A mammogram uses low-dose X-rays to screen for breast cancer, while a pacemaker is a small device implanted under the skin, usually near the collarbone, to regulate an irregular heartbeat. Patients with a pacemaker can generally have a mammogram, but it is not a simple, routine procedure. The screening is considered safe, provided specific precautions are taken by both the patient and the imaging technologist. The primary concern is not the X-ray itself, but the physical compression required during the examination, which necessitates modified techniques to protect the implanted device and its wires.
Understanding the Safety
Standard X-ray mammography is considered safe for patients with pacemakers because the procedure does not use the strong magnetic fields that are known to interfere with or damage implantable electronic devices. Unlike a Magnetic Resonance Imaging (MRI) scan, the X-ray radiation from a mammogram does not pose a direct threat to the pacemaker’s electronic circuitry or its programming. The main risk is entirely mechanical, involving the physical compression of the device or the delicate lead wires that run from the device to the heart.
Physical trauma from the compression paddles could potentially cause a fracture in the lead wires or damage the pacemaker generator itself. A damaged lead could lead to sensing or pacing failures, which would disrupt the heart’s rhythm regulation. Because the pacemaker is typically implanted just beneath the skin in the chest area, the ipsilateral breast (the breast on the same side) requires special attention to ensure the device is not crushed during the imaging process. This risk is managed by technologist training and procedural modifications, which focus on preventing direct compression over the device pocket or the path of the leads.
Procedural Adjustments During Screening
The screening procedure for a patient with a pacemaker requires the technologist to make specific modifications to prevent damage and ensure patient comfort. The most common technique is to use specialized or oblique positioning to maximize the breast tissue imaged while keeping the compression paddle away from the pacemaker generator. This often involves deliberately excluding the device and the tissue immediately surrounding it from the direct path of compression.
In the standard medio-lateral-oblique (MLO) view, the pacemaker is more likely to project onto the image, requiring the technologist to be highly careful with positioning. The goal is to avoid placing the compression paddle directly over the device pocket, which is typically located in the upper, outer chest near the axilla. Compression force must be carefully monitored and may be reduced in the area near the device implantation site to prevent trauma to the device or lead wires. While reduced compression can lead to slightly less optimal image quality or a smaller amount of breast tissue being visualized, the modification is a necessary trade-off to protect the function of the implanted device.
Essential Communication and Follow-Up
The patient plays a significant role in ensuring a safe and effective mammogram by proactively communicating their medical history. It is necessary to inform the scheduling staff and the technologist immediately upon arrival that a pacemaker is implanted. This notification allows the clinic to allocate sufficient time for the procedural adjustments and to assign a technologist experienced in imaging patients with implanted devices.
The patient should be prepared to provide details about the pacemaker, including the side of implantation and, if possible, the specific brand and model. After the mammogram is complete, a follow-up with a cardiologist or device clinic technician is recommended to confirm the pacemaker’s integrity. A device check will verify that the settings and function, such as lead impedance and sensing capabilities, have not been negatively affected by the physical compression, providing reassurance that the device is working correctly.