Transcript mammography lecture part 1 & 2

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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)
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Mammograms
don’t look fun
but they can
save a life!
Man – o - gram
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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
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Do it for those you love….
And who love you
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POSITIONING
Routine Images aka “screening mammo”
(not screaming)
CC
- cranio caudad
MLO – mediolateral oblique
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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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Marker? Which side is axilla?
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MLO – RT BREAST
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POSITIONING
CC – CRANIOCAUDAD
 MLO – MEDIAL LATERAL OBLIQUE
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“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
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Axillaries tail extends from lat.
base of the breasts to axillaries
fossa
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Tapers ant. from the base
ending in nipple, surrounded
by areola
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Female Breast
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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 ?
COOPER’S 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
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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
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MOSTLY SEEN UPPER
OUTER QUADRANT
STROMAL
 FATTY TISSUE
 CONNECTIVE
TISSUE
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(COOPER’S
LIGAMENTS –
SUSPENSATORY
LIGAMENTS
3 Tissue Types
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Breast Classifications
Breast Changes with Age
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Fibro-glandular Breast
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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
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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
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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 men’s 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.
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Gynecomastia
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Benign excessive development of male mammary gland
Occurs in 40% of male cancer pt’s
Survival rates with treatment are 97% for 5 years
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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
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THE AUGMENTED
BREAST
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
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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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