Scheduling a Mammogram
By: Stacey Nester
Positive patient communication begins at the time the mammogram appointment is scheduled. Instilling confidence in the women is of utmost importance to acquiring the best images possible as well as ensuring women have a positive experience at your facility. The scheduling personnel should be trained in approaching the mammogram patient with care.
Questions that need to be asked when scheduling a mammogram:
When was your last mammogram?
Screening mammograms should not be scheduled less than 1 year and 1 day after the last mammogram. Medicare is very strict on this and insurance companies tend to following medicare guidelines. It is true that some insurance companies may cover a mammogram as long as it is in the same month as the previous done one year prior. Abiding by medicare guidelines ensures that women will not receive a bill. If the mammogram is a diagnostic mammogram, then the rules go out the window. These can be scheduled any time after the last screening mammogram.
Where was your last mammogram done?
Scheduling personnel should have access to look up the woman’s last mammogram if it it was done at their facility to make sure it has been a year. If the last mammogram was done at another facility and depending upon department protocol, the woman should either be asked to bring their previous images or, at the time of the exam, fill out a release of records so the previous images can be retrieved.
Is this exam a follow up to a recent mammogram?
If the answer is yes and the previous mammogram was done at your facility, all is ok. The technologist will have the previous films showing the area of interest and the follow up images can be performed accordingly. If the previous mammogram was done elsewhere, the follow up exam cannot be done without the prior films, and a written report is not sufficient. The technologist cannot guess where the area in question is and taking extra images to “relocate” the area of concern would be administering unnecessary radiation.
Do you have any new symptoms?
The answer to this question will aid in the scheduling of the proper procedure. If the woman is experiencing a new symptom, a notation should be made so the technologist is aware at the time of the exam. If the symptom is a new lump a breast ultrasound appointment should also be made.
Do you have implants?
This is sometimes a sensitive subject. It is true that some women do not want to reveal this. However, it is important to know at the time of scheduling as some facilities will allot more time for a mammogram done with implants. It is also important for this to be noted on the order, or the schedule, which ever the case may be.
Is there a time of the month that your breasts are routinely more tender?
Scheduling a mammogram around the time of the month when a woman’s breasts are the least tender is important for 2 reasons. The obvious reason it that the compression will be more tolerable. The technologist will be able to apply maximum pressure for the best quality of images. Lack of compression can allow subtle changes to hide within the breast tissue. On the flip side, lack of compression can sometimes create the illusion of pathology that does not truly exist. The second reason is that breast tenderness is typically due to the collection of fluid. If the breasts are filled with fluid one year, and the year before they were not, the comparison will not be as sensitive. This may lead to women being called back for additional views unnecessarily. Consistency in exams year to year is of utmost importance.
Do you have any physical disabilities that make having a mammogram difficult (challenging)?
This is a particularly sensitive question, though important for facilities that adhere to tight mammogram schedules. It is fact that more time is needed for someone who is in a wheelchair or cannot stand for extended periods of time. Even patients on 24 hr oxygen, who are not in a wheelchair, may need some extra time so they can sit down between images. Knowing this advance allows the scheduler to allot extra time for these women.
Patient Instructions at the time of scheduling a mammogram:
After the mammogram has been properly scheduled, scheduling personnel should communicate the following instructions to the women:
Please do not wear perfume, powder, or deodorant the day of your exam.
If the facility supplies deodorant wipes, let the patient know this. Also recommend that they can bring with them their deodorant, lotions, or perfumes to use when their mammogram is complete.
Keep jewelry to a minimum. Any jewelry worn should be easy to remove. Necklaces can be draped over the back during the exam. Small earrings are typically fine to keep on, it is the dangling ones that will need to be removed. Rings and watches are not of concern. Nipple piercings are also not a problem and do not need to be removed.
Wear clothing that is easily removed from the waist up. Dresses are not a good choice for a mammogram appointment unless they can be easily dropped to hang from the waist down.
Any symptoms that you may be experiencing should be communicated in detail with technologist at the time of your appointment.
Remember to let the technologist know about scars you have from breast biopsies. Scar tissue may look abnormal on a mammogram. A scar marker placed on the skin will alert the Radiologist that any abnormality it that area could very well be due to scar tissue from a biopsy.
Point out to the technologist any moles or extra nipples that you have on your breasts. Moles may look like abnormalities inside the breast. Skin markers, placed by the technologist, will help the Radiologist to know the abnormality is actually on the skin surface, not inside of the breast. The Radiologist should know this at the time of reading to avoid being called back for extra imaging.
Tell the technologist if you have any recent trauma to your breasts, even if any bruises have faded by the time of your mammogram. Bruises in the breast may show up on a mammogram. It is important for the Radiologist to be alerted to this at the time of reading to avoid a positive reading and being called back for extra imaging.
Bring previous mammograms from other facilities if you have them in your possession.
Patients following instructions carefully can improve the quality of a mammogram. It’s the job of the scheduler to do their best to explain those instructions.