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MAMMOGRAPHY

Presenter:Sarose bhandari

Mammography is the radiological study of soft Mammography is the radiological study of soft tissue of breast.tissue of breast.

Specific type of imaging that uses a low dose x-Specific type of imaging that uses a low dose x-ray system to examine breasts.ray system to examine breasts.

Breast cancer is the leading cause of cancer Breast cancer is the leading cause of cancer deaths in women which occurs mainly between deaths in women which occurs mainly between 35-55 years of age. 35-55 years of age.

Our chief aim is to discover cancer in the earliest Our chief aim is to discover cancer in the earliest stage.stage.

The importance of mammography is directly The importance of mammography is directly related to detection and management of cancer of related to detection and management of cancer of the breast.the breast.

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The breast is a conical The breast is a conical structure with base at structure with base at chest wall and apex at chest wall and apex at nipple, located between nipple, located between the deep and superficial the deep and superficial layers of the superficial layers of the superficial fascia.fascia.

It lies over the pectoralis It lies over the pectoralis major and serratus major and serratus anterior muscles anterior muscles extending from 2extending from 2ndnd –3 –3rdrd rib rib to 6to 6thth-7-7thth rib. rib.

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The breast is made up of 16-The breast is made up of 16-20 lobes which are divided 20 lobes which are divided into many lobules.into many lobules.

The lobe contains glandular The lobe contains glandular elements called acini, elements called acini, draining ducts, connective draining ducts, connective tissue and interlobular tissue and interlobular stroma.stroma.

The ducts of each acinus join The ducts of each acinus join to form the lactiferous duct to form the lactiferous duct that drains the lobe.that drains the lobe.

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In 1913, a German Physician named Soloman In 1913, a German Physician named Soloman

reported the radiographic appearance of breast reported the radiographic appearance of breast

cancer.cancer.

By mid 1950s mammography was refined to the By mid 1950s mammography was refined to the

point of being a reliable clinical tool.point of being a reliable clinical tool.

Refinements include low KV, X-ray tubes, Mo Refinements include low KV, X-ray tubes, Mo

targets and high detail, industrial grade x-ray targets and high detail, industrial grade x-ray

film.film.

High speed x-ray film with faster resolution was High speed x-ray film with faster resolution was

first introduced by Du-Pont in 1970.first introduced by Du-Pont in 1970.

Improved Film Screen combinations were Improved Film Screen combinations were

developed by Kodak and Du Pont in 1975.developed by Kodak and Du Pont in 1975.5

Direct Exposure film Direct Exposure film

Mammography.Mammography.

Xero Mammography.Xero Mammography.

Thermography.Thermography.

Breast sonography.Breast sonography.

Digital mammography.Digital mammography.

MR mammography MR mammography

PET scanning.PET scanning.6

MR guided breast biopsy.MR guided breast biopsy.

Stereotactic guided breast Stereotactic guided breast

biopsy.biopsy.

Ultrasound guided breast biopsy.Ultrasound guided breast biopsy.

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1.1. Late 1Late 1stst child. child.

2.2. Null parityNull parity

3.3. Common among spinsters.Common among spinsters.

4.4. Family history of Ca breast.Family history of Ca breast.

5.5. Age at menarche <12 years.Age at menarche <12 years.

6.6. Smoking.Smoking.

7.7. Obesity.Obesity.

8.8. Age at menopause- whether natural or induced.Age at menopause- whether natural or induced.

9.9. Hypertension.Hypertension.

10.10. Metastasis from Ca cervix.Metastasis from Ca cervix.

11.11. May be due to hormonal replacement therapy May be due to hormonal replacement therapy & unnecessary mammographs.& unnecessary mammographs.

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In our department: In our department:

Unit name - Mammorax (TOSHIBA)Unit name - Mammorax (TOSHIBA)

Model name- MGU-100DModel name- MGU-100D

Output rating- 3.5 kWOutput rating- 3.5 kW

Max. kVp – 39 & Min. kVp – 22Max. kVp – 39 & Min. kVp – 22

Max. mAs – 600 & Min. mAs – 2Max. mAs – 600 & Min. mAs – 2

Anode- Molybdenum ( 9700 rpm)Anode- Molybdenum ( 9700 rpm)

Target angle- 10 degree (small) & 16 degree (large)Target angle- 10 degree (small) & 16 degree (large)

Focal spot size- 0.1mm (small) & Focal spot size- 0.1mm (small) &

0.3mm (large)0.3mm (large)

