Mammo reg Flashcards
1
Q
BSE involves
A
Looking & feeling for changes in the breast
2
Q
CBE is a check of the breast by who?
A
Qualified healthcare professional
3
Q
ACS recommends women 20 & older perform BSE
A
Every month
4
Q
Women 20-39 should have a CBE how often?
A
Every 3 years
5
Q
Women 40 & older should have screen mammo & CBE how often?
A
Every year
6
Q
Thorough clinical exam will:
A
Locate lumps/suspicious areas, Nipple changes, Skin changes in breast, Lymph nodes n armpit & above collarbone
7
Q
Medical/family history provides:
A
Symptoms & risk factors for breast cancer & benign breast conditions; questions about other health problems
8
Q
Effectiveness & sensitivity of mammogram ——- with age.
A
Increases
9
Q
Average glandular dose of screen-film mammogram with grid
A
0.1-0.2 rad
10
Q
Biggest risk factor for breast cancer
A
Gender
11
Q
High risk factors
A
Age, Age, Genes-brCA1&2…, Close blood relative, Personal hx breast ca
12
Q
Moderate risk factors
A
1st degree relative w breast ca, Atypical hyperplasia on biopsy, High rad dose to chest, High bone density after menopause
13
Q
Minor risk factors
A
No child bearing or after 30, Not breast feeding , Early menarche/late menopause, Post menopausal obesity, Long term use HRT/contraceptive, Alcohol consumption, Obesity
14
Q
Examples of benign breast disease
A
Painful cyst Painful cyst, Nipple discharge, Only detected on mammo:
Ca+, circumscribed tumors, lesions, asymmetric densities, skin thickening
15
Q
Ca+
A
circumscribed tumors
16
Q
2 main classes breast cancer
A
Ductal, Lobular
17
Q
90% all cases of breast cancer?
A
Ductal carcinoma
18
Q
Stage 0 carcinoma is confined to
A
duct (DCIS)
19
Q
Cancer has spread from ducts into surrounding stromal tissue & possibly pectoral fascia/ muscle
A
Invasive/infiltrating Ductal carcinoma
20
Q
Lobular carcinoma accounts for — to —-% all breast cancers
A
5-10
21
Q
Not seen on mammo in 50% cases
A
abnormal cells grow w/in lobules not penetrating lobule walls
22
Q
Difficult to perceive on mammo
A
may show as spider web or cause skin retraction
23
Q
Other breast carcinomas account for less than 10% & have —– prognosis than infiltrating Ductal/lobular cancers
A
Better
24
Q
Single most effective tool in detection breast cancer
A
Mammogram
25
Describe malignant asymmetric density on mammogram
Speculated/stellate lesion w solid central tumor & radiating structures
26
Malignant circumscribed lesions
Ill-defined & high density radiopaque, except few rare are low density
27
Ductal ca+
Granular or casting type Ca+ & usually appear in clusters
28
2 types mammography screening
Conventional-analog, Digital-w cassette or wo
29
2 types digital detectors
Direct, indirect (cassette less)
30
Uses high frequency sound waves & based on pizoelectric effect
U/S
31
Highly vascular lesions are often
Malignant
32
MRI based on magnetic properties of ----- ------- in the body.
Hydrogen atoms
33
--------- --------- ----------- involves injecting contrast while breast is under compression
Contrast digital mammography
34
Dual energy subtraction used for what 3 reasons?
Enhance masses, Eliminate obscuring structures
| Separate soft tissue from contrast or Ca+ deposits
35
3 types nuclear medicine studies used w/mammography
PET, Breast scintigraphy
| Lymphoscintigraphy
36
PET imaging uses ------ based on the need that cancer cells have for sugar
FDG-fluorodeoxyglucose
37
Breast scintigraphy aka ------- Or by the trade name -------.
Scintimammography, Miraluma
38
Breast scintigraphy uses what isotope? What kind of camera?
Tc-99m sestamibi, Gamma
39
_______ can be used to reduce blind dissection of axillary nodes & resultant side effects
Lymphoscintigraphy
40
Lymphoscintigraphy aka
Sentinel node mapping
41
Lymphoscintigraphy uses injection of radio isotope where?
