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How can we offer lower Breast MRI
Our contract prices are lower than what
individuals can get for themselves for the following five reasons: (1) Compared
to a one-time client, we send a very large number of patients to imaging centers
(i.e. volume discount); (2) the patients we refer are paying cash (i.e.
increase cash flow to Centers): (3) Centers do not have to bill and wait for
insurance reimbursement (i.e. saves the Centers on overhead); and (4) our patients fill in available openings which increases the Center's bottom line
by minimizing staff and equipment idle time (i.e. increased opportunity
advantage); (5) Centers must contract with a third party to offer rates at or
below Medicare reimbursement rates. If a Medicare participating Center were to
offer an individual cash rates lower than Medicare reimbursement rates, the
Center could be held liable for huge financial penalties, and/or they could lose
their ability to participate in the Medicare program.
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What is MRI of the Breast?
Magnetic resonance imaging (MRI) is a noninvasive medical test that
helps physicians diagnose and treat medical conditions. MR imaging uses
a powerful magnetic field, radio frequency pulses and a computer to
produce detailed pictures of organs, soft tissues, bone and virtually
all other internal body structures. The images can then be examined on a
computer monitor, printed or copied to CD. MRI does not use ionizing
radiation (x-rays). Detailed MR images allow physicians to better evaluate various parts
of the body and certain diseases that may not be assessed adequately
with other imaging methods such as x-ray, ultrasound or computed
tomography (also called CT or CAT scanning). MRI of the breast offers
valuable information about many breast conditions that cannot be
obtained by other imaging modalities, such as mammography or ultrasound.
What are some common uses of the procedure?
MRI of the breast is not a replacement for mammography or ultrasound
imaging but rather a supplemental tool for detecting and staging breast
cancer and other breast abnormalities. Medical studies are
currently being conducted to determine whether MRI and other imaging
methods can contribute to the early detection and prevention of deaths
from breast cancer.
MR imaging of the breast is performed to:
- assess multiple tumor locations, especially prior to breast
- identify early breast cancer not detected through other means,
especially in women with dense breast tissue and those at high risk
for the disease.
- evaluate abnormalities detected by mammography or ultrasound.
- distinguish between scar tissue and recurrent tumors.
- determine whether cancer detected by mammography, ultrasound, or
after surgical biopsy has spread further in the breast or into the
- assess the effect of chemotherapy.
- provide additional information on a diseased breast to make
- determine the integrity of breast implants.
Without contrast material, an MRI of the breast
- breast tissue density.
- enlarged ducts.
- leaking or ruptured breast implants.
- the presence of enlarged lymph nodes.
By comparing breast images taken before and after
contrast material injection, an MRI exam can determine:
- if there are breast abnormalities.
- whether an abnormality looks benign (non-cancerous) or malignant
- the size and location of any abnormality that looks malignant.
How should I prepare for the MRI?
You may be asked to wear a gown during the exam or you may be allowed
to wear your own clothing if it is loose-fitting and has no metal
fasteners. Guidelines about eating and drinking before an MRI exam
vary with the specific exam and also with the facility. For some types
of exams, you will be asked to fast for 8-12 hours. Unless you are told
otherwise, you may follow your regular daily routine and take
medications as usual.
Some MRI examinations may require the patient to swallow contrast
material or receive an injection of contrast into the bloodstream. The
radiologist or technologist may ask if you have allergies of any kind,
such as allergy to iodine or x-ray contrast material, drugs, food, the
environment, or asthma. However, the contrast material used for an MRI
exam, called gadolinium, does not contain iodine and is less likely to
cause side effects or an allergic reaction.
The radiologist should also know if you have any serious health
problems or if you have recently had surgery. Some conditions, such as
severe kidney disease may prevent you from being given contrast material
for an MRI.
Women should always inform their physician or technologist if there
is any possibility that they are pregnant. MRI has been used for
scanning patients since the 1980's with no reports of any ill effects on
pregnant women or their babies. However, because the baby will be in a
strong magnetic field, pregnant women should not have this exam unless
the potential benefit from the MRI is assumed to outweigh the potential
If you have claustrophobia (fear of enclosed spaces) or anxiety, you
may want to ask your physician for a prescription for a mild sedative.
Jewelry and other accessories should be left at home if possible, or
removed prior to the MRI scan. Because they can interfere with the
magnetic field of the MRI unit, metal and electronic objects are not
allowed in the exam room. These items include:
- jewelry, watches, credit cards and hearing aids, all of which
can be damaged.
- pins, hairpins, metal zippers and similar metallic items, which
can distort MRI images.
- removable dental work.
