mammography, hysterosalpinogography Flashcards
1
Q
what is one of the most common cancers in women
A
breast cancer
2
Q
do the majority of women with breast cancer have family hx?
A
no
3
Q
is breast cancer treatable?
A
yes! one of the most
4
Q
what leads to the best prognosis of breast cancer
A
early detection and treatment
5
Q
what type of generators are used
A
high-frequency generators
6
Q
what is linearity
A
linear factor changes
ie double mA=double radiaiton
7
Q
the consistent radiation output of mammo tubes leads to …
A
excellent linearity and reproducability
8
Q
what are the tube & filter materials
A
Mo/Mo
Mo/Rh
sometimes Rh/Rh
9
Q
when is Rh/Rh used?
A
10
Q
what is the most common grid type
A
moving linear focused
11
Q
what is an HTC grid
A
high transmission cellular
honeycomb or cross-hatch, reduces in 2 directions
12
Q
what are soft-tissue grids
A
allows use of higher kVps, improving penetration
13
Q
what features contribute to pt comfort (4)
A
rounded corners
heated detectors
automatic release of compression
14
Q
what does FFDM stand for
A
full-field digital mammography
15
Q
what is FFDM
A
full field digital mammography
uses digital tech to capture images of the breast
16
Q
what are the key features of FFDM (5)
A
digital image capture
improved image quality
low radiation dose
computer-aided detction
efficient workflow
17
Q
how does FFDM image capture
A
entire breast in a single view, more detail and more manipulable
18
Q
how does FFDM have improved image quality
A
higher contrast resolution and better dynamic range
easier to detect abnormalities
19
Q
how does FFDM have lower dose
A
generally requires less dose to begin with
20
Q
how does FFDM use CAD
A
can be integrated with CAD systems to automatically highlight areas of concern
21
Q
how does FFDM contribute to efficient workflow
A
digital images can be easily stored and transmitted, facilitating faster procedures
22
Q
how must mammo images be viewed?
A
on a high-res monitor, regulated
23
Q
what is digital breast tomosynthesis
A
reconstructs 3 dimensional information of objects, based on the finite number of images
24
Q
mammographic interpretation requires:
A
sensitivity (detect lesions)
specificity (determine whether lesion is malignant or benign)
25
what is used to improve detection rates? by how much?
double-reading by a second radiologist
by about 10%
26
DICOM stands for what
digital imaging and communications in medecine
27
how old and often are asymptomatic pts screened?
at 50+, every 2 years
28
how old and often are asymptomatic pts with risk factors screened?
40+, every 1-2 years
29
what is a diagnostic mammogram?
a mammo performed in patients presenting with signs or symptoms
30
how does mammo meet screening standards? (6)
- be simple (2 projs)
- be acceptable
- high sensitivity and specificity
- repriducible
- cost-effective
- low risk-to-benefit ratio
31
what are the 5 indications for diagnostic mammos
- palpable mass
- other symptoms (swelling, bleeding, pain, etc.)
- changes to skin
- changes to nipple
- unilateral bloody or clear discharge
32
does mammo confirm breast cancer diagnosis?
no!!! can only be diagnosed through a biopsy
33
does digital breast tomosynthesis (DBT) require breast compression
yes, still does
34
name 5 risk factors for breast cancer
- female
- age
- overweight (post menopausal)
- menopausal hormone therapy
- physical inactivity
- alcohol consumption
- long term smoking
35
what does CAD do?
point out areas of interest for the radiologists to review
36
what are the 3 medical risk factors
high breast tissue density
high bone density
high dose radiaiton to chest
37
what are the 4 reproductive risk factors
- long menstrual history
- recent use of oral contraceptives
- never given birth
- first child after 30
38
what is menarche
the first period
39
what is nulliparous
never given birth
40
what are the 2 additional risk factors
- family hx, 1st degree relative
- BRCA1 and BRCA2 gene mutations
41
what genes with mutations will be a risk factor
BRCA1 and BRCA2
42
what drugs can be used to reduce risk in high-risk women
tamoxifen and raloxifene
43
what are cooper's ligaments
the suspensory ligaments of the breast
44
on what muscles does the base lie
anterior to pectoralis major and serratus anterior muscles
45
the axillary tail extends from ___ into ___
upper lateral base of breast
into axillary fossa
46
the breast tapers ___ from the base
anteriorly
47
which aspects of the breasts are the most mobile
inferior and lateral
48
breast are composed of ___ lobes
15-20
49
lobules contain ___ (3)
glandular tissue
draining dicts
connective tissue
50
what does the space between the lobes contain
fatty tissue
51
the lymphatic vessels of the breast drain into which lymph nodes
internal mammary nodes
axillary lymph nodes
52
what is the average size of the craniocaudad diameter of the breast
12-15 cm
53
what rib level does the tail generally reach
2nd rib
54
what rib does the base of the breast generally sit around
6th or 7th rib
55
What is a significant change in breast anatomy that occurs during menopause?
a decrease in glandular tissue due to low estogren
56
What is the primary role of the Cooper's ligaments in the female breast?
To provide structural support by connecting the breast tissue to the overlying skin.