Around the tumor
42
Principle behind Lymphoscintigraphy
First node sentinel node, receives drainage from a tumor & can be used to predict presence or absence of tumor in remaining nodes
43
Technology that uses 11 low dose images taken during 7-11 seconds; x-ray tube rotates 50 deg. arc around breast
Digital tomosynthesis
44
CT laser mammography based on what principle?
angiogenesis
45
______ involves removal of content of cyst and is often performed under u/s guidance
cyst aspiration
46
FNA ideal for cyst eval. and aspiration. Uses ___ to ____ gauge needle
22-25
47
which breast intervention usually requires a cytotechnologist eval of sample
Fine needle aspiration
48
3 treatments for breast cancer
surgery,surgery, drugs (chemo/hormone therapy), radiation therapy
49
_________ removes breast tissue and some of underarm lymph nodes
modified radical mastectomy
50
_______ is removal of entire breast
mastectomy
51
which mastectomy removes entire breast, lymph nodes, and chest wall muscles?
radical mastectomy (RARELY PERFORMED)
52
most breast conserving surgery
lumpectomy
53
two common types of flap techniques
TRAM, latissimus dorsi flap
54
more common form of radiation treatment
external beam
55
internal beam radiation usually lasts ______ to ____ days and can begin _____ after surgery.
7-9; day
56
how long does external beam radiation usually last? and how long after surgery can it begin?
5-7 weeks; 1 month after surgery
57
which of 3 treatments is systemic treatment?
chemotherapy (affects all cells of body)
| common antiestrogen drug tamoxifen
58
common antiestrogen drug
tamoxifen
59
antiestrogen drug less toxic than tamoxifen?
raloxifene
60
SERMS
selective estrogen receptor modulators
61
3 uses of hormonal treatment using SERMS
prevent estrogen from latching onto tumor cell receptors, shrink/stop recurrence of breast cancer
lower risks breast cancer in postmenopausal women
62
2 newer flap techniques
DIEP; gluteal free
63
____ used to evaluate nipple discharge
duct expansion
64
_____ is prelude to surgical biopsy & necessary if stereo localization not available
preop localization
65
pre op localization can be performed w/which modalities
mammo
66
______ biopsy recommended with lesions that are difficult to approach or close to breast surface.
open surgical
67
which intervention can be used to confirm finding of FNA or FNB
open surgical biopsy
68
_____ uses 22-25 g needle to remove cell samples from nonpalpable lesions for cytological analysis.; often used with stereo localization
FNB-fine needle biopsy
69
Method of locating nonpalpable lesions by using computer to calculate precise location.
Stereotactic breast localization/biopsy
70
Intensity of x-ray beam is less on _____ side of tube due to _____ effect.
anode; anode heel
71
Cathode side of x-ray tube is always directed to the _______
the thickest area of the breast.
72
Material used for exit port or window of x-ray tube
borosilicate glass or beryllium (Be)
73
Why is the exit window of x-ray tube NOT made of regular glass?
regular glass window would harden the emerging beam by eliminating soft characteristic radiation
74
KVp range will depend on ______ material available
target/filtration
75
How does Kvp range affect contrast?
contrast higher in thinner breast; lower in thicker breast
76
Increased kvp allows ____ dose but reduced _____
lower; contrast
77
The ______-_____ combination will essentially shape the x-ray beam
providing the necessary kvp range to penetrate dense/fatty breasts.
78
older mammography generators were _______.
three phase
79
All modern generators are _________.
high frequency generators
80
molybdenum target with _____ mm molybdenum filtration or 0.05 mm rhodium filtration.
0.03
81
rhodium target with _____mm rhodium filtration
0.025
82
molybdenum and tungsten alloy target with ____ or ____ filtration
molybdenum; rhodium
83
molybdenum and rhodium alloy target with _____ or _____ filtration
molybdenum; rhodium
84
tungsten target and _____ or rhodium filtration (some digital units)
silver
85
Flat surface of compression paddle must be ____ to IR
parallel
86
Chest wall of compression paddle should not extend beyond chest wall edge of IR by more than ____% of SID
2
87
Lip of compression paddle should have a _____ angle at the chest wall
right
88
lip along the chest wall should be ---to---- cm in height
2-4
89
(yes no) A shadow of vertical edge of compression paddle should not be visible on the image
TRUE
90
Recommended focal spot sizes in mammography are ___ (smaller/routine work) & ____(magnification).
