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MAMMOGRAPHY

LECTURE #1rev 2010Positioning & Anatomy

RTEC 255 -Week # 3

D. Charman, M.Ed.,R.T.(R,M)

RADIOGRAPHIC IMAGING OF THE BREAST

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Mammograms

dont look fun

but they can

save a life!

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3Mano - gram

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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 founduntil they reach this size

A mammogram can findcancer when it is only this size

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5Do it for those you love.

And who love you

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Routine Images -

aka screening mammo

(not screaming)

CC

- cranio caudad

MLOmediolateral oblique

POSITIONING

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More on MAMMO Equipmentweek 8

With Xray & Mammo QC

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Compression Important:

Evens Density of Breast

Reduces Motion

AEC choice depends of size

and composition of breast

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CC

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17Marker? Which side is axilla?

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MLORT BREAST

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POSITIONING

CCCRANIOCAUDAD

MLOMEDIAL LATERAL OBLIQUE

TRUE LATERAL

ETC

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TRUE LAT CONE-MAG

http://www.breastcancer.org/cmn_sta_idx.htmlhttp://www.breastcancer.org/cmn_sta_idx.htmlhttp://localhost/var/www/apps/conversion/RT%20255/doTooltip(event,0)

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Magnification = increase OID

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37Anatomy of the Breast

Vary in shape & size

Cone shaped with the postsurface (base) overlying the

pectoralis & serratus muscles

Axillaries tail extends from lat.base of the breasts to axillariesfossa

Tapers ant. from the baseending in nipple, surrounded

by areola

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Female Breast Consists of 15-20 lobes

Divide into several

lobules

Lobules containacini, draining ducts

and interlobular

connective tissue.

By teenage yearseach breast contains

hundreds of lobules

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See Mammo Study Guide

TDLU ?

COOPERS Ligaments

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Breast profile:

Aducts

Blobules Cdilated section of duct to hold

milk

Dnipple

Efat

Fpectoralis major muscle

Gchest wall/rib cage

Enlargement:

Anormal duct cells Bbasement membrane

Clumen (center of duct)

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Lymph node areasadjacent to breast area.

Apectoralis major muscle

Baxillary lymph nodes:levels

Caxillary lymph nodes:

levels Daxillary lymph nodes:

levels

Esupraclavicular lymphnodes

Finternal mammarylymph nodes

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42Lymph Nodes

Lymphatic vessels of the

breast drain laterally andmedially

Laterally into the axillarylymph nodes (C & D)

75& drain towardaxilla

Medially into themammary lymph nodes

25% towardmammary chain (F)

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Breast ScintomotographyIsotope matches tumor to node involvement

More on Breast Pathology & Procedures next lecture..

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45Quadrants of the breast

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TYPES OF

BREAST TISSUEGLANDULAR

DUCTS

LOBES LOBULES

TDLU

MOSTLY SEEN UPPEROUTER QUADRANT

STROMAL

FATTY TISSUE

CONNECTIVETISSUE

(COOPERS

LIGAMENTSSUSPENSATORY

LIGAMENTS

473 Tissue Types

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473 Tissue Types

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Breast Changes with Age

Breast Classifications

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Fibro-glandular Breast

Fibro-glandular

Dense with very

little fat

Females 15-30

years of age

Or 30 years or

older withoutchildren

Pregnant or

lactating

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Fibro-fatty Breast Fibro-fatty

Average density

50% fat & 50%

fibro-glandular Women 30-50

years of age

Or womenwith 3 or

more children

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Fatty Breast

Fatty

Minimal density Women 50 and

older

(postmenopausal),

men and children

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THE MALE BREAST

Male Mammography and Cancer

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Male Breast Cancer Statistics:

According to the American Cancer Society,

about 0.22 percent of mens cancer deathsare from breast cancer.

This disease is 100 times more common in

womenthan it is in men. Thanks to greater awareness and better

treatments, the survival rates for both menand women are on the rise.

56G ti

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56Gynecomastia

Benign excessive development of male mammary gland

Occurs in 40% of male cancer pts

Survival rates with treatment are 97% for 5 years

57Gynecomastia:

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57Gynecomastia:

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, acondition in which a male has an extra X

chromosome

58G ti

http://adam.about.com/encyclopedia/000382.htmhttp://adam.about.com/encyclopedia/000382.htm

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58Gynecomastia

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.

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Position?

Best Seen ?

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male breast

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Male Mammography

1300 men get breast cancer per year

1/3 die

Most are 60 years or olderNearly all are primary tumors

Symptoms include:

Nipple retractionCrusting

Discharge

Ulceration

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male mastectomy

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THE AUGMENTED

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THE AUGMENTED

BREAST

Difficulty with IMPLANTS

64Breast Implants

http://bp3.blogger.com/_iIPeRvSBcXo/RdE3u8ZVXrI/AAAAAAAAABo/tEknErCtH30/s1600-h/DSCN0937.JPG

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64Breast Implants

Is it worth the risk?

65Complication with Breast

http://www.yourpersonalbest.com/augmentation.html

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65Complication with Breast

Augmentation

Mammography has a 80-90% true positive ratefor detecting breast cancer in those womenwithout implants

Decreases to 60% with implantsBecause 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

66Elkland Method for Imaging with

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66Elkland Method for Imaging with

Breast Implants

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PUSH BACK TECHNIQUE

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71Other Imaging of the Breast

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Other Imaging of the Breast

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73Xero mammography (early years

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74OTHER CHALLENGES TO

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OTHER CHALLENGES TO

MAMMOGRAPHY

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