- IR Height is determined by lifting the breast to achieve a 90 deg angle to the chest wall - IR at the level of the infra mammary crease at its upper limits - Breast pulled forward onto the IR with the nipple in profile - The arm on the side of interest is relaxed with the shoulder back out of the way - Head turned away from the side being examined - Inform patient that compression will be applied - Bring compression paddle into contact with the breast while sliding the hand towards the nipple - Wrinkles and folds on the breast should be smoothed out and compression applied until taut Check the medial and lateral aspects of the breast for adequate compression

- Degree of obliquity should be between 30-60 deg depending on the patients body habitus - IR parallel with the upper 1 third of the pectoral muscle of the affected side - Top of IR must be at the level of the axilla - Affected arm elevated over the corner of the IR and rest the hand on the hand grip - With your thumb and fingers, gently lift breast up, out and away from the chest wall. The nipple should be in profile - Slowly apply compression with breast held away from chest wall and up to prevent sagging - upper edge of the compression device must rest under the clavicle - Lower edge must include the inframammary fold - Wrinkles and folds on the breast should be smoothed out - Have patient gently retract opposite breast with opposite hand if necessary to prevent superimposition

- Defines lesions or area with compression - Separates overlying parenchyma - Better visualisation of small lesions located in the posterior breast

- The smallest focal spot is used 0,1mm ( because of the large OID, this decreases geometric unsharpness ) - Demonstrates margins of lesion and microcalcifications - Magnifies the area of interest with improved detail - Determines the characteristics of microcalcifications and the margins of suspected lesions

- There are various forms depending on the cells involved - Tumours may develop in the ducts or lobes of the breast - DUCTAL CARCINOMA INSITU- within the milk ducts - LOBULAR CARCINOMA INSITU- within lobules of breast - INVASIVE DUCTALCARCINOMA- from milk ducts then spreads to surrounding tissue

Module 17: Reproductive Radiography Flashcards by Bonga Tshabalala

HYSTEROSALPINGOGRAM. HSPG

INDICATIONS

Determine the size and shape and position of the uterus and Fallopian tubes
To demonstrate lesions such as polyps and tumour masses
To investigate the patent of the Fallopian tubes in cases of sterility and infertility

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HYSTEROSALPINGOGRAM. HSPG

CONTRAINDICATIONS

Pregnancy,
suspected ectopic pregnancy
Acute infection of the vagina or cervix

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HYSTEROSALPINGOGRAM. HSPG

CONTRAST MEDIA

Water soluble iodinated contrast

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HYSTEROSALPINGOGRAM. HSPG

PREPARATION

1 Administration of non gas forming laxative on the preceding evening

2- Cleansing enemy until the rectum flow is clear

3- Withhold the preceding meal

4- Explain the procedure to the patient

5- Schedule appointment 10 days following the onset of menstruation ( the endometrium is least congested and it’s a few days before ovulation hence no danger of radiating a fertilised ovum )

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HYSTEROSALPINGOGRAM. HSPG

PROCEDURE

Patient bladder empty prior examination to prevent pressure displacement by the bladder
Patient supine in LITHOTOMY position
Vaginal canal is irrigated and perineal area is cleaned
With vaginal speculum in position, the physician inserts a uterine cannula thru the cervical canal
A water soluble contrast medium is introduced via the cannula into the uterine cavity from where it will flow through the patent Fallopian tubes and spill into the peritoneal cavity
CR 5cm above the symphysis pubis ( AP, obliques, Lateral )

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MAMMOGRAPHY SCREENING

Performed on an asymptomatic patients
Goal is to detect breast cancer when still small
Early detection improves patients chances for successful treatments
Recommended every one to two years for women over 40
2 projections done CC and MLO

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DIAGNOSTIC MAMMOGRAPHY

Performed on patients that have clinical signs of breast disease or an abnormality was found during screening mammography
Specific projections are obtained to rule out cancer such as =

magnification

Spot compression

Medio lateral

LATEROMEDIAL etc

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BREAST CANCER RISK FACTORS

AGE

Incidence increases with age

FAMILY HISTORY

A women whose daughter, sister, or mother developed breast cancer, especially at an early age, is at a higher risk

HORMONAL HISTORY

Women with early menses ( before 12)
Women with late menopause ( after 52 )
No children

PERSONAL HISTORY

If a women had breast cancer in one breast she is 3or 4 times more likely to develop breast cancer in the opposite breast

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COMPRESSION VIEW

A critical component in breast imaging

- It is controlled by the radiographer, use as much compression as the patient can tolerate

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COMPRESSION VIEW

FUNCTION

Decrease thickness of the breast, better visualisation of anatomy and abnormalities
Reduce overlapping normal shadows,which can appear as suspicious lesions
Allow the use of a lower x ray dose, thinner breast tissue
Immobilise the breast
Reduce scatter which leads to poor quality
Brings the breast as close to the IR as possible