0.4mm; 0.15mm
91
Most commonly used focal spot size for routine work
0.3mm
92
most commonly used focal spot size for magnification
0.1mm
93
Size and shape of focal spot size are determined by what 3 things?
size and shape electron beam hitting anode, design and relationship filament coil to focusing cup
angle of anode
94
In mammography the aim is to have the _____ focal spot with the ____SID
smallest; longest
95
SID in mammo is fixed
50-80cm
96
_____ cassette systems are used in mammography to provide the best spatial resolution
single-screen
97
AEC controls length of exposure and determines___ of the final image
density
98
Two types AEC found in modern mammography
ionization chamber; phototimer
99
Underexposure occurs when the AEC cell is not placed over the _____ area of the breast.
densest
100
Magnification will _____ scatter and as the mag factor increases, pt. skin dose ____.
reduce; increases
101
Magnification causes ____ in image resolution; compensated by_____
decrease; small focal spot size
102
Faster screens have _____ spatial resolution
lower
103
Mammography films are _____ emulsion and ____ contrast
single; high
104
High contrast films generally have limited ______ latitude
exposure
105
______ screen cassette systems are used in mammography to provide best spatial resolution
single
106
two common types of film processors for mammography
standard 90 sec. processingextended processing
107
Factors affecting film processing include (3)
developer time
108
Grids are used to improve radiographic contrast by ______ the amount scattered radiation that reaches the IR.
decreasing
109
The use of grids will ALWAYS result in ______ dose to the patient.
increased
110
Mammography grids are ______ than conventional radiography grids
thinner
111
interspace material
carbon fiber; wood
112
Grid strip is made of ______
lead
113
mammography grid ratios
3:1; 5:1
114
grid frequency
30-50 lines/cm
115
_____ focused grid-movement in ____ direction only and focused to SID
Linear; one
116
Cones, collimators, and diaphragms are known as ____ ____ devices
beam restricting or limiting
117
Collimation should not extend beyond any edge of IR by more than ___ % of SID
2
118
Decreasing the x-ray field will require _____ in exposure to maintain constant density
increase
119
2 main digital mammography systems
cassette-based; cassette-less
120
cassette-less systems can be considered to be___ or ____ conversion systems
direct; indirect
121
_____ _____ is the flat-panel detector often used in the direct system
amorphous selenium
122
____ ____ ____ arrays are used to transfer electronic signals from the selenium photoconductor to a computer
thin-film transistor (TFT)
123
In cassette-based systems the imaging plate has a ______ ______ with an active ingredient-europium-activated barium fluorohalide which is activated when exposed to x-rays
photostimulable phosphor
124
In all digital systems the spatial resolution will depend on
pixel size
125
_______ is the smallest discrete picture element of an image
pixel
126
Increased pixel size will _____ resolution and increase ____.
increase; noise
127
______ prereads the mammograms identifying areas of suspicion or areas needing additional workup
CAD
128
picture archiving and communication system
enables teleradiography and filmless libraries which can be accessed via telephone
129
Guidelines for QA and processor quality control are determined by _____ & _____
MQSA; ACR
130
Darkroom cleanliness
daily
131
processor qc
daily
132
mobile unit qc
daily
133
screen cleaning
weekly
134
analysis of fixer retention in film
quarterly
135
darkroom fog
semiannually
136
screen-film contact
semiannually
137
monitor cleaning
Daily
138
compression indicator
weekly
139
laser imager test (including SMPTE detector calibration/flat field)
weekly
140
SNR & CNR, MTF
weekly
141
Automatic optimization of parameters (AOP)
monthly
142
Monitor calibration and SMPTE pattern
weekly
143
viewboxes and viewing conditions
weekly
144
phantom images
weekly
145
visual checklist
monthly
146
repeat/reject analysis
quarterly
147
compression test
semiannually
148
review of medical physicist's survey report
annually
149
The ____ must perform all the manufacturer-recommended digital qc test.
medical physicist
150
Primary responsibility of interpreting radiologist
interpreting the mammography and ensuring that they are of optimal diagnostic quality
151
______ responsible for yearly review of medical audit with lead qc mammographer
radiologist
152
confirms and verifies that processor chemical system is working properly according to specifications
processor quality control
153
processor qc should be carried out _____
daily
154
instruments for processor qc
21 step sensitometer; densitometer
155
processor qc records should be saved for how long?
