1
MAMMOGRAPHY
LECTURE #1
rev 2010
Positioning & Anatomy
RADIOGRAPHIC IMAGING OF THE BREAST
RTEC 255 -Week # 3
D. Charman, M.Ed.,R.T.(R,M)
2
Mammograms
don’t look fun
but they can
save a life!
Man – o - gram
3
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 found
until they reach this size
A mammogram can find
cancer when it is only this size
4
Do it for those you love….
And who love you
5
POSITIONING
Routine Images aka “screening mammo”
(not screaming)
CC
- cranio caudad
MLO – mediolateral oblique
6
7
8
9
More on MAMMO Equipment – week 8
With Xray & Mammo QC
10
11
12
13
14
Compression Important:
Evens Density of Breast
Reduces Motion
AEC choice depends of size
and composition of breast
15
CC
16
Marker? Which side is axilla?
17
18
19
20
MLO – RT BREAST
21
22
23
24
25
26
27
28
29
30
POSITIONING
CC – CRANIOCAUDAD
 MLO – MEDIAL LATERAL OBLIQUE

“TRUE” LATERAL
 ETC

31
32
TRUE LAT
CONE-MAG
33
34
35
36
Magnification = increase OID
Anatomy of the Breast


Vary in shape & size
Cone shaped with the post
surface (base) overlying the
pectoralis & serratus muscles

Axillaries tail extends from lat.
base of the breasts to axillaries
fossa

Tapers ant. from the base
ending in nipple, surrounded
by areola
37
38
Female Breast

Consists of 15-20 lobes
 Divide into several
lobules
 Lobules contain
acini, draining ducts
and interlobular
connective tissue.
 By teenage years
each breast contains
hundreds of lobules
39
See Mammo Study Guide
TDLU ?
COOPER’S Ligaments
40








Breast profile:
A ducts
B lobules
C dilated section of duct to hold
milk
D nipple
E fat
F pectoralis major muscle
G chest wall/rib cage




Enlargement:
A normal duct cells
B basement membrane
C lumen (center of duct)
41







Lymph node areas
adjacent to breast area.
A pectoralis major muscle
B axillary lymph nodes:
levels
C axillary lymph nodes:
levels
D axillary lymph nodes:
levels
E supraclavicular lymph
nodes
F internal mammary
lymph nodes
Lymph Nodes

Lymphatic vessels of the
breast drain laterally and
medially
 Laterally into the axillary
lymph nodes (C & D)
 75& drain toward
axilla
 Medially into the
mammary lymph nodes
 25% toward
mammary chain (F)
42
43
Breast Scintomotography
Isotope matches tumor to node involvement
More on Breast Pathology & Procedures next lecture…..
44
Quadrants of the breast
45
46
TYPES OF
BREAST TISSUE
GLANDULAR
 DUCTS
 LOBES
 LOBULES
 TDLU

MOSTLY SEEN UPPER
OUTER QUADRANT
STROMAL
 FATTY TISSUE
 CONNECTIVE
TISSUE

(COOPER’S
LIGAMENTS –
SUSPENSATORY
LIGAMENTS
3 Tissue Types
47
48
49
50
Breast Classifications
Breast Changes with Age
51
Fibro-glandular Breast

Fibro-glandular
 Dense with very
little fat
 Females 15-30
years of age
 Or 30 years or
older without
children
 Pregnant or
lactating
52
Fibro-fatty Breast

Fibro-fatty
 Average density
 50% fat & 50%
fibro-glandular
 Women 30-50
years of age
• Or women
with 3 or
more children
53
Fatty Breast

Fatty
 Minimal density
 Women 50 and
older
(postmenopausal),
men and children
54
THE MALE BREAST
Male Mammography and Cancer
55
Male Breast Cancer Statistics:
According to the American Cancer Society,
about 0.22 percent of men’s cancer deaths
are from breast cancer.
 This disease is 100 times more common in
women than it is in men.
 Thanks to greater awareness and better
treatments, the survival rates for both men
and women are on the rise.

Gynecomastia



Benign excessive development of male mammary gland
Occurs in 40% of male cancer pt’s
Survival rates with treatment are 97% for 5 years
56
Gynecomastia:
Prominent Male
Breasts







57
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, a
condition in which a male has an extra X
chromosome
Gynecomastia
58
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.

59
Position?
Best Seen ?
60
male breast
61
Male Mammography
1300 men get breast cancer per year
 1/3 die
 Most are 60 years or older
 Nearly all are primary tumors
 Symptoms include:
 Nipple retraction
 Crusting
 Discharge
 Ulceration

62
male mastectomy
63
THE AUGMENTED
BREAST
Difficulty with IMPLANTS
Breast Implants
Is it worth the risk?
64
Complication with Breast
Augmentation
65
Mammography has a 80-90% true positive rate
for detecting breast cancer in those women
without implants
 Decreases to 60% with implants
 Because 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

Elkland Method for Imaging with
Breast Implants
66
67
68
“PUSH BACK” TECHNIQUE
69
70
Other Imaging of the Breast
71
72
Xero mammography (early years
73
OTHER CHALLENGES TO
MAMMOGRAPHY
74
75