SID= 65 cmsSID= 65 cms

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Contd….Contd…. Grid ratio: 5:1Grid ratio: 5:1 Grid density: 31lines/cmGrid density: 31lines/cm Grid movement: reciprocatingGrid movement: reciprocating Inherent filtration: 1mm BeInherent filtration: 1mm Be Beryllium window portBeryllium window port Anode heat storage capacity: 300 kHUAnode heat storage capacity: 300 kHU C-arm rotation:180 degree to -150 C-arm rotation:180 degree to -150

degreedegree AEC sensors: 7 locationsAEC sensors: 7 locations Filter: Mo/RhFilter: Mo/Rh

There can be 2 types of There can be 2 types of Mammography Equipment:Mammography Equipment:

A.A. Mammography with general Mammography with general equipment:equipment: To modify conventional To modify conventional x-ray equipment so that it may be x-ray equipment so that it may be successfully used for mammography successfully used for mammography as well as other radiography.as well as other radiography.

B.B. Specifically designed unit for Specifically designed unit for mammography called the mammography called the DEDICATEDDEDICATED MAMMOGRAPHY UNIT.MAMMOGRAPHY UNIT.

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In this certain changes have to be made in In this certain changes have to be made in the general tube to maintain longer the general tube to maintain longer wavelength radiation (soft radiation).wavelength radiation (soft radiation).

A.A. Filter MaterialsFilter Materials:: it is removed from the it is removed from the path of the beam so that the longer path of the beam so that the longer wavelength for mammography may be wavelength for mammography may be retained in its composition.retained in its composition.

Limitation: Limitation: in absence of filter, in absence of filter, radiograph is adversely affected by radiograph is adversely affected by scatter radiation when unit is used for scatter radiation when unit is used for other examination.other examination.

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B.B. Light beam diaphragm: Light beam diaphragm: it is replaced it is replaced by a long cone used to limit field size by a long cone used to limit field size to cover area of interest only.to cover area of interest only.

Limitation: Limitation: the filter material and light the filter material and light beam diaphragm has to be replaced if beam diaphragm has to be replaced if the unit is to be used for general the unit is to be used for general radiography.radiography.

C.C. Support SystemSupport System: : For the patients’ For the patients’ breast and the film:breast and the film:

There should be a seat for the patient. There should be a seat for the patient. Both seat and table should have the provision for Both seat and table should have the provision for

varying the heights.varying the heights.13

D.D. The GeneratorThe Generator: : it is modified to provide kV it is modified to provide kV

range of 20-40 kV. For mammography ideal range of 20-40 kV. For mammography ideal

quality of radiation is related to quality of radiation is related to

homogeneity.homogeneity.

6 or 12 pulse generator or constant 6 or 12 pulse generator or constant

potential generator should be used.potential generator should be used.

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The first such dedicated unit was CGR The first such dedicated unit was CGR Senographe introduced in 1969.Senographe introduced in 1969.

This unit is specially designed for This unit is specially designed for mammography only.mammography only.

It is mobile and can be wheeled into position It is mobile and can be wheeled into position for examining a patient in lying down on an for examining a patient in lying down on an ordinary x-ray table.ordinary x-ray table.

It can also be a fixed installation.It can also be a fixed installation.

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It has the following Features:It has the following Features:

1.1. Cassette Holder.Cassette Holder.

2.2. Breast Compression Device.Breast Compression Device.

3.3. Breast Cones.Breast Cones.

4.4. Low KV X-Ray Tube.Low KV X-Ray Tube.

5.5. Tube Support.Tube Support.

6.6. Full range of movement for Tube Assembly. Full range of movement for Tube Assembly.

7.7. Automatic Exposure Timer.Automatic Exposure Timer.

8.8. H.T. Generator for low KV Range.H.T. Generator for low KV Range.

9.9. Patient Seat, Control Panel and Lead Patient Seat, Control Panel and Lead

Screens.Screens.

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A.A. Compact and thus requires small space Compact and thus requires small space for installation.for installation.

B.B. Allows all projections of breast and axilla Allows all projections of breast and axilla to be taken in standing or seated to be taken in standing or seated position.position.

C.C. Convenient to use and allows speedier Convenient to use and allows speedier mammography. mammography.

D.D. Overall quality of mammograph Overall quality of mammograph improved.improved.

DISADVANTAGE: DISADVANTAGE: Chest wall is not properly Chest wall is not properly

visualized.visualized.

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Cones.Cones. Compression Devices.Compression Devices. Image receptor support (IRS).Image receptor support (IRS). Grid.Grid.

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A.A. Cones: - Cones: - are required for proper direction are required for proper direction

of x-ray beam, proper collimation and for of x-ray beam, proper collimation and for

rejecting scatter radiation, protection of rejecting scatter radiation, protection of

chest wall by reduction of dose, it self acts chest wall by reduction of dose, it self acts

as a compression.as a compression.