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COMPRESSION view

PROCEDURE

Review previous images for positioning, compression and exposure factors
Explain procedure to patient
Instruct patient to remove jewellery, deodorant or powder that may cause artefacts on the image
Obtain patient history
Note locations of scars, palpable mass, moles, warts
Explain why you need additional images to the patient and that they do not necessarily indicate a potential problem
Place a Radiopaque marker on the nipple
When ever possible, the mobile tissues should be moved towards the fixed tissues
Between exams, use disinfectant to clean the equipment

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CC PROJECTION

IR Height is determined by lifting the breast to achieve a 90 deg angle to the chest wall
IR at the level of the infra mammary crease at its upper limits
Breast pulled forward onto the IR with the nipple in profile
The arm on the side of interest is relaxed with the shoulder back out of the way
Head turned away from the side being examined
Inform patient that compression will be applied
Bring compression paddle into contact with the breast while sliding the hand towards the nipple
Wrinkles and folds on the breast should be smoothed out and compression applied until taut

Check the medial and lateral aspects of the breast for adequate compression

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CC PROJECTION

STRUCTURES DEMONSTRATED

Entire breast including central, subareolar, medial breast
The pectoral muscle is included in approximately 30% of all CC projections
Nipple in profile

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POSTERIOR NIPPLE LINE

MEASURE,ENT

PNL measurement on the CC must be within 1cm of the depth of PNL on MLO projection

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MLO PROJECTION

Degree of obliquity should be between 30-60 deg depending on the patients body habitus
IR parallel with the upper 1 third of the pectoral muscle of the affected side
Top of IR must be at the level of the axilla
Affected arm elevated over the corner of the IR and rest the hand on the hand grip
With your thumb and fingers, gently lift breast up, out and away from the chest wall. The nipple should be in profile
Slowly apply compression with breast held away from chest wall and up to prevent sagging
upper edge of the compression device must rest under the clavicle
Lower edge must include the inframammary fold
Wrinkles and folds on the breast should be smoothed out
Have patient gently retract opposite breast with opposite hand if necessary to prevent superimposition

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MLO PROJECTION

STRUCTURES DEMONSTRATED

Entire breast tissue, emphasis on the lateral aspect and axillary tail
Inferior aspect of the pectoral muscle extending to the PNL or below
Pectoral muscle showing anterior con exits to ensure a relaxed shoulder and axilla
Inframammary fold must be seen and breast must not be drooping

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SPOT COMPRESSION

Defines lesions or area with compression
Separates overlying parenchyma
Better visualisation of small lesions located in the posterior breast

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MAGNIFICATION

The smallest focal spot is used 0,1mm ( because of the large OID, this decreases geometric unsharpness )
Demonstrates margins of lesion and microcalcifications
Magnifies the area of interest with improved detail
Determines the characteristics of microcalcifications and the margins of suspected lesions

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BREAST CANCER

There are various forms depending on the cells involved
Tumours may develop in the ducts or lobes of the breast
DUCTAL CARCINOMA INSITU- within the milk ducts
LOBULAR CARCINOMA INSITU- within lobules of breast
INVASIVE DUCTALCARCINOMA- from milk ducts then spreads to surrounding tissue

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BREAST CANCER

CLINICAL SIGNS

May be asymptomatic in early stages
Palpable lump in breast or under the arm
Nipple discharge
Nipple invasion
Skin dimpling
Change is breast side or shape

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BREAST CANCER

IMAGING

Mammography
US
MRI

BREAST CANCER

RADIOGRAPHIC APPEARANCE

Mammo

Malignancy has poorly defined margins, with speculations radiating from the mass
Clustered calcifications are very small and localised to one area of the breast

FIBROADENOMA OF THE BREAST

Solid, benign tumours that often occurs in women over 30

A firm , smooth lump with a well defined shape

Clinical signs

- Painless
Moves easily under the skin

Imaging

US
Mammography

FIBROADENOMA OF THE BREAST

RADIOGRAPHIC APPEARANCE

Mammo

Well- circumscribed lesion
Defined margin

Determines a mass as either solid or cystic

FIBROCYSTIC BREAST

- Benign condition of the breast - Multiple cysts, usually bilateral - The cysts will vary in size and amount of fluid with the menstrual cycle

FIBROCYSTIC BREAST Clinical signs

- Lumpy breast tissue - Tender, painful breasts Imaging - Mammo - Ultrasound

FIBROCYSTIC BREAST RADIOGRAPHIC APPEARANCE

Mammogram - Smooth, well circumscribed mass with no invasion of surrounding tissue US - Determines a mass as either solid of cystic

