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mammo > Mammo reg > Flashcards

Mammo reg Flashcards

1
Q

BSE involves

A

Looking & feeling for changes in the breast

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2
Q

CBE is a check of the breast by who?

A

Qualified healthcare professional

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3
Q

ACS recommends women 20 & older perform BSE

A

Every month

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4
Q

Women 20-39 should have a CBE how often?

A

Every 3 years

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5
Q

Women 40 & older should have screen mammo & CBE how often?

A

Every year

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6
Q

Thorough clinical exam will:

A

Locate lumps/suspicious areas, Nipple changes, Skin changes in breast, Lymph nodes n armpit & above collarbone

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7
Q

Medical/family history provides:

A

Symptoms & risk factors for breast cancer & benign breast conditions; questions about other health problems

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8
Q

Effectiveness & sensitivity of mammogram ——- with age.

A

Increases

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9
Q

Average glandular dose of screen-film mammogram with grid

A

0.1-0.2 rad

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10
Q

Biggest risk factor for breast cancer

A

Gender

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11
Q

High risk factors

A

Age, Age, Genes-brCA1&2…, Close blood relative, Personal hx breast ca

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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

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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

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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

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15
Q

Ca+

A

circumscribed tumors

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16
Q

2 main classes breast cancer

A

Ductal, Lobular

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17
Q

90% all cases of breast cancer?

A

Ductal carcinoma

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18
Q

Stage 0 carcinoma is confined to

A

duct (DCIS)

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19
Q

Cancer has spread from ducts into surrounding stromal tissue & possibly pectoral fascia/ muscle

A

Invasive/infiltrating Ductal carcinoma

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20
Q

Lobular carcinoma accounts for — to —-% all breast cancers

A

5-10

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21
Q

Not seen on mammo in 50% cases

A

abnormal cells grow w/in lobules not penetrating lobule walls

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22
Q

Difficult to perceive on mammo

A

may show as spider web or cause skin retraction

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23
Q

Other breast carcinomas account for less than 10% & have —– prognosis than infiltrating Ductal/lobular cancers

A

Better

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24
Q

Single most effective tool in detection breast cancer

A

Mammogram

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25
Q

Describe malignant asymmetric density on mammogram

A

Speculated/stellate lesion w solid central tumor & radiating structures

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26
Q

Malignant circumscribed lesions

A

Ill-defined & high density radiopaque, except few rare are low density

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27
Q

Ductal ca+

A

Granular or casting type Ca+ & usually appear in clusters

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28
Q

2 types mammography screening

A

Conventional-analog, Digital-w cassette or wo

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29
Q

2 types digital detectors

A

Direct, indirect (cassette less)

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30
Q

Uses high frequency sound waves & based on pizoelectric effect

A

U/S

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31
Q

Highly vascular lesions are often

A

Malignant

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32
Q

MRI based on magnetic properties of —– ——- in the body.

A

Hydrogen atoms

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33
Q

——— ——— ———– involves injecting contrast while breast is under compression

A

Contrast digital mammography

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34
Q

Dual energy subtraction used for what 3 reasons?

A

Enhance masses, Eliminate obscuring structures

Separate soft tissue from contrast or Ca+ deposits

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35
Q

3 types nuclear medicine studies used w/mammography

A

PET, Breast scintigraphy

Lymphoscintigraphy

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36
Q

PET imaging uses —— based on the need that cancer cells have for sugar

A

FDG-fluorodeoxyglucose

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37
Q

Breast scintigraphy aka ——- Or by the trade name ——-.

A

Scintimammography, Miraluma

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38
Q

Breast scintigraphy uses what isotope? What kind of camera?

A

Tc-99m sestamibi, Gamma

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39
Q

_______ can be used to reduce blind dissection of axillary nodes & resultant side effects

A

Lymphoscintigraphy

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40
Q

Lymphoscintigraphy aka

A

Sentinel node mapping

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41
Q

Lymphoscintigraphy uses injection of radio isotope where?

