1. MAMMOGRAPHY LECTURE #2 rev 2014 Positioning & Anatomy
RADIOGRAPHIC IMAGING OF THE BREAST
RTEC 255 -Week # 4 /5
D. Charman, M.Ed.,R.T.(R,M)

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

3. Man – o - gram

4. 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    

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

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

8. MAX 25 PSI - how is this measured?

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

14. CC

16. Marker? Which side is axilla?

20. MLO – RT BREAST

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

31. TRUE LATERAL
                          

32. Magnification = increase OID
CONE-MAG

33. 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

34. 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

35. See Mammo Study Guide
TDLU ?
COOPER’S Ligaments

36. 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)

37. 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

38. 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

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

41. Quadrants of the breast

42. 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

43. 3 Tissue Types

46. Breast Changes with Age
Breast Classifications
Breast Changes with Age

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

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

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

50. THE MALE BREAST
Male Mammography and Cancer

51. 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.

52. 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

53. 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

54. 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.

55. Position?
Best Seen ?

56. male breast

57. 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

58. male mastectomy

59. Difficulty with IMPLANTS
THE AUGMENTED BREAST
Difficulty with IMPLANTS

60. Breast Implants Is it worth the risk?

61. 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

62. Elkland Method for Imaging with Breast Implants

64. “PUSH BACK” TECHNIQUE

67. Xero mammography (early years

68. OTHER CHALLENGES TO MAMMOGRAPHY

69. Risk Factors for Breast Cancer
Age: the older you are, the higher the risk
Family history: mother, sister with breast cancer
Genetics: presence of BRCA1 or BRCA2 genes
Breast architecture; dense breast tissue
Menstruation: onset before age 12
Menopause: onset after age 55
Prolonged use of estrogen
Late age at birth of first child or no children
Education: risk increases with higher education
Socioeconomics: risk increases with higher status