MAMMOGRAPHY LECTURE #1 rev 2010 Positioning & Anatomy RADIOGRAPHIC IMAGING OF THE BREAST RTEC 255 -Week # 3 D. Charman, M.Ed.,R.T.(R,M)

Mammograms don’t look fun but they can save a life!

Man – o - gram

A mammogram can find breast cancer when it is very small -- 2 to 3 years before you can feel it. 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 when it is only this size    

Do it for those you love…. And who love you

Routine Images - aka “screening mammo” (not screaming) POSITIONING Routine Images - aka “screening mammo” (not screaming) CC - cranio caudad MLO – mediolateral oblique

More on MAMMO Equipment – week 8 With Xray & Mammo QC

Compression Important: Evens Density of Breast Reduces Motion AEC choice depends of size and composition of breast

CC

Marker? Which side is axilla?

MLO – RT BREAST

POSITIONING CC – CRANIOCAUDAD MLO – MEDIAL LATERAL OBLIQUE “TRUE” LATERAL ETC

TRUE LAT CONE-MAG                           

Magnification = increase OID

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

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

See Mammo Study Guide TDLU ? COOPER’S Ligaments

Breast profile: 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)

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

Lymph Nodes Lymphatic vessels of the breast drain laterally and medially Laterally into the axillary lymph nodes (C & D) 75& drain toward axilla Medially into the mammary lymph nodes 25% toward mammary chain (F) 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

Breast Scintomotography Isotope matches tumor to node involvement More on Breast Pathology & Procedures next lecture…..

Quadrants of the breast

TYPES OF BREAST TISSUE GLANDULAR DUCTS LOBES LOBULES TDLU STROMAL MOSTLY SEEN UPPER OUTER QUADRANT STROMAL FATTY TISSUE CONNECTIVE TISSUE (COOPER’S LIGAMENTS – SUSPENSATORY LIGAMENTS

3 Tissue Types

Breast Changes with Age Breast Classifications Breast Changes with Age

Fibro-glandular Breast Dense with very little fat Females 15-30 years of age Or 30 years or older without children Pregnant or lactating

Fibro-fatty Breast Fibro-fatty Average density 50% fat & 50% fibro-glandular Women 30-50 years of age Or women with 3 or more children

Fatty Breast Fatty Minimal density Women 50 and older (postmenopausal), men and children

THE MALE BREAST Male Mammography and Cancer

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. Thanks to greater awareness and better treatments, the survival rates for both men and women are on the rise.

Gynecomastia Benign excessive development of male mammary gland Occurs in 40% of male cancer pt’s Survival rates with treatment are 97% for 5 years

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

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.

Position? Best Seen ?

male breast

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

male mastectomy

Difficulty with IMPLANTS THE AUGMENTED BREAST Difficulty with IMPLANTS

Breast Implants Is it worth the risk?

Complication with Breast Augmentation Mammography has a 80-90% true positive rate for detecting breast cancer in those women without implants Decreases to 60% with implants Because 85% of breast tissue is obscured More images are needed than the standard two projections There is a risk of rupturing the implant Loss of sensation from surgical scars

Elkland Method for Imaging with Breast Implants

“PUSH BACK” TECHNIQUE

Other Imaging of the Breast

Xero mammography (early years

OTHER CHALLENGES TO MAMMOGRAPHY