Mammography uses low-dose x-rays of the breast to detect breast cancer. Standard views include craniocaudal and mediolateral oblique. Compression is used to flatten and separate breast tissue for clearer images. Digital mammography uses solid-state detectors instead of film. Tomosynthesis creates 3D-like images that improve detection. Additional views like spot compression provide targeted views of areas of interest. Mammography is not 100% accurate but can find cancers early and reduce mortality when used regularly.

1. mammography?

2. • first used to examine breast tissues by the german
surgeon- ALBERT SALMON .
• a mammogram is a x ray exam of breast to detect and
evaluate any changes in the breast.

3. indication
• breast cancer-the first symptoms of breast cancer usually appear
as an area of thickened tissue in the breast. other symptom-pain,
resdness, nipple discharge, inverted nipple, change in the size o
shape of the breast. stages of breast cancer- *stage 0= known as
ductal carinoma in situ, (cells that line the milk ducts of the breast
have become cancer).
*stage 1= tumors measures upto 2 c.m across. it
has not affected any lymph nodes.
* stage 2 = it has started to spread to nearby nodes ,
has not spread to the lymph nodes.
*stage 3 = the cancer has spread to distant organs.

4. • breast lump: localized swelling.
• nipple discharge.
• breast pain.
• follow up for previously evaluated mammographic
findings.

5. contra-indication
• pregnancy
• radiation therapy to chest/mediastinal
• active collagen disease: immune system causes
inflammation in our collagen, it is the main structural
protein found in various connective tissue.

7. mammography x- ray tube
• target materials consists of- molybdenum(42) rhodium(45)
• molybdenium is the best material to be used in
mammography.
• allows production of low energy spectrum of radiation
• low kvp(26-40)

8. filtration
• materails that are placed in the path of the x ray beam in
order to absorb those x ray with low energy.
• molybdenum- best used for lower kvp
• rhodium
• yttrium (39)

9. collimation:
• used to shape radiation field.
• less scatter.
• smaller exposed area, better for patient dose.

10. breast compression
• breast is compressed using a rigid transparent plastic
compression plate.
• breast is compressed for better spatial resolution.
• spatial resolution is the ability of an imaging system to
diffrentiate between two near by objects.
• reduce movement blur.

11. views :
• standard view:craniocaudal view(cc view), 45 degree
lateral oblique(MLO).
• additional view: extendd CC view,true lateral view, axillary
view, cleavage view, paddle compression view,
magnification view, eklund view.

12. what is CC View?
• the mammography equipement is positioned with the x
ray beam axis pointing vertically downwards.
• the women faces the machine, with her arms by her side.
• she is standing and is rotated 15-20 degrees to bring the
side under examination close to the horizontal breast -
support table.
• the table is at the level of infra mammary crease(lower
boundary of breast)

15. • the nipple should be in the midline of the breast and in profile.
• the women head is turned away from the side under the
examination.
• the breast is lifted up and rotated medially 5-10 degrees so that
the nipple is just medial to the midline of the film.
• as the hand is removed, the breast is compressed firmly to a
level that the women can tolerate.
• a remote cotrolled foot compression device allows this to be
achieved more easily.
• compression must be released as soon as the exposure ends.

16. MLO
• allows visualization of the largest amount of breast tissue.
• the mammographic equipement is routinely angled at 45 degrees from
the vertical.
• the women arm is placed on the top of the table with elbow flexed and
dropped behind it.
• the table height is adjusted so that the lower border of the breast is 2-3
c.m above the edge of the film.
• the breast is gently extended upwards and outwards to ensure it contacts
the breast - support table.
• the compression plate is applied.
• when the compression is almost complete, the breast is checked for skin
folds and radiographer’s hand is removed.

17. 45 degree lateral oblique(MLO).
• lateral side of the breast is probably the most common place for pathological
changes to occur.
• for an ML view, the tube emitting the x-ray is medial and the detector plate is
lateral.
• for the LM view, the tube is lateral and the detector is placed medially.
• lateral views are extremely useful in determining the exact location of an
abnormality in the breast.
• ML view is best for lesions located in the central or lateral breast
• LM view is best for evaluating medial lesions.