- pens, pocketknives and eyeglasses.
- body piercings.
In most cases, an MRI exam is safe for patients
with metal implants, except for a few types. People with the following
implants cannot be scanned and should not enter the MRI scanning area
unless explicitly instructed to do so by a radiologist or technologist
who is aware of the presence of any of the following:
- internal (implanted) defibrillator or pacemaker
- cochlear (ear) implant
- some types of clips used on brain aneurysms
You should tell the technologist if you have
medical or electronic devices in your body, because they may interfere
with the exam or potentially pose a risk, depending on their nature and
the strength of the MRI magnet. Examples include but are not limited to:
- artificial heart valves
- implanted drug infusion ports
- implanted electronic device, including a cardiac pacemaker
- artificial limbs or metallic joint prostheses
- implanted nerve stimulators
- metal pins, screws, plates, stents or surgical staples
In general, metal objects used in orthopedic surgery pose no risk
during MRI. However, a recently placed artificial joint may require the
use of another imaging procedure. If there is any question of their
presence, an x-ray may be taken to detect the presence of and identify
any metal objects. Patients who might have metal objects in
certain parts of their bodies may also require an x-ray prior to an MRI.
Dyes used in tattoos may contain iron and could heat up during MRI, but
this is rarely a problem. Tooth fillings and braces usually are not
affected by the magnetic field but they may distort images of the facial
area or brain, so the radiologist should be aware of them.
What does the equipment look like?
The traditional MRI unit is a large cylinder-shaped tube surrounded
by a circular magnet. You will lie on a moveable examination table that
slides into the center of the magnet. Some MRI units, called short-bore systems, are designed so that the
magnet does not completely surround you; others are open on the sides
("low-strength" open MRI). These units are especially helpful for
examining patients who are fearful of being in a closed space and for
those who are very obese. Newer open MRI units provide very high quality
images for many types of exams; however, open MRI units with older
magnets may not provide this same quality. Certain types of exams cannot
be performed using open MRI. For more information, consult your doctor. The computer workstation that processes the imaging information is
located in a separate room than the scanner.
How does the procedure work?
Unlike conventional x-ray examinations and computed tomography (CT)
scans, MRI does not depend on ionizing radiation. Instead, while in the
magnet, radio waves redirect the axes of spinning protons, which are the
nuclei of hydrogen atoms, in a strong magnetic field. The magnetic
field is produced by passing an electric current through wire coils in
most MRI units. Other coils, located in the machine and in some cases,
placed around the part of the body being imaged, send and receive radio
waves, producing signals that are detected by the coils. A
computer then processes the signals and generates a series of images
each of which shows a thin slice of the body. The images can then be
studied from different angles by the interpreting physician.
Overall, the differentiation of abnormal (diseased) tissue from normal
tissues is often better with MRI than with other imaging modalities such
as x-ray, CT and ultrasound.
How is the procedure performed?
MRI examinations may be performed on outpatients or inpatients.
You will be positioned on the moveable examination table. Straps and
bolsters may be used to help you stay still and maintain the correct
position during imaging. For an MRI of the breast, you will lie
face down on your stomach with your breasts hanging freely into
cushioned openings, which are surrounded by a breast coil, which is a
signal receiver that works with the MRI unit to create the images. It is
important to remain very still throughout the exam. This is best
accomplished by making sure you are comfortable and can relax rather
than trying to actively hold still tensing your muscles. Be sure to let
the technologist know if something is uncomfortable, since discomfort
increases the chance that you will feel the need to move during the
exam. Even very small movements can limit the ability to get a quality
If a contrast material will be used in the MRI exam, a nurse or
technologist will insert an IV line into a vein in your hand or arm. A
saline solution may be used. The solution will drip through the IV to
prevent blockage of the IV line until the contrast material is injected.
You will be moved into the magnet of the MRI unit and the radiologist
and technologist will leave the room while the MRI examination is
performed. If a contrast material is used during the examination,
it will be injected into the intravenous line (IV) after an initial
series of scans. Additional series of images will be taken during or
following the injection.
When the examination is completed, you may be asked to wait until the
technologist or radiologist checks the images in case additional images
are needed. Your intravenous line will be removed. MRI
exams generally include multiple runs (sequences), some of which may
last several minutes. The imaging session lasts between 30 minutes and
one hour and the total examination is usually completed within an hour
and a half. MR spectroscopy, which provides additional information
on the chemicals present in the body's cells, may also be performed
during the MRI exam and may add approximately 15 minutes to the exam
What will I experience during and after the
Most MRI exams are painless.
