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74 Avenue des Gobelins, 75013 PARIS
Métro Place d'Italie
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6 Place d'Italie, 75013 PARIS
Métro Place d'Italie
Tèl : 01 43 36 36 33
Fax : 09 72 36 29 71 
cimiparis13@gmail.com

F.A.Q

MAMMOGRAPHY

 
Breast cancer most often starts in an asymptomatic way, meaning that there is no clinical sign showing that a patient is carrying this illness.

mammography is the standard examination for detection of breast cancers or of pre-cancerous lesions at an early, subclinical, i.e. impalpable stage, thus enabling patients to benefit from less intrusive treatments and a better prognostic.

At what age should one have the first mammography?

Normally the first mammography is from around the age of 40,and is prescribed individually by a gynaecologist or GP, and it should be renewed every 2 years. From the age of 50, women are invited to an organized screening every 2 years by their department of residence. The screening can also be organised on prescription. It is of course possible to have the mammography in a neighbouring department rather than that of residence. For example if you live in Seine–et-Marne, you can be invited to have your breast cancer screening in Paris. The screening can begin at a younger age if there are family antecedents, it should begin 5 years before the youngest case of cancer in the family.


What is the frequency of mammographies?

The interval of 2 years was chosen because it constitutes the best compromise between radiation exposure and the cost to the collectivity. Furthemore, the interval is sufficiently close so that if a cancer appeared within this time span, its detection would still be at a sufficiently early stage. When there are family antecedents of the first degree, i.e. mother or sister, or several antecedents of the second degree, aunt, grandmother, the mammography should be done on an annual basis.

Are there risks linked to radiation exposure when having breast cancer screening?
Radiation exposure for a mammography is minimal, whatever type of equipment is employed, as only low-voltage is used.  Digital mammography equipment has reduced radiation exposure even further, and the images taken for each breast reduced to two so as to deliver the strict minimum dosage.

No observations have been mentioned in medical literature of any harmful effects of X rays used for diagnostic purposes. 

Precaution however encourages prudence. If one makes a comparison with the radiation exposure of radiotherapy, (using doses which have no comparison whatsoever to those used for mammographies), no deleterious effect has been observed in the case of radiation exposure to the thorax after the age of 30 (because of the maturation of certain genes) whereas before this age, cases were observed. Concerning the problem of thyroid radiation exposure the most recent Canadian studies have shown that the use of a thyroid shield was not necessary and was even detrimental because it prevented the mammography being conducted in the normal way and repeat X rays were needed (so doses increased), image angles were modified (so losing certain information) for the shield to be seen on the X rays. Furthermore, because the thyroid is not strictly in the X ray radiation field, the quantity of emissions arriving indirectly on this organ is very small and unquantifiable.

(canadian site :www.imagewisely.org).

Why is breast ultrasound so often used in conjunction with a mammography? 

Ultrasound is often combined with a mammography. This examination is not reimbursed under the organized screening programme (but it is covered by health insurance). Nor does it fulfill the requirements of a mass screening programme because it is operator dependant, cannot be subject to quality controls and is none repeatable.

In “trained” hands ultrasound combined with a mammography is the best standard. Indeed, when breasts present a certain density (i.e. a volume of glandular and/or fibrous tissue) up to 30% of cancers are only visible by this procedure.  

That means that a mammography can be perfectly normal and a cancer detected only by ultrasound. The ultrasound is therefore systematically combined with the mammography when breasts present a certain density, in the opinion of the radiographer, and of course when there is some sort of anomaly on the mammography requiring further investigation.  Different anomalies can be diagnosed through this procedure.  


What is the Bi-rad classification? 

A classification was established by the American College of Radiology. This Bi-rad classification corresponds to the following observations:

-If the breasts are classified ACR1, no anomaly has been detected;

If the breasts are classified ACR2 there is an anomaly which is most certainly benign and for which no surveillance or further screening is required.

