Rad Idea: CEM Offers Fast MRI

By Jaimee Herchler & Jill Gullett

University Hospitals of Cleveland is proud to be one of the only hospitals in North East Ohio to offer patients Contrast Enhanced Mammography (CEM). 

Contrast Enhanced Mammography (CEM) is a supplemental imaging exam that combines radiation and contrast dye, similar to that used in a CT scan, to capture images of the breast. This new technology is used to improve the detection of breast cancers. This has been shown to be beneficial for those with a newly diagnosed breast cancer, those with dense breast tissue, and patients who are unable to have a breast MRI.

How it Works

An intravenous (IV) line is placed in the arm and the contrast is given through the IV line. After the contrast has been administered, the procedure is similar to a regular mammogram. Two pictures of each breast are obtained, although more pictures may sometimes be needed. The process takes approximately 10 minutes from start to finish.

Following the exam, a radiologist will interpret the images and determine whether additional imaging tests are necessary or if a breast biopsy should be performed. The radiologist can help answer any questions a patient may have.

The contrast dye is naturally absorbed and excreted by the body. 

Benefits and Risks

There are several benefits of CEM. It is safe and faster than a breast MRI. It is effective at detecting cancers, particularly highlighting cancers that may be masked on a regular mammogram or breast ultrasound. It is especially useful for individuals with extremely dense breast tissue, where cancers can be hidden 

With benefits come risks. CEM utilizes radiation for imaging which is slightly more than a standard four-picture mammogram but still within safe limits. Patients with kidney disease may not be able to have the test. While allergic reactions to the dye are rare, the most common reactions are mild, such as hives. CEM is not recommended for individuals with known allergies to contrast dye, those who are pregnant or breastfeeding, or individuals with kidney problems.

Preparing a Facility for CEM

CEM requires additional software and hardware (addition of a copper filter) upgrade to the mammogram machine as well as a power injector for the contrast injection. A crash cart and contrast reaction kit should also be easily accessible by all staff. 

Staffing requirements included pre- and post- procedural education to include IV placement, standardizing response to contrast reactions, familiarizing technologists with machine settings and use of the power injector. A radiologist or other licensed physician must also be present in the facility to evaluate and treat any contrast associated reaction. 

Establishing protocols and a workflow along with proper education and training is essential to a successful program.

With an engaged leadership team and appropriate planning, the implementation of CEM has been worth the effort for University Hospital and one that patients and providers have appreciated. •

Jaimee Herchler is a Radiology Supervisor at University Hospitals St. John Medical Center. Jill Gullett is a Breast Center Supervisor at University Hospitals Cleveland Medical Center.

Share your RAD IDEA via an email to editor@mdpublishing.com.