A

Around the tumor

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42
Q

Principle behind Lymphoscintigraphy

A

First node sentinel node, receives drainage from a tumor & can be used to predict presence or absence of tumor in remaining nodes

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43
Q

Technology that uses 11 low dose images taken during 7-11 seconds; x-ray tube rotates 50 deg. arc around breast

A

Digital tomosynthesis

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44
Q

CT laser mammography based on what principle?

A

angiogenesis

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45
Q

______ involves removal of content of cyst and is often performed under u/s guidance

A

cyst aspiration

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46
Q

FNA ideal for cyst eval. and aspiration. Uses ___ to ____ gauge needle

A

22-25

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47
Q

which breast intervention usually requires a cytotechnologist eval of sample

A

Fine needle aspiration

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48
Q

3 treatments for breast cancer

A

surgery,surgery, drugs (chemo/hormone therapy), radiation therapy

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49
Q

_________ removes breast tissue and some of underarm lymph nodes

A

modified radical mastectomy

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50
Q

_______ is removal of entire breast

A

mastectomy

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51
Q

which mastectomy removes entire breast, lymph nodes, and chest wall muscles?

A

radical mastectomy (RARELY PERFORMED)

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52
Q

most breast conserving surgery

A

lumpectomy

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53
Q

two common types of flap techniques

A

TRAM, latissimus dorsi flap

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54
Q

more common form of radiation treatment

A

external beam

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55
Q

internal beam radiation usually lasts ______ to ____ days and can begin _____ after surgery.

A

7-9; day

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56
Q

how long does external beam radiation usually last? and how long after surgery can it begin?

A

5-7 weeks; 1 month after surgery

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57
Q

which of 3 treatments is systemic treatment?

A

chemotherapy (affects all cells of body)

common antiestrogen drug tamoxifen

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58
Q

common antiestrogen drug

A

tamoxifen

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59
Q

antiestrogen drug less toxic than tamoxifen?

A

raloxifene

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60
Q

SERMS

A

selective estrogen receptor modulators

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61
Q

3 uses of hormonal treatment using SERMS

A

prevent estrogen from latching onto tumor cell receptors, shrink/stop recurrence of breast cancer
lower risks breast cancer in postmenopausal women

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62
Q

2 newer flap techniques

A

DIEP; gluteal free

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63
Q

____ used to evaluate nipple discharge

A

duct expansion

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64
Q

_____ is prelude to surgical biopsy & necessary if stereo localization not available

A

preop localization

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65
Q

pre op localization can be performed w/which modalities

A

mammo

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66
Q

______ biopsy recommended with lesions that are difficult to approach or close to breast surface.

A

open surgical

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67
Q

which intervention can be used to confirm finding of FNA or FNB

A

open surgical biopsy

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68
Q

_____ uses 22-25 g needle to remove cell samples from nonpalpable lesions for cytological analysis.; often used with stereo localization

A

FNB-fine needle biopsy

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69
Q

Method of locating nonpalpable lesions by using computer to calculate precise location.

A

Stereotactic breast localization/biopsy

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70
Q

Intensity of x-ray beam is less on _____ side of tube due to _____ effect.

A

anode; anode heel

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71
Q

Cathode side of x-ray tube is always directed to the _______

A

the thickest area of the breast.

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72
Q

Material used for exit port or window of x-ray tube

A

borosilicate glass or beryllium (Be)

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73
Q

Why is the exit window of x-ray tube NOT made of regular glass?

A

regular glass window would harden the emerging beam by eliminating soft characteristic radiation

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74
Q

KVp range will depend on ______ material available

A

target/filtration

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75
Q

How does Kvp range affect contrast?

A

contrast higher in thinner breast; lower in thicker breast

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76
Q

Increased kvp allows ____ dose but reduced _____

A

lower; contrast

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77
Q

The ______-_____ combination will essentially shape the x-ray beam

A

providing the necessary kvp range to penetrate dense/fatty breasts.

