Mammography Basic technique
Basic Mammographic Techniques
It is the mammographer's aim to produce a consistently high quality mammographic
image.This is paramount in diagnostic mammography to enable the Radiologist to
accurately evaluate the image.
Views
Cranio Caudal View
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This view includes most of the breast tissue.
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Ensure firstly the bucky height is correct and at the level of the infra mammary
fold so the breast is fully elevated including the posterior tissue. This reduces
the chance of pulling the skin as the compression comes down.
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The patient stands facing the bucky with her head turned away from the side
being examined. Keep one arm around her shoulder and the other hand to
position the breast. Position from the medial side of the woman
Criteria for assessing the CC view
1. As much medial and lateral tissue visualised as possible
2. Aim to include pectoral muscle
3. Correct exposure
4. Adequate compression
5. No movement
6. Proper processing
7. No artefacts
8. No skin folds or shoulder in view
9. Images should be symmetrical
10. Correct film ID-patient details, markers, date, and radiographer's initials
11. Nipple in profile-if difficult, do an extra nipple view.
Medio-Lateral Oblique
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The degree of angulation depends on the angle of the pectoralis major
muscle. The film holder should be parallel to the angle of the pectoral muscle
at the mid axillary line. Generally taller, slimmer women need a steeper angle.
Smaller women may need to be more lateral and larger breasted women less
than 45 degrees.
Ask the woman the place her hand on the bar as the armpit is placed over the
bucky corner. Ensure no folds on the lateral side of the breast and check all
the lateral tissue is on the edge of the Bucky. The arm should be resting over
and on to the back of the bucky.
Gently push the shoulder down by the hand on the clavicle.
Once sure there is adequate axillary tissue, position the breast and apply the
compression while supporting the inferior aspect. The breast needs to be
pulled up and out so that it will be imaged at 90 degrees to the chest wall.
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Ensure no folds and smooth out the inframammary region. To be sure that all
the breast tissue has been imaged the top of the compression plate should be
just below the clavicle and the inner edge alongside the sternum.
Criteria for assessing the MLO view
Its limitation is that it does not include all of the medial breast tissue.
1.
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6.
Pectoral muscle viewed to nipple line
Full width of pectoral muscle
Nipple in profile
Visualisation of inframammary fold
No skin folds
Ideally images should be symmetrical
Lateral Projection
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This view may be performed as an aid to radiological correlation of a clinical
lump. A lateral view may also be performed in examining prostheses to
ensure inclusion of as much tissue as possible.
It is also a work up view of detected lesions.
Latero-Medial
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The tube is rotated 90 degrees with the bucky at the level of the sternal notch.
The chin is over the top of the bucky and the sternum against the edge so all
tissue is shown. The arm of the side of interest holds the c-arm handle and
the elbow flexed to relax the pectoral muscle.
The whole breast is lifted upwards and outwards from the chest wall. With the
nipple in profile the compression is applied gradually to include the
inframammary area and as much pectoral muscle as possible.
Medio-Lateral
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The tube is rotated 90 degrees and the lateral aspect of the chest wall is
along the bucky edge. The height is at the level of the axilla.
The arm of the side being examined is lifted and supported on top of the
bucky.
The breast is lifted upwards and onwards and compression applied so the
nipple is in profile
Criteria for assessing the Lateral view
1.
2.
3.
4.
The nipple must be in profile
Good visualisation of the inframammary area
A short wedge of pectoral muscle at the chest wall edge
Breast tissue should be well compressed and lifted up and out at 90 degrees
to the chest wall.
Jigsaws
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To demonstrate the tissue on a large breasted woman with a degree of
overlap from film to film so that no tissue is missed, it is necessary to divide
the areas of breast tissue. In our clinic the cc view is divided into 1-lateral
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2-medial portion 3-front/nipple area. With the obl view
o A-pectoral area
o B-inferior portion,
o C- anterior/nipple area.
