The document presents an overview of mammography, detailing its definition, history, equipment, and various types used for breast cancer detection. It emphasizes patient preparations, indications for mammography, and radiation safety, highlighting the benefits of early detection. Additionally, it discusses technical factors and specific views related to mammography imaging.

1. Mammography
Presented by Akari Kyaw
Fourth Year
B. Med Tech (MIT)
24.6.2020

2. Contents
• Definition
• History
• Anatomy
• Mammography equipments
• Types of mammography
• Indications
• Patient preparation
• Preparation as a patient
• mammography views
• Radiation safety
• Benefits
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3. Mammography
 X ray imaging of breast organ
 Also called mastography
 Radiographic procedure that uses special equipment to produce images
of high contrast and high resolution for the diagnosis of breast leisions
 Using low energy X rays(usually around 30 kVp)
 goal of mammography is the early detection of breast cancer, typically
through detection of characteristic masses or microcalcifications.
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4. History of mammography
 1913 (Dr. Albert Solomon)
First attempt at mammography
 1950 (Robert Egan)
First utilized low kVp and high mAs techniques
 1960
Development of xero-mammography
 1990
Screen-film mammography was accepted
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7. Anatomy of breast
 Mammary gland
 A conic or hemispheric eminence
 Located on the anterior and lateral wall
 Average breast extends from the anterior portion of the 2nd
rib(clavicle) down to the 6th or 7th (mid sternum)
 Comprises 15 to 20 lobes which are covered by adipose tissue that
primarily accounts for its size and shape
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9. Breast classifications
• Fibroglandular breast
• Fibrofatty breast
• Fatty breast
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10. Fibroglandular breast
• Common age group- 15 to 30 years(and childless women> 30
years old)
• Pregnant or lactating women
• Radiographically dense
• Very little fat
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11. Fibrofatty breast
• 30 to 50 years
• Young women with three or more pregnancies
• Average radiographic density
• 50% fat and 50% fibroglandular
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12. Fatty Breast
• >50 years
• Postmenopausal
• Minimal radiographic density
• Breasts of children and men
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13. Methods of localization
Two methods are
commonly used;
1. Quadrant system
• Upper outer quadrant
• Upper inner quadrant
• Lower outer quadrant
• Lower inner quadrant
2. Clock system
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14. Mammography Equipments
Mammography equipment comprise of;
 High frequency generator
 Molybdenum target
 Filter
 Grid
 Compression device
 Automatic exposure control system
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15. High frequency generator
 Works on single phase
 Provides rectified smoothed voltage supply to the tube
 Small in size with good reproducibility
 Providing up to 600 mAs
 Employ small focal spots, low kVp technique, low
grid ratio and special screen films
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16. Target and filter
Most of the mammography X ray tubes are
designed with;
• Mo target with Mo Filter
• Mo target with Rh Filter
• Rh target with Rh Filter
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17. Grid
 Placed between the breast and
cassette
 To reduce scatter radiation
 Improve contrast sensitivity
 Lower grid ratio than that of general
X ray(4:1 or 5:1)
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18. Compression device
 Made of a plastic that allows transmission of low energy X rays
 Should have a straight edge that allows the compression to
grasp the breast tissue close to the chest wall
 Applied at 25 to 45 pounds of pressure
 Used to decrease the thickness of the breast tissue
 To bring the breast structures as close to IR
 To decrease dose needed and scattered radiation
 To decrease motion and geometric unsharpness
 To increase contrast 18

19. Automatic Exposure control (AEC)
 Employs phototimers to measure the X ray intensity and
quality
 Kept closer to the image receptor
 To minimize the object to image distance(OID)
 Improving spatial resolution
There are two types of AEC available,
 Ionization chamber type
 Solid state diode type
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24. Types of mammography
There are two types of mammography;
 Screening mammography
 Performed in asymptomic patients
 Diagnostic mammography
 Performed on high risk patients or patients with
symptoms
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25. Indications for Mammography
 Screening as check up
 Abnormality found on screening mammogram.
 Short interval follow up of probably benign but
abnormal mammogram.
 Patient/physician identified breast lump.
 Focal breast pain/tenderness.
 Suspected Abscess.
 Spontaneous nipple discharge.
 New nipple changes (e.g. inversion)
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26. Patient preparation
 Put on a gown
 Remove any jewelry, talcum powder, or antiperspirant
 Drape the upper torso with a gown or sheet except during
actual positioning and radiographic exposure
 Explain the procedure and documents any relevant
patient history as per departmental protocol
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27. • Patient history include the following
 Number of pregnancies
 Family history of cancer including breast cancer
 Medications (eg; hormone therapy) currently taken
 Previous breast surgery
 Previous mammograms when and where performed
 Reason for current visit such as screening mammogram,
lumps, pain, or discharge
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28. Preparation for a mammogram as a patient
 Scheduling
 Precautions
 Breastfeeding
 Personal hygiene
 Clothing
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29. What Not To Do Before a Mammogram
 DON'T apply deodorant before your mammogram
 DON'T wear a dress or one-piece outfit
 DON'T go right before or during your period
 DON'T consume caffeine products (coffee, chocolate)
several days up to two weeks before the appointment
 DON'T worry if you've had prior mammograms at other
facilities
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30. Standard mammography views
 Craniocaudal view(CC)
Basic superior to inferior
projection
 Mediolateral oblique view(MLO)
Superomedial- inferolateral
oblique projection
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Additional or special views
 Mediolateral projection (true lateral breast position)
 Exaggerated craniocaudal (laterally)(XCCL) projection
 Implant displaced (ID) (EKLUND Method)
 Cleavage view (CV)
 Tangential (TAN)
 Axillary tail view(AT)
 Axillary view(AX)

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Technical factors
• SID - Fixed, varies with manufacturer (about 60cm, 24 in)
• IR size - 18x24 cm or 24x30 cm, crosswise
• Grid
• Analog and digital system
• Applied voltage
 Ranges from 25-30 kVp
 80-100 mAs
 Exposure time – 1-4 s

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Radiation safety
We must obey cardinal rules;
• Time
• distance
• shielding

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Benefits of mammography
•Reduces the risk of dying from breast cancer
•Reduces the risk of having to undergo chemotherapy; Screening often
allows for the detection of cancers at an early stage of development
•Allows women to know the health of their breasts.

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References
 K. L. Bontrager and J. P. Lampignano (2014) Text Book Of
Radiographic Positioning And Related Anatomy, 8th Edition
 Department Of Radiology, Dartmouth Geisel School Of
Medicine 2020 Indications For Diagnostic Mammography
 Quebec; Breast cancer screening