mammography.pptx

mammography

1. Mammography

2. A mammogram is an x-ray picture of the breasts. It is used to find tumors and to help tell the difference between non-cancerous ( benign ) and cancerous (malignant) disease. Mammography uses low dose x-ray; high contrast, high-resolution film; and an x-ray system designed specifically for imaging the breasts.

3. Early detection of breast cancers. To help the radiologist or surgeon guide the needle to the correct area in the breast during biopsy.

4. Anatomy The breast is a mass of glandular, fatty, and fibrous tissues positioned over the pectoral muscles of the chest wall and attached to the chest wall by fibrous strands called Cooper’s ligaments. A layer of fatty tissue surrounds the breast glands and extends throughout the breast. The fatty tissue gives the breast a soft consistency.

5. The breast is composed of: milk glands (lobules) that produce milk ducts that transport milk from the milk glands (lobules) to the nipple nipple areola (pink or brown pigmented region surrounding the nipple) connective (fibrous) tissue that surrounds the lobules and ducts fat

6. Breast profile: A ducts B lobules C dilated section of duct to hold milk D nipple E fat F pectoralis major muscle G chest wall/rib cage

7. Schematic Diagram of the Female Breast                  

8. Basic Physics of Mammography: X-ray images depend on differences in x-ray stopping power (attenuation) to separate tissues. In general, a clear separation between normal functioning tissue, and abnormal cancerous tissues is not possible since their attenuation if very similar. However both functional tissue and cancer can be separated from fatty storage tissues which normally surround active breast tissue, even in lean persons. This is due to a substantially lower attenuation caused by fat. In older women, the functional glandular tissue diminishes, leaving only thin supporting tissues clearly outlined by fatty tissues. Mammography in these "mature" breasts is very effective, since even small cancers are well outlined by fat. In addition, many cancers develop calcium deposits which strongly stop X-rays and are easily seen on mammograms.

9. Basic Limitations of Mammography: Since mammography cannot separate normal gland tissue from tumors, it is much more effective when gland tissue diminishes with age. Many women retain glandular tissue as they "mature", and it camouflages tumors until they are large. As you might expect, the young women's breast normally contains more active tissue, which again interferes with detection of small cancers.

10. Types of Mammography Screening Diagnostic Ductgram/Galactogram (imaging the breast ducts)

11. Screening mammography Screening mammography is an x-ray examination of the breasts in a woman who is asymptomatic (has no complaints or symptoms of breast cancer). The goal of screening mammography is to detect cancer when it is still too small to be felt by a woman or her physician. Early detection of small breast cancers by screening mammography greatly improves a woman's chances for successful treatment. Screening mammography is recommended every one to two years for women once they reach 40 years of age and every year once they reach 50 years of age . In some instances, physicians may recommend beginning screening mammography before age 40 (i.e. if the woman has a strong family history of breast cancer).

12. Diagnostic mammography Diagnostic mammography is an x-ray examination of the breast in a woman who either has a breast complaint (for example, a breast lump or nipple discharge is found during self-exam ) or has had an abnormality found during screening mammography. It is more involved and time-consuming than screening mammography and is used to determine exact size and location of breast abnormalities and to image the surrounding tissue and lymph nodes. Typically, several additional views of the breast are imaged and interpreted during diagnostic mammography. Thus, diagnostic mammography is more expensive than screening mammography.

13. Mammography equipment

14. How is Mammography Performed? During mammography, the technologist will position the patient and image each breast separately. One at a time, each breast is carefully positioned on a special film cassette and then gently compressed with a paddle (often made of clear Plexiglas or other plastic). This compression flattens the breast so that the maximum amount of tissue can be imaged and examined.

15. Cont… At some facilities, mammography technologists may place adhesive markers to the breast skin prior to taking images of the breast. The purpose of the adhesive markers is twofold: first , to identify areas with moles, blemishes or scars so that they are not mistaken for abnormalities, and secondly, to identify areas that may be of concern (e.g. a lump was felt during physical examination). Some centers routinely mark the nipple with a small dot to provide a clear "landmark" for the radiologist on the mammogram images.

