A brief explanation regarding mammogram exam towards women all around the world including cranio-caudal (CC) and medio-lateral oblique (MLO) views.

1. MAMMOGRAM

2. 01
INTRODUCTION

3. BREAST ANATOMY
Vary in shape and size.
Female breasts contain
different types of soft tissue;
i. Glandular tissue
ii. Fibrous tissue
iii. Fatty tissue
(MSKCC, 2021)
Figure 1.0 The anatomy of the breast from the side view (left image)
and front view (right image) of the breast (MSKCC, 2021).

4. WHAT IS MAMMOGRAM?
 Mammography is a specialized medical imaging techniques that uses a low-
dose x-ray system to see inside the breasts.
 A mammography exam, also called a mammogram, aids in the early detection
and diagnosis of breast. It can be used as screening or diagnostic tools.
 Three recent advances in mammography include digital mammography,
computer-aided detection (CAD) and breast tomosynthesis.
(RSNA, 2021)

5. ADVANCES IN MAMMOGRAM
DIGITAL (FFDM)
A system which replace x-
ray film into electronics that
convert x-rays into better
mammographic pictures of
the breast with a lower
radiation dose.
Images can be transferred
to a computer for review by
the radiologist and for long
term storage
CAD
CAD systems search
digitized mammographic
images for abnormal areas
of density, mass, or
calcifications that may
indicate the presence
of cancer. It highlights
these areas and alerting
the radiologist to carefully
assess this area.
TOMOSYNTHESIS
An advanced form of
breast imaging where
multiple images of the
breast from different
angles are captured and
reconstructed into a three-
dimensional image set
which is similar to
computed tomography
(CT) imaging.
(RSNA, 2021)

6. SCREENING DIAGNOSTIC
• For all women over 40 y/o to look
for early signs of breast cancer.
• Doesn’t have to have any signs or
symptoms
• Focus on specific area of
concern usually suspicious
screening or suspicious lump.
TYPES OF MAMMOGRAM PROCEDURES
(SCCA, 2012)

7. 02
INDICATION

8. INDICATIONS FOR SCREENING
AGE FAMILY HISTORY
Getting a screening if any of
family member having a history
of breast cancer before.
SYMPTOMS
ACS recommends that women
ages 40 to 44 have the choice
to start yearly mammography
Having no signs and symptoms
of the breast cancer
(Cancer.Net, 2015)

9. INDICATIONS FOR DIAGNOSTIC
(P. Jeff, 2018)
Figure 2.0 The early sign of the breast cancer (P. Jeff, 2028).

10. CONTRAIDICATIONS
ABSOLUTE
CONTRAINDICATION
There are no absolute
contraindications to
screening mammography
RELATIVE
CONTRAINDICATION
 Age less than 40 years old in
women
 Pregnancy and
breastfeeding
 Women with breast implant
(Lee, W., 2016)

11. 03
PREPARATION

12. PATIENT PREPARATIONS
INSTRUCTION TO PATIENTS:
i. Do not wear deodorant, talcum powder or lotion under your arms or in the
breasts area on the day of the exam because it can appear on the
mammogram as calcium spots and interfere with correct diagnosis.
ii. Patient is suggested to wear loose clothing so that it is easier to change later.
iii. Describe any breast symptoms or problems to the technologist performing
the exam.
iv. Obtain your prior mammograms and make them available if they were done
at a different location. This is needed for comparison with your current exam.
(Gwacha & Jha, 2017)

13. 04
EQUIPMENT

14. MAMMOGRAM UNIT
Figure 3.0 The digital mammography unit complete with
tomosynthesis (chudzr, 2016). (chuzdr, 2016)

15. 05
PROCEDURE

16. ROUTINE VIEWS
CRANIO-CAUDAL : CC views is a view from above. It must show the medial
part as well as the external lateral portion of the breast as much as possible.
PROCEDURE :
 Patient is standing with the body facing the mammography unit.
 The IR is raised until the level of the inframammary crease.
 Lean patient forward, pulled the breast and place on the plate.
 Rotate head away from the breast being examined.
 Make sure the inframammary fold and wrinkles smoothed out.
 Move the opposite breast out of the way.
 Compression is applied on the breast while nipple is in profile.
 Central ray is perpendicular and direct vertically from above.
 Markers on the axillary area.
Figure 4.0 CC compression
(Gwacha & Jha,
2017).
(Gwacha & Jha, 2017; Halls 2019)