-If the breasts are classified ACR3 there is anomaly which appears benign but for which surveillance is recommended, or a follow-up examination or an MRI scan for example or even a sample taken  as an extra precaution;

-If the breasts are classified ACR4 then there is an anomaly which requires precise identification with a biopsy (or puncture) because this anomaly could be linked to a cancer

-If the breasts are classified ACR5 then there is an anomaly which is strongly suspected to be of a cancerous nature for which a biopsy could also be carried out, in this case more in the aim of confirming the diagnostic and for pre-therapeutic purpose.

Is a mammography a painful procedure?

A mammography is not a painful procedure, especially when those in charge are experienced personnel who are specialists in this domain. It is uncomfortable at worst. Breasts might be compressed in the mammography equipment because by diminishing the thickness of penetrating tissue, the dosage delivered to each breast is reduced and the resolution, i.e. the quality of the image, is better. It is therefore better to carry out this examination after menstruation, because the  breasts will be less sensitive, thus reducing the risk of  any possible 

discomfort.

 

What is a breast tomosynthesis?

A breast tomosynthesis is a mammography application which generates 3D breast images. It is similar to a mammography except that the X-ray tube moves around during the procedure. The image acquisitions taken from several angles enable 3D reconstruction of cross-sectional images thus overcoming the tissue overlap issues of a conventional mammography. It therefore facilitates breast image analysis by the radiologist and can sometimes detect tumours which are not visible from a conventional mammography. 

 

What does the tomosynthesis differ for the patient?

The tomosynthesis completes the mammography. The only difference for the patient is breast compression which lasts a little longer (several seconds) than for a conventional mammography but this inconvenience is compensated  by the radiologist’s improved analysis of the obtained images.

 

Is the tomosynthesis used for all patients?

Yes, it complements the mammography. The only exception is for those patients with breast prostheses, for whom there would be no benefit.

MICROBIOPSY

This allows the specialist to determine the nature of the anomaly detected by ultrasound. The patient can see the radiologist when the appointment is made so that the latter can explain the procedure.

The biopsy is taken in the radiology practice  ultrasound department with the patient lying on their back.

 

After identification of the puncture zone, the examination begins by cleaning the skin before a local anaesthetic is applied to the area where the sample is to be taken.  

After 5 minutes (the time it takes for the anaesthetic to work) the sample taking will begin using ultrasound guidance. Several samples are taken in order to determine the exact nature of the lesion. 

The examination takes approximately 15 minutes. A waterproof dressing is applied to the puncture area and should be kept on for 24 hours. Bruising may occur in the puncture area. It will gradually reabsorb itself. Painkillers are offered to the patient at the end of the procedure. 

This procedure does not inhibit any normal activity after the biopsy, but any sport should be avoided for a few days. The samples are sent to the laboratory for analysis:

The results are sent to the  GP within around 8 days.

MACROBIOPSY

This enables the specialist to determine the nature of the anomaly detected by mammography but which cannot be seen on an ultrasound. In most cases it concerns micro calcifications.  The patient can see the radiologist when the appointment is made so that the latter can explain the procedure.

If the patient is taking anticoagulants, this should be mentioned to the radiologist who will decide if the procedure can take place or if it should be rescheduled. The biopsy is taken at the radiology practice using mammography guidance and the patient lies on their side. The examination begins with three mammography images in order to identify the  anomaly to be punctured. 

The skin is then cleaned  and  a local anaesthetic  applied to the area where the sample is to be taken.  After 5 minutes, an incision is made and samples can be taken under mammographic guidance.

A mammographic control will be carried out at the end of the procedure to ensure that the samples are sufficient. Sometimes a clip (radio-opaque marker) may be placed on the puncture area at the end of the procedure.

The procedure takes 20 to 30 minutes. A steri-strip is placed on the puncture area to be kept on for 8 days, the time it takes to heal. A waterproof dressing is then applied. This will allow the patient to shower without the puncture zone getting wet. Bruising may occur where in the puncture region. It will gradually reabsorb itself. Painkillers are offered to the patient at the end of the procedure. 

The dressing is checked before the patient leaves the surgery.

