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MAMMOGRAPHY
LECTURE #1
rev 2010

Positioning & Anatomy

RADIOGRAPHIC IMAGING OF THE BREAST

RTEC 255 -Week # 3 D. Charman, M.Ed.,R.T.(R,M)

Mammograms dont look fun but they can save a life!

Man o - gram

A mammogram can find breast cancer when it is very small -- 2 to 3 years before you can feel it. No screening tool is 100% effective. Good quality mammograms can find 85-90% of cancers

Some cancers are not found until they reach this size

A mammogram can find cancer when it is only this size

Do it for those you love. And who love you

POSITIONING
Routine Images aka screening mammo
(not screaming)

CC

- cranio caudad MLO mediolateral oblique

More on MAMMO Equipment week 8 With Xray & Mammo QC

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Compression Important: Evens Density of Breast Reduces Motion AEC choice depends of size and composition of breast

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CC

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Marker? Which side is axilla?

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MLO RT BREAST

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POSITIONING
CC CRANIOCAUDAD MLO MEDIAL LATERAL OBLIQUE

TRUE LATERAL ETC

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TRUE LAT

CONE-MAG

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Magnification = increase OID

Anatomy of the Breast

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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

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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

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See Mammo Study Guide

TDLU ? COOPERS Ligaments

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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 Enlargement: A normal duct cells B basement membrane C lumen (center of duct)

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Lymph node areas adjacent to breast area. A pectoralis major muscle B axillary lymph nodes: levels C axillary lymph nodes: levels D axillary lymph nodes: levels E supraclavicular lymph nodes F internal mammary lymph nodes

Lymph Nodes

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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)

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Breast Scintomotography
Isotope matches tumor to node involvement

More on Breast Pathology & Procedures next lecture..

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Quadrants of the breast

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TYPES OF BREAST TISSUE

GLANDULAR DUCTS LOBES LOBULES TDLU STROMAL FATTY TISSUE CONNECTIVE TISSUE

MOSTLY SEEN UPPER OUTER QUADRANT

(COOPERS LIGAMENTS SUSPENSATORY LIGAMENTS

3 Tissue Types

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Breast Classifications Breast Changes with Age

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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

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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

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Fatty Breast

Fatty Minimal density Women 50 and older (postmenopausal), men and children

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THE MALE BREAST

Male Mammography and Cancer

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Male Breast Cancer Statistics:

According to the American Cancer Society, about 0.22 percent of mens cancer deaths are from breast cancer. This disease is 100 times more common in women than it is in men. Thanks to greater awareness and better treatments, the survival rates for both men and women are on the rise.

Gynecomastia

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Benign excessive development of male mammary gland Occurs in 40% of male cancer pts Survival rates with treatment are 97% for 5 years

Gynecomastia: Prominent Male Breasts

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Most Common Causes : Puberty (hormonal growth and changes during adolescence) Estrogen exposure (female hormone present in the body and the environment) Androgen exposure (body-building hormones) Marijuana use Medication side effects (older men) One symptom of Klinefelter's syndrome, a condition in which a male has an extra X chromosome

Gynecomastia

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is a benign male breast (non-cancerous) condition Some men who have prominent breasts, or uneven breasts, often feel some embarrassment about their body image. This condition can also cause emotional conflict over sexual identity.

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Position? Best Seen ?

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male breast

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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

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male mastectomy

THE AUGMENTED BREAST

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Difficulty with IMPLANTS

Breast Implants Is it worth the risk?

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Complication with Breast Augmentation

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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 Loss of sensation from surgical scars

Elkland Method for Imaging with Breast Implants

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PUSH BACK TECHNIQUE

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Other Imaging of the Breast

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Xero mammography (early years

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OTHER CHALLENGES TO MAMMOGRAPHY

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