The AEC must be placed under the most glandular area of breast tissue to
avoid under or over exposed films. It is important to inspect previous films
prior to imaging. KV should be 26-28 KVp. For dense breasts Rhodium is
used.
AEC and Kvp Selection
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The AEC must be placed under the most glandular area of breast tissue to avoid under
or over exposed films. It is important to inspect previous films prior to imaging. KV
should be 26-28 KVp. For dense breasts Rhodium is used.
Conclusion
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Good basic techniques are necessary in breast cancer detection. Hence high
quality image standards are a must as well as good basic positioning
techniques to aid in the early detection of breast cancer
Specialised Views
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Specialized views are to demonstrate tissue not fully seen in routine views, perhaps
due to special positioning problems. Specialized views are also performed to help
categorise mammographic lesions.
1. Extended CC View
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Normally done with lateral bias
No body rotation so that sagittal orientation is achieved
Useful for lateral lesions in axillary tail
2. Cleopatra View
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Used to visualise the axillary tail
Compresses the lateral aspect close to the pectoral muscle
Get patient to lean sideways
3. Cleavage View
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Visualises lesions deep in the medial aspect of the breast
May need to use a manual exposure
Can be difficult on thin women
Some tissue posterior to cleavage should be visible if positioned correctly
4. Coned Compression View
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Can be taken in any projection
Allows better compression over a small area, separating overlying structures
and enhancing image detail
Better definition of lesions against a fatty background
Separates superimposed ductal structures in the retroareolar area
The paddle allows further back imaging
Often combined with magnification
5. Magnification View
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Useful to define calcifications
Provides sharper more defined image
No bucky as air gap reduces scatter radiation
Spot or full compression paddle can be used
6. Pinch View for Breast Prostheses
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Implants may inhibit breast compression and obscure some breast tissue
An additional latero-medial view is needed if the implant cannot be displaced,
to demonstrate all tissue as well as possible
Manual exposures may be necessary
For the implant, which can be displaced, the routine views should be taken
with the implant in place, and the implant displaced (4 views per breast)
Modified compression technique enables improved imaging of the breast
tissue, free of the implant
There is always some compromise when imaging the augmented breast
7.Tangential View
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To visualise superficial lesions close to the skin with the least amount of
overlying tissue to allow better margin differentiation
The area may be a mass, a tender area or a skin dimpling
Place a lead marker over the area of interest
Rotate the breast until the skin marker is tangential
Use spot compression
Can be magnified
8.Axillary View
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Useful for visualising axillary soft tissue
Often the breast tissue is over penetrated
Answer the following questions on mammography and then find the answers in the
word find
1. The lateral and [ _ _ _ _ _ _ _ _ ] aspects of the breast are most mobile and if correctly utilised will allow
consistent optimal breast tissue visualisation.
2. The axillary tail of breast tissue extending towards the axilla is also known as the tail of [ _ _ _ _ _ _ ].
3. [ _ _ _ _ _ _ _ ] ligaments provide structural support for the breast tissue.
4. DCIS is commonly indicated on mammography by the presence of [ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ].
5. In working up and investigating in determinant calcifications seen on the mammogram, what magnified view
is most useful and should ALWAYS be performed [ _ _ _ _ _ _ _ ].
6. What are the basic two views taken in mammography? [ _ _ _ _ _ _ - _ _ _ _ _ _ ] and Medio-Lateral Oblique.
7. The breast tissue drains predominantly to the [ _ _ _ _ _ _ _ _ ] lymph nodes.
8. [ _ _ _ _ _ _ _ _ _ _ ] is the common anode target material in mammography.
9. The active glandular breast tissue is known as the breast [ _ _ _ _ _ _ _ _ _ _ ].
10. For over 60 years the surgical gold standard for breast cancer was the radical mastectomy named after the
surgeon who developed the technique, [ _ _ _ _ _ _ _ _ ].
11. What would be the most likely diagnosis for a discrete mobile lump in a 25-year-old female? [ _ _ _ _ _ _ _
_ _ _ _ _ ].
