Dr. Paredes is the Founder and Director of The Ellen Shaw de Paredes Institute for Women's Imaging, Glen Allen, VA. She is also a member of the editorial board of this journal.

A year ago, as I embarked on opening a new practice, I was asked, "How can you survive doing breast imaging"? At that time I wrote "Taking a Chance" in this journal, in which I chronicled my move from academia to opening a private radiology practice for women's imaging. Since then, much has happened that has inspired me to share some thoughts, particularly about mammography. Here are the facts about breast imaging:

• Mammography is a proven method to reduce the mortality rate from breast cancer.
• The volume of patients who undergo mammography has grown tremendously over the last 2 decades, yet only approximately 50% of women are being screened.
• There is a current shortage of breast imagers, and there are many positions available.

Here is the fiction:

• Mammography services are financially unable to stand alone.
• Malpractice risk is so great that one should not specialize in this field.

In opening the practice, I felt that I was taking a large risk, but based on an analysis of the business plan it seemed feasible. So I took the plunge. The basic concept is to provide the highest level of service that I possibly can, including offering immediate interpretation to all patients. This requires working efficiently and accurately, being organized, and having a terrific staff. The vast majority of patients prefer to wait for the mammogram to be read and to receive their results in person the same day.

The convenience to patients, the reduced anxiety in getting immediate results, and the ability to have a full diagnostic work-up, if necessary, on the same day have made this practice highly sought after. The convenience to the referring physicians has also been improved by completing the work-up and helping to organize the management plan for the patient.

I recently saw a new patient who told me that her doctor had referred her to me specifically. Her doctor had told her that I had "raised the bar" for radiology practice in the area.

Interestingly, I recently spoke with one of my former fellows who had opened a similar practice just a few months before I did. Initially, he was very concerned about the financial risk, yet he wanted to focus on breast imaging and to try to provide a higher level of service than he was able to in his prior practice. He also has achieved great success in his practice. In our conversation, he told me that another physician had also described him as "raising the bar" for patient care.

Practicing breast imaging is highly rewarding. Providing the best level of service that one can is wonderful. The personal reward is knowing that the detection of a small, early breast cancer results in a cure. Patients are most appreciative of the attention to their care. In addition to the clinical benefits, the financial rewards are significant. In the outpatient setting, mammography is not a financial loser but instead can be very successful. Perhaps most importantly, as my former fellow agreed, the ability to be the decision makers and to establish and implement the philosophy of the practice allows us to perform our best work. I encourage anyone who has even the slightest interest in breast imaging to investigate it further. You will find great professional fulfillment and tremendous personal satisfaction.