What is Breast Imaging Radiology Like?

Session 105

There are no typical days in radiology. Dr. Anjali Malik joins me to talk about breast imaging, guided biopsy, and what it means to develop a diagnostic “eye.”

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Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points.

[01:25] Interest in Radiology and Breast Imaging Radiology

Anjali's interest in Radiology and Breast Imaging Radiology happened at the same time during her internal medicine rotation. After reading the book, Felson's Primer for Chest Radiology, this made her realize that the whole science of imaging was far more interesting than she knew it could be.

Immediately after internal medicine rotation, she worked with a breast surgeon in a community setting, particularly in New Orleans (prior to Hurricane Katrina). Post-Hurricane Katrina, he came to Tulane University and tried to recreate the heavy breast surgery practice. She had seen a lot more breast surgeries than an average surgery medical student did.

That being said, she was exposed to the breast surgery population. She likes the pathology, the patients, and procedures. However, she didn't want surgery or do 5 years of general surgery to go on to breast surgery. So her mentor pointed her to the direction of breast imaging radiology at Tulane.

Anjali also has a background in public health and did her BA in Public Health at Johns Hopkins. She feels every part of the field spoke to her.

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[05:25] Traits that Lead to Becoming a Good Breast Imaging Radiologist

Anjali points out that to be a good breast imaging radiologist, you have to be cerebral and have problem-solving skills and spatial awareness. You have to be patient and observant. Having a good eye is also helpful.

As much as pattern recognition is important, you should also be patient, thorough, and be able to direct a surgeon on they should approach the case.

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[06:30] Types of Cases

In breast imaging radiology, you're screening for breast cancer. Possible cases include invasive, ductal or ductal carcinoma in situ, or lobular carcinoma, papillary carcinoma, and the occasional medullary or mucinous carcinoma.

They basically diagnose all sorts of system and processes within the breast. They regularly diagnose lymphoma via the axillary lymph nodes seen on screening mammograms.

Sometimes, within the breast, they see an enlarged lymph node and are able to provide a primary diagnosis on something not known.

Other cases they diagnose include tuberculosis, sarcoidosis, and amyloidosis. They also deal with the more benign things that happen within the breast like fibroadenomas in young, reproductive-aged females. Lactating females can get lactational adenomas, galactocoele, mastitis, etc.

Outside of being breast imaging radiologist, Anjali practices general radiology.  She's doing body ultrasound on a daily basis. Some cases she sees are nodules, ovarian cysts, fibroids, and cancer of all of the above organs.

For her, being able to use imaging as a tool has shaped medicine and she's excited to see more of what will come.

[08:30] Typical Day

Anjali describes having no typical day as it varies day-to-day. Even if she does the same thing in theory everyday, every patient presents something new