1 year
156
sensitometric images saved for how long?
last full month
157
ensures screens are free of dust or potential artifacts
screen cleanliness
158
screen cleanliness performed how often?
weekly and anytime dust or artifacts noted by mammographer or radiologist
159
mammography viewboxes should have luminance level of at least
3000 cd/m2
160
purpose of phantom images
to ensure that image density, contrast, uniformity, and quality are maintained at optimum levels
161
thickness of mammo phantom
4-4.5 cm
162
phantom should have a ____ mm thick acrylic disc
4
163
Mammo phantom should always be viewed by same 5 things
erson, view box, viewing conditions, type magnifying glass, time of day
164
_____ ensures mechanical integrity and safety of mammo equipment and accessory devices
visual checklist
165
visual check list includes (4)
indicator lights, displays, mechanical locks, detents
166
Overall repeat rate should not exceed ____% but rate lower than ___% is acceptable once QA program is operational
2; 5
167
To be statistically meaningful, a volume of ______ patients needs to be measured.
250
168
Purpose of fixer retention in film analysis
determine quantity of residual fixer (hypo) in processed film
169
If there's an excess of hypo retained on film, what has to be done?
processor wash tanks and water flow rates and fixer replenishment rates must be assessed
170
Materials for darkroom fog test
mammo or routine x-ray unit, densitometer, radiopaque card, watch or timer
171
screen-film contact will influence image _____.
sharpness
172
which test requires use of copper wire mesh screen of at least 40 wires/in grid density?
screen/film contact and identification
173
Optical density of final image should be b/w _____ when measured near chest wall side of film.
0.7-0.8
174
Any cassette having a large area (>1cm in diameter) of poor contact that cannot be eliminated must____.
be replaced.
175
Multiple small areas of poor contact (less than 1cm) are considered ______.
acceptable
176
Adequate compression ranges from ----to---- in automatic mode
25-45 lb (111-200 NEWTON)
177
the initial automatic compression should not exceed ____
45 lb pressure
178
______ act was enacted on October 27, 1992
MQSA
179
Only organizations authorized to issue MQSA certification
FDA; SAC (States as Certifiers)
180
Mammograms and medical records of patients must be kept for a period of not less than ____ years or not less than ____ if no additional mammos of pt. performed at the facility
5; 10
181
Records (mammography report) must include (5)
pt name, additional pt. identifier
date of exam
name of radiologist interpreting mammo
final assessment finding
182
All facilitIes must send each patient a summary of mammography report written in lay terms within ____ days of the exam.
30
183
Concerned findings must be sent within ___ to ___ days
3; 5
184
____ or ____results are acceptable
verbal; written
185
Most commonly used assessment category
BIRAD
186
HIPAA
Health Insurance Portability and Accountability Act
187
How does HIPPA affect medical audit and why?
does NOT; bc MQSA documentation patient information can be released w/o pt. authorization
188
Film in CR and DR has been replaced by ____
storage phosphor screen
189
other names for storage phosphor screen
image recorder (IR), image recorder (IR), image plate (IP), photostimulable phosphor (PSP)
190
Before a mammography facility can legally perform mammograms it must ____.
be cerifted
191
Provisional certification (for 6 mo) is usually issued by _____as soon as the accreditation has been accepted.
FDA
192
which test checks communication by AWS, detector, and printer
SMPTE
193
_____ checks auto-timing with auto kVp and or auto selection of target and filter
AOP-automatic optimization of parameters
194
SNR/CNR check ensures_____ and checks consistency of ____
contrast is within acceptable range; CNR
195
flat field calibration checks image quality of detector including (5)
```
brightness nonuniformity;
high frequency modulation HFM
SNR nonuniformity
bad ROI
bad pixel verification
```
196
_______ verifies consistent quality of images acquired by detector and displayed on AWS monitor/printer
phantom test on monitor/printer
197
Breasts are ____ glands of reproductive system with ____ function.
accessory; secreting milk for newborn
198
Areola contains many small protrusions on its surface called____ ______.
