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How to Become a Mammographer – The Complete Guide

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Becoming a Mammography Technologist

In radiography, mammography is considered a sub-specialty, and several prerequisites have to be met before considering a mammography certification. Before you are eligible to become a certified mammography technologist, you must first be licensed or registered to practice as a radiologic technologist. Then, you can pursue a post-primary path to mammography certification.

Joining the Mammography Registry

If being a mammographer is your long-term career goal, you first have to train to be a radiologic technologist. Radiologic technologists capture x-rays of internal organs, bones, and soft tissues and assist radiologists in various procedures. To become a radiologic technologist, certain requirements have to be met.

What degree do you need to become a mammographer?

An associate’s degree is required to seek credentialing as a radiologic technologist, and you cannot become a mammographer without it. Your associate’s degree must come from an ARRT recognized institution, so make sure you do your research before enrolling. This degree does not have to be in radiology, and you can earn it before or after a radiological studies program, but you must receive the degree before sitting for the ARRT exam for radiology technicians.

Why do you need a degree?

Associate’s degrees provide general education courses that help you learn and grow as a mammographer and adjust to changes in technology and guidelines throughout your future career. Obtaining a degree teaches important communication and analytical skills and helps shape an understanding of human behavior that is invaluable to your role as a radiologic technologist and mammographer and how you interact with and support your patients.

What other education do you need for certification?

To become a radiologic technologist, you also need to complete specific education requirements for the certification you’re pursuing. A lot of programs combine an associate’s degree with the classes required to be a qualified radiologist, so it’s possible to complete both at the same time. At the end of this coursework, you have three years to apply for certification and registration. After this is completed, you can work as a radiologic technologist and begin pursuing mammography.

How long does it take to be a mammographer?

The time table to becoming a mammographer varies depending on how you choose to pursue the certification. Most associate’s programs that fulfill the requirements for certification as a radiologic technologist take about two years. After you complete the initial radiologic technologist certification, you can begin the additional education required to sit for the mammography exam.

If you are already a practicing radiologic technologist, the process is much shorter. Generally, course work and clinical experience can be completed in two years, possibly less depending on whether or not you are working while pursuing the certification. After these things are completed, you can sit for the mammography exam and start the next chapter of your career.

Education Requirements

There are precise educational requirements for certification and registration in mammography. This helps you master the specific knowledge needed not only to pass the exam, but also to perform as a skilled and knowledgeable mammographer.

Education requirements include completing 40 hours of didactic training, completed in the 24 months before you apply to take the exam. These courses must be ARRT-approved credits and must span three categories: patient care, including patient interaction and management; image production, including image acquisition and quality assurance; and procedures, including anatomy, physiology, and pathology, mammographic positioning, special needs, and imaging procedures.

You do have the flexibility to choose the classes that make up the required 16 credits. The only requirement is you must have at least one credit covering each of the main topics of patient care, image production, and procedures. For example, you can take one credit each of patient care and image production and get the remaining 14 credits from procedures, or take five credits about patient care, six about image production, and five in procedures. That said, as these educational requirements also inform the information on the certification exam, it is a good idea to focus on a broad number of topics instead of sticking with one category. Per ARRT, each of these categories includes specific topics, and you don’t want to overlook anything.

Patient care encompasses patient interactions and management, including:

  • Patient communication, including pre-exam instructions, explanation of the procedure, and patient education.
  • Patient assessment of breast cancer risks and the implication for imagining, including the epidemiology of breast cancer, including incidence and risk factors; signs and symptoms of breast cancer; documentation of medical history and clinical findings; and the importance of previous mammograms.
  • Breast cancer treatment options, covering surgical options, non-surgical options, and reconstruction.

Image production covers image acquisition and quality assurance and covers topics like:

  • Design characteristics of mammography units, including digital mammography, kVp range, mammography tube, compression paddles, grids, and system geometry.
  • Digital acquisition, display, and informatics, including acquisition type, image receptors, monitors, digital image display and informatics, and computer-aided detection.
  • Quality assurance, covering accreditation and certification and MQSA regulations.
  • Quality control, encompassing mammographer tests with a focus on purpose, frequency, equipment and procedure, performance criteria, and corrective action; and medical physicist tests, focusing on purpose and frequency.
  • Mammographic technique and image evaluation, covering technical factors and evaluation of image quality.

