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Case 44 Answer
Implant patients should have MLO and CC whole breast and implant-displaced views (thus 4 views of each breast instead of 2). This can be performed as either a screening or diagnostic exam. It obviously takes longer and costs more to perform and read, but as of this writing (7/2002) mammography of patients with implants is not reimbursed any more than a patient with no implants.
At this time, screening ultrasound is not recommended by this author; however, there are some published studies which support screening ultrasound which remain debated in the literature (Kolb T, Gordon P). Because of the user-variability of ultrasound, both in time of examination and expertise of interpretation, this practice may or may not be feasible in your clinical setting.
What about these implants?