B.B. Compression Devices: - Compression Devices: - compression is compression is

applied by a transparent compression applied by a transparent compression

plate attached to the Film Holding Tray to plate attached to the Film Holding Tray to

give a high quality mammogram.give a high quality mammogram.

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Advantages of Compression:Advantages of Compression:1.1. Provides uniform thickness of breast.Provides uniform thickness of breast.2.2. Provides immobilization of the part Provides immobilization of the part

during exposure.during exposure.3.3. Produces radiograph of uniform density.Produces radiograph of uniform density.4.4. Reduces geometric unsharpness due to Reduces geometric unsharpness due to

closer subject to cassette distance.closer subject to cassette distance.5.5. Reduces scatter and improves contrast.Reduces scatter and improves contrast.6.6. Reduces tissue overlap and improves Reduces tissue overlap and improves

spatial and contrast resolution.spatial and contrast resolution.7.7. Enhances recognition of architectural Enhances recognition of architectural

distortion produced by tumours.distortion produced by tumours.

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C.C. Image Receptor Support:Image Receptor Support:

There are grooves for holding There are grooves for holding moving grid assembly and cassette moving grid assembly and cassette holder of sizes 18 X 24 cm and 24 X holder of sizes 18 X 24 cm and 24 X 30 cm.30 cm.

Biopsy cassette holder and Biopsy cassette holder and magnification device can also be magnification device can also be fitted in those grooves.fitted in those grooves.

C.C. Grids: - Grids: - moving grids are used.moving grids are used.

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Limitations of Mammography:

•Its sensitivity is only up to 85% in its specificity.

•Particularly less sensitive and less specific in younger women with denser breasts.

•40% cases go undetected.

•Type of lesion can’t be determined.

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Features of mammography tubeFeatures of mammography tube

Single side emulsion film of small grain size Single side emulsion film of small grain size

with a single intensifying screen of rare with a single intensifying screen of rare

earth is placed in a carbon fiber cassette.earth is placed in a carbon fiber cassette.

This eliminates parallel & cross-over effects This eliminates parallel & cross-over effects

which cause un sharpness.which cause un sharpness.

In our department we use single In our department we use single

Gadolinium Oxy-SulphideGadolinium Oxy-Sulphide screen with screen with

single side emulsion single side emulsion Ortho-Chromatic Film Ortho-Chromatic Film

of size 18x24cms.of size 18x24cms.

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Ca breast , Screening , mastectomy.Ca breast , Screening , mastectomy. Evaluation of breast signs and Evaluation of breast signs and

symptoms: - pain, mass, discharge, symptoms: - pain, mass, discharge, thick skin, nipple eczema.thick skin, nipple eczema.

Pre-op evaluation of palpable mass.Pre-op evaluation of palpable mass. Follow up of Ca breast patient.Follow up of Ca breast patient. Guidance for F.N.A.C.Guidance for F.N.A.C. To assess contra lateral breast.To assess contra lateral breast. To determine size, extent and location To determine size, extent and location

of lesion in breast. of lesion in breast. 27

Fibroadenosis – increase in density of Fibroadenosis – increase in density of breast tissue.breast tissue.

Lobectomy – removal of breast lobes.Lobectomy – removal of breast lobes. HRT – hormone replacement therapy.HRT – hormone replacement therapy. In Post-op cases after surgery and R.T. In Post-op cases after surgery and R.T.

to confirm:to confirm:• Removal of abnormality.Removal of abnormality.• Assess post-procedural complications.Assess post-procedural complications.• Detect recurrent tumor at surgical Detect recurrent tumor at surgical

site.site.

Both breasts should be radiographed Both breasts should be radiographed because comparison is valuable because comparison is valuable between the two for clinical diagnosis.between the two for clinical diagnosis.

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BASIC VIEWS:BASIC VIEWS: CRANIO-CAUDAL VIEW.CRANIO-CAUDAL VIEW. MEDIO-LATERAL OBLIQUE VIEW.MEDIO-LATERAL OBLIQUE VIEW.

SUPPLEMENTARY VIEWS:SUPPLEMENTARY VIEWS: MEDIO LATERAL VIEW.MEDIO LATERAL VIEW. LATERO-MEDIAL VIEW.LATERO-MEDIAL VIEW. AXILLARY VIEW. AXILLARY VIEW. EXAGGRETED CRANIO-CAUDAL EXAGGRETED CRANIO-CAUDAL

VIEW ( CLEOPATRA VIEW ).VIEW ( CLEOPATRA VIEW ). MAGNIFICATION TECHNIQUES &MAGNIFICATION TECHNIQUES & LOCALIZED COMPRESSION VIEW.LOCALIZED COMPRESSION VIEW.

