1 mammography lecture #1 rev 2010 positioning & anatomy rtec 255 -week # 3 d. charman,...

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MAMMOGRAPHYLECTURE #1 rev 2010

Positioning & Anatomy

RTEC 255 -Week # 3RTEC 255 -Week # 3

D. Charman, M.Ed.,R.T.(R,M)D. Charman, M.Ed.,R.T.(R,M)

RADIOGRAPHIC IMAGING OF THE BREASTRADIOGRAPHIC IMAGING OF THE BREAST

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Mammograms don’t look fun

but they can save a life!

3Man – o - gram

4 A mammogram can find breast cancer when A mammogram can find breast cancer when it is very small -- 2 to 3 years before you it is very small -- 2 to 3 years before you can feel it.can feel it.

No screening tool is 100% effective. Good No screening tool is 100% effective. Good quality mammograms can find 85-90% of quality mammograms can find 85-90% of cancerscancers

Some cancers are not found until they reach this size

A mammogram can find cancer when it is only this size

5Do it for those you love….And who love you

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Routine Images - aka “screening mammo” (not screaming)

CC - cranio caudadCC - cranio caudadMLO – mediolateral obliqueMLO – mediolateral oblique

POSITIONING

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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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17Marker? Which side is axilla?

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MLO – RT BREAST

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POSITIONING

CC – CRANIOCAUDADCC – CRANIOCAUDAD MLO – MEDIAL LATERAL OBLIQUEMLO – MEDIAL LATERAL OBLIQUE

““TRUE” LATERALTRUE” LATERAL ETCETC

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TRUE LAT CONE-MAG

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Magnification = increase OID

37Anatomy of the Breast

Vary in shape & sizeVary in shape & size Cone shaped with the post Cone shaped with the post

surface (base) overlying the surface (base) overlying the pectoralis & serratus musclespectoralis & serratus muscles

Axillaries tail extends from lat. Axillaries tail extends from lat. base of the breasts to axillaries base of the breasts to axillaries fossafossa

Tapers ant. from the base Tapers ant. from the base ending in nipple, surrounded ending in nipple, surrounded by areolaby areola

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Female Breast Consists of 15-20 lobesConsists of 15-20 lobes

Divide into several Divide into several lobuleslobules

Lobules contain Lobules contain acini, draining ducts acini, draining ducts and interlobular and interlobular connective tissue.connective tissue.

By teenage years By teenage years each breast contains each breast contains hundreds of lobuleshundreds of lobules

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See Mammo Study Guide

TDLU ?

COOPER’S Ligaments

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Breast profile:Breast profile: AA ducts ducts BB lobuleslobules CC dilated section of duct to hold dilated section of duct to hold

milkmilk DD nipplenipple EE fat fat FF pectoralis major musclepectoralis major muscle GG chest wall/rib cage chest wall/rib cage

Enlargement:Enlargement: AA normal duct cells normal duct cells BB basement membrane basement membrane CC lumen (center of duct) lumen (center of duct)

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Lymph node areas Lymph node areas adjacent to breast area.adjacent to breast area.

AA pectoralis major musclepectoralis major muscle BB axillary lymph nodes: axillary lymph nodes:

levels levels CC axillary lymph nodes: axillary lymph nodes:

levels levels DD axillary lymph nodes: axillary lymph nodes:

levels levels EE supraclavicular lymph supraclavicular lymph

nodesnodes FF internal mammary internal mammary

lymph nodeslymph nodes

42Lymph Nodes Lymphatic vessels of the Lymphatic vessels of the

breast drain laterally and breast drain laterally and mediallymedially Laterally into the axillary Laterally into the axillary

lymph nodes (C & D)lymph nodes (C & D)75& drain toward axilla75& drain toward axilla

Medially into the Medially into the mammary lymph nodesmammary lymph nodes

25% toward mammary 25% toward mammary chain (F)chain (F)

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Breast ScintomotographyIsotope matches tumor to node involvement

More on Breast Pathology & Procedures next lecture…..

