How often have you heard the following from an outside clinician, “My patient has a breast lump? Maybe, while they are in the emergency department for abdominal pain, she can go ahead and get a breast ultrasound to take a look.” And, as a new radiologist yourself, you may wonder why, out of convenience, you should not say yes. I mean, what’s the big deal, right? How hard can it be to do an ultrasound of the breast while the ED docs are taking care of the patient for something else? It’s a two-minute procedure!
Well, there is a lot more to that simple breast ultrasound than you might think at first glance. And, believe it or not, you may be doing a lot more patient harm than you think if you are using an ultrasound machine in the emergency department. So, let’s talk about some of the factors, more specifically, that you should consider before making that decision to allow breast imaging outside of the breast department!
Wasted Health Care Dollars
If you scan a patient for a lump in the emergency department, what are the chances you are going to need to do it again? Close to 100%! Why? Breast ultrasound techs have a particular skill set that is unique to their specialty. Plus, the Sonosite is not the same as the hardcore breast ultrasounds used for breast imaging. Who wants to pay for both a wholly inadequate test and an additional appropriate exam in the breast department the following day?
Inferior Equipment
Now, for the next point. Most Emergency Departments don’t stock themselves with the latest and greatest equipment for imaging of the breast. How many times do inferior machines create masses when there are none? A lot! And how many lesions are missed due to poor penetration of the tissue or lower resolution? A ton! It pays to wait.
Technologist Performing Cases Without Experience
Most technologists in the breast department have been performing breast ultrasound for years. It’s not quite the same when you ask a technologist without this experience (which you might have at nighttime!) to complete the case. It is very easy to under call and overcall a breast ultrasound without the appropriate qualifications.
Radiologists Interpreting Cases Without Breast Experience
What are the chances that you will get a radiologist with a ton of breast experience on call? Maybe 50-50 at best? In truth, most of the die-hard mammographers don’t even take emergency calls. And, now you are asking a second rate breast radiologist to do your exam. It makes no sense!
Additional Procedures With Untoward Harm
Inferior equipment and inexperienced ultrasound users lead to further tests that the radiologist or imager will recommend. More importantly, however, inferior exams are not harmless. Quickly, an inadequate breast ultrasound can lead to an unnecessary biopsy or aspiration with potential complications such as bleeding and infection. Or even worse, a pneumothorax (I’ve seen it before!)
No Knowledge of BI-RADS/Patient Letters
Nowadays, the government heavily legislates breast imaging, and they regulate the process down to the result letters that you send. What are the chances that the radiologist uses the appropriate lexicon for the exam? And, is the ED radiologist prepared to create the proper letter to the patient when he completes the test? Probably not! You may not be following the letter of the law!
Are There Any Exceptions?
OK. For every rule, there is an exception. And, I can think of one condition off-hand that may “qualify” as a “breast emergency.” That diagnosis would be a breast abscess. But, even this exception is debatable. Some radiologists would say you can sometimes drain it the next day in the breast imaging center as an outpatient.
Breast Ultrasound Is Generally Not An Emergency Procedure- Don’t Perform It Outside The Breast Department!
For the most part, however, there are many ramifications to performing breast ultrasound outside the breast center. And, you don’t want to contribute to poor patient care. So, please, I implore you. If you are ever pushed to complete a breast ultrasound outside the breast imaging department for a lump, tell your colleagues why it doesn’t make sense!