16. Breast compression is necessary in order to: Even out the breast thickness so that all of the tissue can be visualized. Spread out the tissue so that small abnormalities are less likely to be obscured by overlying breast tissue. Allow the use of a lower x-ray dose since a thinner amount of breast tissue is being imaged. Hold the breast still in order to minimize blurring of the image caused by motion. Reduce x-ray scatter to increase sharpness of picture.

17. Mammo app of normal breast Different tissues in the breast absorb different amounts of x-rays, producing different shades of black, gray, and white on the film: Fatty tissue absorbs a small amount of x-rays and appears black or dark gray. Normal fibrous and glandular tissues (milk glands, lymph nodes) contain water fluid and absorb a moderate amount of x-rays, and appear light gray. Fibrous and glandular tissues may contain calcium and appear nearly white or white.

18. Breast comp & mammo app..

19. Mammographic views Standard views Supplemental views

20. Standard views CC (cranio-caudal) view MLO (medio-lateral oblique) view

21. Supplemental Views Lateromedial, LM: Mediolateral view, ML Exaggerated cranial-caudal, Magnification views, Spot compression view

22. Mediolateral Oblique View (MLO) The mediolateral oblique view (MLO) is taken from an oblique or angled view. During routine screening mammography, the MLO view is preferred over a lateral 90-degree projection because more of the breast tissue can be imaged in the upper outer quadrant of the breast and the axilla (armpit).

23. With the MLO view, the pectoral (chest) muscle should be depicted obliquely from above and visible down to the level of the nipple or further down. The shape of the muscle should curve or bulge outward as a sign that the muscle is relaxed; the medial (middle) portion of the breast should be prominent in the MLO view. It is important that compression be applied over the whole image area. The nipple should be depicted in profile and a small stomach fold should be visible as a sign that the whole breast is reproduced.

24. Cranio-Caudal View (CC) The cranio-caudal view (CC) images the breast from above. This view may be taken during routine screening mammography and during diagnostic mammography. With the CC view, the entire breast parenchyma (glandular tissue) should be depicted. The fatty tissue closest to the breast muscle should appear as a dark strip on the x-ray and behind that it should be possible to make out the pectoral (chest) muscle. The nipple should be depicted in profile.

25. Spot compression view cont… Spot compression views show the borders of an abnormality or questionable area better than the standard mammography views. Some areas that look unusual on the standard mammography images are often shown to be normal tissue on the spot views. True abnormalities usually appear more prominently and the margins (borders) of the abnormality can be better seen on compression views.

26. ASSESSMENT CATEGORIES Category 0 / Need Additional Imaging Evaluation Finding for which additional imaging evaluation is needed. This is almost always used in a screening situation and should rarely be used after a full imaging work up. A recommendation for additional imaging evaluation includes the use of spot compression, magnification, special mammographic views, ultrasound, etc. Whenever possible, the present mammogram should be compared to previous studies. The radiologist should use judgment in how vigorously to pursue previous studies. Category 1 / Negative There is nothing to comment on. The breasts are symmetrical and no masses, architectural disturbances or suspicious calcifications are present

27. Category 2 / Benign Finding This is also a negative mammogram, but the interpreter may wish to describe a finding. Involuting, calcified fibroadenomas, multiple secretory calcifications, fat containing lesions such as oil cysts, lipomas, galactoceles, and mixed density hamartomas all have characteristic appearances, and may be labeled with confidence. The interpreter might wish to describe intramammary lymph nodes, implants, etc. while still concluding that there is no mammographic evidence of malignancy.

28. Category 3 / Probably Benign Finding - Short Interval Follow-Up Suggested A finding placed in this category should have a very high probability of being benign. It is not expected to change over the follow-up interval, but the radiologist would prefer to establish its stability. Data are becoming available that shed light on the efficacy of short interval follow-up. At the present time, most approaches are intuitive. These will likely undergo future modification as more data accrue as to the validity of an approach, the interval required, and the type of findings that should be followed.

29. Category 4 / Suspicious Abnormality - Biopsy Should Be Considered These are lesions that do not have the characteristic morphologies of breast cancer but have a definite probability of being malignant. The radiologist has sufficient concern to urge a biopsy. If possible, the relevant probabilities should be cited so that the patient and her physician can make the decision on the ultimate course of action. Category 5 / Highly Suggestive of Malignancy - Appropriate Action Should Be Taken These lesions have a high probability of being cancer

30. Category 6: Biopsy proven malignancy