12. Which muscle should ideally be demonstrated with adequate width and length to the level of the nipple on
the mediolateral oblique views? [ _ _ _ _ _ _ _ _ ]
13. Suspicious areas often need [ _ _ _ _ ] [ _ _ _ _ _ _ _ _ _ _ _ ] views to separate superimposed structures by
spreading out the breast tissues in a localised area.
14. What filter material is commonly used with molybdenum target for imaging thicker denser breasts? [ _ _ _ _
_ _ _ ].
15. The [ _ _ _ _ _ ] [ _ _ _ _ _ ] quadrant has the highest percentage incidence of breast cancer.
16. What breast core biopsy sampling device is vacuum assisted? [ _ _ _ _ _ _ _ _ _ ]
17. A woman presents with hypoplasia of the Left breast. There is also marked abnormality of the thorax and
upper limb on the same side. This looks like [ _ _ _ _ _ _ _ ] syndrome.
18. The suppressor gene p53 prevents cells with damaged DNA from dividing. Women who are missing this
gene have a rare condition called [ _ _ ] [ _ _ _ _ _ _ _ _ ] making them highly susceptible to a wide range of
cancers.
19. Breast MRI of women with breast implants can accurately demonstrate infra and extra capsular rupture.
Leakage of the silicon gel can cause the implant shell to collapse and fold in on itself producing the [ _ _ _ _ _ _
_ _ ] sign.
20. A mammographic abnormality which has a spiculated appearance and is evident on only one view could
possibly be a
[ _ _ _ _ _ _ ] [ _ _ _ _ ].
Answers:
1. The lateral and INFERIOR aspects of the breast are most mobile and if correctly utilised will allow
consistent optimal breast tissue visualisation.
2. The axillary tail of breast tissue extending towards the axilla is also known as the tail of SPENCE.
3. COOPERS ligaments provide structural support for the breast tissue.
4. DCIS is commonly indicated on mammography by the presence of MICROCALCIFICATIONS.
5. In working up and investigating in determinant calcifications seen on the mammogram, what magnified view
is most useful and should ALWAYS be performed LATERAL.
6. What are the basic two views taken in mammography? CRANIO-CAUDAL and Medio-Lateral Oblique.
7. The breast tissue drains predominantly to the AXILLARY lymph nodes.
8. MOLYBDENUM is the common anode target material in mammography.
9. The active glandular breast tissue is known as the breast PARENCHYMA.
10. For over 60 years the surgical gold standard for breast cancer was the radical mastectomy named after the
surgeon who developed the technique, HALSTEAD.
11. What would be the most likely diagnosis for a discrete mobile lump in a 25-year-old female?
FIBROADENOMA
12. Which muscle should ideally be demonstrated with adequate width and length to the level of the nipple on
the mediolateral oblique views? PECTORAL
13. Suspicious areas often need SPOT COMPRESSION views to separate superimposed structures by
spreading out the breast tissues in a localised area.
14. What filter material is commonly used with molybdenum target for imaging thicker denser breasts?
RHODIUM.
15. The UPPER OUTER quadrant has the highest percentage incidence of breast cancer.
16. What breast core biopsy sampling device is vacuum assisted? MAMMOTOME
17. A woman presents with hypoplasia of the Left breast. There is also marked abnormality of the thorax and
upper limb on the same side. This looks like POLANDS syndrome.
18. The suppressor gene p53 prevents cells with damaged DNA from dividing. Women who are missing this
gene have a rare condition called LI FRAUMENI making them highly susceptible to a wide range of cancers.
19. Breast MRI of women with breast implants can accurately demonstrate infra and extra capsular rupture.
Leakage of the silicon gel can cause the implant shell to collapse and fold in on itself producing the LIGUINE
sign.
20. A mammographic abnormality which has a spiculated appearance and is evident on only one view could
possibly be a RADIAL SCAR.