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Breast Axis: The line drawn Breast Axis: The line drawn from the center of the circle from the center of the circle to which breast is attached to which breast is attached to chest wall to the nipple is to chest wall to the nipple is called breast axis.called breast axis.

Saggital plane: Divides the Saggital plane: Divides the breast into medial and breast into medial and lateral portions.lateral portions.

Transverse plane: divides Transverse plane: divides the breast into upper and the breast into upper and lower portions.lower portions.

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Breast is divided into 4 Breast is divided into 4 quadrantsquadrants

In normal erect rest in In normal erect rest in position the axial plane position the axial plane makes an angle of 20-30* makes an angle of 20-30* with the sagittal plane of the with the sagittal plane of the body and transverse plane body and transverse plane makes an angle of 30-50* makes an angle of 30-50* with horizontal.with horizontal.

The RETROMAMMARY SPACE The RETROMAMMARY SPACE lies behind the glandular lies behind the glandular tissue and should be visible tissue and should be visible on a correctly positioned on a correctly positioned mammogram.mammogram.

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The patient should be prepared by The patient should be prepared by removing the clothing and dressing of the removing the clothing and dressing of the area under investigation.area under investigation.

The patient should be instructed do not The patient should be instructed do not wear talcum powder, deodorant or wear talcum powder, deodorant or antiperspirant or lotion under your arms or antiperspirant or lotion under your arms or on your breasts on the day of the exam. on your breasts on the day of the exam. These can appear on the mammogram as These can appear on the mammogram as calcium spots.calcium spots.

Explain the procedure to the patient.Explain the procedure to the patient.

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Describe any breast systems or problems to the Describe any breast systems or problems to the technologist performing the exam.technologist performing the exam.

If possible, obtain prior mammograms and make If possible, obtain prior mammograms and make them available to the radiologist at the time of the them available to the radiologist at the time of the current exam.current exam.

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This view is important for demonstrating This view is important for demonstrating medial and lateral quadrant lesions.medial and lateral quadrant lesions.

The patient is in sitting position on an adjustable The patient is in sitting position on an adjustable stool facing the film holder or in an erect position.stool facing the film holder or in an erect position.

The height of film holder is adjusted to a height The height of film holder is adjusted to a height sufficient for the breast to lie comfortably on the sufficient for the breast to lie comfortably on the holder.holder.

The transverse plane of breast should be parallel The transverse plane of breast should be parallel to the film.to the film.

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Now the compression is applied on Now the compression is applied on the breast that much that can be the breast that much that can be bearable.bearable.

Head is turned to the opposite side.Head is turned to the opposite side.

The vertical beam is centered to the The vertical beam is centered to the centre of the breast superoinferiorly.centre of the breast superoinferiorly.

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•Retro-mammary space is not fully visualized due Retro-mammary space is not fully visualized due to convexity of the chest wall.to convexity of the chest wall.

•Some segments of the medial and lateral parts Some segments of the medial and lateral parts are not visualized because the breast is curved are not visualized because the breast is curved over the chest wall & the edge of the film is over the chest wall & the edge of the film is straight. So to overcome this, patient is slightly straight. So to overcome this, patient is slightly rotated medially or laterally according to the rotated medially or laterally according to the lesion.lesion.

Limitations:Limitations:

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Nipple should be in profile & in Nipple should be in profile & in centre.centre.

Compression should be even.Compression should be even.

No skin fold should be superimposed No skin fold should be superimposed on the breast.on the breast.

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This view is done to see the lesions located on This view is done to see the lesions located on the upper and lower quadrants.the upper and lower quadrants.

Mammography stand is rotated at an angle of Mammography stand is rotated at an angle of 30-60 degree.30-60 degree.

Patient is rotated to the opposite side.Patient is rotated to the opposite side. Nipple is kept in profile & pectoralis muscles Nipple is kept in profile & pectoralis muscles

are included. are included. Opposite breast is retracted by the opposite Opposite breast is retracted by the opposite

hand.hand. Firm pressure is applied.Firm pressure is applied. Central ray is perpendicular to the film.Central ray is perpendicular to the film.

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Evaluation criteria:Evaluation criteria:

Nipple should be in profile.Nipple should be in profile. Compression should be even.Compression should be even. Pectoralis muscles and lower Pectoralis muscles and lower

axillary lymph nodes should be axillary lymph nodes should be seen clearly.seen clearly.

