1
MAMMOGRAPHY
LECTURE #2
rev 2014
Positioning & Anatomy
RADIOGRAPHIC IMAGING OF THE BREAST
RTEC 255 -Week # 4 /5
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”
CC
(not screaming)
- cranio caudad
MLO – mediolateral oblique
6
7
MAX 25 PSI - how is this measured?
9
10
11
12
13
Compression Important:
Evens Density of Breast
Reduces Motion
AEC choice depends of size
and composition of breast
14
CC
15
Marker? Which side is axilla?
16
17
18
19
MLO – RT BREAST
20
21
22
23
24
25
26
27
28
29
POSITIONING
CC – CRANIOCAUDAD
 MLO – MEDIAL LATERAL OBLIQUE

“TRUE” LATERAL
 ETC

30
TRUE LATERAL
31
Magnification = increase OID
CONE-MAG
32
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
33
34
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
35
See Mammo Study Guide
TDLU ?
COOPER’S Ligaments
36
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)
37







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)
38
39
Breast Scintomotography
Isotope matches tumor to node involvement
More on Breast Pathology & Procedures next lecture…..
40
Quadrants of the breast
41
42
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
43
44
45
46
Breast Classifications
Breast Changes with Age
47
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
48
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
49
Fatty Breast

Fatty
 Minimal density
 Women 50 and
older
(postmenopausal),
men and children
50
THE MALE BREAST
Male Mammography and Cancer
51
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
52
Gynecomastia:
Prominent Male
Breasts







53
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
54
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.

55
Position?
Best Seen ?
56
male breast
57
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

58
male mastectomy
59
THE AUGMENTED
BREAST
Difficulty with IMPLANTS
Breast Implants
Is it worth the risk?
60
Complication with Breast
Augmentation
61
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
62
63
64
“PUSH BACK” TECHNIQUE
65
66
Xero mammography (early years
67
OTHER CHALLENGES TO
MAMMOGRAPHY
68
Risk Factors for Breast Cancer










Age: the older you are, the higher the risk
Family history: mother, sister with breast cancer
Genetics: presence of BRCA1 or BRCA2 genes
Breast architecture; dense breast tissue
Menstruation: onset before age 12
Menopause: onset after age 55
Prolonged use of estrogen
Late age at birth of first child or no children
Education: risk increases with higher education
Socioeconomics: risk increases with higher status
69
70
71