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78
Q

older mammography generators were _______.

A

three phase

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79
Q

All modern generators are _________.

A

high frequency generators

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80
Q

molybdenum target with _____ mm molybdenum filtration or 0.05 mm rhodium filtration.

A

0.03

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81
Q

rhodium target with _____mm rhodium filtration

A

0.025

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82
Q

molybdenum and tungsten alloy target with ____ or ____ filtration

A

molybdenum; rhodium

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83
Q

molybdenum and rhodium alloy target with _____ or _____ filtration

A

molybdenum; rhodium

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84
Q

tungsten target and _____ or rhodium filtration (some digital units)

A

silver

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85
Q

Flat surface of compression paddle must be ____ to IR

A

parallel

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86
Q

Chest wall of compression paddle should not extend beyond chest wall edge of IR by more than ____% of SID

A

2

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87
Q

Lip of compression paddle should have a _____ angle at the chest wall

A

right

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88
Q

lip along the chest wall should be —to—- cm in height

A

2-4

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89
Q

(yes no) A shadow of vertical edge of compression paddle should not be visible on the image

A

TRUE

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90
Q

Recommended focal spot sizes in mammography are ___ (smaller/routine work) & ____(magnification).

A

0.4mm; 0.15mm

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91
Q

Most commonly used focal spot size for routine work

A

0.3mm

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92
Q

most commonly used focal spot size for magnification

A

0.1mm

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93
Q

Size and shape of focal spot size are determined by what 3 things?

A

size and shape electron beam hitting anode, design and relationship filament coil to focusing cup
angle of anode

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94
Q

In mammography the aim is to have the _____ focal spot with the ____SID

A

smallest; longest

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95
Q

SID in mammo is fixed

A

50-80cm

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96
Q

_____ cassette systems are used in mammography to provide the best spatial resolution

A

single-screen

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97
Q

AEC controls length of exposure and determines___ of the final image

A

density

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98
Q

Two types AEC found in modern mammography

A

ionization chamber; phototimer

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99
Q

Underexposure occurs when the AEC cell is not placed over the _____ area of the breast.

A

densest

100
Q

Magnification will _____ scatter and as the mag factor increases, pt. skin dose ____.

A

reduce; increases

101
Q

Magnification causes ____ in image resolution; compensated by_____

A

decrease; small focal spot size

102
Q

Faster screens have _____ spatial resolution

A

lower

103
Q

Mammography films are _____ emulsion and ____ contrast

A

single; high

104
Q

High contrast films generally have limited ______ latitude

A

exposure

105
Q

______ screen cassette systems are used in mammography to provide best spatial resolution

A

single

106
Q

two common types of film processors for mammography

A

standard 90 sec. processingextended processing

107
Q

Factors affecting film processing include (3)

A

developer time

108
Q

Grids are used to improve radiographic contrast by ______ the amount scattered radiation that reaches the IR.

A

decreasing

109
Q

The use of grids will ALWAYS result in ______ dose to the patient.

A

increased

110
Q

Mammography grids are ______ than conventional radiography grids

A

thinner

111
Q

interspace material

A

carbon fiber; wood

112
Q

Grid strip is made of ______

A

lead

113
Q

mammography grid ratios

A

3:1; 5:1

114
Q

grid frequency

A

30-50 lines/cm

115
Q

_____ focused grid-movement in ____ direction only and focused to SID

A

Linear; one

116
Q

Cones, collimators, and diaphragms are known as ____ ____ devices

A

beam restricting or limiting

117
Q

Collimation should not extend beyond any edge of IR by more than ___ % of SID

A

2

118
Q

Decreasing the x-ray field will require _____ in exposure to maintain constant density