Procedure encompasses multiple areas of education, including anatomy, physiology, and pathology. It covers the following topics:

  • Localization terminology, covering clock position, quadrants, and triangulation.
  • External anatomy, including breast margins, nipple, areola, angle of pectoral muscle, skin, axillary tail, and inflammation fold.
  • Internal anatomy, including fascial layers, retro mammary space, fibrous tissues, glandular tissues, adipose tissues, Cooper ligaments, pectoral muscle, vascular system, lymphatic drainage.
  • Cytology, which covers epithelial cells, myoepithelial cells, and basement membrane.
  • Pathology, including mammographic appearance and reporting terminology; benign pathology and mammographic appearance, high-risk pathology and mammographic appearance; malignant pathology and mammographic appearance.

Mammographic positioning, special needs, and imaging procedures are also included under the umbrella of Procedures and include these subjects:

  • Views, including craniocaudal, mediolateral oblique, mediolateral, lateromedial, and more.
  • Special patient situating, which covers chest wall variations, irradiated breasts, male breasts, post-surgical breasts, lactating breasts, and more.
  • Imaging examinations, like mammography, breast ultrasound, breast MRI, and sentinel node mapping.
  • Interventional procedures, including informed consent; procedures and associated imaging; and handling and disposing of biohazardous materials.

As you can see, there is a wide range of subject matter to cover when pursuing the necessary education to become a mammographer, which is one reason why it is considered a specialty in the field.

Clinical experience requirements

Before becoming certified as a mammographer, there are specific clinical guidelines that have to be documented. Clinical experience is a hands-on way to verify that those preparing for a career in mammography have the fundamental knowledge and skills necessary to be successful in their career.

The activities required during the clinical experience are determined by analyzing the job responsibilities of mammographers currently practicing. An advisory committee then takes these tasks and determines the number of each type of procedure you have to perform during clinical.

Candidates for mammography registration are required to document 100 repetitions of various procedures according to the following criteria:

  • You must meet the qualifications of the Mammography Quality Standards Act, including the completion of 25 supervised mammography procedures.
  • You must perform 75 mammographic procedures, screening or diagnostic, in addition to the 25 required by the MQSA. These can be done using any modality, but they must be performed on a patient, not in a simulation.
  • The following tasks must be done with every procedure:
    • Familiarize patients with the equipment and provide for their comfort and cooperation by acting with compassion and providing psychological support.
    • Obtain and record clinical history as it is relevant to the performance and interpretation of the procedure being performed.
    • Document lumps, moles, scars, and so on with markers on the break or create a diagram on a clinical information sheet.
    • Answer patient questions about multiple topics, including the need for additional imaging and guidelines for mammography screening.
    • Select the appropriate equipment for the patient and the procedure.
    • Choose appropriate exposure factors depending on breast tissue density, patient’s age, equipment characteristics, and numerical compression scale.
    • Document projection used and breast imaged.
    • Position patient and equipment appropriately according to protocol or requisition.
    • Evaluate the images for quality and proper identification.
  • You must perform quality control following manufacturer’s recommendations, including evaluation and recording, with documentation including
    • Interpretation workstation
    • Monitoring cleaning
    • Phantom images
    • Artificial evaluation
    • Signal-to-noise ratio, as required by the manufacturer
    • Contrast-to-noise ratio, as required by the manufacturer
    • Modulation transfer function, as required by the manufacturer
    • Compression force
    • Repeat analysis
    • Visual checklist
    • Review of medical physicist’s annual survey report
  • You must review at least 10 procedures with a certified physician for evaluation of anatomy, positioning, technique, and pathology
  • You must assist with, observe, or participate in four of the following:
    • Needle localization
    • Breast MRI
    • Breast ultrasound
    • Stereotactic procedure
    • Breast implant imaging
    • Ductography or galactography
    • Tissue marker clip placement
    • Diagnostic mammogram
    • Recall from a screening mammogram

Exemptions may be granted if you are unable to meet all of the requirements due to the limitations of the facility, though official requests have to be made explaining the situation and why an exception is necessary. To receive an exemption, you must also provide documentation and a source of information for an educational opportunity done in place of the requirement.

