (R1, R2s)Senior residents (R3, R4s)
  • Read the BI-RADS atlas
    • Mammo section at minimum but ideally mammo and sono sections before starting first week
    • Read MRI section by second rotation 
    • Watch a mammo being performed 
  • Scan as much as possible real time
    • Spend time with the tech watching them scan and then scan after tech finishes while tech presents case to attending
    • Introduce yourself to the patient & ask her permission to scan while tech & attending are checking
  • Preview the screens
    • Decide if you want to give a BI-RADS 0, 1 , or 2
    • Then observe attending read out
    • Once you’re comfortable with the dictation software, you can start pre-dictating as well
  • Observe procedures
    • Once you see a few, put sterile gloves on so you can get familiar with the equipment 
    • Ie. try firing the biopsy gun before attending uses it to biopsy
  • Screening numbers: need 240 in six months 
  • Diagnostic cases 
  • Procedures under supervision 
  • MRIs

All years
  • Email CHP-RIS name and MRN number whenever you dictate a case and notice priors with “0” images in PACS requesting priors be sent to UV 
  • Do not reference priors available only in McKesson, if they were from the Mount Sinai network, they should be migrated as above.  If they were from an outside practice and available in McKesson, we do not have rights to view these studies.
  • Keep a list of the cases you give a “0” to so you can track cases that attending may change more easily in your nuance list
  • Track the ones that attending also agrees to give a BI-RADS 0 and follow up the outcomes--great way to learn
  • EPIC access is essential 
    • Consults are a great way to learn: pre-dictate with attending supervision/guidance
  • Consent cases for procedures AFTER you have been oriented and observed
    • Be sure you know what procedure you are consenting for and have confirmed with the procedure attending that getting consent is appropriate
    • Consent: “Imaging guided biopsy of left/right breast with tissue marker” or “Imaging guided localization of left/right breast”
    • Time out form-> more specific: “Stereotactic/Ultrasound/MRI guided biopsy/localization Right/Left breast calcifications/mass/clip [LOCATION] with tissue marker” 
    • Ask about medication and metal allergies, blood thinners/bleeding issues 
    • Procedures are all done under sterile conditions, minimal risk of infection & bleeding, plenty of local anesthesia (lidocaine) will be given (may feel a “pinch & burn”). After breast is numb, will feel pressure but should not feel anything sharp. If feel something sharp, let us know
    • For MRI biopsies: let patient know there is a possibility (about 10%) biopsy will be cancelled if the area cannot be reproduced (i.e. doesn’t enhance) 
    • Marking clips are placed to mark all biopsies – if patient is refusing tissue marker get attending. (bottom line is that we will not do biopsy without marker but detailed discussion should be done by fellow or attending) 
    • Unless you are fluent in another language and have hospital approval to consent in that language, get consent by phone with the assistance of a translator from Pacific interpreters. Write the interpreter’s name and ID# on the consent form. It will have to be dictated onto the report. 
  • Post procedure instructions 
    • Shower after 24 hours 
    • No soap, lotions, etc on steri-strip. Steri-strip should fall off in 5 days. If not, can remove it on 6th day 
    • Limit overhead motion or anything that moves the breast for 24-48 hours 
    • Tylenol as needed for pain 
    • Ice 15 min on, 15 min off for first day 
    • Wear a sports bra/tight bra after procedure and it may be more comfortable to sleep in it the first night 
    • Soreness and bruising expected post procedure





MQSA REQUIREMENTS

  • Starting with the medical residency graduating classes of 2014, the American Board of Radiology (ABR) requires each resident to demonstrate proficiency across all of diagnostic radiology by completing a Comprehensive Core Examination after 36 months of residency training. This examination will be followed by a Final Certifying Examination administered 15 months after the resident graduates from the medical residency program. Graduates will no longer have the opportunity to become board certified by the ABR during the medical residency.
  • In order to immediately begin independent interpretation of mammograms following a residency program, medical residency graduates of 2014 or later must:
    • Have interpreted 240 mammographic examinations under direct supervision within any 6-month period during the last two years of the medical residency. (That is, for newly graduating medical residents, the interpretation of the 240 exams may be during any 6-month period during the last 2 years of the residency program, as opposed to the last six months of the residency program, as was previously required.)
    • Have completed 3 months of formal training in the interpretation of mammograms and in topics related to mammography (including instruction in radiation physics specific to mammography, radiation effects, and radiation protection).
    • Have completed a minimum of 60 category I hours of documented medical education in mammography (including instruction in the interpretation of mammograms, basic breast anatomy, pathology, physiology, technical aspects of mammography, and quality assurance and quality control in mammography), with at least 15 of the category I hours having been acquired within the 3 years immediately prior to the date that the physician qualified as an interpreting physician.

ATTENDING ON CALL

  • There is a breast imaging attending on call who is available to answer patient questions and concerns at all times
  • The attending on call is listed on the on call schedule


BOOKS

  1. BI-RADS Atlas, 5th edition (Available on Google Drive MSBISLW@gmail.com)
  2. Ikeda, Breast Imaging: The Requisites 
  3. Cardenosa, Breast Imaging Companion 
  4. Tabar and Dean, Teaching Atlas of Mammography 
  5. Cardenosa, Breast Imaging (Core Curriculum series) 
  6. Dershaw, Imaging-guided Interventional Breast Techniques 
  7. Morris and Liberman, Breast MRI: Diagnosis and Intervention 
  8. Stavros AT. Breast ultrasound. Philadelphia, Pa: Lippincott Williams & Wilkins, 2003 
  9. Shah and Mandava, Breast Imaging: A core Review

Ċ
RadRez Administrator,
Aug 20, 2018, 7:56 PM
ĉ
RadRez Administrator,
May 17, 2018, 9:03 AM
Ċ
RadRez Administrator,
Sep 19, 2018, 8:22 AM
Ċ
Cherisse Wada,
Jul 10, 2019, 1:28 PM
Ċ
RadRez Administrator,
Oct 27, 2018, 3:39 AM
Ċ
Cherisse Wada,
Jul 10, 2019, 1:27 PM
Ċ
Cherisse Wada,
Jul 10, 2019, 1:28 PM