A

increase

119
Q

2 main digital mammography systems

A

cassette-based; cassette-less

120
Q

cassette-less systems can be considered to be___ or ____ conversion systems

A

direct; indirect

121
Q

_____ _____ is the flat-panel detector often used in the direct system

A

amorphous selenium

122
Q

____ ____ ____ arrays are used to transfer electronic signals from the selenium photoconductor to a computer

A

thin-film transistor (TFT)

123
Q

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

A

photostimulable phosphor

124
Q

In all digital systems the spatial resolution will depend on

A

pixel size

125
Q

_______ is the smallest discrete picture element of an image

A

pixel

126
Q

Increased pixel size will _____ resolution and increase ____.

A

increase; noise

127
Q

______ prereads the mammograms identifying areas of suspicion or areas needing additional workup

A

CAD

128
Q

picture archiving and communication system

A

enables teleradiography and filmless libraries which can be accessed via telephone

129
Q

Guidelines for QA and processor quality control are determined by _____ & _____

A

MQSA; ACR

130
Q

Darkroom cleanliness

A

daily

131
Q

processor qc

A

daily

132
Q

mobile unit qc

A

daily

133
Q

screen cleaning

A

weekly

134
Q

analysis of fixer retention in film

A

quarterly

135
Q

darkroom fog

A

semiannually

136
Q

screen-film contact

A

semiannually

137
Q

monitor cleaning

A

Daily

138
Q

compression indicator

A

weekly

139
Q

laser imager test (including SMPTE detector calibration/flat field)

A

weekly

140
Q

SNR & CNR, MTF

A

weekly

141
Q

Automatic optimization of parameters (AOP)

A

monthly

142
Q

Monitor calibration and SMPTE pattern

A

weekly

143
Q

viewboxes and viewing conditions

A

weekly

144
Q

phantom images

A

weekly

145
Q

visual checklist

A

monthly

146
Q

repeat/reject analysis

A

quarterly

147
Q

compression test

A

semiannually

148
Q

review of medical physicist’s survey report

A

annually

149
Q

The ____ must perform all the manufacturer-recommended digital qc test.

A

medical physicist

150
Q

Primary responsibility of interpreting radiologist

A

interpreting the mammography and ensuring that they are of optimal diagnostic quality

151
Q

______ responsible for yearly review of medical audit with lead qc mammographer

A

radiologist

152
Q

confirms and verifies that processor chemical system is working properly according to specifications

A

processor quality control

153
Q

processor qc should be carried out _____

A

daily

154
Q

instruments for processor qc

A

21 step sensitometer; densitometer

155
Q

processor qc records should be saved for how long?

A

1 year

156
Q

sensitometric images saved for how long?

A

last full month

157
Q

ensures screens are free of dust or potential artifacts

A

screen cleanliness

158
Q

screen cleanliness performed how often?

A

weekly and anytime dust or artifacts noted by mammographer or radiologist

159
Q

mammography viewboxes should have luminance level of at least

A

3000 cd/m2

160
Q

purpose of phantom images

A

to ensure that image density, contrast, uniformity, and quality are maintained at optimum levels

161
Q

thickness of mammo phantom

A

4-4.5 cm

162
Q

phantom should have a ____ mm thick acrylic disc

A

4

163
Q

Mammo phantom should always be viewed by same 5 things

A

erson, view box, viewing conditions, type magnifying glass, time of day

164
Q

_____ ensures mechanical integrity and safety of mammo equipment and accessory devices

A

visual checklist

165
Q

visual check list includes (4)

A

indicator lights, displays, mechanical locks, detents

166
Q

Overall repeat rate should not exceed ____% but rate lower than ___% is acceptable once QA program is operational

A

2; 5

167
Q

To be statistically meaningful, a volume of ______ patients needs to be measured.

A

250

168
Q

Purpose of fixer retention in film analysis

A

determine quantity of residual fixer (hypo) in processed film

169
Q

If there’s an excess of hypo retained on film, what has to be done?

