3. What is mammography..??
Mammography is a radiographic modality to
detect breast pathology and cancer.
Breast cancer accounts for 32% of cancer
incidence and 18% of cancer deaths in women in
the United States.
Approximately 1 in 8 or 9 women in the US will
develop breast cancer over her lifetime.
A mammogram can find breast cancer when it is
very small -- 2 to 3 years before we can feel it.
4. 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 even when it is micro in
size
5. The standard techniques used for breast imaging
are:
1. Screen film x-Ray mammography.
2. Real-Time ultrasound.
3. Other new techniques include:
MRI
Color Doppler
Contrast ultrasound
Digital Mammography
Scintimammography
6. Principles Of Breast Cancer
Patients in the early stages respond well to
extensive surgery
Patients with advanced disease do poorly
The earlier the diagnosis, the better the
chance of survival
Mammography is the tool for early detection
8. contraindication
Breast implant
Severe nipple discharge
Large palpable mass
Inflammation
Women within reproductive age
15-40 (benefit over risk)
10. Patient preparation
The patient is requested to take proper bath before coming
for the procedure
Patient should not wear deodorant, talcum powder or
lotion under her arms or on her breasts as these may appear
on the mammogram and interfere with correct diagnosis.
She is suggested to wear loose clothing so that it is easier
for her to change for the procedure
She is asked to bring along any histopathological report if
done before mammography for clinical co-relation
A clean green hospital gown should be provided to the
patient before procedure.
Patient privacy should be maintained and a conducive
environment should be created.
11. Development Of Mammography
In 1913, radiographic appearance of breast cancers was
first reported
1950’s – Industrial grade x-ray film used
1975 – High speed/resolution film introduced by
DuPont
1992 – MQSA implemented
12. MQSA
Mammography Quality Standards Act
Mandated the following:
Formal training and continuing education
Required regular inspection of equipment
Documentation of quality assurance
Report means of reporting results, follow-
up, tracking patients, and monitoring
outcomes
13. Breast Cancer Screening
American Cancer Society(ACS) and American College of
Radiology(ACR) suggest that all women over 50 years should
undergo annual mammography.
Women between 40 and 49 should have one done every
alternate year.
A baseline mammogram should be done at the onset of
menopause.
14. Risk Factors
Age
Incidence increases with age
Hormonal History
More sensitive to carcinogens during
menarche
Family History
Women with positive family members
are more prone to breast cancer
15. Type of mammographic
examination
1.Diagnostic mammography is performed on
patients with symptoms or elevated risk
factors. Two or three views of each breast
may be required.
2.Screening mammography is performed on
asymptomatic women with the use of a two-
view protocol, usually medial lateral
oblique and cranial caudad, to detect on
unsuspected cancer
17. How x-ray is produce?
X-rays are produced due to sudden
deceleration of fast moving electrons when
they collide or interact with the target
anode. In this process, 99% of the electron
energy is converted into heat and 1% of
energy is converted into X-ray.
There are two type of x-ray production
1.bremsstrahlung x-ray
2.characteristic x-ray
18. 1.bremsstrahlung x-ray
Bremsstrahlung x-rays
result from the
interaction between a
projectile electron and
a target nucleus.
The electron is slowed
and its direction is
changed.
19. Characteristic x-ray
Characteristic x-rays are produced after ionization of a k-
shell electron.
When an outer-shell electron fills the vacancy in the k
shell, an x-ray is emitted.
In mammography, 17.5-19.5kev characteristic x-ray is
produced with Mo target and 23kev is produced with Rh
target.
20. In mammography low kVp is used because
it helps to minimize compton scattering and
maximize the photoelectric effect inorder to
enhance the differential absorption by
various tissues of the breast.
As glandular tissue of breast is highly
radiosensitive, low kVp helps to reduce
radiation dose to breast.
21. General x-ray tube Mammography tube
1.Both bremsstrahlung x-ray and
charateristic x-ray produced
only charaterisctic x-ray
2.High kVp 50-120 is used. 20-35 kVp is used.