Some patients, however, find it uncomfortable to remain still during
MR imaging. Others experience a sense of being closed-in
(claustrophobia). Therefore, sedation can be arranged for those patients
who anticipate anxiety, but fewer than one in 20 require it. It is
normal for the area of your body being imaged to feel slightly warm, but
if it bothers you, notify the radiologist or technologist. It is
important that you remain perfectly still while the images are being
recorded, which is typically only a few seconds to a few minutes at a
time. For some types of exams, you may be asked to hold your breath. You
will know when images are being recorded because you will hear tapping
or thumping sounds when the coils that generate the radiofrequency
pulses are activated. You will be able to relax between imaging
sequences, but will be asked to maintain your position as much as
You will usually be alone in the exam room during the MRI procedure.
However, the technologist will be able to see, hear and speak with you
at all times using a two-way intercom. Many MRI centers allow a friend
or parent to stay in the room as long as they are also screened for
safety in the magnetic environment.
You may be offered or you may request earplugs to reduce the noise of
the MRI scanner, which produces loud thumping and humming noises during
imaging. MRI scanners are air-conditioned and well-lit. Some scanners
have music to help you pass the time. When the contrast material is
injected, it is normal to feel coolness and a flushing sensation for a
minute or two. The intravenous needle may cause you some discomfort when
it is inserted and once it is removed, you may experience some bruising.
There is also a very small chance of irritation of your skin at the site
of the IV tube insertion.
If you have not been sedated, no recovery period is necessary. You
may resume your usual activities and normal diet immediately after the
exam. A few patients experience side effects from the contrast material,
including nausea and local pain. Very rarely, patients are allergic to
the contrast material and experience hives, itchy eyes or other
reactions. If you experience allergic symptoms, a radiologist or other
physician will be available for immediate assistance.
It is recommended that nursing mothers not breastfeed for 36 to 48
hours after an MRI in which a contrast material was given.
Who interprets the results and how do I get them?
A radiologist, a physician specifically trained to supervise and
interpret radiology examinations, will analyze the images and send a
signed report to your primary care or referring physician, who will
share the results with you.
What are the benefits vs. risks?
- MRI is a noninvasive imaging technique that does not involve
exposure to ionizing radiation.
- MRI has proven valuable in diagnosing a broad range of
conditions, including detecting and staging breast cancer,
particularly when other imaging studies (mammography, ultrasound,
etc.) fail to provide adequate information.
- MRI enables the discovery of abnormalities that might be
obscured by bone with other imaging methods.
- The contrast material used in MRI exams is less likely to
produce an allergic reaction than the iodine-based materials used
for conventional x-rays and CT scanning.
- MRI is growing in popularity as an addition to traditional x-ray
mammography in the early diagnosis of breast cancer.
- MRI has been shown to detect small breast lesions that are
sometimes missed by mammography.
- MRI can successfully image the dense breast common in younger
women, as well as breast implants, both of which are difficult to
image using traditional mammography.
- MRI as an addition to mammography has been shown to be useful in
evaluating women at high risk for breast cancer.
- If a suspicious lesion is seen with MRI only, MRI can provide
guidance for biopsy.
- The MRI examination poses almost no risk to the average patient
when appropriate safety guidelines are followed.
- If sedation is used there are risks of excessive sedation. The
technologist or nurse monitors your vital signs to minimize this
- Although the strong magnetic field is not harmful in itself,
implanted medical devices that contain metal may malfunction or
cause problems during an MRI exam.
- There is a very slight risk of an allergic reaction if contrast
material is injected. Such reactions usually are mild and easily
controlled by medication. If you experience allergic symptoms, a
radiologist or other physician will be available for immediate
- Nephrogenic systemic fibrosis is currently a recognized, but
rare, complication of MRI believed to be caused by the injection of
high doses of MRI contrast material in patients with very poor
What are the limitations of MRI of the Breast MRI?
High-quality images are assured only if you are able to remain
perfectly still or hold your breath, if requested to do so, while the
images are being recorded. If you are anxious, confused or in severe
pain, you may find it difficult to lie still during imaging.
A person who is very large may not fit into the opening of a
conventional MRI machine. The presence of an implant or other
metallic object sometimes makes it difficult to obtain clear images and
patient movement can have the same effect. Although there is no
reason to believe that magnetic resonance imaging harms the fetus,
pregnant women usually are advised not to have an MRI exam unless
MRI may not always distinguish between cancer tissue and edema fluid.
MRI typically costs more and may take more time to perform than other
imaging modalities. MRI of the breast cannot always
distinguish between cancer and benign breast disease, leading to a false
positive result. A false positive is a test result that indicates a
suspicious finding when there is in fact no cancer present.
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