Mammography

This is an overview of mammography imaging for medical imaging technology students. I hope this will help you to get well appliance in your field.

1. Mammography Presented by Akari Kyaw Fourth Year B. Med Tech (MIT) 24.6.2020

2. Contents Definition History Anatomy Mammography equipments Types of mammography Indications Patient preparation Preparation as a patient mammography views Radiation safety Benefits 2

3. Mammography X ray imaging of breast organ Also called mastography Radiographic procedure that uses special equipment to produce images of high contrast and high resolution for the diagnosis of breast leisions Using low energy X rays(usually around 30 kVp ) goal of  mammography  is the early detection of breast cancer, typically through detection of characteristic masses or microcalcifications . 3

4. History of mammography 1913 ( Dr. Albert Solomon ) First attempt at mammography 1950 ( Robert Egan ) First utilized low kVp and high mAs techniques 1960 Development of xero-mammography 1990 Screen-film mammography was accepted 4

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7. Anatomy of breast Mammary gland A conic or hemispheric eminence Located on the anterior and lateral wall Average breast extends from the anterior portion of the 2 nd rib(clavicle) down to the 6 th or 7 th (mid sternum) Comprises 15 to 20 lobes which are covered by adipose tissue that primarily accounts for its size and shape 7

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9. Breast classifications Fibroglandular breast Fibrofatty breast Fatty breast 9

10. Fibroglandular breast Common age group- 15 to 30 years(and childless women> 30 years old) Pregnant or lactating women Radiographically dense Very little fat 10

11. Fibrofatty breast 30 to 50 years Young women with three or more pregnancies Average radiographic density 50% fat and 50% fibroglandular 11

12. Fatty Breast >50 years Postmenopausal Minimal radiographic density Breasts of children and men 12

13. Methods of localization Two methods are commonly used; Quadrant system Upper outer quadrant Upper inner quadrant Lower outer quadrant Lower inner quadrant Clock system 13

14. Mammography Equipments Mammography equipment comprise of; High frequency generator Molybdenum target Filter Grid Compression device Automatic exposure control system 14

15. High frequency generator Works on single phase Provides rectified smoothed voltage supply to the tube Small in size with good reproducibility Providing up to 600 mAs Employ small focal spots, low kVp technique, low grid ratio and special screen films 15

16. Target and filter Most of the mammography X ray tubes are designed with; Mo target with Mo Filter Mo target with Rh Filter Rh target with Rh Filter 16

17. Grid Placed between the breast and cassette To reduce scatter radiation Improve contrast sensitivity Lower grid ratio than that of general X ray(4:1 or 5:1) 17

18. Compression device Made of a plastic that allows transmission of low energy X rays Should have a straight edge that allows the compression to grasp the breast tissue close to the chest wall Applied at 25 to 45 pounds of pressure Used to decrease the thickness of the breast tissue To bring the breast structures as close to IR To decrease dose needed and scattered radiation To decrease motion and geometric unsharpness To increase contrast 18

19. Automatic Exposure control (AEC) Employs phototimers to measure the X ray intensity and quality Kept closer to the image receptor To minimize the object to image distance(OID) Improving spatial resolution There are two types of AEC available, Ionization chamber type Solid state diode type 19

20. 20 Have you ever seen mammography X-ray machines?

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22. 22 How do we perform with mammography?

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24. Types of mammography There are two types of mammography; Screening mammography Performed in asymptomic patients Diagnostic mammography Performed on high risk patients or patients with symptoms 24

25. Indications for Mammography Screening as check up Abnormality found on screening mammogram. Short interval follow up of probably benign but abnormal mammogram. Patient/physician identified breast lump. Focal  breast pain /tenderness. Suspected Abscess. Spontaneous nipple discharge. New nipple changes (e.g. inversion) 25

26. Patient preparation Put on a gown Remove any jewelry, talcum powder, or antiperspirant Drape the upper torso with a gown or sheet except during actual positioning and radiographic exposure Explain the procedure and documents any relevant patient history as per departmental protocol 26

27. Patient history include the following Number of pregnancies Family history of cancer including breast cancer Medications ( eg ; hormone therapy) currently taken Previous breast surgery Previous mammograms when and where performed Reason for current visit such as screening mammogram, lumps, pain, or discharge 27

28. Preparation for a mammogram as a patient Scheduling Precautions Breastfeeding Personal hygiene Clothing 28

29. What Not To Do Before a Mammogram DON'T apply deodorant before your mammogram DON'T wear a dress or one-piece outfit DON'T go right before or during your period DON'T consume caffeine products (coffee, chocolate) several days up to two weeks before the appointment DON'T worry if you've had prior mammograms at other facilities 29

30. Standard mammography views Craniocaudal view(CC) Basic superior to inferior projection Mediolateral oblique view(MLO) Superomedial- inferolateral oblique projection 30

31. 31 Additional or special views Mediolateral projection (true lateral breast position) Exaggerated craniocaudal (laterally)(XCCL) projection Implant displaced (ID) (EKLUND Method) Cleavage view (CV) Tangential (TAN) Axillary tail view(AT) Axillary view(AX)

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33. 33 Technical factors SID - Fixed , varies with manufacturer (about 60cm, 24 in ) IR size - 18x24 cm or 24x30 cm, crosswise Grid Analog and digital system Applied voltage Ranges from 25-30 kVp 80-100 mAs Exposure time – 1-4 s

34. 34 Radiation safety We must obey cardinal rules; Time distance shielding

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36. 36 Benefits of mammography Reduces the risk of dying from breast cancer Reduces the risk of having to undergo chemotherapy; Screening often allows for the detection of cancers at an early stage of development Allows women to know the health of their breasts.

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38. 38 References K. L. Bontrager and J. P. Lampignano (2014) Text Book Of Radiographic Positioning And Related Anatomy, 8 th Edition Department Of Radiology, Dartmouth Geisel School Of Medicine 2020 Indications For Diagnostic Mammography Quebec; Breast cancer screening