3.Target / filter: W /Cu ,Al Mo/Rh
4. Window : Glass Beryllium or very thin borosilicate
glass
5. SID : 100 or 180 cm 60- 80 cm
6. Anode angulations: 6-20 degree
tube angle : nil
6 degree
tube angle : 23-25 degree
7.Focal spot : 0.1-1mm and 0.3-
3mm
0.1mm and 0.3mm
22. Generator and target/ filter
combination
1. High frequency generator with 5-10KHz
power is used
2. Target/filter:
W/60 µm Mo
Mo/30 µm Mo
Mo/50 µm Rh
Rh/50 µm Rh
23. Filtration
Window of x-ray tube should not attenuate x-ray
beam significantly
Be window: Z=4 or very thin Borosilicate glass
window
Inherent filtration of no more than 0.1 mm Al
equivalent
Under no circumstances is total beam filtration
less than 0.5 mm Al equivalent.
25. Compression
Compression is achieved with a low attenuating lexan paddle
attached to a compression device
10 to 20 Newtons (22 to 44 pounds) of force is typically
used
Parallel to the breast support table
Spot compression uses small paddles
Principal drawback of compression is patient discomfort
26. Compression
Breast compression is necessary
Spread the anatomy out to minimise overlaying
structures (improve contrast)
Equalise thickness to ensure homogenous density
on the radiograph
Bring the structures closer to the detector to
reduce geometric unshaprness
less scatter, more contrast, less geometric
blurring of the anatomic structures, less motion
and lower radiation dose to the tissues
27. Automatic Exposure Control (AEC)
The AEC, also called a phototimer, is a device that uses a
radiation sensor, an amplifier and .a voltage comparator to
control the exposure.
It is a device that automatically calculates the exposure
time that is required to produce optimum density on the
film.
When the required optimum density is produced, the AEC
terminate the exposure and hence reduces the dose that
may have increased with manual selection of exposure
factor and exposure time.
AEC detector is located underneath the cassette in
mammography unlike conventional radiography.
28. Anatomy of the Breast
Vary in shape & size
Cone shaped with the post
surface (base) overlying the
pectoralis & serratus muscles
Axillaries tail extends from lat.
base of the breasts to axillaries
fossa
Tapers ant. from the base
ending in nipple, surrounded
by areola
29. Female Breast
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
30. 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
Enlargement:
A normal duct cells
B basement membrane
C lumen (center of duct)
Breast profile
31. Lymph node:
Lymphatic vessels of the breast
drain laterally and medially
Laterally into the axillary
lymph nodes (C & D)
Medially into the mammary
lymph nodes
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
35. 35
Fibro-glandular Breast
Human breast is
composed of mainly
fibroglandular tissue
which is highly
radiosensitive, hence ,
it is to be protected
from high radiation
exposure
36. 36
Average density
50% fat & 50%
fibro-glandular
Pregnant and lactating
mother are less prone
to breast cancer
Spinsters are more
prone to it
54. 54
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.
Benign excessive development of male mammary gland
Occurs in 40% of male cancer pt’s
Survival rates with treatment are 97% for 5 years
55. 55
Gynecomastia:
Prominent Male
Breasts
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
56. 56
Gynecomastia
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.
58. 58
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
59. Full-field digital
mammography (FFDM).
Recently approved by the U.S. Food and
Drug Administration (FDA), this technique
involves taking digital images of the breast.
Digital images are captured electronically
and can be viewed on a computer. Their
magnification, brightness and contrast can be
adjusted and enhanced to better reveal
abnormalities.
60. Xeromammography
Xeromammography is a photoelectric method of
recording an x-ray image on a coated metal plate,
using low-energy photon beams, long exposure
time, and dry chemical developers.
It is a form of xeroradiography.[1]
This process was developed in the late 1960s by
Jerry Hedstrom, and used to image soft tissue, and
later focused on using the process to detect breast
cancer.
62. Tomosynthesis
Tomosynthesis: Tomosynthesis is a special kind
of mammogram that produces a 3-dimensional
image of the breast by using several low dose x-
rays obtained at different angles. For
tomosynthesis, the breast is positioned and
compressed in the same way as for a mammogram
but the x-ray tube moves in a circular arc around
the breast. It takes less than 10 seconds for the
imaging. The information from the x-rays is sent
to a computer, which produces a focused 3-D
image of the breast. The x-ray dose for a
tomosynthesis image is similar to that of a regular
mammogram
69. In the scintimammography
procedure, a woman receives
an injection of a small amount
of a radioactive substance
called 99technetium sestamibi,
which is taken up by cancer
cells, and a gamma camera is
used to take pictures of the
breasts.
Also called miraluma test
(when with sestamibi)
Breast Scintomotography
(NMBI)
Isotope matches tumor to node involvement
