Anxiety
fear of surgery — tomophobia
"some patients [] are afraid they won’t wake up from surgery"
-- Anesthesiologist in a 2017 interview on minimizing pre-surgery.
Greek: tomos, cut
"some patients [] are afraid they won’t wake up from surgery"
-- Anesthesiologist in a 2017 interview on minimizing pre-surgery.
Greek: tomos, cut
Which level of detail is more effective?
(A)
FILMS COMPARED:
Prior Images available and compared.
FINDINGS:
The breasts have scattered fibroglandular tissue. The background parenchymal enhancement is mild.
No interval development of suspicious focus of enhancement or suspiciously enhancing mass in either breast.
No axillary adenopathy.
(B)
Contrast Bilateral
IMPRESSION: Bi-RÄDS 2- BENIGN
1. Bilateral 3 mm well-circumscribed enhancing nodules which are unchanged and are benign.
2. No suspicious mass or abnormal enhancement seen in either breast.
FULL RESULT: Mild diffuse background enhancement is present bilaterally.
The chest wall, axillary regions, internal mammary regions and limited visualization of the upper abdomen and chest wall are unremarkable.
RIGHT BREAST FINDINGS: A 3 well—circumscribed heterogeneously enhancing nodule in the right anterior breast at 7:00 (#6/81) is entirely unchanged from 9/4/13 and earlier studies. This is bright on the T2-weighted sequence (#4/82) and is benign. No suspicious mass or enhancement is seen in the right breast.
LEFT BREAST FINDINGS: A 3 mm well-circumscribed nodule in the left anterior breast directly behind the nipple (#6/74) today shows heterogeneous enhancement on the subtraction color images but is unchanged in size from 9/4/13 and 8/12/10 (#500/25) . This is bright on the T2—weighted sequence and is a benign lesion. No suspicious mass or enhancement is seen in the left breast.
FILMS COMPARED:
Prior Images available and compared.
FINDINGS:
The breasts have scattered fibroglandular tissue. The background parenchymal enhancement is mild.
No interval development of suspicious focus of enhancement or suspiciously enhancing mass in either breast.
No axillary adenopathy.
(B)
Contrast Bilateral
IMPRESSION: Bi-RÄDS 2- BENIGN
1. Bilateral 3 mm well-circumscribed enhancing nodules which are unchanged and are benign.
2. No suspicious mass or abnormal enhancement seen in either breast.
FULL RESULT: Mild diffuse background enhancement is present bilaterally.
The chest wall, axillary regions, internal mammary regions and limited visualization of the upper abdomen and chest wall are unremarkable.
RIGHT BREAST FINDINGS: A 3 well—circumscribed heterogeneously enhancing nodule in the right anterior breast at 7:00 (#6/81) is entirely unchanged from 9/4/13 and earlier studies. This is bright on the T2-weighted sequence (#4/82) and is benign. No suspicious mass or enhancement is seen in the right breast.
LEFT BREAST FINDINGS: A 3 mm well-circumscribed nodule in the left anterior breast directly behind the nipple (#6/74) today shows heterogeneous enhancement on the subtraction color images but is unchanged in size from 9/4/13 and 8/12/10 (#500/25) . This is bright on the T2—weighted sequence and is a benign lesion. No suspicious mass or enhancement is seen in the left breast.
Practice guidelines for MRI surveillance for long-term follow-up
Ask customer service to find you the practice guideline!
(1) notesnet.carefirst.com Open Doc < provider.carefirst.com search on query=mri+breast*&
MRI of the breast is considered medically necessary for the following indications for screening for breast cancer in the following high risk patients:
Women with history of radiation to the chest between ages 10 and 30. (If history of Hodgkin’s Disease, breast screening should start 8 to 10 years post-therapy, or at age 40,...
https://www.anthem.com/medicalpolicies/policies/mp_pw_a053263.htm
(1) MRI of the breast for routine screening purposes, is considered experimental / investigational, as it does not meet TEC criteria # 2 - 5.
(1) notesnet.carefirst.com Open Doc < provider.carefirst.com search on query=mri+breast*&
MRI of the breast is considered medically necessary for the following indications for screening for breast cancer in the following high risk patients:
- with a known BRCA1 or BRCA2 mutation; or
- a high-risk of BRCA1 or BRCA2 mutation, due to the known presence of the mutation in first or second-degree relatives (male or female); * or
- who have Li-Fraumeni syndrome or Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome or who have a first-degree relative with one of these syndromes, or
- at high risk (20% or greater lifetime risk) of developing breast cancer as identified by model ** that are largely defined by family history, or
- in conjunction with mammography for women with a lifetime risk >20% based on a history of lobular carcinoma in situ (LCIS) or atypical ductal hyperplasia (ADH)/atypical lobular hyperplasia (ALH) or
- who received radiation therapy to the chest between the ages of 10 and 30 years of age.
Women with history of radiation to the chest between ages 10 and 30. (If history of Hodgkin’s Disease, breast screening should start 8 to 10 years post-therapy, or at age 40,...
https://www.anthem.com/medicalpolicies/policies/mp_pw_a053263.htm
http://www.aetna.com/cpb/medical/data/100_199/0105.html
MRI of the breast for all other conditions is considered not medically necessary.
* NOTE: First-degree relatives includes the patient's parents, full siblings, and children. A second-degree relative includes the individual's grandparents, grandchildren, aunts, uncles, nephews, nieces, and half siblings.
** Examples of models used in estimating risk and that utilize family history include the Claus, Tyrer-Cusick and BRCAPRO models (see References, Claus, et al; Parmigiani, et al; Tyrer, et al).
Educational Scholarschip Resources for some of the 325K American childhood cancer survivors
Under the Fair Use Exception, I am entering the listing given in the hard-copy of the March 2012 issue because the listings do not currently appear on the web-site in a clickable form.
http://www.cityofhope.org/about/publications/survivorship-connection/winter2012/Pages/scholarships-for-childhood-cancer-survivors.aspx
Here goes (--abbrevs by mkg)
www.beyondthecure.org
www.cancerforcollege.org
www.graceamerica.org/home.html
www.scaphon.org/scholarships.html SoCal Assoc of Ped Hema/Onc Nurses
www.supersibs.org
www.workingaginstcancer.org/suvivor_scholoarship.html
http://www.cityofhope.org/about/publications/survivorship-connection/winter2012/Pages/scholarships-for-childhood-cancer-survivors.aspx
Here goes (--abbrevs by mkg)
www.beyondthecure.org
www.cancerforcollege.org
www.graceamerica.org/home.html
www.scaphon.org/scholarships.html SoCal Assoc of Ped Hema/Onc Nurses
www.supersibs.org
www.workingaginstcancer.org/suvivor_scholoarship.html
PCAN's walk for Purple Walk for Pancreatic Cancer
http://purplestride.org/find_a_local_event.html
4th leading cause of cancer death in US
from Pancreatic Cancer Action Network
1500 Rosecrans Avenue, Suite 200, Manhattan Beach, CA 90266 Toll Free: 877-272-6226 Phone: 310-725-0025 Fax: 310-725-0029
4th leading cause of cancer death in US
from Pancreatic Cancer Action Network
1500 Rosecrans Avenue, Suite 200, Manhattan Beach, CA 90266 Toll Free: 877-272-6226 Phone: 310-725-0025 Fax: 310-725-0029
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