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45Quadrants of the breast

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TYPES OF BREAST TISSUE

GLANDULARGLANDULAR DUCTSDUCTS LOBESLOBES LOBULESLOBULES TDLUTDLU

MOSTLY SEEN UPPER MOSTLY SEEN UPPER OUTER QUADRANTOUTER QUADRANT

STROMALSTROMAL FATTY TISSUEFATTY TISSUE CONNECTIVE CONNECTIVE

TISSUE TISSUE (COOPER’S (COOPER’S

LIGAMENTS – LIGAMENTS – SUSPENSATORY SUSPENSATORY LIGAMENTSLIGAMENTS

473 Tissue Types

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Breast Changes with Age

Breast Classifications

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Fibro-glandular Breast

Fibro-glandularFibro-glandular Dense with very little Dense with very little

fatfat Females 15-30 years of Females 15-30 years of

ageageOr 30 years or older Or 30 years or older

without childrenwithout children Pregnant or lactating Pregnant or lactating

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Fibro-fatty Breast Fibro-fattyFibro-fatty

Average densityAverage density50% fat & 50% 50% fat & 50%

fibro-glandularfibro-glandularWomen 30-50 years Women 30-50 years

of ageof age• Or women with 3 Or women with 3

or more childrenor more children

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Fatty Breast

FattyFatty Minimal densityMinimal density Women 50 and Women 50 and

older older (postmenopausal), (postmenopausal), men and childrenmen 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, According to the American Cancer Society,

about 0.22 percent of men’s cancer deaths about 0.22 percent of men’s cancer deaths are from breast cancer. are from breast cancer.

This disease is This disease is 100 times more common in 100 times more common in womenwomen than it is in men. than it is in men.

Thanks to greater awareness and better Thanks to greater awareness and better treatments, the survival rates for both men treatments, the survival rates for both men and women are on the rise.and women are on the rise.

56Gynecomastia

Benign excessive development of male mammary glandBenign excessive development of male mammary gland Occurs in 40% of male cancer pt’sOccurs in 40% of male cancer pt’s Survival rates with treatment are 97% for 5 yearsSurvival rates with treatment are 97% for 5 years

57Gynecomastia: Prominent Male Breasts

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

58Gynecomastia is a benign male breast (non-cancerous) is a benign male breast (non-cancerous)

conditioncondition Some men who have prominent breasts, or Some men who have prominent breasts, or

uneven breasts, often feel some embarrassment uneven breasts, often feel some embarrassment about their body image. about their body image.

This condition can also cause This condition can also cause

emotional conflict over emotional conflict over

sexual identity.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 year1300 men get breast cancer per year 1/3 die1/3 die

Most are 60 years or olderMost are 60 years or older Nearly all are primary tumorsNearly all are primary tumors Symptoms include:Symptoms include:

Nipple retractionNipple retraction CrustingCrusting DischargeDischarge UlcerationUlceration

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male mastectomy

63THE AUGMENTED

BREAST

Difficulty with IMPLANTSDifficulty with IMPLANTS

64Breast ImplantsIs it worth the risk?

65Complication with Breast Augmentation Mammography has a 80-90% true positive rate Mammography has a 80-90% true positive rate

for detecting breast cancer in those women for detecting breast cancer in those women without implantswithout implants Decreases to 60% with implantsDecreases to 60% with implants

Because 85% of breast tissue is obscuredBecause 85% of breast tissue is obscured More images are needed than the standard two More images are needed than the standard two

projectionsprojections There is a risk of rupturing the implantThere is a risk of rupturing the implant Loss of sensation from surgical scarsLoss of sensation from surgical scars

66Elkland Method for Imaging with Breast Implants

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“PUSH BACK” TECHNIQUE

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71Other Imaging of the Breast

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73Xero mammography (early years

74OTHER CHALLENGES TO MAMMOGRAPHY

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