1. Special Views
Orientation

2. 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

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

6. 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

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

9. SIO Rt 1:00 or 7:00

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

11. CLEAVAGE

12. CLEAVAGE IMAGE

13. 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

17. 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

18.
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.

20. 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.

23. Magnification
Border detail
Calcifications
Specimens

24. 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

26. Magnification

27. CC Milk of Calcium (Pearl)

28. 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

29. 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.

30. Pectus Excavatum

31. Pectus Excavatum

32. Thin Base Breasts

33. Cancer Patients Post Mastectomy Breast Conservation Therapy
BCT with Radiation Therapy