Breast Imaging Flashcards
What are 7 malignant breast cancers?
Invasive ductal
DCIS
Lobular Carcinoma
Tubular
Inflammatory
Triple Negative
Paget’s disease
What are 6 symptomatic clinical indications?
New lump
bloody nipple discharge
changes to nipple
skin dimpling
rash around nipple
skin thickening
What are 3 asymptomatic clinical indications?
Family history
surgery follow-up
breast screening
What is triple assessment clinic?
Clinical exam
imaging (mammogram and/or ultrasound)
Biopsy
What is mammography?
Imaging modality that uses low energy x-rays specifically for imaging of breast tissue
What does mammography practice utilise?
Standardized views of breasts for assessment of breast lesions
What are 4 technical requirements of mammography?
High spatial resolution
contrast between cancerous tissue & normal glandular tissue
minimize radiation dose
high signal-to-noise ratio
What are 7 parts of a mammographer?
Generator
x-ray tube
target
beryllium window
molybdenum filter
compression device
AEC - automatic exposure control
What does the beryllium window do?
minimises absorption of radiation in tube
What does the molybdenum filter do?
absorbs unwanted radiation
What are two targets in the equipment?
Molybdenum
Rhodium
What is the linear attenuation coefficient?
Constant that describes fraction of attenuated incident photons in monoenergetic beam per unit thickness of a material
What is the x-ray spectrum determined by?
x-ray tube anode material
filter material kV
What voltage are mammography devices?
24-32kV
What are filters used for?
Reduce low energy components of x-ray spectrum
Which filter is used for thicker breast tissue?
Rhodium
What is a focal spot?
Area in anode where electrons are targeted
smaller focal spot = sharper image production
(lower energie)
What is spatial resolution limited by?
Focal spot
What acts as the AEC?
Detector
What 3 things does the AEC ensure?
signal to noise & contrast to noise
ratios are adequate
doses are within limits
How is full field digital mammography different?
X-ray film replaced by digital detector & latent image is converted into a digital data set
What are routine projections?
Cranio-caudal
45-degree medio-lateral oblique
What should the CC projection should demonstrate?
Whole breast
appropriate depth
nipple in profile
majority of medial & lateral
pectoral muscle on centre of film
no movement
What should the MLO projection demonstrate?
Pectoral muscle to level of nipple
no skin folds
inflamammary angle clearly visible
nipple in profile
What are benefits of breast compression?
More uniform breast thickness
more homogenoous film density
separation of structures in breast
reduced thickness = reduced dose
How much is the compression in CC and MLO?
70-140N CC
100-140N in MLO
When are breast ultrasound used?
Symptomatic
recall from mammo/MRI
Image guidance of procedures
assess response to treatment
What are 4 roles of ultrasound?
Diagnosis
staging (TNM)
Guide treatment planning
Assess response to treatment
Does ultrasound need a AOC?
Yes - its not specific/sensitive enough to screen the breast without a palpable AOC
When are MRIs used?
Screening/surveillance
Increased breast density
imaging characteristics of some cancers may look benign on mammograms
specific cancer types
What 2 types of breast cancer is MRI used?
TP53
BRCA
What are 2 other imaging modalities used?
Digital breast tomosynthesis
Contrast enhanced spectral mammography
What are DBTs?
Low-dose projection images acquired by rotating x-ray tubes around stationary compressed breast in a limited angular range
What is CESM?
Complementary breast imaging modality low energy (26-31kVp) & high energy image (45-49kVp)
What is the MoA pf CESM?
IV injection of a contrast dye
series of x-ray images
high energy & low energy exposure (4 positions)
Image examined
