1 Flashcards
What’s the limit in on manual compression
None
Benefits of compression
Decreases radiation by decreasing thickness
Separates overlap/super
Brings lesions closer to detector
What projection helps detect if a lesion is medial or lateral to the nipple?
CC
Best lateral position for pain at sternum
LM
What projection best images the posterior and upper outer quadrant
MLO
Most moveable parts of the breast
Lateral and inferior
What projection sees teacup calls the best?
Lateral
What is lymphosciniography?
Sentinel node mapping
Sub-Areolar lymph plexus injected to ID sentinel node
If the detector is too high which tissue may be lost
Posterior inferior
What type of biopsy is least invasive but needs cytologist there
FNB
If detector is too low what tissue might be missed
Superior and posterior
What type of biopsy uses a 14G needle, takes large sample
Core
RT QC daily
Phantom (checks detector)
RT monthly tests
Compression thickness
Visual
AWS/RWS
Quarterly Tech QC
Compression force
Optional Tech QC
Repeat analysis
Types of filters used on fatty breast
RH or MO
Types of filters used on dense breasts
AG (silver)
RH
Material used on exit window
BE
What does the physicist check yearly (14)
Equipment
Collimation
Spatial and MTF resolution
Contrast (SNR/CNR)
AEC
Phantom
KVP
HVL
AV gland dose
Room illumination
Eval tech QC
Compression
Paddle
AWS/RWS
What is primapara
Nullipara
One child
No children
Subjective
Perceived by pt
Objective
Seen, heard, felt
Side effects of tamoxifen
Uterine/endometric CA
Pulmonary embolism
Deep vein thrombosis
Difference between DIEP and TRAM flap
DIEP uses skin, fat, abdomen muscles, need to connect BV
Tram uses tissue muscle
What type of material does HTC grid use
Copper for strips
Air for interspace
What does WW control
Contrast
What does WL mean
Brightness
Av dose with a GRID
.3 RAD (300 MRAD 3 mGy)
AV dose without a grid
.1 RAD (100 MRAD 1Mgy)
Risk factors
(15)
Female
Age
Personal history
Family history
Genetics
Abnormal BX
Race
Early period
Late menopause
0 kids
Late age primipara
Previous chest RAD
Obesity
HRT
Density
Skin changes
Skin changes (thick, lesion, irritation, swelling, eczema, itchiness, redness, distortion)
Removal of entire breast with possibly a few nodes
Simple/total
Removal of Entire breast including lymph nodes
Nipple, skin, chest lining
Modified Rad
ER + drug types
SERMS, aromatase inhibitors
Treatment drug that has risks of deep vein thrombosis, cataracts and uterine CA
Tamoxifen
Treatment drugs for HER2 Neu CA
Trastuzumb
Lapitinib (Tykerb)
SERM drugs
Tamoxifen
Ralox (evista)
Fulv (faslo)
KVP range
20-40
Anode tilt
0-16
Grid ratio
3:1 - 5:1
Advantage of flat panel receptors
Wide latitude
^ DQE
^ sensitivity
Linear response
Improved workflow
Decrease repeat
Storage/retrieval
PACS
Telerad
Initial training MQSA
Tech 40 hrs
Physicist 20+40 60?
DR 60 hrs
CEU
15
Required on image
Name
ID
View
Laterality
Facility name/location
Tech ID
Mammo unit ID
How long images kept?
5 years or ten if only one
Equip q’s
Is there procedure for correction for poor quality images
Comply with image quality standards
Procedure for oversight QA/QC
Image eval
KVP
MAS
AEC
Exposure
Compression thickness
Target/filter
Focal spot
Grid
Magnification
Labeling
Image quality
Positioning
Compression
Exposure
Contrast
Sharpness
Noise
Artifacts
Collimation
Motion
CC require
Nipple centered/in profile
Pec muscle on 30-40?
