US Breast — Dictation, Appropriateness, and Dose for Residents

It’s 3 PM on a busy outpatient rotation. Your list is full, and the next case is a targeted right breast ultrasound for a 34-year-old with a new palpable lump. The prior mammogram was inconclusive due to extremely dense tissue. Your attending is going to want a perfect BI-RADS lexicon description for any finding—shape, orientation, margin, echo pattern, posterior features—and a definitive BI-RADS category with a clear recommendation. No pressure.

When I was a resident, this was the exact scenario where I’d pull up my saved templates, hoping I had one that fit. Getting the description right is everything; it’s the difference between a confident BI-RADS 4 recommendation and a wishy-washy report that gets bounced back. This guide is built for that moment. It’s a high-yield template and a quick clinical refresher, written by a radiologist for trainees on the front lines. For more tools like this, check out our free residents and fellows resource hub.

What a Diagnostic and Targeted Breast Ultrasound Covers and What Attendings Look For

A diagnostic or targeted breast ultrasound is a problem-solving tool. Unlike screening mammography, it’s not meant to survey the entire breast landscape. Instead, it’s a focused, high-resolution interrogation of a specific area of concern. It uses a high-frequency (12-18 MHz) linear transducer to provide exquisite detail of breast parenchyma, distinguishing cysts from solid masses, characterizing solid lesions, and guiding biopsies with precision.

Your attending expects the report to answer a few key questions:

• Cyst vs. Solid: Is the palpable or mammographic finding a simple fluid-filled cyst or a solid mass?
• BI-RADS Lexicon: If solid, what are its characteristics? The report must systematically describe its shape, orientation, margins, echo pattern, and posterior acoustic features.
• Location and Size: Precise clock-face location, distance from the nipple, and three-dimensional measurements are mandatory.
• Axillary Status: For suspicious masses, the ipsilateral axilla must be evaluated for abnormal lymph nodes (cortical thickening, loss of fatty hilum).
• Correlation and Recommendation: How does this finding correlate with the prior mammogram? What is the final BI-RADS category and the explicit next step (e.g., return to screening, 6-month follow-up, biopsy)?

Radiology Report Template for US Breast (Diagnostic and Targeted)

This template is designed for direct use in your dictation system. It includes the essential elements for a comprehensive diagnostic or targeted breast ultrasound report, with placeholders for your specific findings.

Technique

Real-time grayscale and color Doppler ultrasound imaging of the [right/left] breast was performed using a high-frequency linear array transducer. The examination was targeted to the palpable area of concern at the [e.g., 2 o’clock] position, corresponding to the finding on the prior mammogram dated [date]. The ipsilateral axilla was also evaluated.

Findings

Prior Comparison: [e.g., Mammogram from YYYY-MM-DD]

Breast Parenchymal Echotexture: The breast tissue is [heterogeneously dense/fatty/scattered fibroglandular densities].

Targeted Area of Concern ([Right/Left] Breast):
At the [e.g., 2 o’clock] position, [e.g., 4 cm] from the nipple, there is a [e.g., hypoechoic] mass.

• Size: It measures [e.g., 1.2 x 0.8 x 1.0 cm].
• Shape: [Oval / Round / Irregular]
• Orientation: [Parallel / Not parallel (taller-than-wide)]
• Margin: [Circumscribed / Indistinct / Angular / Microlobulated / Spiculated]
• Echo Pattern: [Anechoic / Hypoechoic / Isoechoic / Hyperechoic / Complex cystic and solid]
• Posterior Features: [No posterior features / Posterior enhancement / Shadowing]
• Vascularity: Color Doppler imaging demonstrates [no internal vascularity / internal vascularity / peripheral vascularity].
• Other Features: [e.g., No associated architectural distortion or skin thickening.]

(If no discrete mass is found, describe the tissue:)
Targeted evaluation of the palpable area at [clock face] reveals [e.g., prominent fibroglandular tissue without a discrete sonographic correlate].

Axilla:
Evaluation of the [right/left] axilla demonstrates lymph nodes with normal morphology, including preserved fatty hila and normal cortical thickness.

Impression

(Use the key principles below to form your impression)

• Simple Cyst (BI-RADS 2): Anechoic, well-circumscribed, posterior enhancement, no internal flow. Benign.
• Complicated Cyst (BI-RADS 3): Low-level internal echoes, no flow. Probably benign, recommend 6-month follow-up ultrasound.
• Suspicious Solid Mass (BI-RADS 4/5): Irregular shape, non-parallel orientation, spiculated/angular/microlobulated margins, posterior shadowing. Suspicious for malignancy, recommend ultrasound-guided core biopsy.
• Probably Benign Solid Mass (BI-RADS 3): Circumscribed, oval, parallel-oriented hypoechoic mass consistent with a fibroadenoma. Probably benign, recommend 6-month follow-up ultrasound.

EXAMPLE IMPRESSION:

A [e.g., 1.2 cm] irregular, hypoechoic, non-parallel oriented solid mass with indistinct margins is identified in the [right/left] breast at the [e.g., 2 o’clock] position. This is suspicious for malignancy.

BI-RADS CATEGORY 4: SUSPICIOUS

RECOMMENDATION: Ultrasound-guided core biopsy of the [right/left] breast mass at [2 o’clock].

Free Template Sources for Radiology Residents

Building a personal library of templates is a rite of passage. But you don’t have to start from scratch. If you need templates for other modalities or subspecialties, two great free repositories exist that are curated by and for radiologists.

