ROTATIONS‎ > ‎

MAMMO


LOCATION & TIME

Hours:
Location

Mount Sinai West/Brodsky and Mount Sinai St. Luke's
  • Faculty representative: Dr. Karen Lee
  • Schedule:
    • Monday, Tuesday:  West
    • Wednesday, Thursday:  SL
    • Friday:  West
  • 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)
  • Faculty representative: Dr. Ami Shah
  • Location: 
    • 10 Union Square East
    • 4th floor, Suite 4L
    • New York, NY 10003 
Mount Sinai Chelsea 
  • Faculty representative: Dr. Lisa Abramson
  • Location: 
    • 325 West 15th Street
    • 1st floor, Mammography Suite
    • New York, NY 10011

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

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

DICTATING

MagViewIkonopedia
  • Used at SL and Chelsea
  • Request access by emailing CHP-RIS
  • CHP-RIS@mountsinai.org
  • Used at RAW (Brodsky) and CAM
  • Login
    • For access, put in email address and hit forgot password to reset
    • If email is unknown, email CHP-RIS@mountsinai.org
  • To view your numbers
    • Analytics > set date range > resident exam counts

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

For residents graduating in 2014 and later:
  • There is a proposed policy pending FDA approval:  "Physicians who 
    • 1) successfully complete a diagnostic radiology residency program in 2014 (or later)
    • 2) have interpreted or multi-read at least 240 mammographic examinations under the direct supervision of an interpreting physician in any 6-month period during the last 2 years of this residency
    • 3) have passed their certifying board's core exam by the end of their residency are otherwise exempt."
  • After graduation you need to read 960 cases within 24 months to maintain certification, otherwise you need to requalify. Also, you will need 15 mammography CME hours in 36 months

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

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