The first test should virtually always be a mammogram. The radiologist will add elective mammographic views as needed. Breast ultrasound should virtually never be ordered as an initial diagnostic modality, with the possible exception of pediatric age groups with breast symptoms. If a breast mass is identified by mammography, a breast ultrasound can assist in the determination whether the mass is a cyst (benign) or a true solid neoplasm (potentially malignant). Breast ultrasound can also be ordered in cases where the mammogram is negative but there is a specific palpable abnormality. CT and MRI are not usually necessary and should only be considered after consultation with a mammographer.