1. RAD 354 Chapt. 19 Mammo Also know as soft tissue radiography
Breast CA is the 2nd leading cause of cancer related death in women (lung CA is first)
1 in every 8 women will get breast CA

2. Two types of Mammo Screening – for asymptomatic patients
Diagnostic – for symptomatic or elevated risk patients
Baseline mammo is the first mammo done and is usually done prior to the age of 40

3. Risk factors for Breast CA
Age – the oloder the higher the risk
Family history – mom/sister with breast CA
Genetics – presence of BRCA1/2 genes
Menstruation – onset prior to age 12
Menopause – after age 55
Late childbirth age or no kids
Education – higher ed= higher risk
Socioeconomics = higher risk with higher status

4. Breast anatomy – all SIMILAR atomic mass density!
Fibrous
Glandular – most radiosensitive breast tissue
Adipose – less dense and less dose
If a malignancy is present, it usually presents as a distortion of ductal and connective tissue patterns
80% is ductal and many have microcalcifications

5. Imaging breast tissues
Low kVps = 20 – 35 kVp range
Target material is tungsten (W), Molybdenum (Mo) or Rhodium (Rh)
Filter material is dictated by target material
Beryllium or borosilicate
If tungsten target – then molybdenum or rhodium filter
Inherent filtration is approx. 0.1 mm al equiv.
Focal spot sizes mm (large/small)

6. Other mammo infro
Heel effect is always used (chest wall at cathode side of tube)
Compression always used: increased spatial resolution, lower pt. dose and focal spot blur
Grids are usually 4:1 or 5:1 FOCUSED
AEC’s require reproducible images at low dose kVp’s of +/- 0.1 OD

7. Mammo Image Receptors
Historically there have been many receptors used (direct-exposure, xeroradiography, screen-film and digital receptors
Current are only screen-film and digital receptors in this country
Digital’s advantage is post image acquisition processing; disadvantage is spatial resolution limitations (pixel size of receptor)

8. Mammo Unit

9. Mammo Radiograph

10. RAD 354 Chapt. 20 Mammo QC American College of Radiology (ACR)
Mammo Quality Standards Act (MQSA)
Mammo is the only Fed. Mandated licensed specialty in all 50 state and U.S. territories

11. QC Team
Radiologist – oversees the ENTIRE mammo QC program including CQI processes
Physicist – annual evaluation of the imaging systems; advising the mammographer
Mammographer – most involved in reality of the QC trio

12. Mammo QC Program Darkroom Cleanliness – daily
Processor QC – daily (sensitometry/densitometry) OD tolerance
Screen Cleanliness – weekly
View boxes/viewing conditions – weekly
Phantom images – weekly
Visual checklist (imaging unit lights, locks, etc.) - monthly

13. QC Program Con’t Repeat analysis – quarterly / 250 pts. (<2%)
Fixer/hypo retention – quarterly
Radiologist conference – quarterly
Darkroom fog – semi annually (safelights, leakage light, wattage of bulbs, distance)
Screen film – Semi annually
Compression – semi annually (never >40 lbs in auto mose) lbs

14. Breast Anatomy

15. Lymphatic drainage

16. Mammo QC Kit

17. Where I want to go on spring break

18. Where I will be for spring break