19. extended cranio-caudal view:
• the routine CC view will not showmany abnormilities in the
upper quadrant of the breast, which will be demonstrated
on the medio-lateral oblique projection.
• as all lesions must be demonstrated on two projections,
this extended crnio-caudal projection is useful for
demonstrating the outer quadrant, axillary tail and axilla.
• the women stands close to the equipement, with her
breast aligned slightly side of the midline of the breast
support table.
• the breast is lifted gently and placed on the table

20. • the women is then encourged to lean 10-15degrees
laterally.
• compression is applied , the exposure is made and
compression released immediately.

21. magnification view
• A magnification view in mammography is performed to evaluate and count
microcalcifications.
• This allows the acquisition of magnified images of the region of interest.
• magnified projections are done in the cranio-caudal and mediolateral
projections.
• the women is placed in the position for the lateral and cranio caudal
projections in turn.
• it is important to realize that the field will cover only the half of the breast
under examination.
• Provides additional information on margins, satellite lesions, and
microcalcifications. Can also be useful for asymmetric tissue .

22. cleavage view
• A cleavage view (also called "valley view") is a
mammogram view that depict the posteromedial portion of
both breasts (the “valley” between the two breasts) by
placing them on the cassette at the same time and pulling
them anteriorly.
• Modified CC view that improves visualization of area
between breasts. Both breasts are positioned on the
detector.

23. axillary view
• An axillary view (also known as a "Cleopatra view“) is a
type of supplementary mammographic view. It is an
craniocaudal view for better imaging of the lateral portion
of the breast to the axillary tail.
• This view allows imaging of the axillary tail of the breast. It
resembles the ML view but allows evaluation of breast
tissue more laterally oriented.

24. spot view
• A spot view (also known as a spot compression view or
focal compression view) is an additional mammographic
view performed by applying the compression to a smaller
area of tissue using a small compression paddle,
increasing the effective pressure on that spot. This results
in better tissue separation and allows better visualization
of the breast tissue in that area.

25. patient preparation?
• give verbal instruction.
• patient should refrain from using lotions, powder, and
deodrants the day of examination.
• patients clothing from waist up will be removed.

26. abnormalities:
• cysts: fluid filled sacs.
• calcification: deposition of calcium.
• fibroadenomas: benign tumors.

27. Why is compression important in
mammography?
• Decreases radiation dose
• Separates glandular tissue
• Decreases superimposition of tissue
• Improves resolution or clarity of the image
• Increases contrast to visualize subtle differences in tissue
• Reduces scatter radiation

28. digital mammography
• Digital mammography is a specialized form of
mammography that uses digital receptors and computers
instead of x-ray film.
• the X-ray film is replaced by solid-state detectors that
convert X-rays into electrical signals.
• The electrical signals are used to produce images of the
breast that can be seen on a computer screen or printed
on special film similar to conventional mammograms.
• also called full-field digital mammography (FFDM)

29. Tomosynthesis (3D Mammography)
• Tomosynthesis or “3D” mammography is a new type of
digital x-ray mammogram which creates 2D and 3D-like
pictures of the breasts.
• This tool improves the ability of mammography to detect
early breast cancers.
• The images include thin one millimeter slices.
• The “3D” images reduce the overlap of breast tissue, and
make it possible for a radiologist to better see through
your breast tissue on the mammogram.

30. • Multiple studies have shown that “3D” mammography
increases the detection of breast cancer by approximately
25%, and decreases the number of false positive call
backs by approximately 15%.

31. Galactography or ductography
• is a medical diagnostic procedure for viewing the milk
ducts.
• The procedure involves the radiography of the ducts after
injection of a radiopaque substance into the duct system.
• The procedure is used for investigating the pathology of
nipple discharge.

32. ADVANTAGES
• It is time-efficient.
• It is easier to see slight differences between tissues.
• It requires lower average radiation dosage.
• Reduces the risk of dying from breast cancer.
• Reduces the risk of having to undergo chemotherapy.

33. LIMITATION
• they are no 100% accurate in showing if a women has
breast cancer.
• mammograms look normal though breast cancer is
present.
• mammograms look abnormal een though there is no
cancer in breast.
• women with dense breasts have more false negative
limitations of mammograms.