There are also limits to the number of experiences you can report for each day, and each must be recorded and verified online using the appropriate clinical experience tool. Studies show that short experiences over a long period are more effective than long experiences over a shorter time, so only so many procedures may be officially documented in a day. For mammography, you can record as many as 16 experiences a day. This does not mean that you should only perform 16 mammograms a day, only that 16 can be officially counted.

The clinical portion can take a while if you are trying to fit in clinical days around a work schedule, but this part of the preparation for the exam can usually be completed in a few months.

Mammography Certification

After getting certified as a radiology technologist and completing the required education and clinical requirements for the mammography, you can seek certification.

How do I get certified as a mammographer?

To get certified as a mammographer, you have to pass the certification exam. This exam is usually taken online at a cooperating testing center. You will receive an official score report within four weeks of the exam date. If you do not pass, you are given three attempts to pass the exam within three years.

Mammography exam

The mammography exam assesses the knowledge and skills needed to perform entry-level tasks as a mammography technician. The topics covered refer back to the same task inventory used during clinical experiences. This exam is 140 questions long, including 25 unscored pilot questions. The breakdown of scored questions is as follows:

  • Patient care – 14
  • Image production – 33
  • Procedures – 68

Specific topics that the exam covers includes:

  • Patient communication, including pre-exam instructions, explanation of procedures, establish rapport, providing comfort, addressing limitations, and providing education.
  • Patient assessment, covering the epidemiology of breast cancer, including incidence and risk factors; signs and symptoms; documentation of medical history and clinical findings, and relevance of previous mammograms.
  • Breast cancer treatment options, including surgical, non-surgical, and reconstruction.
  • Image acquisition and quality control, including design characteristics of mammography equipment; digital acquisition, display, and informatics; quality assurance and evaluation; quality control; and mammographic technique and image evaluation.
  • Anatomy, physiology, and pathology, which covers localization terminology, external anatomy, internal anatomy, cytology, and pathology, which covers mammographic appearance and reporting, characteristics of masses, characteristics of calcifications, and BI-RADS categories.
  • Pathology also includes benign, high risk, and malignant pathology and appearance on mammography.
  • Mammographic positioning, covering views, special patient situations, imaging examinations, and interventional procedures.

Mammography registry

After you have passed the exam, you are then qualified to work independently as a mammographer. Certificates of completion from your coursework and documentation of 25 mammograms must be available for the MQSA to review. Keep this information on file at the mammography facility you’re working in and make sure you have a copy for your records.

Maintaining certification

After you have received your mammography certification, you have to meet certain requirements to stay actively qualified. You must complete 15 continuing education credits every three years, and maintain records of when you completed them. MQSA inspectors will verify that you have met this requirement.

You also have to perform 200 mammograms every two years to fulfill the required clinical aspect of certification. These should be documented by the manager of the facility you’re working in and provided to you or an MQSA inspector upon request.

How Much Do Mammographers Make an Hour?

How much you will make as a mammographer depends on a lot of factors, including where you live. Although income information for mammographers is not specified, according to the Department of Labor Statistics, radiologic technologists in California make about $41.40 an hour for a yearly salary of $86,000. In Mississippi, the average hourly wage is $22.91 an hour or about $47,600 a year.

Why Becoming a Mammographer Is Worth the Investment

Becoming a mammographer takes a lot of time. Before you can even consider it, you have completed the requirements for becoming a radiologic technologist, including obtaining an associate’s degree and passing a certification exam. After you can practice independently as a radiologic technologist, you can begin pursuing the educational and clinical experience required to sit for the mammography exam.

Is it worth it?

Mammography aids in the early detection of breast cancer and has saved countless lives. Since 1990, it has helped reduce the number of breast cancer deaths by almost a third.

Being a mammographer makes you a key player in the detection and treatment of breast cancer. Plus, you get to be there for the people who have to cope with this devastating diagnosis, helping them feel calm during the procedure and giving their doctors the images they need to diagnose the disease and develop a suitable treatment plan.

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