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Breast Exam Practice Questions 1 Flashcards

1
Q

What is volume averaging?

A

An imaging artifact that results in the filling in of cystic structures due to the lack of a finite beam width

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2
Q

What is the second leading cause of cancer mortality in women ?

A

Breast cancer
- lung cancer is first

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3
Q

How many women will be diagnosed with breast cancer during their lifetime?

A

1 in 8
- 12.4%

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4
Q

What percentage of men make up breast cancer cases?

A

Approximately 1%

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5
Q

What are standoff pads composed of?

A

Gel like substance

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6
Q

Whats the thickness for a standoff pad?

A

Typically vary in thickness from 0.5 -1.5 cm

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7
Q

What is the average speed of sound in breast tissue?

A

1450 m/sec

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8
Q

What is the average speed of sound in soft tissue?

A

1540 m/sec

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9
Q

What is the speed of sound slower in breasts?

A

Higher fat content

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10
Q

What is the formula for axial resolution?

A

AR = SPL/2

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11
Q

Axial resolution

A

An ultrasound system’s ability to define two structures lying in the same plane as the ultrasound beam

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12
Q

What can improve axial resolution?

A

Increasing transducer frequency Elevational resolution or slice thickness is the worst measure of image resolution

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13
Q

What is the worse measure of image resolution?

A

Elevational resolution or slice thickness

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14
Q

What does 1.5D transducers permit?

A

Focusing in the elevation plane

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15
Q

For soft tissue, high frequency ultrasound is attenuated at what rate?

A

0.5 dB/cm/MHz

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16
Q

What is the most useful scanning technique when scanning a patient presenting with nipple discharge?

A

Convergent scanning technique
- radial

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17
Q

What characteristic do benign breast lesions have regarding compresisbility?

A

Usually more easily compressed than malignant lesions
- can rotate under compression

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18
Q

How do malignant lesions appear on shear-wave elastography? Why?

A
  1. Malignant lesions appear larger during shear-wave elastography
  2. Because the hard, desmoplastic reaction surrounding the cancer is also imaged, making it appear larger than the actual size of the tumour
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19
Q

What does system gain settings determine?

A

The amount of amplification an echo receives prior to reaching our TV monitor
- It applies uniform amplification to all returning echoes.

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20
Q

What kind of vascular flow is suspicious for malignancy?

A

Mean flow velocities 25-40 cm/sec range on colour flow doppler
- higher mean flow compared to benign lesions

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21
Q

When is the extended field of view imaging beneficial for imaging?

A

Enable measurement of large breast abscesses

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22
Q

What does spatial resolution improve with?

A

Increasing transducer frequency

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23
Q

What is the most popular method of scanning the breast?

A

Convergent technique
- radial

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24
Q

Why does the Bayonet sign imaging artifact occur?

A

The ultrasound system assumes the speed of sound in the tissues being examined is 1540 m/sec
- helps with needle aspirations