A

processor wash tanks and water flow rates and fixer replenishment rates must be assessed

170
Q

Materials for darkroom fog test

A

mammo or routine x-ray unit, densitometer, radiopaque card, watch or timer

171
Q

screen-film contact will influence image _____.

A

sharpness

172
Q

which test requires use of copper wire mesh screen of at least 40 wires/in grid density?

A

screen/film contact and identification

173
Q

Optical density of final image should be b/w _____ when measured near chest wall side of film.

A

0.7-0.8

174
Q

Any cassette having a large area (>1cm in diameter) of poor contact that cannot be eliminated must____.

A

be replaced.

175
Q

Multiple small areas of poor contact (less than 1cm) are considered ______.

A

acceptable

176
Q

Adequate compression ranges from —-to—- in automatic mode

A

25-45 lb (111-200 NEWTON)

177
Q

the initial automatic compression should not exceed ____

A

45 lb pressure

178
Q

______ act was enacted on October 27, 1992

A

MQSA

179
Q

Only organizations authorized to issue MQSA certification

A

FDA; SAC (States as Certifiers)

180
Q

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

A

5; 10

181
Q

Records (mammography report) must include (5)

A

pt name, additional pt. identifier
date of exam
name of radiologist interpreting mammo
final assessment finding

182
Q

All facilitIes must send each patient a summary of mammography report written in lay terms within ____ days of the exam.

A

30

183
Q

Concerned findings must be sent within ___ to ___ days

A

3; 5

184
Q

____ or ____results are acceptable

A

verbal; written

185
Q

Most commonly used assessment category

A

BIRAD

186
Q

HIPAA

A

Health Insurance Portability and Accountability Act

187
Q

How does HIPPA affect medical audit and why?

A

does NOT; bc MQSA documentation patient information can be released w/o pt. authorization

188
Q

Film in CR and DR has been replaced by ____

A

storage phosphor screen

189
Q

other names for storage phosphor screen

A

image recorder (IR), image recorder (IR), image plate (IP), photostimulable phosphor (PSP)

190
Q

Before a mammography facility can legally perform mammograms it must ____.

A

be cerifted

191
Q

Provisional certification (for 6 mo) is usually issued by _____as soon as the accreditation has been accepted.

A

FDA

192
Q

which test checks communication by AWS, detector, and printer

A

SMPTE

193
Q

_____ checks auto-timing with auto kVp and or auto selection of target and filter

A

AOP-automatic optimization of parameters

194
Q

SNR/CNR check ensures_____ and checks consistency of ____

A

contrast is within acceptable range; CNR

195
Q

flat field calibration checks image quality of detector including (5)

A 
brightness nonuniformity; 
high frequency modulation HFM
SNR nonuniformity
bad ROI
bad pixel verification
196
Q

_______ verifies consistent quality of images acquired by detector and displayed on AWS monitor/printer

A

phantom test on monitor/printer

197
Q

Breasts are ____ glands of reproductive system with ____ function.

A

accessory; secreting milk for newborn

198
Q

Areola contains many small protrusions on its surface called____ ______.

A

Morgagni tubercles

199
Q

Nipple contains ___to____ orifices (collecting ducts) that transfer milk from _____ _____.

A

15-20; lactiferous ducts

200
Q

____ _____ (layer of adipose tissue and connective fascia) separates breast from pectoral muscle

A

retromammary space

201
Q

____ _____ are the supportive structures of breast

A

coopers ligaments

202
Q

Breast receives its arterial supply from branches of ____ _____ & ____ ____

A

internal mammary; lateral thoracic arteries

203
Q

Venous network under nipple drains into _____ and ____ mammary veins

A

axillary; internal

204
Q

Primary lymphatic drainage of breast is to the ____.

A

axilla

205
Q

Majority of normal axillary lymph nodes is less than _____ and has kidney shaped appearance

A

2 cm

206
Q

Average female breast consists of ____ lobes containing glandular lobules.

