Mammography In Practic Flashcards
What is the biggest sign/ risk factor of breast cancer in men
High levels oestrogen
klinefelters syndrome is a genetic condition affecting hormone levels that may cause breast cancer in men, what is this
Men are born with an extra X chromosome
How can male to female gender reassignment cause breast cancer in men
Synthetic hormones affecting hormone levels which can lead to cancer
What 2 pathologies can be a risk factor to breast cancer in males
Liver damage
Inflammation or damage to testes
Age is the most significant risk factor for breast cancer in men, what age range is this
60-70
Know that studies showed male infertility was associated with increased risk of breast cancer in men
What are physical symptoms of male breast cancer
- unilateral enlargement (may also have tenderness)
- hard or irregular breast tissue
- rapidly occurring enlargement
- recent onset
- fixed mass
- abnormality of nipple
- abnormality of surrounding skin
What are physical symptoms of female breast cancer
- lump or area of thickened tissue in breast not previously there
- change in size or shape of one or both breasts
- discharge of fluid spontaneously from nipple
- lump or swelling in either of armpits
- dimpling of breast
- rash on or around nipple
- change in nipple appearance
What are the 4 tier system of radiographers when screening breast cancer
- assistant practitioner
- mammographer
- advanced practitioner
- consultant radiographer
What is the FDS / its purpose
faster diagnosis standard
- target that you should not wait more than 28 days from referral to finding out whether you have cancer or not
What are the 2 vetted/referal pathways for cancer
RED pathway- urgent, clinical examination, appropriate imaging +/- biopsy same day
BLUE pathways- non urgent, clinical examination, appropriate imaging depending on age
What type form of mammogram should women over 40 receive
Bilateral mammogram
Patients under 40 have ultrasound first unless clinically suspicious symptoms
Why would you do a CT scan for breast cancer
Check for secondary/metastatic changes
Why would nuclear medicine bone scan be done for suspected breast cancer
Check for metastatic bone cancer
Why would a dexa bone scan be done
To check and monitor bone density following hormonal treatments
Why would a PET scan be done
Indeterminate lesions active or not/ axillary scarring or reoccurrence
What might be the different aims of using digital mammography, ultrasound, MRI
Digital mammography: basic screening, assessment views, eclund technique for augmented breast, stereotactic guided biopsy, contrast enhanced mammography, tomosynthesis
Ultrasound: characterise lesion in 2D vascularity, accurate assessment of size, guiding biopsy, inserting tumour bed markers
MRI: lobular carcinoma or extent/ focality of disease
What are the 2 modern mammography units
Siemans
Hologic
What are the 7 key parts of a mammography unit
- reachable controls for movement and compression
- protective face guard
- patient handle to aid positioning
- compression paddle
- detector/bucky
- fully rotating tube head and detector
- foot paddles
What are the 2 main positioning of the patient during mammography
Medio-lateral oblique
Cranio-caudal
What should you see on a media-lateral oblique view of breast
- ISPACEMAN
- adequate compression
- no skin folds
- nipple in profile
- pectoral muscle to nipple level or posterior nipple line (PNL)
- pectoral muscle at appropriate angle
- inframammary angle shown clearly
- symmetry
- whole breast imaged
What would you see on a cranium-caudal view of the breast
- ISPACEMAN
- no skin fold
- nipple in profile
- medial border demonstrated
- back of breast clearly shown with some medial, central and lateral
- some axillary tail shown
- whole breast images
- absence of artefacts covering image
- symmetry
What is the NHS BSP mammography image assessment tool
Mandatory for use within programme for image review at individual, peer and department levels.
Be aware that pacemakers will not be affected by xrays from mammogram but radiographer should adjust the xray equipment to make the woman as comfortable as possible and avoid pressure on wires or pacemaker
What is an eclund MLO/CC
Posterior superior displacement of the implants
- A procedure used to do a mammogram (x-ray of the breasts) in women with breast implants. The implant is pushed back against the chest wall and the breast tissue is pulled forward and around it so the tissue can be seen in the mammogram.
