1. Mammography # 1
Week 2

2. Mammography Facts
1 in 8 women who live to 95 will develop breast cancer
Most common malignancy in women, only lung cancer kills more women
One of the most treatable cancers
Before Mammo fewer than 5% of pt’s survived 4 years after diagnosis with a 80% recurrence
With a radical mastectomy survival increased to 40% with a 10% recurrence

3. Goal of Mammography Detect cancer before it is palpable
Early detection, diagnosis and treatment is the key to a favorable prognosis

4. How would your family feel with you missing from the family picture?

5. How would you feel about your father, brother or mother missing from the family picture?

6. Breast Self Exam

7. Breast Dimpling

8. Breast Cancer

9. Peau d’orange

10. 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

11. 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

12. 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

13. Quadrants of the Breast

14. 3 Tissue Types

15. Breast Changes with Age

16. Breast Classifications

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

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

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

20. Positioning

21. Various Mammographic Positioning

22. Ouch! Why Compression? Two Reasons:
Decrease thickness of breast tissue
Reduce OID

23. Cranio- caudad :CC

24. Diagram of Proper CC Positioning

25. CC Images

26. Multiple Bilateral Benign Calcifications

27. Breast Cancer

28. Carcinoma

29. Microcalcifications

30. CC positioning CR Perpendicular
Film tray brought to level of inframammary crease
Wrinkles and folds smoothed out
Compression applied
Markers on axillary side

31. CC Criteria No motion Nipple in profile
All pertinent anatomy demonstrated
Dense areas penetrated
High contrast & optimal resolution
Absence of artifacts
Marker & patient ID visible

32. Medio-lateral Oblique: MLO

33. MLO Diagram for Proper Positioning

34. MLO Properly Positioned

35. Bilateral MLO

36. MLO positioning CR & cassette (IR) angled 45 degrees
Top of cassette (IR) at axilla
Compression applied
Nipple in profile
Marker at axilla

37. MLO criteria No motion Pectoral muscle to level of nipple visualized
Breast pulled away from chest wall
Nipple in profile
Dense areas of breast penetrated
High contrast & optimal resolution
Absence of artifacts
Marker & PT ID visible

38. What position is this?

39. What position is this?

40. Breast Implants Are they worth it?

41. 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

42. Elkland Method for Imaging with Breast Implants

43. Image Comparison Which is the Push back (Elkland)?

44. Male Mammography and Cancer

45. 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

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

47. Old and New Equipment

48. Cone Magnification

49. Cone magnification

50. Mammography Equipment

51. Digital vs. Film