MODULE 2 Flashcards
performed by a healthcare professional/ physician to detect any abnormalities and warning signs
Clinical Breast Exam
every woman should do once a month at home; do it yourself
Breast Self-Exam
Screening method:
Opportunistic or Programmatic
What is screening?
refers to a test, examination, evaluation, assessment performed on an asymptomatic individual
GOAL of screening?
prevent death and suffering/occurrence of diseases through an early intervention
General Principle of Screening:
- screening is of greatest value for individuals who are most likely to
develop a certain disease - early treatment is more effective than later treatment in reducing mortality
Important to determine a person’s risk of developing breast cancer
and use that information to:
- Recommend the modality
- Frequency of screening
- Determine whether referrals are needed for genetic testing
/chemoprevention / prophylactic surgery
Harms of Screening
- raise anxiety if there is false positive screening
- overtreatment of some tumors that would never become apparent
- economic cost: healthcare system/patient
Risk Factors
Hormone Therapy
Non-modifiable
Postmenopausal
Reproductive Factor
Subtances Use
- can’t be changed
- family history
- age, chest radiation history, dense breast tissue, genetic alteration, race
NON-MODIFIABLE
- obesity
POSTMENOPAUSAL
Combined estrogen-progesterone in
women with intact uteri
HORMONE THERAPY
⬆️ age
the more susceptible we are to breast CA
- Alcohol
- Current smoking
SUBTANCE USE
- Absence of breastfeeding
- Early menarche
- Late first pregnancy >35 years old
- Nulliparity
REPRODUCTIVE FACTOR
never been pregnant or given birth
NULLIPARITY
Highest Probability (%) of developing breast cancer by Age
70 and older
Defective Genes
BRCA1
BRCA2
p53
STK11
CDH1
PALB2
PTEN
Mismatch repair genes
Components of Breast Screening Examination
I. Breast Awareness
II. Physical Examination
III. Risk Assessment
IV. Screening Mammography
V. MRI
VI. UTS
- screening method used in attempt to detect early breast cancer
- checking your own breast for possible lumps, distortions, or swelling
BREAST SELF EXAMINATION
Benefits of BSE
• Education about self-awareness
• Empower women
• General breast health
• Lower risk of death or metastasis
• Lesser advanced-stage cancer
• Raise awareness among women at risk
Harm of BSE
• False positive result
• Gain anxiety if found abnormality
It is advisable to do BSE..
once a month after menstruation
STEPS TO BREAST SELF-EXAMINATION
- Stand infront of a mirror
Shoulder straight
Hands on hip
Look for dimpling, dripping, lump, pulled in nipple (inverted/retracted), rash, skin changes - Raise arms, look for the same changes
- Look for sign of fluid cominf out (blood, milky/ yellow fluid, watery)
- Palpate breast while lying. Use finger pads to palpate.
Cover entire breast, side to side (from collarbone to abdomen: armpit to cleavage) - Feel breast while standing/ sitting. However, many find it easier to feel breast while showering or wet.
PATTERNS FOR PALPATION
CIRCULAR
LINES
WEDGES
systematic palpation
visual inspection of the entire breast
performed by doctor, nurse practitioner, nurse, or physician assistant
Clinical Breast Examination
GOAL of MAMMOGRAPHY
early detection of breast cancer, typically through characteristic detection of masses or microcalcifications
highly engineered so we can image the breast
mammographic machine
BASIC PROJECTION:
Cranio-caudal (CC)
Medio-lateral Oblique (MLO)
other name for MLO
Lundgren’s Oblique View
(Z) atomic # of tissue:
7-8
(Z) atomic # of tumors, calcifications:
20
easier to image..
older breast bcs of fatty replacement
a lot of scattering (compton) than absorption (photoelectric effect)
causes low differential absorption
type of xrays we use:
Characteristic xrays
lower xray energy used,
improve contrast resolution
enhance differential absorption
Components of equipment:
• Anti scatter grids
• Automatic exposure control
• Breast compressor
• Cassette holder
• Collimator / cone
• Generator
• Support system
• X-ray tube
xray energy required for good
contrast:
20 - 40 kVp
maximum mA:
200 mA
For homogenous x-ray beam,
High Frequency Generator is required
Target materials:
Molybdenum 42
Rhodium 45
Tungsten 74
most common anode target material used?