A small portion of infra mammary A small portion of infra mammary fold should also be included.fold should also be included.

This view is done to demonstrate posterior breast This view is done to demonstrate posterior breast structure and laterally placed lesion.structure and laterally placed lesion.

Patient is made to lie on a table in supine position Patient is made to lie on a table in supine position or in erect position.or in erect position.

Hand of the side to be examined is kept under the Hand of the side to be examined is kept under the head if supine.head if supine.

The film is placed under the breast supported by The film is placed under the breast supported by a foam pad.a foam pad.

Nipple is in profile.Nipple is in profile. Opposite hand is used to retract the opposite Opposite hand is used to retract the opposite

breast. C.R. is perpendicular to the mid-point of breast. C.R. is perpendicular to the mid-point of the breast. the breast.

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This view is mainly done for medial part This view is mainly done for medial part of breast to see medially placed of breast to see medially placed abnormalities.abnormalities.

Film holder is placed against the patients Film holder is placed against the patients sternum. sternum.

Elevate the ipsilateral arm.Elevate the ipsilateral arm. Patient is asked to pull herself forwards.Patient is asked to pull herself forwards. Apply compression.Apply compression. Nipple is brought in profile.Nipple is brought in profile. C.R. is directed horizontally to the mid C.R. is directed horizontally to the mid

portion of the lateral side of the breast.portion of the lateral side of the breast.45

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This view demonstrates the axillary lymph This view demonstrates the axillary lymph nodes & axillary portion of breast tissue nodes & axillary portion of breast tissue specially in patients having breast malignancy.specially in patients having breast malignancy.

NOTE : NOTE : Increase the exposure by approximately Increase the exposure by approximately 2 kVp.2 kVp.

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AXILLARY TAIL VIEW

AXILLARY TAIL VIEW

*Patient is in erect position.*Patient is in erect position.

*Arm of the affected side is abducted at *Arm of the affected side is abducted at 90 degree.90 degree.

*Patient is rotated through 30degree *Patient is rotated through 30degree towards the affected side.towards the affected side.

*The breast is allowed to fall away from *The breast is allowed to fall away from chest wall, then compression is applied.chest wall, then compression is applied.

*C.R. is directed 5c.m. below apex of *C.R. is directed 5c.m. below apex of axilla.axilla.

This projection is done only if a significant This projection is done only if a significant amount of breast tissue lies in axillary region.amount of breast tissue lies in axillary region.

This is modified view of cranio-caudal This is modified view of cranio-caudal projection.projection.

For this position, patient is rotated medially For this position, patient is rotated medially to place the lateral aspect of the breast on to place the lateral aspect of the breast on the cassette & compression is applied.the cassette & compression is applied.

The patient is asked to hold the cassette The patient is asked to hold the cassette firmly against the chest wall.firmly against the chest wall.

This view often demonstrates lateral aspect This view often demonstrates lateral aspect and axillary tail of the breast.and axillary tail of the breast.

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EXAGGRATED CRANIO-CAUDAL OR CLEOPATRA VIEW

EXAGGRATED CRANIO-CAUDAL VIEW

Magnification views of the specific quadrant Magnification views of the specific quadrant

of breast can be taken by increasing the of breast can be taken by increasing the

object film distance using fine focal spot object film distance using fine focal spot

less than 0.15mm.less than 0.15mm.

The amount of magnification usually ranges The amount of magnification usually ranges

from 1.5 to 2.5 times.from 1.5 to 2.5 times.

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Useful in evaluating the characteristic of breast Useful in evaluating the characteristic of breast calcification.calcification.

Margins of the breast masses to determine Margins of the breast masses to determine whether breast lesions are likely to benign or whether breast lesions are likely to benign or malignant.malignant.

If other positions indicates the presence of a If other positions indicates the presence of a lesion, magnification may clarify whether a lesion lesion, magnification may clarify whether a lesion is present or not.is present or not.

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With specialized compression With specialized compression

plate device area is spread more plate device area is spread more

effectively removing effectively removing

superimposed structures, thus superimposed structures, thus

better delineation of the margins better delineation of the margins

of a suspected area.of a suspected area.

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ADVANTAGES:ADVANTAGES:

High resolution and contrast.High resolution and contrast.

High background density.High background density.

Reasonable exposure latitude.Reasonable exposure latitude.

High speed. High speed.

Reduction in exposure dose to patient.Reduction in exposure dose to patient.

Eliminates parallel and cross over effect &Eliminates parallel and cross over effect &

No absorption of x-rays by front screenNo absorption of x-rays by front screen

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ULTRASOUND:ULTRASOUND:

It is a valuable addition to conventional It is a valuable addition to conventional

mammography in evaluation of a dense mammography in evaluation of a dense

breast.breast.

