Use of the lateral arm in tomosynthesis-guided SCOUT Reflector placement procedures.

Preoperative localization procedures are important for guiding surgical excision of non-palpable findings in the breast. The SCOUT Reflector (Merit Medical, South Jordan UT, USA) is a non-wire-based localization device that has been incorporated into clinical use with great success. SCOUT Reflectors can be placed using several imaging modalities, including tomosynthesis. One drawback to SCOUT Reflector placement under tomosynthesis guidance is an inability to directly visualize the introducer needle tip, a factor that limits precision. In this brief communication, we describe the use of a lateral arm attachment for tomosynthesis guided SCOUT Reflector placement. Precise SCOUT Reflector placement can be achieved using the lateral arm due to the ability to clearly visualize the introducer needle and the SCOUT Reflector within the introducer needle bore prior to deployment.

An unusual artifact observed on screening mammography in a patient with an LVAD.

PURPOSE: Screening mammography and digital breast tomosynthesis consist of high-resolution x-ray images to identify findings that are potentially indicative of breast cancer, enabling early detection and reduction of breast cancer mortality. Imaging artifacts can occasionally occur, sometimes due to patient-related medical devices. Because of continuous evolution of new technologies, there is potential for novel artifacts to be encountered. In this technical note, we report an unusual artifact in the screening mammogram of a patient with an Abbott HeartMate 3 left ventricular assist device (LVAD). METHODS: A 72-year-old patient with a HeartMate 3 LVAD presented to our breast imaging facility for a standard screening exam with digital breast tomosynthesis (Selenia Dimensions, Hologic Inc., Bedford, MA) and synthetic 2D images (C-view, Hologic Inc., Bedford, MA). RESULTS: Linear artifacts oriented in the anteroposterior dimension demonstrating a spatial periodicity of ∼1.4 mm were seen on all left breast images, whereas concurrent right breast images did not demonstrate any artifacts. Repeat attempts using two identical digital breast tomosynthesis units demonstrated the same artifacts. No other exam at our imaging center that day demonstrated any such artifacts. Mammogram exams performed on this patient prior to her LVAD placement did not exhibit any similar artifacts. CONCLUSION: Findings support the patient's LVAD as the underlying source of linear artifacts observed on left breast images, particularly given the proximity of the LVAD to the left breast. With the number of patients receiving LVAD placement on the rise, as well as increasing median survival rates status post LVAD implantation, recognition of this LVAD related artifact on mammography may be important.