Molybdenum
Advantages of using Molybdenum
- increased number of low-energy photons is produced
- high radiographic contrast is achieved in the image
- specific x-ray energies required for breast imaging are produced
Disadvantages of using Molybdenum
- less x-ray photon output due to a lower atomic number—42
- increased mAs is required to maintain image receptor exposure
- increased pt dose
low atomic number
- produce low-energy characteristic x-rays
- used in mammography
to compensate the low xray photon output of Molybdenum
increase mAs
focal spot sizes:
0.3 - typical
0.10 - 0.15 - magnification
SID
60 - 65 cm
Tube tilt
6 - 24°
anode angle
0 - 6°
Effective anode angle
at least 22-24° for a 24 × 30-cm field area
(Be) Beryllium
- has low atomic no. and lower absorption of less than 5 kVp x-rays
1mm of Be is equivalent to..
0.1mm Al material
achieves better uniformity of the
transmitted x-rays through the breast
anode heel effect
decreases the equipment bulk near the patient’s head
Positioning the cathode over the chest wall of the patient and the
anode over the nipple
tilted XRT allows a narrower effective FS improving..
spatial resolution
Target and filter combination:
• Mo-42 target with 0.03mm Mo-42 filter
• Rh-45 target with 0.025mm Rh-45 filter
• W-74 target with 0.05mm Rh-45 filter
using target & filter combination we can..
protect low xray energy by filtering high xray energy
uses 17.6 keV & 19.7 keV to produce characteristic radiation
Moly/Moly Spectrum
Moly/Rhodium Spectrum
- good for denser breast
- breast greater than 5 cm thick
Molybdenum/Rhodium Filter
Rhodium/Rhodium Filter
Rhodium anode
20.3 keV & 22.7 keV
molybdenum filter
20 keV
rhodium filter
23.22 keV
for breasts less than 5 cm thick
moly/moly filter
- used for proper direction of xray beam
- embedded inside
- proper collimation
- rejecting scatter radiation
- protection of chest wall and lungs from unnecessary radiation
Collimator / Cones
THREE DESIGN ARE CURRENTLY USED:
Fixed aperture
Interchangeable cones for various sizes of breast
Internal set of collimating blades
preferred interspace material?
carbon fiber
must be a moving grid?
anti scattered grid
3 types of anti scattered grid
linear grid structure
cellular grid structure
air gap & magnification
use of grid increases
patient dose
4:1 grid ratio
double the patient dose
unique grid is developed specially for the mammography:
High Transmission Cellular (HTC) Grid
crossed type grid
HTC grid
copper - grid stripe
air - interspace
flat surfaced plate used for uniform
compression
compression plate
for equal compression to all areas of the breast
slanted S.O.F.T paddles
Advantages of Compression Plate
➢ Provides immobilization of the POI during exposure
➢ Produces radiograph of uniform density
➢ Reduces geometric unsharpness due to closer object to IR distance
➢ Reduces scatter and improves contrast
➢ Reduces tissue overlap and improves resolution
➢ Enhances recognition of architectural distortion produced by tumors
used to magnify small area of breast for better visualization
better compression for over small area
spot compression
Amount of compression:
25 - 40 pounds of pressure
- designed to measure x –ray intensity at image receptor and x –ray quality
- place after the image receptor
PHOTOTIMERS or AUTOMATIC EXPOSURE CONTROL
A preset value corresponds to a specified..
SNR for digital mammography
Acceptable optic density for film-screen
single-coated film-screen combination commonly used
GADOLINIUM OXYSULPHITE
MAMMOGRAPHIC CASSETE
18X24/ 24X30 cm
digital mammography
full-field digital mammography
Direct conversion uses
Amorphous Selenium
Indirecr Conversion uses
MASTECTOMY
INTRODUCED IN 1898 BY HALSTEAD
Developed clinical techniques for mammography
LE BORGNE- URUGUAY GERSHON-COHEN- US
GROS- GERMANY
Breast XEROGRAPHY introduction by WOLFE and RUZICKA in
1960
INDICATIONS: BCCEFFIT
BREAST CARCINOMA
CALCIFICATION
CYST
EPITHELIAL HYPERPLASIA
FIBROADENOMA
FIBROSIS
INTRADUCTAL PAPILLOMA
TUMOR
grid ratio
3:1
5: 1