1. PRESENTING BY: SUMREEN KOSAR, ASSISTANT PROFESSOR DESH BHAGAT UNIVERSITY PUNJAB 2. over view:  Introduction to mammography.  Anatomy.  Breast cancer.  Imaging modalities.  Role of a mammographic technologist.  Mammographic views.  Reporting system.  Additional information for a mammography technologist.  Artifacts.  Male mammography .  Conclusion.

1. BREAST IMAGING
PRESENTING BY:
Ms. Sumreen Kosar
Assistant Professor
Allied Health Sciences
DESH BHAGAT UNIVERSITY

2. CONTENTS
 Why Mammogram?
 Anatomy
 Introduction to mammography
 Role of a mammographic radiographer
 Type of mammography
 Mammographic views
 Reporting system
 Equipment's
 Artifacts.

3. October is Breast Cancer Awareness Month
 1 in every 22 Indian women will be diagnosed with breast cancer in
her lifetime
 Breast cancer is the most common form of cancer in women
 American College of Radiology recommends annual screening
mammography for women starting at age 40. This affords the
maximum benefits of reduced breast cancer deaths, less extensive
treatments for cancers that are found, decreased chance of advanced
disease at diagnosis, and discovery and treatment of high risk
lesions. Breast cancer incidence increases substantially around age
40.

4. American Cancer Society for women at average risk
 Women ages 40 to 44 should have the choice to start annual breast
cancer screening with mammograms if they wish to do so.
 Women age 45 to 54 should get mammograms every year.
 Women age 55 and older should switch to mammograms every 2
years, or have the choice to continue yearly screening.
 Screening should continue as long as a woman is in good health
and is expected to live 10 more years or longer.

9. Anatomy

11. Definition
The breast of an adult women is a milk-producing, tear.-
shaped gland.
It support by and attachment to the front of the chest wall
on either side of sternum by ligament.
Positioned over the pectoral muscles of chest wall and
attached to the chest wall by fibrous strand called as
Cooper’s ligament.

12. BRESAT COMPOSITION
The breast is a mass of glandular, fatty and
fibrous tissues and contain no muscle tissue.
A layer of fatty tissue surrounds the best glands
and extends throughout the breast.
This layer of fatty tissue give the breast a soft
consistency

13.  Milk gland (lobules) that produce milk
 Ducts transport milk from milk glands (lobules) to the
nipples.
 Nipples
 areola (pink or brown pigmented region surrounding
the nipple)
 connective (fibrous) tissue surrounds ducts and
lobules.
 Fat

14. Male vs female breast
• Male vs. Female anatomy
Male breasts are composed of fat, with some
glandular tissue.
They also show areolas and nipples.
Female breasts have similar structures, but,
in addition, contain: glandular tissue (lobes,
lobules), acini, ducts, Cooper’s ligaments,
Montgomery’s glands.

15. Introduction to Mammography
Mammography is a special x-ray of breasts with
compression in order to recognize any
abnormalities of breast, with dedicated
mammography unit.

16. Indications
Pain/ tenderness
 Swelling
 Nipple Discharge (mild)
 Calcification
 Benign or malignant tumor
 Lymph node enlargement

17. Contraindication
Breast Implant
Severe Nipple Discharge
 Large palpable mass
 Inflammation
Women within reproductive age

18. Role of a Mammographic Radiographer
1. Greets patients by confirming patient identification; reviewing
imaging request; checking for special instructions.
2. Gains patient cooperation by reducing anxieties; providing
explanations of imaging procedures; explaining equipment; answering
questions.
3. Conducts mammography study by positioning breasts; adjusting
compression mechanisms; instructing patient to hold breath; retreating
to lead protected area; adjusting equipment controls to set exposure
factors; activating equipment to take image; releasing compression
mechanisms; preparing for next positioning and view.
4. Minimizes radiation to patient and staff by practicing radiation
protection techniques.

19. 5. Maintains production and quality of mammograms by following established
standards and procedures; developing mammograms; observing mammogram
results; determining necessary adjustments for optimum results; retaking
mammograms as required; forwarding completed studies to radiologist for
interpretation.
6. Keeps mammography supplies and patient drapes ready by inventorying stock;
placing orders; collecting and processing laundry.
7. Maintains safe, secure, and healthy work environment by following, and
enforcing standards and procedures.
9. Documents patient mammogram services by completing patient record
charting.
10. Updates job knowledge by participating in educational opportunities; reading
professional publications; maintaining personal networks; participating in
professional organizations.

