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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
1 topic, 2 min.
2 topics, 5 min.
5 topics, 33 min.
3 topics, 14 min.
8 topics, 28 min.
4 topics, 20 min.
4 topics, 25 min.
22 topics, 1 hr. 17 min.
BI-RADS Assessment Categories – Overview
11 m.BI-RADS 1
5 m.BI-RADS 2 – Left Lumpectomy
4 m.BI-RADS 2 – Right Lumpectomy, Right Non-Enhancing Mass
2 m.BI-RADS 2 – Left Post Excisional Biopsy Change
3 m.BI-RADS 2 – Marked BPE, Stable
3 m.BI-RADS 2 – Bilateral Stable Findings
4 m.New focus of enhancement on a high risk patient (BI-RADS 4)
3 m.BI-RADS 3 – Changing Pattern of Background
2 m.BI-RADS 4 – Linear NME, Left Breast
4 m.BI-RADS 4 – Right Extensive DCIS, Left Dominant Focus
4 m.BI-RADS 4 – New Diagnosis Left Cancer, Focal NME left
3 m.BI-RADS 4 – New Diagnosis Right Breast Cancer, Nodes on Right
5 m.BI-RADS 4 – Left Axillary Node Metastasis, Evaluate for Breast Cancer
3 m.BI-RADS 5 – Suspicious Mass in Left Breast, Not Biopsied Yet
5 m.BI-RADS 5 – Left Breast Cancer, MRI Shows Right Cancer
5 m.BI-RADS 5 – New Diagnosis Right Cancer, Suspicious Masses in Right Breast
3 m.BI-RADS 5 – Right Inflammatory Cancer, Bilateral Nodes
4 m.BI-RADS 6 – Right Breast Cancer, No Other Findings
3 m.BI-RADS 6 – Left Breast Cancer, No Other Findings
2 m.BI-RADS 6 – Left Breast Cancer, Index Mass
4 m.BI-RADS 6 – Pre and Post Neoadjuvant Chemotherapy (NAC) for Left Breast Cancer
5 m.0:01
Okay, our next case for protocol and anatomy
0:05
is a 31-year-old woman who is seen for high
0:08
risk screening, and she has a family history of
0:10
breast cancer and four relatives at young ages.
0:14
So, appropriately being seen
0:17
for high-risk screening. Mr.
0:19
We'll go to our case.
0:23
So this is our, our case.
0:25
I won't go through the localizer here, but this
0:28
is the T1-weighted, non-fat saturated series,
0:33
and I just wanted to show you this in a patient
0:35
who has a larger breast size, kind of a larger
0:38
sized patient with fattier breast tissue.
0:43
So just going from the top, you
0:46
can see that the patient has a lot
0:48
of axillary tissue on both sides.
0:52
Pectoralis minor and major muscles are
0:55
well seen and are lower signal intensity.
1:00
There's a lot of fatty tissue here.
1:01
So that's high signal intensity.
1:09
Kind of going through that, but no, so a bigger
1:12
patient, we can still fit the patient in, we
1:15
can still get the nipples pointing downward.
1:20
And of course, you know, by convention,
1:24
we image prone, but we display the
1:29
images as if the patient is.
1:32
Lying on her back, but keep in mind
1:36
that the patient is always prone.
1:40
And going through that STIR sequence,
1:44
this is a sort of a quieter
1:47
breast than the last one we looked at.
1:50
There are some lymph nodes in the
1:52
axilla, and then, you know, not
1:58
too much going on in the breast.
2:01
This is our pre-contrast sequence. Sometimes,
2:05
with very fatty breast tissue, it can
2:08
be hard to do fat saturation, especially
2:11
at the top and bottom of the exam.
2:14
You can see some areas where our fat saturation
2:17
is a little bit inhomogeneous, but in the breast
2:22
itself, we've actually done a pretty good job.
2:25
You can see most of that fat is well
2:28
saturated, even down to the last image.
2:35
And then after contrast, we get some
2:39
enhancement of our blood vessels.
2:41
You can see internal mammary artery
2:42
and vein are enhancing, and liver.
2:48
This patient doesn't have very much
2:51
enhancement in her breast tissue.
2:57
Then there's to show you her
3:03
And you can see lots of blood vessels
3:05
here on the maximum intensity projection
3:07
image, a little bit of tissue enhancement,
3:12
really nothing significant here.
Interactive Transcript
0:01
Okay, our next case for protocol and anatomy
0:05
is a 31-year-old woman who is seen for high
0:08
risk screening, and she has a family history of
0:10
breast cancer and four relatives at young ages.
0:14
So, appropriately being seen
0:17
for high-risk screening. Mr.
0:19
We'll go to our case.
0:23
So this is our, our case.
0:25
I won't go through the localizer here, but this
0:28
is the T1-weighted, non-fat saturated series,
0:33
and I just wanted to show you this in a patient
0:35
who has a larger breast size, kind of a larger
0:38
sized patient with fattier breast tissue.
0:43
So just going from the top, you
0:46
can see that the patient has a lot
0:48
of axillary tissue on both sides.
0:52
Pectoralis minor and major muscles are
0:55
well seen and are lower signal intensity.
1:00
There's a lot of fatty tissue here.
1:01
So that's high signal intensity.
1:09
Kind of going through that, but no, so a bigger
1:12
patient, we can still fit the patient in, we
1:15
can still get the nipples pointing downward.
1:20
And of course, you know, by convention,
1:24
we image prone, but we display the
1:29
images as if the patient is.
1:32
Lying on her back, but keep in mind
1:36
that the patient is always prone.
1:40
And going through that STIR sequence,
1:44
this is a sort of a quieter
1:47
breast than the last one we looked at.
1:50
There are some lymph nodes in the
1:52
axilla, and then, you know, not
1:58
too much going on in the breast.
2:01
This is our pre-contrast sequence. Sometimes,
2:05
with very fatty breast tissue, it can
2:08
be hard to do fat saturation, especially
2:11
at the top and bottom of the exam.
2:14
You can see some areas where our fat saturation
2:17
is a little bit inhomogeneous, but in the breast
2:22
itself, we've actually done a pretty good job.
2:25
You can see most of that fat is well
2:28
saturated, even down to the last image.
2:35
And then after contrast, we get some
2:39
enhancement of our blood vessels.
2:41
You can see internal mammary artery
2:42
and vein are enhancing, and liver.
2:48
This patient doesn't have very much
2:51
enhancement in her breast tissue.
2:57
Then there's to show you her
3:03
And you can see lots of blood vessels
3:05
here on the maximum intensity projection
3:07
image, a little bit of tissue enhancement,
3:12
really nothing significant here.
Report
Description
Faculty
Lisa Ann Mullen, MD
Assistant Professor; Breast Imaging Fellowship Director
Johns Hopkins Medicine
Tags
Women's Health
MRI
Breast
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