What is hickman (central) lines
- hickman line is a tube that goes into the chest and directly into one of the major blood vessels
- end of hickman line hangs out of chest and sealed off with cap
What is the purpose of using hickman central lines
Inserted to enable chemotherapy to be administered
Once treatment is completed the line is removed
Be aware that if a woman attends for screening and has hickman line, mammography can be undertaken but care should be taken not to dislodge the line
Be aware that screening should be suspended until 3 months after lactation stops ( regulated by IRMER)
But non significant radiation dose to foetus from mammography
What is ultrasound good at identifying
Fluid filled masses e.g cysts or abscesses and for assessment of lymph nodes both in axillary and breast
What are the negatives of using ultrasound to screen breasts
Difficult to identify pattern changes and asymmetrical breast patterns as you can’t view whole breast in one image
Fine micro calcification unlikely to be seen with US
What is sheer wave elastrogroahy
Shear wave elastography (SWE) is an emerging technology that provides information about the inherent elasticity of tissues by producing an acoustic radiofrequency force impulse
- system evaluates tissue stiffness by measuring the propagation velocity of shear waves inside the tissue in m/s
Why is shear wave elastography used
Routine work up for breast masses to improve the sensitivity for diagnosing malignant lesions and avoiding false-negative reports
Adjunct tool in characterising breast mass esp in suspicious areas
Also useful in determining need for performing invasive histopathological examination and avoiding unwarranted biopsy in some benign lesions
what conditions make a woman eligible for the annual breast MRI screening
- 40-50 yrs old
- previously diagnosed as carrying the BrCA 1 OR BrCa 2 gene (genetic) (causes cancer)
what are pros and cons of using MRI for breast screening
pro
- useful to image dense breast
- assessment tool for lobular cancers
- no radiation
cons
- lengthy
- claustrophobia
- increased false positives
- IV contrast needed
- not very accessible
what is tomosynthesis
advanced form of mammography using low energy xrays to form 3d images
what is tomosynthesis good for
- reducing false negatives
- finding multi focal disease in dense tissue
- calcification of massers
- architecutural distortions
what are negatives tomosyntheis
- ## not good at viewing calcifications
what is the process for taking a breast biopsy
- verbal consent + completed WHO checklist
- position patients, locate area of abnormality using appropriate imaging modality
- clean and prepare skin
- local anaesthetic (injected deep down to biopsy area)
- once numb, small incision made with scalpel
- biopsy core needle inserted through hole and sample taken
what type of technique is used to clean and perp the skin for breast biopsy
aseptic none touch technique
ANTT
what local anaesthetic is used for breast biopsy
lidocaine 1%
what is vacuum assisted breast biopsy
Your doctor uses a special needle attached to a vacuum device to remove the breast tissue
- position
- vacuum
- cut
- remove
if the breast sample is calcified, the sample is imaged to confirm the sample contains the representative calcification
what type of pot is the breast sample put in for labelling and then transporting to lab
formalin pot
how many core samples are taken from the breast
- at least 3
- for stereotactic biopsies, up to 18 samples might be taken
what is a breast marker and when/why is it used
a tiny titanium or stainless steel marker used to mark the site where the biopsy was taken
what are the 7 shaped clips that can be used to mark the sample position
securmark
- barrel
- coil
senomark
- coil
- ribbon
hydromark
-open coil
- butterfly
surgical clip
familiarise yourself with what the different markers look like
what is radio isotope localisation/how is it done
- nuclear medicine
- small dose of radioactive solution injected directly into breast centre of cancer/abnormality
- (injection guided by US or stereotactic guidance (special mammography machine to guide)
what piece of equipment is used to help surgeon remove area of cancer with aid of nuclear medicine
gamma probe (Geiger counter)
why is a gamma probe used in breast cancer surgery with nuclear medicine
- radioactive solution that was injected into cancer releases radioactive substance (gamma rays) that can be detected by the gamma probe and help surgeon locate abnormality
how much radiation is in a diagnostic unit mammogram
0.2 millisieverts
around 4mGy
be aware that an audit/inspection of a minimum of 20 mammograms every 2 months should be undertaken at service level
