




Breast imaging is a specific field in radiology.
As radiologists we are medical specialists occupied
with medical images of the human body and using
these to treat patients. This includes x-ray,
ultrasound, CT scanning, MRI, etc.
Breast imaging include mammography, ultrasound
and MRI.
We are also involved in biopsies of breast lesions.
And staging imaging of breast cancer patients
 A mammogram is a specific breast x-ray.
 It uses x-rays, similar to chest x-rays, but at a much lower
radiation dose and a specific detector (“film”) that allows us
to see the breast tissue.
 Breasts need to be compressed for us to see different
structures within.
 The idea is to see breast cancers before you can feel them to
allow for early treatment - screening mammography.
 Only proven imaging technique that improves survival from
breast cancer.
 Women aged 40 to 54 should have an annual mammogram
 Women 55 years and older should change to having a
mammogram every 2 years– or have the choice to continue with an
annual mammogram
 Screening should continue as long as a woman is in good health
and is expected to live 10 years or longer



Diagnosing slow growing breast cancers that
would never have caused any
harm(overdiagnosis)
Exposure to small amounts of radiation during
screening
Unnecessary anxiety, including in women who are
called back for more tests, but found not to have
breast cancer.



The thinner the breast, the less radiation is
needed to penetrate through the breast to
obtain an image
The more compressed the better tissues are
spread out and the less likely it is that normal
fibroglandular tissue will superimpose and
hide/simulate a cancer
When compressed well, there is less motion
artifact, and a better chance to detect micro
calcification
 Breast ultrasound is used together with mammography to







asses the breasts.
Can be used for screening in younger patients.
No radiation
Not alternative, but adjunct.
Good to decide on significance of lesion seen on
mammogram.
Can see small masses that may be blocked by dense normal
tissue on mammogram.
Cannot see microcalcifications
Could miss certain areas of breast




New technique to separate overlying structures on
mammogram
Between 15 and 30 low quality mammogram
images are obtained from slightly different angles
Superimposed on each other
Scroll through images to show only one level in
focus with the rest blurred
Imaging study using magnetic waves to
view body tissue
 Based on the spinning and flipping of
hydrogen atoms under the influence of
energy in a magnetic field.
 Highly detailed images of the breast
 Gadolinium contrast can be given to
evaluate blood flow into lesions

Used to asses exact extent of lesion.
 In certain cancers where there is a high
risk for more than one cancer.
 In patients with known genetic
predisposition for breast cancer.

Ultrasound vs Stereotactic
 Ultrasound when a mass can be seen on
ultrasound
 Stereotactic for microcalcifications and
lesions too small to see on ultrasound

› Breast imaged from two different angles and
computerised calculations used to navigate
needle to target.
Small metallic (usually Titanium) markers
placed in patient at site of biopsy
 To allow future finding of the biopsy site
 When sampling calcifications, which may
remove all calcifications
 When chemotherapy will be done before
surgery, which may make lesion invisible

To guide surgeon in finding a nonpalpable lesion
 Placed with ultrasound or
mammographic guidance
 Directly before surgery

Inserted to facilitate chemotherapy
 Avoid the need for use of peripheral
veins and repeated venepuncture
 Small palpable hub under the skin that
can be easily punctured
 Connecte to tube in large central vein.





Generally includes
CT chest
CT Abdomen and Pelvis
Occasionally
› MRI Brain
› PET Scan

Aim to look for metastases which would
alter treatment
If your treatment plan includes
radiotherapy
 CT scan with localisation markers
 Used to navigate radiation therapy

Annual mammography
 Follow-up CT
 Sometimes ultrasound
 Port removal

For more info visit:
https://www.xraypmb.co.za/s
/Breastcancerscreening.pdf
https://www.xraypmb.co.za/s
/Image-guided-breast-biopsyshort2.pdf
https://www.xraypmb.co.za/s
/Centralvenousport.pdf
 Dr Werner Harmse
 Interventional and diagnostic
radiologist
 Kauffman and Partners radiology
○ Netcare St Anne’s Hospital
○ Life Hilton Hospital
○ Hilton Health and Wellness
Centre
○ www.xraypmb.co.za
○ 033 392 8800