CC BY-NC-ND 4.0 · Ann Natl Acad Med Sci 2022; 58(02): 060-068
DOI: 10.1055/s-0042-1742586
Review Article

Best Practice Guidelines for Breast Imaging, Breast Imaging Society, India: Part—1

Suma Chakrabarthi
1   Department of Radiology and Imaging, Peerless Hospitex Hospital and Research Center Limited, Kolkata, West Bengal, India
Shikha Panwar
2   Department of Radiology, Mahajan Imaging, Delhi, India
Tulika Singh
3   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Shilpa Lad
4   Department of Radiology, NM Medical, Mumbai, Maharashtra, India
Jwala Srikala
5   Department of Radiology and Imaging, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
Niranjan Khandelwal
6   Former Head, Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Sanjeev Misra
7   Department of Surgical Oncology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
Sanjay Thulkar
8   Department of Radiology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations


Breast imaging is one of the prerequisites for providing high quality breast health care. Choosing the appropriate investigation is central to diagnosing breast disease in women and men who present to health professionals for treatment. Patients with breast disease present to doctors of different subspecialties as well as general practitioners in our country. It is important therefore to provide uniform guidance to doctors in different health care setups of our country, urban and rural, government and private, for breast diseases to be diagnosed and treated optimally. These guidelines framed by the task group set up by the Breast Imaging Society, India have been formulated focusing primarily on the Indian patients and health care infrastructures. These guidelines aim to provide a framework for the referring doctors and practicing radiologists, to enable them to choose the appropriate investigation for patients with breast symptoms and signs. The aim has been to keep this framework simple and practical so that it can guide not only subspecialists in breast care but also help doctors who do not routinely deal with breast diseases, so that breast cancer is not missed. Overall, the aim of this document is to provide a holistic approach to standardize breast care imaging services in India. Part 1 of these guidelines focuses on the best practice principles for mammography, breast ultrasound and breast magnetic resonance imaging. In the absence of a population-based screening program in India, the guidelines to be followed for those women who wish to be screened by mammography have been provided. The key points of these guidelines include the recommendations that mammography is the modality of choice for breast screening and investigation of symptomatic women aged over forty years. Screening is advised annually from the age of forty. Ultrasound is the investigation of choice for pregnant and lactating women and women less than thirty years of age. For women between thirty to thirty-nine years of age, ultrasound can be used initially followed by mammography in presence of clinical or sonographic suspicion of breast cancer. All women diagnosed with breast cancer should have ultrasound and mammography. Breast MRI is useful for assessment of disease extent, problem solving, evaluation of response to neo-adjuvant chemotherapy, identifying occult breast primary and evaluation of augmented breasts.


The best practice guidelines of Breast Imaging Society, India (BISI) are the broad guidelines for investigation, intervention, and management of clients opting for breast screening and patients with breast symptoms in India, and intended for the use of qualified medical caregivers only. These are based on various national and international guidelines and personal experiences and opinions of BISI members, as there are no large credible Indian data to formulate these guidelines. These guidelines are purely recommendatory in nature. Actual decisions for management of patients should be individualized according to own judgment of the caregiver and tailored on case-to-case basis. As scientific knowledge is continuously improving, a regular update of the same by the caregiver is essential. Failure to do so may result in untoward patient management or outcome and BISI members or BISI as the organization cannot be held responsible for that in any manner.

Publication History

Article published online:
16 February 2022

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