34. Xeroradiography/xeromammography
• X-ray imaging in which a picture of the body is recorded on
paper rather than on film.
• a plate of selenium, which rests on a thin layer of aluminium
oxide.
• Xeromammography is a photoelectric method(electrically
charge particle is released within a materia; when it absorbs
electromagnetic radiation) of recording an x-ray image on a
coated metal plate, using low-energy photon beams, long
exposure time, and dry chemical developers.
• This process was developed in the late 1960s by Jerry
Hedstrom, and used to image soft tissue, and later focused on

35. Xeroradiography/xeromammography
• photoelectric method.
• records images without film.
• latent image is converted to positive image .

36. xeroradiography Vs Radiography
• elimination of accidental film exposure, economic benefit,
reduced exposure to radiation dose.
• it involves neither we chemical processing nor the use of
the dark room.
• dis:the process of developement cannot be layed and is it
to completed within 15mins.

37. components:
• xerographic plate.
• corotron.
• casette.
• toner.
• special paper.

38. xerographic plate.
• sheet of aluminium in which a layer of amorphus selenium
has been deposited. In addition, there is an interface layer
between the selenium and aluminium and an overcoating
protecting the selenium surface.
• layers: overcoating, selenium, interface, aluminium.

39. procedure
• the first step in xeroradiographic process is to sensitise
the selenium the selenium layer by applying a uniform
electrostatic(biuld up charges due to conatct with other
crges) charge to its surface in the dark .

40. principle:
• the XR plate is charged to a high positive potential by
corotron(charging device)
• it is then placed in a cassette and used in a manner similar to that
with conventional film in its casette.
• when x rays strike the selenium, photoconduction(material become
more electrically conductive due to absorption of x rays) occurs and
this produces a charge image of the part examined.
• the image is made visible by bringing into proximity to the plate
charged developer or toner particles.
• the resultant powder image is subsequently transferred to paper and
fused providing an opaque XR interpretation and storage.

41. process:
• plate is sensitizes before the exposure.
• the charged plate is placed in a light tight casette and is
exposed to x rays.
• the x ray reaching the plate cause the photoconductor
layer to lose its charge in an amount corresponding to the
intensity of x-ray beam.
• the uniform charge is thus dissipated and the remainning
charge patterns form the ltent electrostatic image.

42. • the exposed plate is placed on the top of a dark box into
which an aerosol of charged tonner particles is sprayed
through a nozzle(produces millions of ink droplets used in
creating the image)
• all toner must be removed before the plate is to be
reused.
• the plate is exposed to a light source that reduces the
bond holding the residual toner to the plate.
• a preclean corotron exposes the plate to an altrnating
current .

43. image quality
image quality is based on ---
• radiographic mottle
• sharpness
• resolution.
• radiographic mottle- depends on film screen mottle and
film gradiness. screen mottle depends on structure mottle
and quantum mottle.

44. • radiographic mottle: it is also known as noise. it directly
related to the number of x-ray photons.
• Fewer photons reaching the image receptor will cause an
undesirable fluctuation in image densities, resulting in
images with a grainy, or sandlike, appearance.

45. sharpness
• ability to define edge of film.
types of unsharpness: geometric unsharpness, motion
unsharpness and photographic or system unsharpness.
geometric unsharpness: *Two principal factors play
simultaneously: the apparent focal spot size and the ratio
between object-film distance (OFD) and focus-film
distance (FFD).
*Fine focal spot sizes will minimise geometric
unsharpness, and therefore give more detailed images.

46. sharpness
*Keeping the ratio FFD:OFD high will minimise
geometric unsharpness.
Motion unsharpness: *is caused by movement of the
patient, the detector or the source of X-rays during the
exposure.
*Movement of the patient can be minimised in a number
of ways: immobilizing the patient, asking the patient to keep
still or to hold the breath and keeping exposure time short.

47. photographic unsharpnesss: *result of the detector
system employed.

48. resolution
• Resolution is the ability of an imaging system to display
two adjacent objects as discrete entities.
• Resolution is also known as spatial resolution