57
what are the 5 stages of tissue variaiton
adolescent
prepregnancy
reproductive
menopausal
senescent
58
which is adolescent
1
59
which is prepregnancy
2
60
which is reproductive
3
61
which is menopausal
4
62
which is senescent
5
63
what must be done for a lactating patient
bets to have them nurse or pump prior
64
when do lobules decrease in size
with increasing age
after pregnancy
65
what is involution
process that removes the milk-producing epithelial cells at weaning
66
what are 4 contraindications for mammograms
young patients -too dense
breasts too sore
kyphotic patients
wheelchair or stretcher
67
what pre exam prep is suggested
maybe ibuprofen 1hr prior
refrain from caffeine for 2 weeks prior
68
what physical preparation is done for mammo (4)
gown open/removed
no jewelry or hair
no deodorant or powders
full hx taken
69
what are the 4 quadrants of the breasts
UOQ, UQ, LQ, LOQ
70
in what quadrants are most cancers detected
UOQ
71
what are the standard mammo projections
craniocaudal x2
mediolateral oblique x2
72
where is the CR directed for a craniocaudal proj
parallel to base, perp to detector
73
5 points on the value of compression
1. produces even thickness
2. immobilization
3. mins superimposition
4. reduce breast dose, improves contrast by reducing scatter
5. reduce OID + geometric blur
74
how thick is the average compressed breast
4cm
75
what is the PNL
posterior nipple line
nipple to chest wall or edge of image
76
how do you know you have all the tissue included on a CC projection (3)
retroglandular fat
pectoral muscle posterior
medial skin reflection
77
what obliquity is used for an average MLO
45 degrees
78
what is the angle for an MLO on a tall and thin pt
60 degrees
79
where does the top of cassette go on a mammo MLO
in axillary, behind pectoral fold, lean into it
80
where does the affected side arm go
elevates, over corner of IR
81
what is the PNL relationship from CC to MLO
MLO PNL measures within 1cm or 1/3inch of PNL on the CC
82
what are these projections
left: craniocaudal
right: mediolateral oblique
83
what SID is used in mammo
24-30 inches
84
what is the kVp range for mammo
25-28 kVp
85
what proj
CC
86
what proj
MLO
87
what procedure is added for pts with palpable masses
addition of a radiopaque marker, to identify location
88
The Posterior Nipple Line on the MLO projection must measure within ________ of the depth of the PNL on the CC projection.
1 cm or 1/3 inch
89
what is gynecomastia
abnormal growth of breast (glandular) tissue, due to irreg hormones actovoty, or drugs
90
what are the 5 screening risk factors for males
- BCRA1/BCRA2 mutation
- family hx
- excess alc, cirrhosis/liver
- klinefelter's syndrome (XXY)
- hormonal changes
91
what is different about doing CC on males?
sometimes done caudocranial instead (due to pectoralis muscle)
92
does breast augmentation increase risk of cancer
nope!
93
what is the Eklund method
the implant displacement technique
94
how is the Eklund method done
implant is pushed posteriorly, implant pulled anterioly
95
what type of implants are the best for using the Eklund method
those placed posterior to the pectoral muscle
96
what has changed from the left to right sets of images
application of Eklund method
97
round/oval masses are more likely ___
to be benign
98
irregular masses are more likely to be ___ or ___
malignant or indication of trauma
99
what does circumscribed mean
well defined border
100
circumscribed borders are likely indicative of ___
benign
101
microlobulated edges are likely ___
50/50 chance
102
what does a spiculated margin indicate
cause for worry
**can be post biopsy, but could also be cancer
103
what is a spiculated margin
fine spicules radiating from the center or the mass
104
this margin is ___
circumscribed
105
this margin is ___
obscured
105
this margin is ___
microlobulated
106
this margin is ___
indistinct
107
this margin is ___
spiculated
108
do breast cancers contain fat?
NEVER!!
109
are radiolucent masses cancer
no! they contain fat, therefore are not
110
what percentage of micro-calcifications are associated with cancer
15-25%
111
what is visualized here
microcalcifications
112
what are the alternate modalities for mammo
MRI or PET
113
what is hysterosalpingography
uses contrast to visualize the uterus and fallopian tubes
114
what are the indications for hysterosalpingography (3)
- asses uterine tube patency
- intrauterine pathology
- eval of unterine tube following tubal ligation/reconstruction
115
when is a hysterosalpingography scheduled for
within 7-10 days following onset of menstruation (least congestion of endometrium)
116
what is the pt prep prior to a hysterosalpingography (3)
empty bladder
NPO 5 hours
laxative day prior
117
when would the contrast spill into the peritoneal cavity in a hysterosalpingography
if tubes are patent
118
how much contrast is used in hysterosalpingography
10-20 ml
119
how is the contrast from a hysterosalpingography removed
absorbed and excreted in 2 hours, by urinary system
120
what type of contrast is used for a hysterosalpingography
iodine-based water-soluble contrast agent
121
what are the hysterosalpingography views
AP scout
AP post injection
LPO/RPO upon req
122
where is the CP on a hysterosalpingography
2" above symph