20. Type of Mammography
Screening Mammogram
Diagnostic Mammogram

22. Mammographic views
For screening: Cranio- caudal view(CC)
Medio-lateral oblique(MLO)
For diagnostic: CC
MLO
- lateromedial(from side towards center of chest)
- mediolateral(from the center of the chest out)

23. Cranio- caudal view(CC)

24. Medio-lateral oblique(MLO)

26. Additional Views
Extended CC view/Cleopatra’s view
Extended CC view-medial or lateral rotation
True lateral view
Axillary view
Cleavage view
Paddle compression view
Magnification view

29. Reporting System
BI-RADS: BREAST IMAGING-REPORTING AND DATA
SYSTEM
System which includes a standardized format to guide patient care
and improve physician communication.
BI-RADS includes specifics for mammography, ultrasound and MRI
reporting.
ALL breast imaging should be performed according to BI-RADS
guidelines

30. BI-RADS CATEGORIES: 1-6
BI-RADS: 0. FURTHER EVALUATION OR COMPARISON TO PRIORS
MAMMOGRAM NEEDED
BI-RADS: 1. NEGATIVE
BI-RADS: 2. BENIGN FINDINGS (be comfortable as these findings are
benign not cancerous)
BI-RADS: 3. PROBABLY BENIGN (implies <2% chance of malignancy)
follow up in a short time frame is suggested.
BI-RADS: 4. SUSPICIOUS OF MALIGNANCY (requires biopsy. May be
subdivided as A,B,C: low, intermediate, moderate)
BI-RADS: 5. HIGHLY SUSPICIOUS (requires biopsy. Implies 95%
likelihood of malignancy proper treatment should be given)
BI-RADS: 6. ALL READY PROVEN MALIGNANCY

31. BI-RADS
BI-RADS: 1 and 2. No action needed
BI-RADS: 3. Short term follow-up, usually in 6
months or consider biopsy (decision may be
based on patient’s preference)
BIRADS: 4 and 5. Take action. Needs biopsy

32. BI-RADS Breast Density
Type 1: “Almost Entirely Fat” or “Mostly
Fatty Replaced” (0-25%)
Type 2: “Scattered Fibroglandular” (25-50%)
Type 3: “Heterogeneously Dense”. (50-75%)
Type 4: “Extremely Dense” (>75%)

33. Breast Density

34. Equipment's

36. Mammography X-Ray Tube

37. Mammography X-Ray Tube
Target materials consist of three main types.
• Molybdenum
• Specialized Tungsten
• Rhodium
 Molybdenum
– the best material to be used in mammography,
– allows production of low energy spectrums of radiation low
kVp (26-40kVp)
Tungsten and Rhodium are used for higher beam needs, in
dense breast tissues.

38. Filtration
Materials that are placed in the path of the X-ray beam in order to
absorb those X-rays with energies above and below the desired
spectrum.
Tube filtration types:
• Molybdenum (Mo) (best used for lower kVp)
• Rhodium (Rh)
• Aluminum (used for above 30 kVp

39. Collimation
Collimator – used to shape radiation field
smaller radiation field means less scatter, collimate
when you can!
Smaller exposed area, better for patient dose

41. Breast Compression
In mammography the breast is compressed using a rigid transparent
plastic compression plate which can be motor driven.

42. Why breast compression?

43.  Better spatial resolution. The breast is brought closer to the
imaging receptor so that magnification and focal spot
blurring is reduced.
 Reduced movement blur, even at the relatively long exposure
times. Less scattered radiation in the image. The beam path
length through the breast is shorter, so there is less material to
do the scattering
 The reduced path length makes practicable the use of lower
energy (less penetrating) X-ray spectra. This gives greater
subject contrast.
 Small areas of pathology buried in glandular tissue can be
better visualized, as malignant tissues tend to be firmer.

44. Breast Support Plate
It’s the plate that hold the breast :
Two parts:
Upper part made from carbon fiber(free absorption)
Lower part made from lead (safe the patient abdomen
from radiation hazard )

45. Advances
1. Digital mammography:
also called full-field digital mammography (FFDM), is a
mammography system in which
the x-ray film is replaced by solid-state detectors that convert
x-rays into electrical signals.
2. Computed aided detection:
that can be obtained from either a conventional film
mammogram or a digitally acquired mammogram.

46. 3. Breast Tomosynthesis:
also called three-dimensional (3-D) breast imaging, is a
mammography system where the x-ray tube moves in an arc over the
breast during the exposure.

47. 4. MRI for Breast
 Just as mammogram is done with specially designed x-ray
machine, Breast MRI requires special equipment
 MRI is used mainly for following purpose:
• To measure the size of the cancer
• To look for any other tumor
• To look at opposite breast
• Screening MRI with yearly mammogram in certain high risk
cases

49. 5. Ultrasound for Breast
 It has become a valuable tool to use along with mammogram
because it’s widely available, noninvasive and cost effective
 It is good to have a closer look at some breast masses, if
required U/S guided FNAC is possible
 It is also used to look at axillary lymph nodes

50. Mass on ultrasound

51. Mass on ultrasound

52. FNAC under ultrasound guidance

53. Artifacts
Belly fold
artifact

54. Pectoral
muscle fold
artifact

55. Hand
artifact

56. Chin
artifact

57. Axillary
skin
fold artifact

58. Motion blur

59. Chest
wall
skin
fold
artifact

60. Powder
artifact
mimicking
micro
calcifications

61. Thank You For Being
Patience