4. Breast p117-122 (Mammography)

Question 1

Mammogram - technique (7)

Answer 1

2 standard views, craniocaudal (CC) and Medial Lateral Oblique (MLO)
Posterior Nipple Line is drawn on MLO, from nipple to chest wall. Needs to touch pec muscle to be adequate.
On CC, draw line from nipple back to chest wall. Should be within 1cm of length of posterior nipple line.
Ideally inframammary fold should be visualised.
“Camel nose” buzzword used to describe a breast on MLO that has not been pulled up and out by radiographer.
Nipple should be in profile in one of 2 views to avoid missing subareolar cancer.
Relaxed pec muscles preferred (concave instead of convex), showing more breast tissue.

Question 2

LMO view (3)

Answer 2

MLO view is standard, sometimes LMO view is used:
- Women with kyphosis or pectus excavatum.
- to avoid medial pacemaker or central line.

Question 3

MLO view trivia (1)

Answer 3

MLO contains most breast tissue of any view

Question 4

Spot compression views (2)

Answer 4

usually need to leave the collumnator open, to give the largest field of view.
Small paddles give better focal compression, large paddles allow good visualisation of land marks.

Question 5

Magnification views (2)

Answer 5

CC and ML (true lateral are obtained). ML (as opposed to MLO) used to help catch “milk of calcium”

Question 6

ML vs LM for true lateral view (4)

Answer 6

True lateral is useful for localising things seen on single view only (CC).
If a mass is lateral on CC (screening mammo) then use ML for diagnostic. If medial, use LM.
This is to move the mass closer to the detector.
If mass only visible on MLO, use ML, as 70% of breast cancers occur laterally.

Question 7

Blur artefact (4)

Answer 7

Blur:
- Can be breathing or inadequate compression, typically inferior breast on MLO.
- Can be tricky to pick up.
- Look at cooper ligaments, they should be thin white lines in fat. If thick or fuzzy, this is likely blur (or oedema)
- If skin thickening, think oedema

Question 8

Grid lines (4)

Answer 8

Mammograms should always use a grid, unless mag view.
Grid works by moving really fast and keeping only X rays that move in straight line.
Blur is seen in 3 scenarios
- Patient moved.
- Exposure too long
- Exposure too short

Question 9

Screening mammograms - general tips (6)

Answer 9

Trying to find 3-8 cancers per 1000 mammograms.
Certain areas can only be seen on a single view, e.g. medial breast on CC may not be seen on MLO.
Inferior posterior breast may not be seen on CC.
Makes these areas high risk for missing cancer.
Recommended to look at mammograms from 2 years prior for comparison, makes it easier to see early changes.

Question 10

Localising lesion (3)

Answer 10

Medial lesion on CC film will be more superior on MLO, and even more superior on ML.
Opposite is true of lateral lesions.
Lead Sinks and Muffins Rise (from CC to MLO to ML)

Question 11

Localising lesion (only seen in CC) (4)

Answer 11

Rolled CC view can help determine if lesion is in superior or inferior breast.
Position breast for CC view, but prior to compression, the breast is rotated medially or laterally along axis of nipple.
Reference point is top of breast.
If you roll the breast medially, superior tumour will move medial and inferior tumour will move lateral.
Opposite is true of you roll breast laterally.

Question 12

BI-RADS/UK System (3)

Answer 12

BI-RADS developed by Americal College of Radiology.
UK uses a 5 point breast imaging scoring system for communication and diagnosis.
M1-5 and U1-5 for mammograms and ultrasound respectively.