BRANT: Chapter 19-20: Imaging the Screening/Diagnostic Patient

Question 1

It is the primary imaging modality used for breast cancer screening

Answer 1

Mammography

Question 2

It is for this reason that the American College of Radiology and the Society of Breast Imaging at this time continue to recommend annual mammographic screening for women at age ____ and older.

Answer 2

40

The American Cancer Society (ACS) recommends starting annual screening at age 45, with an option to transition to biennial screening at age 55.

Question 3

T/F: For high risk women, it would be appropriate to start screening with mammography as early as ages 25 to 30.

Answer 3

True

Question 4

The anode material that is used to generate the x-rays in most dedicated film screen mammography units is ____.

Answer 4

Molybdenum

This allows the production of lower-energy x-rays, which in turn produces greater contrast between soft tissue structures. The structures of the breast do not differ greatly in their inherent contrast, so these low-kilovolt photons are extremely important in producing a high-contrast image.

Question 5

Full-field digital mammography (FFDM) units often use ____ anodes, which are more efficient, have better longevity, and can yield lower radiation doses than molybdenum anodes.

Answer 5

Tungsten

Question 6

The following statements are true, except:
a. Compression spreads overlapping breast structures so that true masses can be differentiated from summation shadows that occur because of overlapping soft tissues.
b. The breast is immobilized during compression so motion unsharpness or blurring due to patient movement is minimized.
c. Geometric unsharpness, caused by the finite focal spot dimension, is minimized by bringing the breast structures closer to the film.
d. Compression renders the breast nearly uniform in thickness so that the film density of tissues near the nipple will be similar to those near the chest wall.
e. Radiation dose can be reduced by good compression; a thinner breast requires fewer photons for penetration.
f. AOTA are true

Answer 6

f. AOTA are true

Question 7

The American College of Radiology recommends that the average glandular dose delivered by a single mammographic view should not exceed ____

Answer 7

3 mGy

Although most mammographic views are approximately 2 mGy.

Question 8

Average effective dose from a standard two-view mammogram is

Answer 8

0.44 mSv

Question 9

The standard views for screening mammography are the

Answer 9

Mediolateral oblique (MLO) view
craniocaudal (CC) view

Question 10

View that depicts the greatest amount of breast tissue.

Answer 10

MLO view

Parallel to the orientation of the patient’s pectoralis major muscle
Angle: 40-60 deg from the horizontal

Marker: placed near the axillary tissues of the breast

Marker of CC view: near the skin close to the lateral aspect of the breast
By convention, when displaying the CC view, the lateral breast is positioned at the superior aspect of the image.

Question 11

Typically on an MLO, this view is performed to better evaluate the anterior breast parenchyma in large breasts

Answer 11

Anterior compression view

Question 12

Performed to visualize the lateral posterior breast tissue on the CC projection

Answer 12

Exaggerated CC lateral view (XCCL)

Question 13

Performed to visualize posteromedial breast tissue in the CC projection

Answer 13

Cleavage view

Question 14

The following describe a properly positioned MLO mammogram, except:
a. Show the pectoralis major muscle down to the level of a line drawn perpendicular to the muscle through the nipple (posterior nipple line)
b. The nipple should be in profile
c. The inframammary fold may not be visible

Answer 14

c. The inframammary fold may not be visible

The nipple should be in profile so that the subareolar area can be adequately evaluated. The inframammary fold should be visible to ensure that the inferior portion of the breast has been imaged

Question 15

T/F: When evaluating a CC mammogram, optimal positioning can be assured when pectoralis muscle is seen centrally on the film and the nipple is in profile

Answer 15

True

Question 16

An alternative method of assuring appropriate visualization of posterior tissues is to measure the distance from the nipple to the edge of the film through the central axis of the breast; this distance should be within ____ of the length of the posterior nipple line as seen on the MLO view

Answer 16

1 cm

Question 17

In patients with breast implants, what other views aside from MLO and CC are done?

Answer 17

2 implant-displaced views

Performed with the implant displaced back against the chest wall with the breast tissue pulled forward

Question 18

It is used to evaluate equivocal findings seen on full-field mammographic views.

Answer 18

Spot compression mammographic views

Spot compression involves a smaller compression paddle than the one used for full-field views, which apply compression to a specific area within the breast.

Compression has several benefits for mammography: decreases breast thickness to improve contrast, reduces blurriness of the image, and displaces glandular tissue. The last characterstic is an important aspect in diagnostic imaging.

Question 19

Determine whether lesion is real or is a summation shadow

Answer 19

Spot compression

Question 20

It is used for magnification views over the MLO projection to evaluate for milk of calcium and for better localization.

Answer 20

90-degree lateral projection

Question 21

Verify skin lesion or if there is a suspicioun for dermal calcifications

Answer 21

Tangential view

Show palpable lesions obscured by dense tissue

Question 22

It is used for better definition of margins of masses and morphology of calcifications

Answer 22

Spot compression with magnification

Question 23

Show lesion in outer aspect of breast and axillary tail no seen on CC view

Answer 23

Exaggerated craniocaudal lateral view (CXXL)

Question 24

Verify true lesions and determine location of lesion seen in one view by seeing how location changes

Answer 24

Rolled views

Question 25

For improved visualization of superomedial tissue

Answer 25

Lateromedial oblique

Question 26

For improved tissue visualization and comfort for women with pectus excavatum, recent sternotomy, prominent pacemaker

Answer 26

Lateromedial oblique

Question 27

Initial imaging for <30 years of age with palpable mass

Answer 27

Ultrasound

Question 28

Most common indication for imaging a male breast

Answer 28

Gynecomastia

Question 29

The following comprise the four mammographic views performed per breast in patients with breast implants, except:
a. CC view
b. MLO view
c. Implant-displaced (ID) view
d. Anterior compression view

Answer 29

d. Anterior compression view

In total, four mammographic views are performed per breast, compared to the usual two views per breast: A, B, C x 2

Question 30

Most widely used materials for breast implants include the following, except:
a. Silicone
b. Saline
c. Both
d. Neither

Answer 30

c. Both