Special Views Orientation

Descriptive Terminology UIQ, UOQ, LIQ, LOQ Clock description 2:00 in rt breast is in UIQ 2:00 in lt breast is in UOQ Always describe abnormalities in terms of quadrant and clock-time

Tangential To Skim the area of interest free of superimposition Must be palpable or viewed in two views Also used for skin calcifications

Tangential UIQ and LOQ require SIO UOQ or LIQ require MLO True Lateral for 12:00 and 6:00 CC for 3:00 and 9:00

2:30 or 8:30 in rt or 3:30 or 9:30 in lt SIO of 15 degrees

SIO Rt 1:00 or 7:00

Cleavage Images the extreme medial aspect of the breast. Both breasts placed on image receptor. Offset breast to cover AEC

CLEAVAGE

CLEAVAGE IMAGE

Spot Compression Used when there is a question of a mass. Tissues spread more evenly, possibly eliminating pseudo mass. If seen on both views, “spot” on both

Spot Compression Procedure Locate mass on CC and MLO Measure with ruler or finger from nipple to area of interest. Measure from medial or lateral side on CC Measure from superior or inferior on MLO

http://sprojects.mmi.mcgill.ca/dir/mammography.html If there are prior mammograms available for review, the individual breasts are evaluated for changes over time.  The goal here is to look for potential changes in asymmetric density as well as to evaluate development of new masses (neodensities) or new calcifications. However, if the present study is unremarkable, prior mammograms are of lesser importance. Soft tissue lesions found within a mammogram often will have distinguishing shape, size, and margin characteristics. Likewise, calcifications can be characterized by their size, number, morphology, distribution, and heterogeneity. These distinguishing characteristics are the basis upon which the interpretation of a mammogram may be classified as benign, malignant, or equivocal. The several subsections of  Tutorial 2  present an introduction to the mammographic appearance of normal and abnormal breast tissues.

Roll Performed instead of or in conjunction with the “Spot Compression” Roll superior part of breast in one direction and inferior aspect in another direction. Mark according to which way superior aspect of breast is rolled.

Magnification Border detail Calcifications Specimens

Magnification Technique No grid Small FSS May use spot compression or large paddle depending on abnormality. Use of grid increases dose, tube loading and motion artifacts due to prolonged exposure. FSS decreased to maintain sharp image. Most FSS perform better at 1.5x mag. Range from 1.4-2x

Magnification

CC Milk of Calcium (Pearl)

Viewing A Mammogram Right and Left opposite each other for CC and MLO Place comparison films either to the sides or above or below current films Hang anatomically Axillary region always up Marker always in Axillary region

Non-Conforming Patients Small Breasted Large Breasted Obese Obese Patient Barrel Chest (Pigeon Breast);20, xcc Pectus Excavatum (Sunken Chest);SIO Kyphoscoliosis; Sit, LM “Wrap around the Corner Breast” Male; Less compression, Use clean thin sponge Small breasted - May need FB or third view for lateral tissue on CC Large breasted obese – May be a problem on MLO. May not necessarily need a larger cassette. Take a 3rd view for anterior aspect. Barrel chest – Almost impossible to get entire breast with two views. May need 20 degree or XCCL to image lateral. Pectus Excavatum – Add SIO for extreme medial Kyphoscoliosis – Have pt sit to straighten upper body. Maybe add LM Male – Hair can cause breast to slip out. Use less compression, have pt pull himself in toward unit. Use clean, thin sponge between compression paddle and breast.

Pectus Excavatum

Pectus Excavatum

Thin Base Breasts

Cancer Patients Post Mastectomy Breast Conservation Therapy BCT with Radiation Therapy