A 7.5 MHz linear probe with real time A 7.5 MHz linear probe with real time

imaging is used.imaging is used.

High frequency U.S (10-13MHz) is used High frequency U.S (10-13MHz) is used

for high resolution imaging.for high resolution imaging.56

1.1. Differentiation of cyst from solid mass.Differentiation of cyst from solid mass.

2.2. Evaluation of palpable mass that is occult Evaluation of palpable mass that is occult

in mammography.in mammography.

3.3. Used for FNAC.Used for FNAC.

4.4. Evaluation of lymph node status.Evaluation of lymph node status.

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• Evaluation of ruptured silicon breast Evaluation of ruptured silicon breast implant.implant.

• Evaluation of abscess.Evaluation of abscess.

• No radiation hazard.No radiation hazard.

• In younger patient, lactating mother and In younger patient, lactating mother and pregnant women having dense breastspregnant women having dense breasts

Contd…..Contd…..

1.1. Differentiation of benign from malignant Differentiation of benign from malignant solid masses.solid masses.

2.2. Inability to detect micro-calcification.Inability to detect micro-calcification.

3.3. Difficulty in scanning near nipple where Difficulty in scanning near nipple where there is concentration of ductal tissue.there is concentration of ductal tissue.

4.4. Movement of underlying tissue by pressure Movement of underlying tissue by pressure can small lesions being missed.can small lesions being missed.

5.5. Poor portrayal of skin detail by contact Poor portrayal of skin detail by contact scanning will cause difficulty in identifying scanning will cause difficulty in identifying lesions in this area.lesions in this area.

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It is also called full – field digital It is also called full – field digital mammography (FFDM ).mammography (FFDM ).

X – Ray film is replaced by solid – state X – Ray film is replaced by solid – state detectors that convert x-rays into detectors that convert x-rays into electrical signals. These detectors are electrical signals. These detectors are similar to those found in digital cameras.similar to those found in digital cameras.

The electrical signals are used to produce The electrical signals are used to produce images of the breast that can be seen on a images of the breast that can be seen on a computer screen or printed on special film computer screen or printed on special film similar to conventional mammograms.similar to conventional mammograms.

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1.1. Post acquisition manipulation possible.Post acquisition manipulation possible.

2.2. Enhances detection of anomalies.Enhances detection of anomalies.

3.3. Selectively increases magnification.Selectively increases magnification.

4.4. Distinguishes between malignant and benign Distinguishes between malignant and benign

lesions.lesions.

5.5. High contrast resolution.High contrast resolution.

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6.6. Eliminates loss of film and the need for Eliminates loss of film and the need for

film library. film library.

7.7. Speed (10 – 12 sec vs 3 min for screen Speed (10 – 12 sec vs 3 min for screen

film).film).

8.8. Potential in reduction of radiation dose.Potential in reduction of radiation dose.

9.9. Storage and transfer of image possible.Storage and transfer of image possible.

10.10. Lower image noise.Lower image noise.

11.11. Quicker than conventional mammography.Quicker than conventional mammography.

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High cost.High cost.

Fixed sizes of image receptors.Fixed sizes of image receptors.

low spatial resolution compared to that low spatial resolution compared to that

of screen film.of screen film.

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Useful to see small lesion because of edge Useful to see small lesion because of edge enhancement.enhancement.

It employs a dry electro-photographic techniqueIt employs a dry electro-photographic technique It uses a charged aluminum plate coated with It uses a charged aluminum plate coated with

selenium powder instead of traditional x-ray selenium powder instead of traditional x-ray filmfilm

The electro-static image is made visible by The electro-static image is made visible by dusting the selenium layer with a fine layer of dusting the selenium layer with a fine layer of charged powder which brings out a fine grain charged powder which brings out a fine grain imageimage

For a permanent image the powder image is For a permanent image the powder image is electro-statically transferred on paperelectro-statically transferred on paper

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Demonstrates high sensitivity in Demonstrates high sensitivity in

breast cancer detection.breast cancer detection.

Permits visualization of breast lesion Permits visualization of breast lesion

usually enhanced after usually enhanced after

administration of I.V. contrast mediaadministration of I.V. contrast media

A special breast detecting surface A special breast detecting surface

coil is used for high signal ratio.coil is used for high signal ratio.

Reduced slice thickness provides Reduced slice thickness provides

optimum resolution.optimum resolution.

