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Breast ultrasound has become an essential tool for the breast surgeon. Traditionally, however, it has not been a part of the general surgical curriculum, and many practicing surgeons are still struggling with how to incorporate breast ultrasound into their practice. This chapter will outline the steps to facilitate this transition.

The minimum requirements for a functional breast ultrasound machine are listed in Table 32-1. Fortunately, because of recent advances in software, solid-state circuitry, and probe technology, machines that are more sophisticated are now available, and a more suitable choice of features would include some of the additional features listed. The most important aspect of the machine itself is the probe, which ideally would be a multifrequency 8 to 14 MHz linear array probe (although a 7.5-10 MHz probe will also work well). Today, almost any unit that will accommodate this type of probe will include the other features required for high-quality scanning.

Table 32-1 Requirements for a Breast Ultrasound Machine

Other requirements include a large, high-quality black and white display, or color display if color Doppler is available, and the ability to record information about the scan on the recorded image, including patient name and/or unique identifier, the date, the location of the scanned image as an icon or text, as well as other information about the mechanics of the scan (depth, Time-Gain Compensation settings probe MHz, and frame rate). Ideally, the machine would allow for digital storage of images in addition to the standard printer port for creation of small black and white glossy prints.

For most surgeons, the main criterion for deciding which machine to purchase is whether the unit needs to be portable. This is important because it is essential to have access to a suitable high-quality unit in the operating room. Although many hospitals have ultrasound equipment available for use in the operating room, the unit may be cumbersome to transport from the radiology department, or, if already available in the operating suite, may not have a suitable probe for breast scanning. The availability of intraoperative ultrasound is important not only for margin assessment and localization of nonpalpable lesions, but also because it provides an excellent venue to develop and to continue to improve ultrasound skills. The ability to visualize gross anatomic and pathologic findings minutes after performing a scan provides immediate feedback about interpretation of the study and ...

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