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Questions to Discuss With Your Physician

Breast CT is a diagnostic service ordered by physicians. If any of the following apply to you, it may be worth bringing up with your doctor at your next visit.

Have You Experienced Any of the Following?

Have you had an uncertain mammogram result?

Have you been called back after a mammogram for additional views or follow-up?
Did your mammogram show something your doctor wants to look at more closely?
Have you been told you have dense breast tissue that makes mammograms harder to read?
Were your imaging results inconclusive, indeterminate, or difficult to interpret?

Have you noticed breast symptoms or changes?

Have you noticed a lump, thickening, or palpable mass in your breast?
Are you experiencing breast pain, swelling, or tenderness?
Have you had nipple discharge or noticed changes to your nipple?
Have you noticed skin changes such as dimpling, retraction, or a rash on your breast?

Do you have relevant personal or family history?

Do you have a personal history of breast cancer?
Does your immediate family have a history of breast or ovarian cancer?
Have you tested positive for BRCA or another genetic risk factor?
Are you due for follow-up imaging after surgery, radiation, or chemotherapy?

Are there reasons standard MRI may not work for you?

Do you exceed weight or size limits for the MRI machine?
Does claustrophobia make enclosed procedures difficult for you?
Do you have a pacemaker or other metal implantable device?
Are you concerned about gadolinium contrast agent retention?

Your next step

If any of these questions
apply, speak with your physician.

Only your doctor can determine whether Breast CT imaging is right for your situation. Bring these questions to your next appointment — or contact us and we’ll help coordinate a referral.

This page is for general information only and does not constitute medical advice. Breast CT is a prescription diagnostic imaging service.

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First Name *

Last Name *

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Referring Physician & Reason for Scan

Requisition required. A written referral order from your physician must be on file before your appointment can be confirmed. If you don’t have the physician’s address or fax number, our front desk staff will contact the office directly.

Physician’s Name *

Physician’s Phone Number If unknown, our staff can look this up.

Office Address If unknown, our staff will contact the physician’s office.

Fax Number Needed to send your appointment confirmation.

Reason for Scan

Select all that apply. ICD-10 codes will be confirmed by our clinical staff based on your selections.

Called back after mammogram Suspicious mammogram finding Dense breast tissue Lump or mass Breast pain Nipple discharge Swelling / thickening Skin changes Personal breast cancer history Family history — breast Family history — ovarian Genetic susceptibility Post-treatment follow-up Benign finding monitoring

Additional Notes

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Please review your information before submitting your scheduling request.

Patient Information

Physician & Referral

Reason for Scan

I understand that a requisition/referral order from my physician must be on file before my appointment can be confirmed, and I authorize Artemis Imaging to contact my physician’s office to obtain or verify it. *

I confirm that the information provided is accurate and authorize Artemis Imaging to use it to process my appointment request and communicate with my referring physician. *

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Request Received

Thank you. We’ve received your scheduling request. Our team will confirm that your physician’s requisition is on file and contact you within 1–2 business days to schedule your appointment.

ARTEMIS

Breast CT Imaging · Katy, TX

Advanced diagnostic breast imaging without compression. FDA PMA approved Koning Vera technology.

(832) 263-8423 info@artemis3dCT.com

23530 Kingsland Blvd, Ste 140
Katy, Texas 77494

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The Koning Vera Breast CT is FDA PMA approved (P130025). This device is intended for diagnostic imaging, not as a replacement for screening mammography. Consult your physician.