Morgagni tubercles
199
Nipple contains ___to____ orifices (collecting ducts) that transfer milk from _____ _____.
15-20; lactiferous ducts
200
____ _____ (layer of adipose tissue and connective fascia) separates breast from pectoral muscle
retromammary space
201
____ _____ are the supportive structures of breast
coopers ligaments
202
Breast receives its arterial supply from branches of ____ _____ & ____ ____
internal mammary; lateral thoracic arteries
203
Venous network under nipple drains into _____ and ____ mammary veins
axillary; internal
204
Primary lymphatic drainage of breast is to the ____.
axilla
205
Majority of normal axillary lymph nodes is less than _____ and has kidney shaped appearance
2 cm
206
Average female breast consists of ____ lobes containing glandular lobules.
15-20
207
Majority of breast diseases occur in ______
TDLUs (terminal duct lobular units)
208
Five categories of malignant and benign lesions
circular/oval, spiculate/stellate
calcifications
thickened skin syndrome
como of any of these 2 or more
209
____ _____ have a distinct central mass
malignant stellate/spiculated
210
3 basic forms of malignant calcifications
casting, granular
| powderlike
211
characteristics of malignant circular/oval lesions
high density; smooth or lobulated and randomly orientated
212
_____ lesions are commonly associated with malignant type calcifications malignant speculated/stellate lesions
malignant speculated/stellate lesions
213
Multiple clusters of powderlike Ca+
powderlike Ca+
214
Granular type Ca+ resemble _____ and are usually grouped close together in single/multiple clusters
sugar or crushed stone
215
______ _____ are irregular in form
size and density
216
If spicules reach skin or muscle, it may cause _____.
localized skin thickening or skin dimpling (retraction)
217
_______ conditions may cause skin thickening
benign or malignant
218
skin thickening syndrome will cause skin to appear obviously thickened generally in ______ portion of breast.
lower dependent
219
example of radiolucent, benign circular/oval lesion
oil cyst, lipoma, galactocel
220
Benign circuular/oval lesion could be these things
lymph node, hematoma, fibroadenolipoma, galactocele
221
capsule which is a thin curved radiopaque line surrounding (benign circular)
fibroadenoma
222
benign spherical or ovoid with smooth borders aligned in direction of nipple
cyst
223
example of circular benign lesion with low density
fibroadenoma, cyst
224
circular benign lesion with halo sign
cyst
225
other benign circular lesions
abscess, calcified hematoma, sebaceous cyst
226
characteristics of benign spiculated lesions
NO central mass or skin thickening/retraction
fine linear densities
translucent oval at center
227
______ is an exception and can appear as a benign spiculated lesion presenting with skin retraction/thickening
traumatic fat necrosis
228
example of benign spiculated lesion with translucent oval center
radial scar
229
very fine linear densities or lower density spicules
radial scars; traumatic fat necrosis
230
characteristics of benign Ca+
```
smooth contours
high uniform density
evenly scattered homogenous
sharply outlined, spherical/oval
pear like
ringlike, hollow
eggshell like
large size, bizarre shape
bilat and evenly scattered following course of ducts
```
231
plasma cell mastitis
smooth contour, high uniform density, BENIGN Ca+
232
(benign) Ca+ arteries
evenly scattered homogenous
233
(benign ca+)sharply outlinedspherical or oval
Ca+ hematoma
234
(benign ca+)pear like
resemble tea cups or pearl drops on lateral projection, milk of Ca+
235
ringlike hollow (benign ca+)
sebaceous gland
236
eggshell like appearance (benign ca+)
oil cyst/ papilloma
237
large size, bizarre shape (benign Ca+)
hemangiomas
238
bilat and evenly scattered following course of ducts throughout parenchyma (benign ca+)
plasma cell mastitis
239
Tram flap
Skin fat and muscle is removed to create breast mount
240
Latissimus Doris flap
Skin, fat and muscle from upper back used to create breast mount
241
Galactocele
Milk filled cyst benign
242
Fibroadenoma
May have calcs
Benign
Common under 25yrs old
243
Lipoma
Fatty tumor
| Benign
244
Hamartoma
Mass of cells and tissues
245
Papilloma
Lump in ducts
| Benign
246
Duct ectasia
Duct is blocked; duct removed
| Common 40-50s