This procedure does not inhibit any normal activity after the biopsy, but any sport should be avoided for a few days. The samples are sent to the laboratory for analysis:

The results are sent to the  GP within around 8 days.

ENDOMETRIOSIS

Endometriosis is an illness of the reproductive organs. It is estimated that 20% of women of reproductive age and a third of infertile women are affected. It impacts quality of life, can trigger psychological consequences, and may impact  partner relationships. This illness can spread outside the reproductive organs into other organs.

What are the usual symptoms?

- very painful periods  and/or sexual intercourse, getting worse over time:

- difficult bowel movements or in urinating especially during menstruation.

It is of vital importance to undertake a full medical examination in the case of this illness, using both clinical examination and imagery in order to determine an appropriate treatment plan; if surgery is necessary this must be completed in one operation by a highly specialised and pluri-disciplinary surgical team combining surgeons from gynaecological, digestive and urological specialities.

How is endometriosis diagnosed?

Using imagery, which is sometimes combined with an echo-endoscopy.

Imagery is a fundamental part of the diagnosis and should be carried out by a radiologist specialised in endometriosis. In CIMI, this is under the responsibility of Dr Marie-Annick DARCHEN and Dr Erick PETIT.

1. Pelvic Ultrasound is the first examination to be undertaken. Performed trans vaginally, it can sometimes exacerbate a patient’s pain but it is essential. 

2. The above is often combined with a Pelvic MRI Scan.

This procedure does not require any forward preparation, nor is there injection of any contrast agent and is completely painless. 
3.Sometimes, when the digestive tract is affected, a virtual colonoscopy using water is also needed (scanner undertaken with water enema associated with intravenous injection of an iodized colour contrast agent). This examination can be quite uncomfortable especially the moment when water passes through the rectum, but this is fleeting discomfort and the procedure is very quick, 
only lasting a few minutes. Normal activity can be resumed immediately following the examination. 

For more information:

The association www.resendo.fr combines medical and paramedical specialists.

Two endometriosis patient associations : 

EndofranceMon endo Ma souffrance

Rectal-echo-endoscopy
The patient’s file is studied during a pluri-disciplinary meeting (radiologist, surgeons, gastroenterologist). If surgery is required, it is advised to the patient. Sometimes another examination may be necessary, a rectal-echo-endoscopy, if there is a suspicion that the digestive organs are affected. It should be undertaken as near as possible to the date of surgery.  The procedure is carried out under general anaesthetic by Dr Olivier MARTY (Clinique du Louvre, Clinique de l’Alma and Hospital Saint Joseph), gastroenterologist and endometriosis specialist.


Can endometriosis affect fertility?
Yes, and it concerns around one patient out of every four suffering from endometriosis. When fertility issues are of primary importance and the patient is otherwise not suffering from any great pain, medically assisted reproduction techniques (ART) can be used, with very good results.

What solutions are there?

-In the case of extreme pain and/or infertility

pluri-disciplinary, specialist surgery by laparoscopy has, in our experience, obvious beneficial effects. Reducing pain in nearly 100% of cases and, in one out of every two cases, obtaining a non-assisted pregnancy after surgery.

-If there is more moderate pain and no immediate concern for 

fertility,  simple hormone therapy is advised, which is, essentially, continuous progesterone, making menstruation cease. This treatment can be sometimes be sufficient to dissipate all clinical symptoms. 

Who are the specialist medical team?

At CIMI :

- Dr Erick PETIT, radiologist specialising in Women's Imaging,Assistant Medical Director and Head of the Women’s Imaging unit of the Medical Imagery Department of Hospital Saint-Joseph, co-Director and founder of the Endometriosis Centre 

- Dr Marie-Annick DARCHEN, radiologist specialised in Women’s Imaging,

At Hospital Saint-Joseph : (Endometriosis Centre)
- Dr Erick PETIT (Women’s Imaging unit of the Medical Imagery Department),
- Dr Virginie ANDRE, gynaecologist
- Dr Olivier MARTY, gastroenterologist specialised in endometriosis
- Dr SAUVANET, Dr AFRIAT, Dr GIRARD and Dr LORIAU, gynaecological, urological and digestive surgeons,
- Dr Delphine LHUILLERY, specialist in pain management.

