Mammo

Question 1

what is mammography

Answer 1

Is the radiographic examination of breasts (usually both) using low energy X radiation (typically around 30kVp)

May be performed either for diagnosis of a clinical finding or for screening of women aged 50-70 yrs. in UK (Age extension RCT trial to include 47-73yrs)

Question 2

why is the machine offset

Answer 2

The whole tube assembly is off set to reduce dose to the torso and directing the useful x-ray beam to the breast tissues.

Question 3

what type of kVP is requried and why

Answer 3

Require low kVp as breast tissues are very similar and it is important to see small differences between them.

Question 4

why is compression applied to the breasts

Answer 4

Compression is applied to the breast to spread out the breast tissues, reducing dose and scatter, it also immobilises the breast reducing movement unsharpness (blur) and spread out over lapping tissues, making it easier to differentiate between normal and abnormal structures.

Question 5

describe mammo technique - CC projection

Answer 5

• Patient stands at medial edge and rests against faceguard (protective cone.)
• Elevate breast to ensure minimal drag from compression and raise or lower C-arm to comfortable position.
• Breast pulled forward to include medial edge and as much lateral edge tissue as possible.
• Nipple in profile but not to the detriment of the posterior breast tissue. One view must have nipple in profile or a second nipple view must be taken.
• Compression applied
• Mirror images required

Question 6

why is it important they are mirror images

Answer 6

aids film reading easier to pick up asymmetric densities

Question 7

describe mommo technique for MLO projection

Answer 7

Assembly adjusted to individual physique, slim woman steeper 50-60 degrees, average angle 45-55 degrees Nipple must be in profile otherwise could hide SAR lesion.
Corner of detector in posterior border of axilla.
Lift breast towards medial and superior borders, to afford better compression and lessen painful drag on the breast.
Eliminate skin folds as could easily hide calcification.
Compress until taut if woman comfortable. Increased pressure beyond this contributes very little to the image

Question 8

refferal pathway

Answer 8

lumps
pain
nipple discharge 
nipple inversion 
change in contour 
faily history

Question 9

refferal pathway - lumps

Answer 9

Any new lump or thickening of tissue. Cysts can occur almost overnight therefore short history of duration likely benign.

Question 10

refferal - pain

Answer 10

Can be cyclical or continuous but can be persistent and severe and may require drug treatment. Imaging if focal pain to rule out underlying problem.

Question 11

refferal nupple discharge

Answer 11

Mostly linked to benign conditions but if serous or bloodstained can indicate malignancy.

Question 12

refferal - nipple inversion

Answer 12

Can be due to age changes. Slit retraction but uneven distortion likely malignancy. Eczema on nipple possible Pagets disease

Question 13

refferal - chnage in contour

Answer 13

May be due to mass lesion distorting breast.

Question 14

refferal - family history

Answer 14

Requires discussion for undertaking earlier screening and genetic testing for gene mutation (may need referral to Genetics.)

Question 15

what is gynaecomastia

Answer 15

Men can develop increase in glandular tissue forming a breast lump, known as gynaecomastia commonly puberty and old age, can be caused by used of steroids, illegal drugs, prescribed medication and can be related to prostate problems, therefore the patient will also undergo a blood test

Question 16

NHSBSP aims

Answer 16

Inviting women between 50 and 70 years (+ age expansion trial)
High quality, two view, bilateral mammography
Three yearly
Timely recall for assessment
Identification of small breast cancers
Prompt referral if cancer diagnosed

Question 17

disadvantage of NHSBSP

Answer 17

Increased risk of radiation induced cancers
Not 100% sensitive: Small cancers can hide in dense tissue/ may not be seen maybe mammographically occult/may be minimal sign only detected in hind sight
Cancer may occur in women even with regular breast screening
Increased anxiety for women waiting for results
High levels of false positives
Potential over treatment

Question 18

risk of mammo causing cancer

Answer 18

increased risk of radiatin induced cancers
However in the relevant age group that risk is said to be outweighed approximately 100:1 by the risk of not detecting a cancer, i.e. mammography saves 100 times more lives than it causes deaths

Question 19

assessment after screening

Answer 19

Triple assessment
Multidisciplinary team
Rapid referral to Surgical breast team

Question 20

reporting on mammograms

Answer 20

Reporting categorisation important:
 to aid the clinician in decision making,
 to standardize interpretation between radiologists
 to be used in statistical analyses of mammography practice.

Question 21

M1 category

Answer 21

normal/no significant abnormality

no significant imaging abnormality

Question 22

M2 category

Answer 22

benign findings

image findings are bengin

Question 23

M3 category

Answer 23

indeterminate/probably bengin

there is a small risk of malignancy, further investigation is indicated

Question 24

M4

Answer 24

findings suspicious of malignancy

there is a moderate rish of malignancy, further investigation is indicated

Question 25

M5 catrgory

Answer 25

findings highly suspicious of malignancy

there is a high risk of malignancy, further investigation is indicated

Question 26

what is looked at in imaging assesment of breast pathology

Answer 26

Asymmetry
Architectural distortion
Masses
Calcification

Question 27

additional techniques/technologies

Answer 27

Tomosynthesis
Ultrasound
MRI
Contrast enhanced spectral mammography
PET – CT?
Molecular breast imaging