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25
What is the most significant reason why ultrasound should not be used as a screening tool for breast cancer?
Ultrasound lacks the detail resolution of mammo - not approved by the FDA
26
What do harmonic imaging do? How?
1. Improves image quality 2. Due to the use of higher frequency harmonics to create the image
27
What do harmonic imaging eliminates?
Artifacts
28
What is the result in cystic structures using THI? Why?
1. Appear more echo free than those imaged with conventional ultrasound systems 2. Due to better signal to noise ratio
29
THI
Tissue harmonic imaging
30
What is another name for Sonoelastography?
Vibrational Doppler Imaging (VDI)
31
What is VDI an adaptation of?
Fremitus
32
What does TGC control perform?
Is used to adjust the strength of returning echoes based on the depth from which they originate - selectively amplifies returning echoes
33
TGC
Time Gain Compensation
34
What is the most common method of breast cancer detection currently?
Screening mammo
35
What is the optimal position when scanning a parasternal Lt breast lesion?
Supine
36
What is the optimal position when scanning a lesion in the upper outer quadrant of the breast? Why?
1. The supine, contralateral, posterior oblique 2. Because it positions the breast as flat as possible on the chest wall, making it as thin as possible, especially if the patient’s arm is raised above the head
37
Ultrasound contrast agents are typically made of encapsulated bubbles. What are their size?
5-7 microns
38
What is the benefit to THI?
Improved tissue contrast - better signal to noise ratio
39
What are two main disadvantages of tissue harmonic imaging?
1. Depth penetration 2. Dynamic range - higher frequencies used to create the image causes depth penetration to decrease - dynamic range is now reduced because the returning harmonic frequencies are much weaker
40
What is targeted breast ultrasound indicated for? (3)
1. Diagnosing rupture of breast implants 2. Guidance of interventional procedures 3. Determining mass characteristics
41
What size structure can a a transducer in the 10-13.5MHz range resolve?
0.2mm or less
42
What should a standoff pad thickness be?
1cm or less - can be 0.5-1.5cm
43
What colour should fat always appear as on ultrasound images?
Medium gray
44
What vascular tendencies are typically found in benign lesions?
They exhibit similar peak systolic velocities and resistivity indices within the center of the mass and the periphery
45
What vascular tendencies are typically found in malignant lesions?
They have higher peak systolic velocities and resistivity indices in the center of the mass
46
What are orthogonal planes?
Planes that are 90 deg to each other - eg) sag and trans
47
What does a lesion with less than 15% compressibility most likely indicate?
Carcinoma
48
What % of a fibroadenoma is compressible?
0-25
49
What % of a cyst is compressible?
>30%
50
What describing the location of a mass within the breast, what do zones 1, 2 and 3 represent?
Distance away from the nipple
51
What plane is the infiltrative zone best visualized in?
Coronal - 3D ultrasound enables the coronal plane
52
What does contrast enhanced ultrasound do? (3)
1. Increases specificity (not sensitivity) of lesions 2. It requires expensive contrast agents 3. Has a higher diagnostic performance when used in the harmonic mode
53
What can CEUS visualize?
Neovascularity of the breast lesion
54
CEUS
Contrast Enhanced Ultrasound
55
What is an advantages of colour flow doppler?
Ability to assign specific colour to a given velocity
56
What are 3 limitations of colour flow doppler?
1. Mean doppler shift frequency and pulse wave spectral analysis 2. Aliasing occurs 3. Angle dependence
57
How many shades of gray are required for breast images in order to delineate the fine differences in tissue architecture?
256
58
Where do most breast lesions occur? (not quadrant)
Near field
59
What is another term for far field?
Fraunhofer zone
60
What is the dead zone?
Zone between the probe and the first echo - cant detect anything in this zone
61
What artifact is created by impedance mismatch?
Reverberation
62
What artifact is seen deep to fluid structures?
Enhancement
63
What artifact is created by strong reflectors?
Mirror image
64
What are 7 things that can be seen on the visual inspection portion of a physical breast exam?
1. Skin retraction 2. Dimpling 3. Bulging 4. Nipple inversion 5. Breast asymmetry 6. Bruising 7. Presence of scars
65
How do older breasts typically feel?
Stringy
66
What are 4 key things a breast ultrasound transducer require?
1. 10-13.5 MHz frequency 2. Broad bandwidth 3. Linear array 4. Large field of view 5. Dynamic focusing
67
What is lateral resolution equal to?
The beam width at any point on the ultrasound beams - LR = BW
68
What artifact occurs when sound does not travel in a straight line?
Refraction
69
What is the speed of sound in silicone breast implants?
1000 m/s
70
What are limitations of power doppler?
Unable to provide information about blood flow direction - just presence
71
What are 3 advantages for power doppler?
1. Extreme sensitivity to flow 2. Provide information about small tortuous vessels 3. Free from aliasing
72
What ultrasound setting controls the intensity of the beam produced by the transducer that should be high enough to penetrate the chest wall?
System power
73
What does fat tissue do to the speed of sound? (2)
1. Makes the speed slower 2. Positions the echoes deeper than they actually are
74
What is the best scanning technique to image ducts?
Radially
75
What is the method called for removing artifacts from the image by viewing the target area from multiple lines of sight?
Spatial compound imaging
76
What is the most important prognostic factor for breast cancer?
Whether or no the cancer has spread to the lymph nodes
77
What is the second most important prognostic factor for breast cancer?
Tumour size - if the cancer is small (<2.0cm) and has not spread to the lymph nodes, the overall 5 year survival rate is considered excellent
78
DBT
Digital Breast Tomosynthesis
79
What should DBT be done with?
2D digital breast mammo
80
What does DBT improve?
Visualization of the infiltrative zone
81
What is a benefit for DBT?
Less radiation
82
What is brachytherapy also known as?
Internal beam radiation
83
What are 3 advantages of brachytherapy?
1. Reduces radiation to the lungs 2. No delay in treatment (chemo) 3. No hospital admission (outpatient)
84
According to the American College of Radiology, ultrasound may be the preferred initial imaging treatment for what? (5)
1. Suspected failed breast implants 2. Dense breasts in women less than 30 years old 3. Pregnant women 4. Lactating women 5. Invasive procedure guidance.
85
What modality is best for identifying microcalcifications?
Mammo
86

Breast (15 decks)

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