A

15-20

207
Q

Majority of breast diseases occur in ______

A

TDLUs (terminal duct lobular units)

208
Q

Five categories of malignant and benign lesions

A

circular/oval, spiculate/stellate
calcifications
thickened skin syndrome
como of any of these 2 or more

209
Q

____ _____ have a distinct central mass

A

malignant stellate/spiculated

210
Q

3 basic forms of malignant calcifications

A

casting, granular

powderlike

211
Q

characteristics of malignant circular/oval lesions

A

high density; smooth or lobulated and randomly orientated

212
Q

_____ lesions are commonly associated with malignant type calcifications malignant speculated/stellate lesions

A

malignant speculated/stellate lesions

213
Q

Multiple clusters of powderlike Ca+

A

powderlike Ca+

214
Q

Granular type Ca+ resemble _____ and are usually grouped close together in single/multiple clusters

A

sugar or crushed stone

215
Q

______ _____ are irregular in form

A

size and density

216
Q

If spicules reach skin or muscle, it may cause _____.

A

localized skin thickening or skin dimpling (retraction)

217
Q

_______ conditions may cause skin thickening

A

benign or malignant

218
Q

skin thickening syndrome will cause skin to appear obviously thickened generally in ______ portion of breast.

A

lower dependent

219
Q

example of radiolucent, benign circular/oval lesion

A

oil cyst, lipoma, galactocel

220
Q

Benign circuular/oval lesion could be these things

A

lymph node, hematoma, fibroadenolipoma, galactocele

221
Q

capsule which is a thin curved radiopaque line surrounding (benign circular)

A

fibroadenoma

222
Q

benign spherical or ovoid with smooth borders aligned in direction of nipple

A

cyst

223
Q

example of circular benign lesion with low density

A

fibroadenoma, cyst

224
Q

circular benign lesion with halo sign

A

cyst

225
Q

other benign circular lesions

A

abscess, calcified hematoma, sebaceous cyst

226
Q

characteristics of benign spiculated lesions

A

NO central mass or skin thickening/retraction
fine linear densities
translucent oval at center

227
Q

______ is an exception and can appear as a benign spiculated lesion presenting with skin retraction/thickening

A

traumatic fat necrosis

228
Q

example of benign spiculated lesion with translucent oval center

A

radial scar

229
Q

very fine linear densities or lower density spicules

A

radial scars; traumatic fat necrosis

230
Q

characteristics of benign Ca+

A 
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
Q

plasma cell mastitis

A

smooth contour, high uniform density, BENIGN Ca+

232
Q

(benign) Ca+ arteries

A

evenly scattered homogenous

233
Q

(benign ca+)sharply outlinedspherical or oval

A

Ca+ hematoma

234
Q

(benign ca+)pear like

A

resemble tea cups or pearl drops on lateral projection, milk of Ca+

235
Q

ringlike hollow (benign ca+)

A

sebaceous gland

236
Q

eggshell like appearance (benign ca+)

A

oil cyst/ papilloma

237
Q

large size, bizarre shape (benign Ca+)

A

hemangiomas

238
Q

bilat and evenly scattered following course of ducts throughout parenchyma (benign ca+)

A

plasma cell mastitis

239
Q

Tram flap

A

Skin fat and muscle is removed to create breast mount

240
Q

Latissimus Doris flap

A

Skin, fat and muscle from upper back used to create breast mount

241
Q

Galactocele

A

Milk filled cyst benign

242
Q

Fibroadenoma

A

May have calcs
Benign
Common under 25yrs old

243
Q

Lipoma

A

Fatty tumor

Benign

244
Q

Hamartoma

A

Mass of cells and tissues

245
Q

Papilloma

A

Lump in ducts

Benign

246
Q

Duct ectasia

A

Duct is blocked; duct removed

Common 40-50s

mammo (1 decks)

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