CONE BEAM

Cone beam is a new dental imaging technique which gives results similar to a scanner but with less radiation exposure.

The most recent Cone Beam units provide an imaging quality equivalent to, or even better than that of a scanner for studying teeth.  

What kind of examination is this?

The procedure takes place with the patient upright, in a very similar manner to that of a standard dental panoramic image.

The only difference is the length of the procedure varying between 5 and 15 minutes depending on the number of teeth to be studied.

The equipment carries out one to three rotations around the patient’s head so as to obtain 3D imaging. 

The results are available on average within 48 hours, the time necessary for the radiologist to study the images obtained on the three planes.

The results are obtained partly on film as well as on CD with integrated visualisation software.

MEMORY DISORDERS

With the increase in life expectancy and medical progress, illnesses causing cognitive disorders like Alzheimer’s are very much on the increase. These pathologies have enormous impact both socially and economically.

Those disorders inciting the patient and/or their entourage to consult a doctor are mostly those concerning memory, language skills or behaviour. Early detection of any organic pathology at the origin of these symptoms offers the patient the best chance of anticipation, prevention and cure.

It is even now possible to detect anomalies long before the appearance of the first symptoms by measuring (by lumbar puncture) AB and Tau proteins in the cerebral-spinal liquid, by MRI scans and by refined neuro-psychological tests.


Memory disorders are, for example, often the result of a simple case of overwork, or mood disorders (depression) or can be linked to certain medication…

They can, on the other hand, be a sign of a degenerative disease which has either appeared or is in gestation but has not fully developed,  (like Alzheimer’s, fronto-temporal and semantic dementia, primary progressive aphasia or subcortical dementia) or which can be linked to vascular pathologies concerning either cerebral micro-circulation (arteriosclerosis) or cerebral circulation concerning the larger vessels.

Lastly, these disorders can  indicate rarer illnesses, (hydrocephaly, amyloid angiopathy), tumours or other illnesses with cerebral tropism.

The first step of any check-up is a clinical examination combined with a neuropsychological evaluation in order to objectify the organicity of the disorders, quantify them and then to establish the first steps to diagnosis. Magnetic Resonance Imaging of the brain will enable the doctors to complete this diagnosis by exploring the regions concerned by these degenerative and vascular disorders.

Once this check-up is complete, the patient can be directed to the appropriate services, be monitored and treated if necessary.

 
 
 
 
 

BONE DENSITOMETRY SCAN

 

The bone densitometry scan  is a radiological procedure designed to measure the mineral content of the bone per unit area (g/cm2).
 

Its aim is to look for signs of osteoporosis which is characterized by  bone calcium deficiency which  in turn increases the risk of fractures.

The equipment measures the bone density of the hips, thighs, and spine using very low dose X-rays.

How is this procedure performed?

No particular preparation is required. The patient lies down on a scanning table, generally on their back.

The X-ray tube moves along slowly above the patient who must simply remain still and breathe slowly.

The procedure only lasts a few minutes and afterwards the radiologist will comment on the results.

SCANNER

 

The scanner, also called a CT scan, is a procedure which examines areas of the body the using X-rays.

Its aim is to produce 3D images of the area to be examined. Instead of being a conventional fixed piece of X-ray equipment,  this X-ray tube will move around the patient during image acquisition, and, with the help of very advanced computing capabilities, cross-sectional images are obtained. Depending on the type of procedure, an injection may be given of an iodine-based contrast  dye. 

The scanner room consists of :

- a ring inside which is the X-ray tube

- a scanning table on which the patient lies and which will move into the inside of the ring

- the control panel behind which sit the medical team

 

Precautions to be taken before the procedure

When the appointment is made, you will be told if you need to buy the contrast dye. In this latter case you will be provided with the pharmacy prescription. There may also be premedication to take if you are allergic to contrast dyes. 

You should tell your doctor if you are pregnant or if you think you may be pregnant so that precautions may be taken.

Do you need to have an empty stomach?