17. ROUTINE VIEWS
MEDIOLATERAL-OBLIQUE : MLO views is an oblique view from the center
of the chest outward. It must show more of the breast in the upper-outer
quadrant, and also the axilla.
PROCEDURE :
 Patient standing with the part of interest in near to IR.
 The image receptor (IR) and central ray (CR) is angle 45 degree.
 The IR is raised until the level of the inframammary crease.
 The breast is then pulled and place on the plate.
 Make sure the inframammary fold and wrinkles smoothed out.
 Compression is applied on the breast while nipple in profile.
 Central ray is direct to the level of base breast.
 Markers on the axillary area.
Figure 5.0 MLO compression
(Gwacha & Jha, 2017).
(Gwacha & Jha, 2017; Halls 2019)

18. ADDITIONAL VIEWS
Figure 6.0 The additional views in mammography (Khare, 2014). (Khare, 2014)

19. 06
IMAGES

20. NORMAL BREAST
 Illustrations of selected
mammography positioning
criteria. A and B, Mediolateral
oblique (A) and craniocaudal
(B) mammographic views.
 Ovals show the glandular
tissue while long arrow in A
shows posterior nipple line
Figure 7.0 The illustration of the selected mammography positioning
criteria (Huppe et al., 2021).
(Huppe et al, 2021)

21. CRITERIA
1. CC IMAGES :
i. No motion
ii. Nipple in profile
iii. All pertinent anatomy demonstrated
iv. Tissue thickness distributed evenly
v. Dense areas penetrated
vi. High contrast and optimal resolution
vii. Absence of artifacts
viii. Marker and patient ID visible
Figure 8.0 The illustration of the normal CC views of right and left
breast (Abdul Lateef & Jefferson., 2017).
(Abdul Lateef & Jefferson, 2017)

22. CRITERIA
2. MLO IMAGES :
i. No motion
ii. Nipple in profile
iii. Pectoral muscles to level of nipple
visualized
iv. Breast pulled away from the chest wall
v. Dense areas penetrated
vi. High contrast and optimal resolution
vii. Absence of artifacts
viii. Marker and patient ID visible
(Abdul Lateef & Jefferson, 2017)
Figure 9.0 The illustration of the normal MLO views of right and left
breast (Abdul Lateef & Jefferson., 2017).

23. 07
FINDINGS

24. BREAST COMPOSITION
Figure 10.0 The Examples of BI-RADS breast composition categories of breast
density in increasing order of density from left to right(Partain et al., 2018).
(Partain et al, 2018)

25. MASS
1. SHAPE : The shape of a mass is either round, oval or irregular
Figure 11.0 The illustration of the shape of the mass in breast (Zonderland & Smithuis, 2014).
(Zonderland & Smithuis, 2014)

26. MASS
2. MARGIN : The density of the mass in the breast images can be circumscribed, obscured,
microlobulated, indistinct and spiculated.
Figure 12.0 The illustration of the different margin of the mass in breast (Zonderland & Smithuis, 2014).
(Zonderland & Smithuis, 2014)

27. MASS
3. DENSITY : The density of a mass is related to the expected attenuation of an equal
volume of fibroglandular tissue. High density is associated with malignancy. It is extremely
rare for breast cancer to be low density.
(Zonderland & Smithuis, 2014)
Figure 13.0 The illustration of the different density of the mass in breast (Zonderland & Smithuis, 2014).

