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Contrast-enhanced spectral mammography (CESM)


A Contrast Enhanced Spectral Mammography Test (CESM) is a type of mammogram 

(breast x-ray) carried out using a special dye (contrast media)  which shows up on x rays. This examination is used to highlight any areas of concern in your breast. The dye is injected into a vein immediately before the mammogram images are taken. The images will give the specialist doctors (Radiologists) more information about your breast condition.

What happens during the CESM procedure?

The staff will explain the procedure in detail to you and check that you are happy to go ahead with the examination. 

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.  A radiographer will then take you to a changing cubicle where you will be asked to remove your clothes down to your waist; you will be given a hospital gown to wear.

When you are changed you will go into the x ray room where a tourniquet (tight band) will be placed around your arm and a small plastic tube (cannula) will be inserted into a vein usually in the crease of your elbow or back of your hand. This should not be painful but you will feel a sharp scratch. Once the cannula is in place you will be given an injection of the x ray dye, this may make you feel a bit warm, have a metallic taste in your mouth and feel like you’re wetting yourself when it is first injected, this is quite normal and nothing to worry about.

The radiographer will then ask you to remove your gown and she will position you for your mammogram. Your breasts will be placed onto the mammography machine and compressed (squashed) 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 please let the radiographer know before she applies the compression.

After your mammogram you will be asked to sit in the changing cubicle with the cannula in place until the images have been checked. Once this is done the cannula will be removed and you will be free to go.

What are the risks of CESM

Mammography uses x rays to produce an image of the breasts. All x rays involve radiation, the amount of radiation used in mammography is very small, equal to the amount of natural radiation we all receive 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 receive on a flight to Australia. If you might have breast cancer then the risk of not having the examination is greater than the risk from radiation.

The x-ray dye you will be injected with is very safe and is used widely in x ray departments every day. The health questionnaire you complete will help the radiographer assess if there is any risk to you, we will check if you have any allergies particularly an allergy to iodine as this is in the dye. The radiographer will refer to the radiologist if there are any queries.

Approximately 3% of patients will experience a mild reaction such as a rash which does not require any treatment and will go away by its self.  1 in 2500 will experience a severe reaction which requires further treatment.  The doctors and radiographers are trained to spot the signs of a reaction so treatment can be given immediately, if required.

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 the staff are trained to position the needle carefully and to watch the area for any signs that the dye may be leaking.  The x ray dye can affect your kidneys however this is in less than 1 in 100 people. You may be given a blood test to check how your kidneys are working if this is thought to 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 any of the following you should not have CESM:

  • Breast implants
  • Allergy to Iodine
  • Kidney failure
  • You are unable to tolerate a mammogram for any reason
  • You are unable to give informed consent

How do I prepare for CESM

There is no special preparation for a CESM, you should continue to take any prescribed medications and eat and drink as normal.  Please let the breast unit know if you are diabetic so we can arrange your appointment for a suitable time.

What will happen after CESM

After your CESM you may require 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 so you can be involved in deciding the best tests and treatment for you.

Most women feel fine after the procedure, you may eat and drink normally and resume your usual activities however if you do feel concerned or unwell please contact the numbers at the end of this leaflet.

Contact Details

If you have any concerns or queries you can contact the Radiology Department on 0191 4452554.

Data Protection

Any personal information is kept confidential.  There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.

In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics.  

Further information is available via Gateshead Health NHS Foundation Trust website or by contacting the Data Protection Officer by telephone on 0191 445 8418 or by email [email protected].

This leaflet can be made available in other languages and formats upon request