PNL w/in 1 cm of MLO
Dense tissue penetrated
Medial/lateral included
Appropriate labels/markers
Key points CC
Detector at raised IMF
Head away
Feet apart, equal wt dist
Raise contralateral arm
Relax arm
Suspend respiration
What is ancillary tail
Inferior/lat of pec muscle
What is fibrous tissue made of
Lobule, duct, glands, lobes
Functional unit
Lobule
Coolers ligament
Connective (fibrous) band that connects skin -breast
Where do lymph nodes drain
Lateral - axillary
Medial - internal thoracic
What is arch distortion
Distorted shape/pattern of tissue
Assymmetry
One breast looks different
Global one view
Focal both views
Types of primarily benign calcs
Skin
Vascular
Milk of calcium
Dystrophic
Rim (eggshell)
Coarse (popcorn)
Round punctate
Suspicious types of calcs
Amorphous
Heterogenic
Fine
Pleomorphic
Linear/rod like
Casting
Spiculated/stellate
Characteristics of benign masses
Round
Oval
Sharp margin
Radiopaque
Smoothe round in TDLU
Cyst
Signs of papilloma
Can have nipple discharge, dilated duct
circular
clusters of calcs
Berry like shape
Painless lump, large, round or oval, radiolucent, ducts
Galactocele
Can have solid painless lump round with distinct borders easily moveable
with micro calcs
Fibroadenoma
Soft painless
Moveable or
No lump
Smoothe
Radiolucent
Lipoma
Hematoma
Breast within breast
Abnormally wide ducts
Can have nipple discharge
Retraction
Pain
Tenderness
Palpable mass
Ducati ectasia
Malignant or benign
Well defined oval mass
Hematoma
Fat necrosis
Ill defined
Irregular
Spiculated
Mass like
Can have calcs
Lump
Smooth border
Radial scar
Spiculated
Low density
Star appearance
ILC
Arch distortion
Calcs
Spiculated mass
Asymmetric density
DCIS
Small clusters (casting) calcs
Soft tissue opacity
Enlarged breast
Red warm
Tender painful
Skin thickening
Nipple problems
Mass with malignant microcalc
Increased breast density
Inflammatory
Swelling
Irritation
Dimpling/retraction
Breast/nipple pain
Discharge
Idc
ILC on Mammo
Arch distortion
Irregular mass
Spiculated mass
Asymmetric density
Nipple changes
Skin thickening
Retraction
Microcalcs
Discrete subareolar mass
Pagets
Palpable fast growing mass
Oval
Hyper dense
Indistinct or circ margins
Sarcoma
Palpable mass
Thickening
Oval/round
Asymmetry
Rare
Sarcoma
What does MLO show best
Extreme posterior and UOQ
MLO positioning
Detector parallel to pec
Armpit corner
Up and out
Nipple in profile
0 sagging
MLO to ML
Medial lesion moves ____
Lateral moves _____
Up
Down
Which lateral is most common
ML projection
AT angle? Direction?
20 degree or less
Custom
Superomedial - inferolateral
What are rolled view for
Superimposition
Lateral position roll superior or inferior
Rolled
When not to do implant displaced view
Implant encapsulated
Why do anterior compression
Uneven breast tissue thickness
Why do mag view
To see fine details
Calcs
Margins of a lesion
Specimen
What is medical outcomes audit
Audit IP every year
Follow up on positive results
How does US work
Piezoelectric principles
High frequency sound waves
Breast MRI
Switching mag fields
RF waves
Uses GAD (paramagnetic)
What needs to be on informed consent
Risks
Benefit
Alternatives
Signature
What js breast localization
Locate non palpable mass or calcs prior to excisional biopsy
Wire placed
When should use manual technique
Implants
Small breast
How much overlap for sectional imaging
2.5 cm (1 inch)
What is contraindicated for MRI
Pacemakers
Aneurism clips
Neurostimulator
Shrapnel
Surgical clips or plates
Metal prosthesis
Metal implants
Cochlear implants
FNA
Removal of content of cyst for testing/analysis
Stereotactic
Determines location of lesion based on x y z coordinates
What determines type of bx?
Suspicion (severity)
Size
Shape
Location
Number of abnormalities
FNB
Obtain cell material for cytological analysis
Cystic and solid lesions
Core biopsy
Can do in US, MG or MRI
Most performed
Removes tissue
Vacuum core
Hollow probe inserted to area cylinder of tissue suctioned out
Rotating knife cuts sample
Advantages of minimally invasive BX
Less visible scarring
Outpatient
Fewer complications
No anesthesia
Less pain/bleeding
Lest costly
Difference between excisional and incisional
I = part of lesion
E= whole lesion
What are casting calcs
Malignant
Fragmented with irregular contours
Pleomorphic
Different shapes
Irregular in size form OD
Stellate
Can have linear rod like calcs
Dystrophix
Sutural (tubular)
Can be result of surgery