• RadReport.org: Maintained by the RSNA, this is a comprehensive library of peer-reviewed templates covering nearly every study you’ll encounter.
• Radiology Templates (AU): An excellent, straightforward resource maintained by Australian radiologists with clean, practical templates.

The Next-Level Move: AI-Assisted Structured Reporting

Memorizing templates is one thing; generating a perfect one under pressure is another. The real friction on call isn’t finding the template, it’s populating it accurately and efficiently while the case list grows. This is where new tools can make a significant difference in your workflow. Instead of clicking through a structured report or editing a macro, you can simply dictate your positive findings in free form—”There’s an irregular hypoechoic mass at 2 o’clock with spiculated margins and posterior shadowing”—and let an AI tool handle the rest.

The GigHz Precision AI reporting assistant is designed for this exact workflow. It parses your free-form dictation of positive findings and automatically generates a complete, structured report using pre-loaded ACR and SIR templates. It helps ensure every key descriptor from the BI-RADS lexicon is included, standardizing your reports and reducing the mental load of remembering every required field. This streamlines the reporting process, letting you focus on the diagnostic interpretation.

When Should You Order a Diagnostic or Targeted Breast Ultrasound? ACR Appropriateness Criteria

Understanding when breast ultrasound is the right first step, a necessary follow-up, or not indicated is crucial. The American College of Radiology (ACR) provides evidence-based guidelines to help with these decisions.

Per the ACR Appropriateness Criteria for Palpable Breast Masses, ultrasound is “Usually Appropriate” as the initial imaging modality for women under 30, and for women 30-39 it is often used alongside diagnostic mammography. For women 40 and over, it is the essential next step after a diagnostic mammogram to characterize a palpable finding.

For Breast Cancer Screening, the role of ultrasound is more specific. While mammography is the primary screening tool for average-risk women, supplemental screening with whole-breast ultrasound “May Be Appropriate” for women with dense breast tissue (BI-RADS categories C or D), as it can detect cancers that may be obscured on a mammogram. It is not recommended as a standalone screening tool.

Key alternatives include:

• Mammography: The first-line modality for breast cancer screening and for the initial evaluation of most breast problems in women over 30. It remains superior for detecting microcalcifications.
• Breast MRI: Typically used for high-risk screening (e.g., BRCA gene mutation carriers), evaluating the extent of disease in newly diagnosed cancer, or for problem-solving in complex cases where mammography and ultrasound are inconclusive.

How Much Radiation Does a Breast Ultrasound Deliver?

One of the primary advantages of breast ultrasound is its safety profile. It uses sound waves, not ionizing radiation, to create images.

A breast ultrasound delivers an effective radiation dose of 0 mSv. This means there is no radiation exposure to the patient, making it an ideal imaging modality for young patients, pregnant or lactating women, and for frequent follow-up examinations without any cumulative radiation risk.

Breast Ultrasound (Diagnostic and Targeted) Imaging Protocol — Key Parameters and Pitfalls

A high-quality breast ultrasound depends on meticulous technique. The goal is to use a high-frequency linear transducer (typically 12-18 MHz) to achieve optimal spatial resolution. The gain should be set so that subcutaneous fat appears as a medium gray, and multiple focal zones should be placed at the depth of the lesion to ensure it is in the sharpest possible focus. All findings must be documented in two orthogonal planes (e.g., radial/anti-radial or longitudinal/transverse).

A common pitfall is distinguishing between a targeted diagnostic exam and a whole-breast screening ultrasound. A targeted exam focuses solely on the area of concern, while a whole-breast screening US requires a systematic survey of all four quadrants of the breast and the retroareolar region, which is significantly more time-consuming.

3+ months free for radiology residents and fellows

If you want to look like a rockstar on your reports, we’ve set up a free access program specifically for trainees. You can dictate your positive findings in free form, and the AI will generate a complete, structured report using the appropriate ACR or SIR templates. It helps ensure your reports are consistent, complete, and use the exact terminology your attendings are looking for.

All we ask in return is your feedback so we can keep improving the product for the next generation of radiologists. The signup is simple—no credit card, no long forms. Just provide the following three items:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or specific fellowship)
3. Your training program / hospital name

To get started, apply for the residents free-access program and we’ll get you set up.

Free GigHz Tools That Pair With This Article

Three free tools that complement the material above:

• ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
• GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
• GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.

Frequently Asked Questions

Is the GigHz Radiology Report Assistant HIPAA-compliant?

Yes. The platform is designed for de-identified workflows by default. It processes the clinical content of your dictation without requiring or storing patient health information (PHI), ensuring compliance with HIPAA privacy and security rules.

Do I need our hospital’s IT department to set this up?

No. The tool is browser-based and requires no local installation or IT integration. It works on any modern web browser, including the one on your call-room computer, personal laptop, or even an iPad.

Does this replace PowerScribe or other dictation systems?

No, it works alongside them. You dictate your findings as you normally would. You can then use the AI-generated structured report as a “scaffold,” copying and pasting it into your official PACS/RIS dictation system for final sign-off. It complements your existing workflow rather than replacing it.

Can I use this on my phone or iPad?

Yes. The platform is fully responsive and works on mobile devices and tablets. This is particularly useful for reviewing or building reports away from a dedicated PACS workstation.

Can I customize the templates?

The system comes pre-loaded with standardized templates from governing bodies like the ACR and SIR. While deep customization is a feature in development, the goal is to promote adherence to these evidence-based standards to improve report quality and consistency.

What happens after I finish my residency or fellowship?

The free access program is specifically for trainees. After you graduate, you would transition to a standard subscription plan. We offer discounts for recent graduates to help ease the transition into practice.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026