28. 08
CONCLUSION

29. CONCLUSION
 Mammography is an x-ray imaging method used to examine the breast for the
early detection of cancer and other breast diseases.
 It is safe but maybe painful for some people.
 Screening mammography actually can reduces the risk of death due to breast
cancer. It is useful for detecting all types of breast cancer, including invasive
ductal and invasive lobular cancer.
 Screening mammography also improves a physician's ability to detect small
tumors to give more treatment options.
 The use of screening mammography increases the detection of small abnormal
tissue growths confined to the milk ducts in the breast, called ductal carcinoma
in situ (DCIS).

30. REFERENCES
MSKCC. (2021). Anatomy of the Breast. Retrieved November 24, 2021, from Memorial Sloan Kettering Cancer Center website:
https://www.mskcc.org/cancer-care/types/breast/anatomy-breast
RSNA, A. (2021). Mammography. Retrieved November 24, 2021, from Radiologyinfo.org website: https://www.radiologyinfo.org/en/info/mammo
SCCA. (2012, October 18). The difference between digital & film mammography | Seattle Cancer Care Alliance. Retrieved November 24, 2021, from
Seattlecca.org website: https://www.seattlecca.org/blog/2012/10/the-difference-between-digital-film-mammography
Cancer.net. (2015, September 17). Breast Cancer - Screening. Retrieved November 24, 2021, from Cancer.net website:
https://www.cancer.net/cancer-types/breast-cancer/screening
Lee, W. (2016, September 21). Screening Mammography - InsideRadiology. Retrieved November 24, 2021, from InsideRadiology website:
https://www.insideradiology.com.au/screening-mammography-hp/
P, Jeff. (2018, February 11). greenimaging-breast-cancer-symptoms-illustration - Green Imaging - Affordable MRIs, CT Scan, Mammogram.
Retrieved November 24, 2021, from Green Imaging - Affordable MRIs, CT Scan, Mammogram website:
https://greenimaging.net/mammogram/greenimaging-breast-cancer-symptoms-illustration/
Huppe, A., Overman, K. L., Gatewood, J., Hill, J., Miller, L., & Inciardi, M. (2017, September 5). Mammography Positioning Standards in the Digital Era:
Is the Status Quo Acceptable? Retrieved November 24, 2021, from Semantic Scholar website:
https://www.semanticscholar.org/paper/Mammography-Positioning-Standards-in-the-Digital-Is-Huppe-
Overman/7de3c4348bb5090f53b2298dc48eb1e27c16dbdb

31. REFERENCES
Abdul Lateef, S., & Jefferson, S. (2017, July 3). MAMMOGRAPHY Positioning & Anatomy. Retrieved November 24, 2021, from Slideplayer.com
website: https://slideplayer.com/slide/11633007/
Partain, N., Mokdad, A., Puzziferri, N., Porembka, J., Seiler, S., Christie, A., Date, D., Rivers, A., Leitch, A., Wooldridge, R., Huth, J., Rao, R. (2018).
Mammographic density changes in surgical weight loss-an indication for personalized screening. BMC Medical Imaging. 18. 10.1186/s12880-017-
0242-4.
Zonderland, H., & Smithuis, R. (2014, October 8). The Radiology Assistant : Bi-RADS for Mammography and Ultrasound 2013. Retrieved November
24, 2021, from Radiologyassistant.nl website: https://radiologyassistant.nl/breast/bi-rads/bi-rads-for-mammography-and-ultrasound-2013
CHUZDR. (2016, November 15). Procedures For A Mammogram Exam - Mammogram Test - ChooseDoctor. Retrieved November 24, 2021, from
ChooseDoctor - Blog website: https://blog.chuzdr.com/mammogram-test/
Gwacha, S., & Jha, R. (2017, February 3). Mammography. Retrieved November 24, 2021, from Slideshare.net website:
https://www.slideshare.net/sabingwachha/mammography-71710423
Halls. (2019, May 6). All about Conventional mammography - Moose and Doc. Retrieved November 24, 2021, from Breast Cancer - Moose and Doc
website: https://breast-cancer.ca/mammopics/
Khare, R. (2014, December 31). Imaging breast mammogram. Retrieved November 24, 2021, from Slideshare.net website:
https://www.slideshare.net/REKHAKHARE/imaging-breast-mammogram