Contrast-enhanced spectral mammography (CESM)

Read our guide below which esplains about a contrast enhanced spectral mammography test (CESM)

You can also download a PDF version of this patient information by following the link on the right.

What is a contrast enhanced spectral mammography test (CESM)?

It’s a type of mammogram (breast x-ray) carried out using a special dye (contrast media) which shows up on x-rays.

This examination highlights any areas of concern in your breast.

We inject a dye into a vein immediately before the mammogram images are taken.

The images will give our specialist doctors (radiologists) more information about your breast condition.

Pregnancy and contrast media

If there’s any chance of you being pregnant, tell the radiographer before the scan.

It could result in the scan being cancelled, re-arranged or an alternative examination being untaken.

What happens during the CESM procedure?

We’ll explain the procedure in detail to you to ensure you’re happy to go ahead with the examination. Please feel free to ask any questions.

You will be asked to complete a health questionnaire before you come into the examination room. This is to ensure that you have no health issues that would prevent you from having a CESM examination.

What happens in the x-ray room?

We’ll ask you to sit down and make yourself comfortable. We’ll put a tight band (tourniquet) around your arm and insert a small plastic tube (cannula) into a vein usually in the crease of your elbow or back of your hand. This shouldn’t be painful, but you will feel a sharp scratch.

Once the cannula’s in place you’ll have an injection of the x-ray dye. This may make you feel:

• a bit warm
• like you’re wetting yourself
• like you have a metallic taste in your mouth.

This is quite normal and nothing to worry about.

What happens during the mammogram?

The radiographer will ask you to remove your gown and will position you for your mammogram. Your breasts will be placed onto the mammography machine and compressed firmly with the plastic plate on the machine. This may feel a little uncomfortable, but it only lasts for a few seconds. The compression is important as it keeps the breast still and helps us to get clearer pictures.

If you have tender breasts, tell the radiographer before the compression.

After your mammogram with the cannula still in place, we’ll ask you to wait until we check the images. Once this is done we’ll remove the cannula.

What are the risks of CESM?

Mammography uses x-rays to produce an image of the breasts.

Radiation

All x-rays involve radiation, but the amount of radiation used in mammography is very small. It’s equal to the amount of natural radiation we all get from the environment over a couple of months.

The amount of radiation in CESM is slightly higher than for a normal mammogram but is still well within the accepted safety limits. The radiation dose is equivalent to the radiation you would get on a flight to Australia.

If you might have breast cancer, the risk of not having the examination is greater than the risk from radiation.

X-ray dye reaction

The dye we inject is very safe and used in x-ray departments every day. The health questionnaire you complete will help the radiographer assess if there’s any risk to you, for example if you have any allergies particularly to iodine which is in the dye. The radiographer will refer to the radiologist if there are any queries.

About 3% of patients will have a mild reaction such as a rash which doesn’t need any treatment and goes away by itself.

1 in 2500 patients will experience a severe reaction which needs further treatment. The radiographers are trained to notice the signs of a reaction and will give treatment immediately, if needed.

Extravasation

Very occasionally the dye can leak out of the vein into the fleshy tissue around the injection area (extravasation). This can be very uncomfortable, but we’re trained to position the needle carefully and watch the area for any signs that the dye may be leaking.

Kidneys

The dye can affect your kidneys but this is in less than 1 in 100 people. You may have a blood test to check how your kidneys are working if we think this might be an issue for you. Your doctor will discuss this with you. If necessary, the blood test can be done on the day of the examination in the Breast Unit.

When should I not have CESM?

If you have:

• breast implants
• an allergy to iodine
• kidney failure
• you can’t tolerate a mammogram for any reason
• you can’t give informed consent.

How do I prepare for CESM?

There’s no special preparation for a CESM. You should continue to take any prescribed medications and eat and drink as normal.

Tell the Breast Unit if you have diabetes so we can arrange your appointment for a suitable time.

What happens after CESM?

You may need further tests such as ultrasound or possibly a breast biopsy. This will depend on the results of the CESM and your doctor will discuss this with you. This is so you can be involved in deciding the best tests and treatment for you.

Most women feel fine after the procedure. You can eat and drink normally and resume your usual activities but if you feel concerned or unwell, contact us.

01494 425689

9am to 5pm, Monday to Friday.

Weekends or after 5pm 

Call out of hours GP or 111 for advice using this leaflet to explain the procedure you have had.

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More help or advice

Contact our patient advice and liaison service (PALS) on 01296 831120 or bht.pals@nhs.net