Screening Mammogram
Name:
Exam Date:
Comparison Date and facility: (Example 1/1/12 from Bailey Medical Center)
Bilateral Screening mammogram
Views:
Bilateral CC and MLO (Sometimes will add anterior compression or XCCL/ XCCM views)
Breast Composition: (choose 1 of the following statements based on appearance)
-Almost entirely fat
-Scattered fibroglandular densities
-Heterogeneously dense which may obscure detection of small masses
-Extremely dense which may lower the sensitivity of mammography
Findings:
Right breast has no evidence of mass, architectural distortion, suspicious micro calcification, skin thickening or nipple retraction.
Left breast has no evidence of mass, architectural distortion, suspicious micro calcification, skin thickening or nipple retraction.
Impression: (choose 1 of the following classifications)
BIRAD 0 incomplete, need additional imaging evaluation, recommend ________.
BIRAD 1 negative, recommend annual screening mammograms.
BIRAD 2 benign findings, recommend annual screening mammograms.
BIRAD 3 probably benign findings, short interval follow up is suggested, Recommend ________. (6 month f/u diagnostic/ US/ etc.)
BIRAD 4 suspicious abnormality, biopsy should be considered. Recommend ________. (Stereotactic/ ultrasound guided/ etc.)
BIRAD 5 Highly suggestive of malignancy. Appropriate action should be taken. Recommend ________. (Surgical consultation)
BIRAD 6 Known and biopsy proven malignancy.
Exam Date:
Comparison Date and facility: (Example 1/1/12 from Bailey Medical Center)
Bilateral Screening mammogram
Views:
Bilateral CC and MLO (Sometimes will add anterior compression or XCCL/ XCCM views)
Breast Composition: (choose 1 of the following statements based on appearance)
-Almost entirely fat
-Scattered fibroglandular densities
-Heterogeneously dense which may obscure detection of small masses
-Extremely dense which may lower the sensitivity of mammography
Findings:
Right breast has no evidence of mass, architectural distortion, suspicious micro calcification, skin thickening or nipple retraction.
Left breast has no evidence of mass, architectural distortion, suspicious micro calcification, skin thickening or nipple retraction.
Impression: (choose 1 of the following classifications)
BIRAD 0 incomplete, need additional imaging evaluation, recommend ________.
BIRAD 1 negative, recommend annual screening mammograms.
BIRAD 2 benign findings, recommend annual screening mammograms.
BIRAD 3 probably benign findings, short interval follow up is suggested, Recommend ________. (6 month f/u diagnostic/ US/ etc.)
BIRAD 4 suspicious abnormality, biopsy should be considered. Recommend ________. (Stereotactic/ ultrasound guided/ etc.)
BIRAD 5 Highly suggestive of malignancy. Appropriate action should be taken. Recommend ________. (Surgical consultation)
BIRAD 6 Known and biopsy proven malignancy.