No, an empty stomach is not necessary. For some procedures however you should only eat a light meal beforehand.

How is the CT scan performed?

Before the scan

The radiographer is the person who will carry out the scan and they will come and find you in the waiting room.

They will lead you into a cubical and ask you to take off your watch, jewellery and any metallic objects (glasses, dentures, credit cards, telephone)

The radiographer may also ask you to remove certain items of clothing.

In some cases they may insert a drip but this all depends on the type of procedure.

You will enter the scanning room and the scanning procedure will be explained.

You will then lie down on the scanning table.

 

During the scan

 The scanning table moves inside the ring before the sequences begin. The radiographer will communicate with  you from the control panel. They tell you when the image acquisitions will begin and may sometimes ask you to hold your breath. The table will move around slowly during the first sequence. 

A contrast dye may be injected into your vein after the first sequence. This product may trigger a sensation of intense heat throughout the body and occasionally leave a metallic taste in your mouth. One or several aquisitions will then be taken.

The procedure only lasts a few minutes.

 

After the scan

The scanning table emerges from the ring and the drip is removed. The radiographer will take you back to your cubicle. You will then see the radiologist who will explain the results of the procedure and will give you the full medical report.

IRM

 

An MRI scan, otherwise known as magnetic resonance imaging, is a procedure which explores one part of the body (head, spine, stomach, joint) not with X-rays but using a magnetic field  (magnet) and (radio) short waves.

The principal behind it consists in harnessing properties of the hydrogen atoms in the human body. If placed in a strong magnetic field, the atoms all align in the same direction, then, as they are excited by the radio waves, they resonate. When the radio waves are turned off, the atoms release the accumulated energy and transmit a signal which is then recorded, located and processed in order to provide an image of the body area explored.

The MRI scan is a painless procedure which lasts anywhere from between 20 to 45 mins. 

 

What precautions should be taken before this procedure?

No specific preparation is required, nor it is necessary to have an empty stomach.

You should tell the doctor :

 

  • If you are pregnant, or think you might be pregnant so that precautions may be taken

  • If you have a pacemaker or any implanted electrical device.  In these cases the procedure is not recommended as such devices may malfunction.

  • If you are carrying any kind of metallic object  (ocular implant, protheses, surgical clips, metallic fragments in the eyes…). Also in these cases the procedure is not recommended, as any metallic fragment might be displaced by the magnetic field.

  • If you are claustrophobic.

 

How is  an  MRI scan performed ?

 

Before the scan

The radiographer is the person in charge of the procedure and they will come to find you in the waiting room.

 

They will lead you into a cubical and ask you to take off your watch, jewellery and any metallic objects (glasses, dentures, credit cards, telephone)

The radiographer may also ask you to remove certain items of clothing.

In some cases they may insert a drip but this all depends on the type of procedure.

You will be asked to enter the MRI room and the procedure will be explained.

A friend or family member can stay with you if required.

You will lie down on the scanning table and the radiographer sets up a receiver frame around the area of your  body to be examined and may place cushions to help you maintain your position.

He will give you a buzzer which you can use should you feel unwell.

The equipment will make alot of noise during this procedure and the radiographer will give you ear plugs or heaphones to listen to music.

He may insert a drip.

 

During the scan

The table will slowly enter the tunnel. The latter is open at both ends. The tunnel is narrow but is lit inside and you will be able to communicate with the radiographer during the procedure or call for help using the buzzer. When you are ready, the radiographer leaves the room  to begin the procedure. A friend or family member may stay with you in the scanning room itself, if required.

During the scan, the equipment makes a noise like a pneumatic drill. The noise will stop during sequences then start again several times over. You should stay still throughout the procedure. In certain cases, the radiographer will inject a product into the drip which triggers a sensation of extreme heat throughout the body.

 

After the scan

At the end of the procedure, the table emerges from the tunnel. The radiographer will remove ear plugs or head phones. They will take you back to the cubicle where you can get dressed again and collect your belongings. The radiologist will then see you to explain the results of the procedure and give you the full medical report.