CERVICAL CARCINOMA

Neoplasm of the cervix - Asymptomatic until the advanced stages - Pap smear screening detects precancerous cells and then removed - Human papilloma Virus infection is a factor in the development of Ca Cervix Vaccinations are now available to young girls

CERVICAL CARCINOMA Clinical signs

- Asymptomatic in the early stages - Vaginal bleeding - Pain during intercourse - Vaginal discharge

CERVICAL CARCINOMA IMAGING

- CT - General Radiography - US - MRi

CERVICAL CARCINOMA RADIOGRAPHIC APPEARANCE

CT - Compression of the urinary bladder by the enlarged cervix - Hydronephrosis maybe evident on CT images due to urethral obstruction from neoplasms General RADIOGRAPHY - Chest x ray to rule out metastasis to the lungs

LEIOMYOMAS UTERINE FIBROID

Benign solid mass of the uterus, developed from an over growth of the uterine smooth muscle tissue - - Most common benign lesions in females - Growth is stipulated by estrogen - Often calcified

LEIOMYOMAS UTERINE FIBROID CLINICAL SIGNS

- Heavy bleeding during menstruation - Bleeding between menstrual cycles - Pelvic pain due to pressure on surrounding structures

LEIOMYOMAS UTERINE FIBROID IMAGING

- KUB - IVU - Ultrasound

LEIOMYOMAS UTERINE FIBROID RADIOGRAPHIC APPEARANCE

KUB - Mottled, popcorn calcifications - May occupy the pelvis or project up into the abdomen IVU - Compress the superior surface ( fundus) of the urinary bladder

ADENOCARCINOMA OF THE PROSTATE GLAND

- Second most common malignancy in males over 50 - Often discovered during a rectal exam, ( hard irregular nodule will be palpated on the prostate ) - An elevated serum PSA (prostate specific antigen ) indicates a prostate abnormality - Most common metastasis is bone ( pelvis , spine femur disease ribs)

ADENOCARCINOMA OF THE PROSTATE GLAND CLINICAL SIGNS

- Asymptomatic during the early stages - Urinary tract obstruction due to compression on the urethra - Dysuria - Inability to urinate - Urgency to urinate - Hematuria

ADENOCARCINOMA OF THE PROSTATE GLAND Imaging

- General RADIOGRAPHY - IVU - CT - US - NM

ADENOCARCINOMA OF THE PROSTATE GLAND RADIOGRAPHIC APPEARANCE

IVU - A carcinoma of the prostate elevates the bladder floor - The impression on the bladder floor is irregular US - Preferred modality in detecting prostatic neoplasms CT and NM - Modalities used during staging and identification of metastases

BENIGN PROSTATIC HYPERPLASIA

Enlarged prostate in males over 50 - The increased growth causes compression of the urethra

BENIGN PROSTATIC HYPERPLASIA CLINICAL SIGNS

- Urinating 2 or more times a night - Dribbling after urinating - Weak urine stream - Urinary retention

BENIGN PROSTATIC HYPERPLASIA IMAGING

IVU often with the post voiding imaging

BENIGN PROSTATIC HYPERPLASIA RADIOGRAPHIC APPEARANCE

IVU - A smooth filing defect caused by the elevation of the bladder floor - Distal fish hook appearance of the distal ureters - Bilateral ureter dilation due to obstruction below the bladder - Post void imaging May demonstrate poor emptying of the urinary bladder

FALLOPIAN TUBES PATNCY

- One cause of infertility in women, is blocked Fallopian tubes - May be unilateral or bilateral blockage - Blockage May be caused by pelvic inflammatory disease

FALLOPIAN TUBES PATNCY Clinical signs

- Asymptomatic | - Difficulty in conceiving

FALLOPIAN TUBES PATNCY Imaging

Hysterosalpingiogram : Iodinated contrast media is administered into the uterus, patent tubes fill with contrast and spill into the peritoneal cavity

FALLOPIAN TUBES PATNCY RADIOGRAPHIC appearance

Blocked Fallopian tubes will not demonstrate contrast spilling into the peritoneal cavity

PELVIC INFLAMMATORY DISEASE

An infection of the upper genital tract ( above the cervix ) - PIDis the most common and serious complication of sexually transmitted diseases aside from AIDS among women

PELVIC INFLAMMATORY DISEASE CLINICAL SIGNS

- Fever - Vaginal discharge or bleeding - Pelvic pain - Can scar the Fallopian tubes, ovaries, lead to ectopic pregnancies, infertility , chronic pelvic pain

PELVIC INFLAMMATORY DISEASE Imaging

ECTOPIC PREGNANCY

Implantation of the fertilised ovum in the cellophane tubes - This occasionally happens , most common region is the Fallopian tubes - A potential life threatening condition

ECTOPIC PREGNANCY CLINICAL SIGNS AND IMAGING

Clinical signs - Abdo pain Imaging US