Attachment 2: Labeling of Mammograms
Mammography films are important medical documents. Standardized labeling of mammography films is important to ensure that films are not lost or misinterpreted. The following labeling guidelines are presented in three groups: (1) those that are required under the MQSA Final Rules, (2) those that are strongly recommended but are not required under the federal rules, and (3) those that are recommended but not required under the federal rules.
Required- A permanent identification (ID) label which contains at least the following information:
- Facility name,
- Facility location (at a minimum, the location shall include the city, state and ZIP code),
- Patient name (first and last),
- Additional patient identification number (e.g., medical record number or social security number; date of birth is less desirable), and
- Date of the examination.
- Radiopaque markers indicating laterality (R/L) and projection/view (MLO, CC) placed near the aspect of the breast closest to the axilla. These radiopaque markers should be placed on the cassette holder so that they can be read directly from overhead. They should not be so large as to be distracting but large enough to be clearly read. Standardized abbreviations for mammography views have been developed, and these should be employed to eliminate confusion from one facility to another.
- The technologist who performed the examination must be identified on the image. Technologist identifiers, such as unique initials, should be placed either on a designated place in the patient ID area or with radiopaque letters on the cassette holder. The facility should maintain a log of the technologists and their identifying initials.
- Cassette/screen identification (usually designated by an Arabic numeral written or pressed on screen). This is used to identify screens with artifacts or defects.
- Mammography unit number (or other unique identifier) if there is more than one unit in the facility. This is usually a Roman numeral.
A "flash card" patient ID system is strongly recommended because it is the most permanent. An advantage of flash labels over stick-on labels is that flash labels reproduce on copy films. The ID should fit squarely in its designated space, near the edge of the film. A flash system is not acceptable if any information is illegible, does not fit, or is lopsided, causing cut-off of information. If the flash system does not meet these requirements, the radiologist should request the film manufacturer's help in putting together a satisfactory one.
Recommended
Separate date stickers. These stickers allow for the date to be easily read with overhead light. They can be color-coded by year to facilitate the sorting of examinations.
Technical factors used. These include target-filter combination, kVp, mAs, exposure time, compression force, compressed breast thickness and degree of obliquity.
Except for view and laterality, labels should be placed as far as possible from the breast so as not to distract from evaluating the breast image. Collimating close to the surface of the breast is not recommended because light transmitted through clear areas of the film adversely affects film viewing. Collimating close to the edge of the breast does not significantly improve image contrast since there is virtually no X-ray scatter from air. Therefore, collimation should be to the edge of the film so that as much of the film as possible will be exposed.