Mammography Technique

Question 1

What is the aim in positioning?

Answer 1

Maximum anatomical coverage
Optimal contrast
Optimal sharpness m
Minimal dose
Minimal movement
Minimal patient discomfort

Question 2

What are some feelings and/or challenges that can be associated when being imaged?

Answer 2

Feelings:-

Anxiousness
Embarrassment
Aggression
Not wanting to be there
Painful breasts

Other challenges:-

Mental /physical disabilities
Language difficulties - limited or no english
Maybe hiding something
May have not read information leaflets
Breast implants
Tattoo
Piercing

Question 3

What are the two standard projections for both men and women?

Answer 3

Medio-Lateral (MLO)
Carnio-Cadual (CC)

Question 4

What are the patient positioning?

Answer 4

Depends on the area of Interest
Magnified (coned), lateral/ extended views, tomosynthesis
Adapted technique for implant/ post surgical / disabled patients
Adapted technique according to the patient’s shape and size

Question 5

How is the cranial-caudal view taken?

Answer 5

The cassette is placed under the breast at the level of the inframamary fold
The breast is then pulled until the inframamary fold is taut
Compression is applied and x-ray beam is directed vertically from above
Posterior medial aspect should also be included

Question 6

How is the medio-lateral oblique view taken?

Answer 6

Best view to image all of the breast tissue and pectoral muscle
The C-arm of the mammographic unit is rotated to 45-degree so that the cassette is parallel to the pectoral muscle
The film holder is kept high up in the axillary fossa and the patient’s arm is abducted to the elbow by 80 degrees
The x-ray beam enters the breast from the medial side - compression is applied to the pectoral major muscles

Question 7

What are some normal aspects in a normal breast mammography?

Answer 7

The slightly dense areas = the glandular tissue
Some asymmetery in size and breast composition is normal
Dense breasts with generalised distribution of glandular tissue
Very little glandular tissue
Widespread microcalcification but not clustered in an irregular fashion therefore considered ‘normal’
Glandular tissue is absent

Question 8

What are some common errors when positioning for each?

Answer 8

Medio-Lateral Oblique (MLO)
Skin Folds and tissues superimposition particularly at the IMA and axillary pectoral muscles

Cranio-Caudal (CC)
Skin Folds and tissue superimposition particularly at the medial and lateral mammary angles

Question 9

What are the anatomical landmarks when imaging a medio-lateral oblique and cranio-caudal?

Answer 9

Medio-lateral oblique
Visualisation of the IMA, pectoralis muscle, retro-glandular fat, nipple in profile

Cranio-caudal
Visualisation of medial (cleavage) and lateral (axillary) mammary angles, pectoralis muscle, retro-glandular fat, nipple in profile

Question 10

Why is it important for the patients position to the stable?

Answer 10

To prevent movement/blur

Question 11

Why is the rotation correction important?

Answer 11

To ensure visualisation of marginal (medial, lateral, inferior, and superior) tissue

Question 12

Why is a relaxed gait and posture important?

Answer 12

To maximise coverage, improve tissue contact, and to optimise compression

Question 13

Why is height selection important?

Answer 13

To ensure tissue is imaged in profile without rotation superimposition

Question 14

What is angulation selection important?

Answer 14

To ensure natural anatomical position and optimal profile visualisation from nipple to chest wall

Question 15

Why is smoothing not the patient’s skin ideal?

Answer 15

To minimise skin folds and tissue superimposition

Question 16

Why is the position of the glandular tissue over exposure chamber important?

Answer 16

To ensure suitable exposure and contrast of denser glandular tissue

Question 17

Why is application of adequate compression important?

Answer 17

To separate and immobilise superimposed tissues, improve contrast and limit dose

Question 18

What are some positioning errors?

Answer 18

Tissue sagging / drooping
Skin smooth - must avoid skin Folds and tissue superimposition particularly at IMA and axillary pectoral muscle
Ensure glandular tissue is positioning centrally over bucky and therefore AEC
Visualisation of pectoralis muscle
Visualisation of appropriate marginal tissue, e.g. medial, lateral, inferior, and superior (for MLO)
Not gaining a stable position
Adequate compression otherwise movement blur
Rotation error - ensure position of feet, hips, and shoulders are appropriate

Question 19

What are some challenges with compression?

Answer 19

Decreases the thickness of breast thus reducing scattered radiation
Improves the image contrast

Question 20

What are some points to receive when you do an image appraisal?

Answer 20

Identify the projection
Fatty tissue peripherally
Denser tissue centrally
If microcalcifications, not significant if not clustered
To ensure all anatomy is visualized, including pectoral muscle margin
No rotation
Nipple profile (pectoral to nipple line - PNL)
No skin folds
No blurring

Question 21

What are some limitations of mammography?

Answer 21

5-10% of breast cancer are mammographically occult - Always listen to patient symptoms
With breast screening comes ‘over diagnosis’
Cultural, generational, socio-economic
HRT/Hormones - can increase patient discomfort/dose
- can limit mammographic sensitivity/contrast
Patient compliance & co-opration

Question 22

What are some things that happenes at a breast clinic?

Answer 22

Clinical assessments
Ultrasound
Biopsy - ultrasound guided or stereotactic biopsy

Question 23

What is ultrasound guided biopsy?

Answer 23

Focal mass or other lesion of unknown nature - palpable or non-palpable
Architectural distortion
Cyst aspiration
? Microcalcification

Question 24

What is stereotatic core biopsy?

Answer 24

Most commonly performed on microcalcifications present in the breast that an ultrasound can’t detect