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MRI is used to guide the radiologists to insert MRI is used to guide the radiologists to insert

instrument to the suspicious area. The instrument to the suspicious area. The

procedure is less invasive than surgical procedure is less invasive than surgical

biopsy, requires only a local anesthetic biopsy, requires only a local anesthetic

leaves little or no scanning and can be leaves little or no scanning and can be

performed in less than an hour.performed in less than an hour.

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It is the procedure by which heat naturally It is the procedure by which heat naturally emitted by the body is detected, measured & emitted by the body is detected, measured & imaged. The most commonly used method of imaged. The most commonly used method of thermography is infra-red thermography. In this thermography is infra-red thermography. In this heat radiation emitting from the skin is heat radiation emitting from the skin is detected & is electronically changed in to detected & is electronically changed in to signal which is used to generate an image.signal which is used to generate an image.

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Advantages:Advantages:

1.1. Totally non-invasive & quite safe.Totally non-invasive & quite safe.

2.2. No ionizing radiation is used.No ionizing radiation is used.

3.3. Convenient & inexpensive compared to Convenient & inexpensive compared to the other imaging modalities.the other imaging modalities.

4.4. May be readily repeated for May be readily repeated for comparison purpose without concern comparison purpose without concern for patient safety.for patient safety.

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Disadvantages:Disadvantages:

1.1. Relatively insensitive in recording Relatively insensitive in recording small tumors.small tumors.

2.2. Inability to achieve reliable & Inability to achieve reliable & consistent interpretation of images consistent interpretation of images has been achieved.has been achieved.

Breast tissue is obtained by introducing a Breast tissue is obtained by introducing a

hollow needle through the skin into the hollow needle through the skin into the

suspicious lesion with the help of special suspicious lesion with the help of special

breast x-ray in the way show whether the breast x-ray in the way show whether the

lesion is malignant or benign. This method is lesion is malignant or benign. This method is

stereotactic biopsy or x-ray guided biopsy.stereotactic biopsy or x-ray guided biopsy.

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Decrease the number of surgical breast Decrease the number of surgical breast

biopsies.biopsies.

Less expensive.Less expensive.

Cause less inconvenience to patient.Cause less inconvenience to patient.

Prevent deformity that might result from Prevent deformity that might result from

surgical biopsies.surgical biopsies.

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It is also called contrast mammography It is also called contrast mammography ductography as the study includes the ductography as the study includes the injection of contrast material into a duct.injection of contrast material into a duct.

There is 10% incidence of carcinoma in women There is 10% incidence of carcinoma in women operated upon for nipple discharge.operated upon for nipple discharge.

It is done for evaluation of spontaneous nipple It is done for evaluation of spontaneous nipple discharge that is bloody, serous or clear in discharge that is bloody, serous or clear in nature originating from one or two ducts.nature originating from one or two ducts.

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Clean the nipple with cleansing agent & betadine Clean the nipple with cleansing agent & betadine is applied.is applied.

Needle is inserted under aseptic conditions into Needle is inserted under aseptic conditions into the orifice of discharging duct.the orifice of discharging duct.

C/M is injected about 1-3 ml.C/M is injected about 1-3 ml. Immediate radiographs are taken in cranio - caudal Immediate radiographs are taken in cranio - caudal

and medio - lateral oblique positions.and medio - lateral oblique positions. Heavy compression is not applied because c/m will Heavy compression is not applied because c/m will

ooze out due to pressure. So light compression is ooze out due to pressure. So light compression is given.given.

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Latest developments in Latest developments in Mammography Units Mammography Units

Introduction of dual metal x-ray tube (having Introduction of dual metal x-ray tube (having dual track of molybdenum/vanadium and dual track of molybdenum/vanadium and rhodium). Rhodium track and filter produces rhodium). Rhodium track and filter produces a slightly higher spectrum for superior a slightly higher spectrum for superior penetration of the dense breast tissues in penetration of the dense breast tissues in the younger women and in those who have the younger women and in those who have undergone radiation treatment or are under undergone radiation treatment or are under hormone therapy.hormone therapy.

Molybdenum / tungsten dual track with a Molybdenum / tungsten dual track with a high emission flat emitter cathode with high emission flat emitter cathode with different K edge filters Mo and Rhodium different K edge filters Mo and Rhodium meant for normal and dense breast.meant for normal and dense breast.

Imaging of the breast improves a physician’s Imaging of the breast improves a physician’s

ability to detect small tumors. When cancers are ability to detect small tumors. When cancers are

small, the woman has more treatment options and small, the woman has more treatment options and

a cure is more likely.a cure is more likely.

