In radiology, the notoriously difficult task of reading mammograms is both an art and a science. No one understands that better than Liane Philpotts, MD, who paints and draws in her spare time, bringing her visual sensibility to her work as a diagnostic radiologist.
Reading digital screening mammograms is an important aspect of Dr. Philpotts' job, but she also spends quite a bit of her time interacting with patients. About 10 percent of mammogram screening patients are called back for follow-up, and Dr. Philpotts and her colleagues see every single one of them. There's so much anxiety regarding breast cancer, she said. We're doing a lot of psychotherapy all day long too.

Dr. Philpotts frequently uses ultrasound to work up questionable mammogram findings. In Connecticut, a 2009 law mandates that women with more than 50 percent dense breast tissue must be informed of the benefits of screening ultrasound or MRI.

MRI is used to screen the highest risk patients, for example patients who are BRCA positive or have a strong family history of breast cancer. Most patients with a new cancer diagnosis will have an MRI, because it allows Dr. Philpotts to better view the extent of disease and determine if there are additional foci in the affected or the opposite breast. It's also useful in the case of breast implants, where there is a risk of rupture, and after lumpectomy, if there is scar tissue that makes it difficult to get a clear view on a mammogram.

Dr. Philpotts is eager to make use of breast tomosynthesis, the latest technological advance in detecting breast cancer. Yale was one of five beta sites to conduct a trial for the first vendor to get FDA approval for the technology last February. Breast tomosynthesis is similar to mammography, except that it generates a 3-D image of the breast that can then be viewed in slices. Dr. Philpotts likens it to leafing through the pages of a book, much like a CT scan but with a much lower radiation level. Dr. Philpotts hopes the new unit will allow her group to heavily utilize Yale's new unit in as many screening patients as possible. "It will probably reduce a lot of callbacks that are false positives due to superimposed tissue," she said. "We may also find a few cancers we might have missed, especially those hiding in dense tissue."