Mammography # 1
Week 2
Mammography Facts
• 1 in 8 women who live to 95 will develop breast cancer
• Most common malignancy in women, only lung cancer kills more women– One of the most treatable cancers
• Before Mammo fewer than 5% of pt’s survived 4 years after diagnosis with a 80% recurrence– With a radical mastectomy survival increased to 40% with a
10% recurrence
Goal of Mammography
• Detect cancer before it is palpable
• Early detection, diagnosis and treatment is the key to a favorable prognosis
How would your family feel with you missing from the family picture?
How would you feel about your father, brother or mother missing
from the family picture?
Breast Self Exam
Breast Dimpling
Breast Cancer
Peau d’orange
Anatomy of the Breast
• Vary in shape & size• Cone shaped with the post
surface (base) overlying the pectoralis & serratus muscles
• Axillaries tail extends from lat. base of the breasts to axillaries fossa
• Tapers ant. from the base ending in nipple, surrounded by areola
Female Breast• Consists of 15-20
lobes– Divide into several
lobules– Lobules contain acini,
draining ducts and interlobular connective tissue.
– By teenage years each breast contains hundreds of lobules
Lymph Nodes
• Lymphatic vessels of the breast drain laterally and medially– Laterally into the
axillary lymph nodes (C & D)
• 75& drain toward axilla
– Medially into the mammary lymph nodes
• 25% toward mammary chain (F)
Quadrants of the Breast
3 Tissue Types
Breast Changes with Age
Breast Classifications
Fibro-glandular Breast
• Fibro-glandular– Dense with very little
fat– Females 15-30 years
of age• Or 30 years or older
without children
– Pregnant or lactating
Fibro-fatty Breast
• Fibro-fatty– Average density
• 50% fat & 50% fibro-glandular
• Women 30-50 years of age
– Or women with 3 or more children
Fatty Breast
• Fatty– Minimal density– Women 50 and older
(postmenopausal), men and children
Positioning
Various Mammographic Positioning
Ouch! Why Compression?
• Two Reasons:
– Decrease thickness of breast tissue
– Reduce OID
Cranio- caudad :CC
Diagram of Proper CC Positioning
CC Images
Multiple Bilateral Benign Calcifications
Breast Cancer
Carcinoma
Microcalcifications
CC positioning
• CR Perpendicular• Film tray brought to
level of inframammary crease
• Wrinkles and folds smoothed out
• Compression applied• Markers on axillary
side
CC Criteria
• No motion• Nipple in profile• All pertinent anatomy
demonstrated• Dense areas penetrated• High contrast & optimal
resolution• Absence of artifacts• Marker & patient ID
visible
Medio-lateral Oblique:
MLO
MLO Diagram for Proper Positioning
MLO Properly Positioned
Bilateral MLO
MLO positioning
• CR & cassette (IR) angled 45 degrees
• Top of cassette (IR) at axilla
• Compression applied
• Nipple in profile• Marker at axilla
MLO criteria
• No motion• Pectoral muscle to level
of nipple visualized• Breast pulled away from
chest wall• Nipple in profile• Dense areas of breast
penetrated• High contrast & optimal
resolution• Absence of artifacts• Marker & PT ID visible
What position is this?
What position is this?
Breast ImplantsAre they worth it?
Complication with Breast Augmentation
• Mammography has a 80-90% true positive rate for detecting breast cancer in those women without implants– Decreases to 60% with implants
• Because 85% of breast tissue is obscured
• More images are needed than the standard two projections
• There is a risk of rupturing the implant
Elkland Method for Imaging with Breast Implants
Image ComparisonWhich is the Push back (Elkland)?
Male Mammography and Cancer
Male Mammography
• 1300 men get breast cancer per year– 1/3 die
• Most are 60 years or older• Nearly all are primary tumors• Symptoms include:
– Nipple retraction– Crusting– Discharge– Ulceration
Gynemastia
• Benign excessive development of male mammary gland• Occurs in 40% of male cancer pt’s• Survival rates with treatment are 97% for 5 years
Old and New Equipment
Cone Magnification
Cone magnification
Mammography Equipment
Digital vs. Film