The use of screening mammography increases the The use of screening mammography increases the

detection of small abnormal tissue growths detection of small abnormal tissue growths

confined to the milk ducts in the breast, called confined to the milk ducts in the breast, called

ductal carcinoma in situ(DCIS). These early tumors ductal carcinoma in situ(DCIS). These early tumors

cannot harm the patients if they are removed at cannot harm the patients if they are removed at

this stage and mammography is the only proven this stage and mammography is the only proven

method to reliably detect these tumors. It is also method to reliably detect these tumors. It is also

useful for detecting all types of breast cancer, useful for detecting all types of breast cancer,

including invasive ductal and invasive lobular including invasive ductal and invasive lobular

cancer.cancer. 77

BENEFITS OF MAMMOGRAPHY

There is always a slight chance of There is always a slight chance of damage to cells or tissue from radiation.damage to cells or tissue from radiation.

The effective radiation dose from a The effective radiation dose from a mammogram is about 0.7mSv, which is mammogram is about 0.7mSv, which is about same as the average person about same as the average person receives from background radiation in receives from background radiation in three months.three months.

Women should always inform their Women should always inform their doctor or x-ray technologist if there is doctor or x-ray technologist if there is any possibility that they are pregnant.any possibility that they are pregnant.

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It is achieved by ALARA (As low as It is achieved by ALARA (As low as Reasonably achievable ) principle: -Reasonably achievable ) principle: -

1.1. Limitation of field size by using collimators. Limitation of field size by using collimators. 2.2. Use of gonad shielding. Use of gonad shielding. 3.3. Careful preparation of patient.Careful preparation of patient.4.4. Use of lead apron.Use of lead apron.5.5. Presence of essential staff inside the Presence of essential staff inside the

mammographic room.mammographic room.6.6. Use of high speed screen film combination, Use of high speed screen film combination,

high mA , short exposure time.high mA , short exposure time.

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Quality of the Mammography Film:Quality of the Mammography Film:

A mammogram is among the A mammogram is among the most technically demanding of all the most technically demanding of all the radiographic procedures. The early radiographic procedures. The early detection of breast cancer and other detection of breast cancer and other changes can be detected only by a high changes can be detected only by a high quality imaging. Whole of the breast tissue quality imaging. Whole of the breast tissue must be imaged with high contrast and high must be imaged with high contrast and high resolution at the lowest dose with as little resolution at the lowest dose with as little noise as possible and at reasonable cost.noise as possible and at reasonable cost.

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It specifies the overall management It specifies the overall management programme, which includes policies and programme, which includes policies and procedures designed to optimize the control procedures designed to optimize the control of the performance of the facilities and its of the performance of the facilities and its equipments.equipments.

The technologist should ensure:The technologist should ensure:1.1. Images are obtained and processed Images are obtained and processed

satisfactorily.satisfactorily.2.2. Analysis and interpretation of such images Analysis and interpretation of such images

should be organized and monitored.should be organized and monitored.3.3. Information derived is accurately and Information derived is accurately and

effectively conveyed to the patient.effectively conveyed to the patient.

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It is the segment of the It is the segment of the overall QA program that specifies and overall QA program that specifies and implements measurements of the implements measurements of the mammographic procedure to detect any mammographic procedure to detect any variations from the optimum so that variations from the optimum so that corrective measures can be taken corrective measures can be taken promptly. A sequence of elements in the promptly. A sequence of elements in the imaging chain must function properly imaging chain must function properly beginning from equipment acceptance beginning from equipment acceptance which is foundation. All components which is foundation. All components should be optimized and monitored. should be optimized and monitored.

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THE TECHNOLOGIST MUST :THE TECHNOLOGIST MUST :

1.1. Conduct herself professionally.Conduct herself professionally.

2.2. Respond to the patients queries.Respond to the patients queries.

3.3. Serve humanity with full respect for the Serve humanity with full respect for the dignity of mankind.dignity of mankind.

4.4. Deliver patient care irrespective of nature Deliver patient care irrespective of nature of disease, sex, race, religion, and socio-of disease, sex, race, religion, and socio-economic status.economic status.

5.5. Take proper care as far as radiation Take proper care as far as radiation protection is concerned.protection is concerned.

6.6. Produce good quality mammographs so that Produce good quality mammographs so that the patient is diagnosed properly and the patient is diagnosed properly and returns home satisfied.returns home satisfied.

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Mammography remains the best screening test Mammography remains the best screening test

of the early detection of breast cancer.of the early detection of breast cancer.

The diagnostic accuracy of mammography The diagnostic accuracy of mammography

however depends upon several factors like however depends upon several factors like

density of the breast and the age of the patient.density of the breast and the age of the patient.

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