Breast Protocol
Protocol
 Scan from nipple outward then back toward nipple including the Tail of Spence (Axillary Region)
 No pathology present - Store image anywhere along scanning section
 Pathology present - image pathology in both planes, measure, utilize color & spectral Doppler
 Protocols will vary at each site - examples of protocols that may be used are identified below
Example of a Whole Breast Examination of the RIGHT Breast
Area of Concern
For Each of the
Following Clock
Positions
 12:00
 3:00
 6:00
 9:00
 10:00
 11:00
Areola/ Nipple
Axilla/ Tail of Spence
Plane
Radial
Label
Include the appropriate clock position
and scan plane
(scan plane only for nipple and axilla)
Radial
Antiradial
Antiradial
Oblique under
nipple
Antiradial
Nipple
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Skin
Premammary Layer
Mammary Layer
Retromammary Layer
Pectoralis Muscle
Pleura/ lung
Skin
Premammary Layer
Mammary Layer
Retromammary Layer
Pectoralis Muscle
Pleura/ lung
Lactiferous Sinus
Axilla

Skin, Fat and Muscle
Example of a Whole Breast Examination of the LEFT Breast
Area of Concern
Plane
Label
Include the appropriate clock position
and scan plane
(scan plane only for nipple and axilla)
For Each of the
Radial
Radial
Following Clock
Positions
 12:00
 1:00
 2:00
 3:00
Antiradial
Antiradial
 6:00
 9:00
Areola/ Nipple
Axilla/ Tail of Spence
Oblique under
nipple
Antiradial
Landmarks
Landmarks
Nipple
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Skin
Premammary Layer
Mammary Layer
Retromammary Layer
Pectoralis Muscle
Pleura/lung
Skin
Premammary Layer
Mammary Layer
Retromammary Layer
Pectoralis Muscle
Pleura/lung
Lactiferous Sinus
Axilla

Skin, Fat and Muscle
Targeted Examination- Typically used when a pathology is seen on mammogram, previous sonogram, or is palpable
AK\backup\Abdomen II\protocols
Breast Protocol
Clock Position
Identify the area of Concern by the
clock position
Plane
Radial


Label
Clock position
Radial
Identify the area of Concern by the
clock position
Antiradial


Clock position
Antiradial
Identify the area of Concern by the
clock position
“Magnified”
Identify the area of Concern by the
clock position
“Magnified” with AP and Length
Measurements
Identify the area of Concern by the
clock position
“Magnified”
Identify the area of Concern by the
clock position
“Magnified” with AP and width
measurements
Identify the area of Concern by the
clock position
“Magnified” with Color Doppler of
pathology
Identify the area of Concern by the
clock position
“Magnified” with Color Doppler &
Spectral Analysis of pathology
Radial


Clock position
Radial
Radial


Clock position
Radial

Antiradial


Clock position
Antiradial

Anterior, posterior, and
lateral walls of pathology
Antiradial


Clock position
Antiradial

Anterior, posterior, and
lateral walls of pathology
Radial


Clock position
Radial

Anterior, posterior, superior,
and inferior walls of
pathology
Radial


Clock position
Radial

Anterior, posterior, superior,
and inferior walls of
pathology
Images Required for BCHS Scan Competency
 All site specific protocol images
 Area of concern radial plane images
 Area of concern antiradial plane images
 Nipple images
 Axilla images
 Pathology images
AK\backup\Abdomen II\protocols

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Landmarks
Skin
Premammary Layer
Mammary Layer
Retromammary Layer
Pectoralis Muscle
Pleura/ lung
Skin
Premammary Layer
Mammary Layer
Retromammary Layer
Pectoralis Muscle
Pleura/ lung
Anterior, posterior, superior,
and inferior walls of
pathology
Anterior, posterior, superior,
and inferior walls of
pathology
Breast Protocol
Anatomical/Image Correlation/Image Orientationhttp://www.obgyn.net/displayarticle.asp?page=/bh/articles/newbreasthandoutI & www.imagingce.info/.../quadLocal.gif
Normal Measurement Ranges
Structure Area of Concern
Skin
Near field
Ducts
Lymph
Nodes
Posterior Nipple
Axillary or
wherever
visualized
Plane
Sagittal
Measurement
2-3 mm
Sagittal
Sagtital &
transverse
Less than 3 mm
Less than 1.5
cm in all planes
Comments
Measure Anterior to Posterior diameter
(use standoff pad or thick layer of gel)
Measure Anterior to Posterior diameter
Abnormal lymph nodes will appear round rather than oval.
Length, width, and height measurements should be taken
to determine size in each plane
Sonographic Appearance
All Anatomy should be compared to
echogenicity of FAT
Fat = medium level gray
Smooth,
thin walls
Macrolobulations
(3 or less
lobulations)
Irregular
contour
Microlobulations
Thickened
Cooper’s
ligaments
Microcalcifications
Homogeneous
Structure
Skin
Glandular Tissue
Fibrous Tissue
Cooper’s Ligaments
Ducts
Muscle
Ribs
Benign Characteristics
Anechoic Hyperechoic
Echogenicity
Echogenic
Isoechoic to Hypoechoic
Hyperechoic
Hyperechoic
Anechoic or Hypoechoic
Hypoechoic with Striations
Echogenic with shadowing
Posterior
enhancement
Suspicious Characteristics-Just takes one!
Spiculated
Angular
Branch
Heterogeneous
margins
pattern
Disruption of tissue planes
Duct
extension
Shadowing
Wider
than
taller
Thin echogenic
capsule
Taller
Hypoechoic
than
compared to
wider
fat
Increased echogencity
anterior to mass
Transducer- Dependent on amount of breast tissue - high frequency linear transducer with minimum of 7 MHz is recommended
Patient Position
 Patient lies supine or slightly oblique (may need support wedge) with arm over head
 Obliqued more for larger breasts - the breast should lay flat to minimize the thickness of the breast
Pathology-- If pathology is present you must document the pathology in its entirety. Images should include:
 Gray scale sagittal and transverse images - document distance from NIPPLE not areola
 SHAPE, MARGIN, ECHOGENICITY, LESION BOUNDARY, ATTENUATION, SURROUNDING TISSUE
 Gray scale sagittal and transverse images with 3 measurements (length, width, and height)
 Color Doppler image to document the presence of blood flow and Spectral Doppler image to document type and velocity of blood
flow (Use Power/Color Doppler with humming to identify solid masses—FREMITUS)
AK\backup\Abdomen II\protocols