Chapter 17

MammographyGold standard for breast cancer detection

Most common in women other than skin cancer2nd leading cause of cancer death in women1 in 8 chance of getting breast cancer1 in 35 chance of dying from it.

MammographyHighly regulated

Mammography Quality Standards Act (MQSA)

All Mammography units must meet federal standards. ACR accredited.

State of Nevada requires annual inspections

External Breast AnatomyInframammary fold

Inferior breast to the chest wall

Axillary TailSuperiolateral aspect

External Breast AnatomyAreola

Dark area surrounding nipple.Montgomery’s gland or Areolar glands (are

Sabaceous glands)

NippleProtrusion containing duct openings

Boundaries of the Breast

Superiorly: 1st or 2nd rib (clavicle)Inferiorly: 6th or 7th (IMF-Inframammary fold)Medially: SternumLaterally: Mid-axillary line at the junction of

the latissimus dorsi muscle.

Internal Breast AnatomyPectoralis Major

Chest muscle posterior to breast.

Retromammary SpaceConnective tissue attaching breast to

pectoralis major.

Parenchyma (Breast) Tissue

Glandular TissueMilk production and duct system

Adipose TissueFatty tissue surrounding glandular tissue

Fibrous (Connective) TissueSurround and support the glandular structures

(Cooper’s Ligament)

Glandular Tissue15 – 20 lobes surrounding the nipple

Alveoli (Acini)Milk producing units

LobulesGroups of alveoli

Glandular TissueDuct

Transports breast milk

AmpulaReservoir at the end of ducts

Mammo CompressionDecrease breast thickness

Brings breast structures close to the IR Decrease dose and scatter

Holds the breast tissue away from the chest wall

CompressionDecreases motion unsharpness

Increase contrast

Separate breast structures

PositioningCraniocaudal (CC)

Mediolateral Oblique (MLO)

Others are possible

Craniocaudal (CC)IR raised for 90º chest wall angle.Compression appliedCorrect placement of the photocell in film

screen mammography is under the most glandular tissue

Typically the anterior third of the breastPectoral muscle should be seen

Mediolateral Oblique CR angled 45º-50º and enters medially.IR raised to the height of the axillaCompression appliedFilm Screen mammography-position of

photocell is under the most glandular tissue typically the anterior third of the breast

Pectoral muscle and inframammary fold should be seen.

Mammography AdvancementFull Field Digital MammographyComputer Aided Detection (CAD)UltrasoundMRI and MR SpectroscopyNuc MedBSGI Breast Specific Gamma Imaging (Caution-

residual radiotracers have been linked to Colon Cancer)

3 D Mammography or Breast Tomosynthesis (Standard mammographic views with approximately

50 individual images. Same compression and positioning.)

BREAST TOMOSYNTHESISBENEFITS1.Improves radiologists' ability to screen for

and detect potential breast cancers. 2.Helps radiologists pinpoint size, shape, and

location of abnormalities. 3.Can help distinguish harmless abnormalities

from real tumors, leading to fewer callbacks and less anxiety for women.

http://www.massgeneral.org/imaging/services/3D_mammography_tomosynthesis.aspx

Getting RegisteredNew Mandates from ARRT

Effective July 200940 Hours of Initial Training

Approx cost -$625 4 day programCandidates must be in compliance with MQSA

requirements for technologists, and are required to complete: (a) a specified

number of mammographicexaminations; (b) quality control procedures; (c) selected

special procedures; (d) mammographicreview and critique. All procedures must be completed

within the 24 months immediately beforeapplication for certification.

www.achievingqi.com- Las Vegas, Multiple dates 2011