Choosing a mammography facility

You can go many places to get a mammogram-breast clinics, radiology departments of hospitals, mobile vans, private radiology practices, doctors' offices. Your doctor can arrange for a mammogram for you, or you can schedule the appointment yourself.

It is important to choose a facility carefully, however, because quality can vary widely from one place to another. One good way to tell if a facility measures up is to find out if it is accredited by the American College of Radiology (ACR).

Facilities accredited by the ACR have their equipment, personnel, and procedures evaluated and approved. To be accredited, facilities must have doctors and other staff members who have been specially trained to perform and interpret breast x-rays. They also must have equipment capable of producing high-quality mammograms with the lowest possible amount of radiation exposure. And they must perform mammography regularly and frequently.

To find out if a facility is ACR-accredited, you can ask to see its ACR certificate, or you can call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

The ACR program is voluntary, and not all high-quality facilities have yet been accredited. If you are considering a facility that is not ACR-accredited, you will want to be sure that your mammogram will be taken with the proper equipment and that the people who take the x-rays and those who check them are properly trained.

The following questions will help you in making your selection. Don't hesitate to call and ask these questions before you make an appointment. A qualified facility should have staff able to answer your questions easily. Choose one whose staff answer "yes" to all of them.

Q. Does the facility use machines specifically designed for mammography?

A. These are called "dedicated" mammography machines. You should not choose a facility that x-rays the breast with a machine used to take x-rays of the bones and other parts of the body.

Q. Is the person who takes the mammograms a registered technologist?

A. Mammographic technologists are trained to position the breast correctly to get a good image. They should be certified by the American Registry of Radiological Technologists or be licensed by the state.

Q. Is the radiologist who reads the mammograms specifically trained to do so?

A. The mammograms should be read by a board-certified radiologist who has taken special courses in mammography.

Q. Are mammograms a regular part of the facility's practice?

A. Studies have shown that facilities performing large numbers of mammograms are likely to comply with many quality standards. The ACR suggests choosing a facility that performs at least 10 mammograms each week.

Q. Is the mammography machine calibrated at least once a year?

A. The machine should be checked by a radiological physicist and adjusted as necessary to be sure that its measurements and doses are correct.

In addition to quality, another important consideration is cost. Most mammograms cost between $50 and $150. More than 40 states now have laws requiring health insurance companies to reimburse all or part of the cost of screening mammograms; check with your insurance company. For women 65 and older, the federal Medicare program pays some of the cost for screening mammography once every 2 years.

Some health service agencies and some employers provide mammograms free, or at low cost. Low cost does not mean low quality, however. A large government survey found that some of the facilities charging the lowest fees (often because they deal in large volumes) were among the best in terms of complying with high-quality standards.

Your doctor, local health department, clinic, or chapter of the American Cancer Society, as well as the Cancer Information Service, may be able to direct you to low-cost programs in your area.