4. Breast imaging
•Mammography .
•US & colour Doppler .
•Galactography .
•MRI (dynamic contrast enhanced).
•CT.
•Scintigraphy .

5. How do we
perform
mammography?
MAMMOGRAPHIC
TECHNIQUE

7. Mammogram Procedure
• The breast is first placed on a
platform and squeezed between 2
plates
• Breast compression is necessary to:
1)even out the breast thickness so all
tissue can be visualized
2) spread out tissue so small abnormalities
won't be obscured by overlying breast
tissue
3)allow the use of a lower x-ray dose since
a thinner amount of breast tissue is being
imaged
4)hold the breast still to eliminate blurring of
image caused by motion
5) reduce x-ray scatter to increase
sharpness of picture.

8. MEDIOLATERAL OBLIQUECRANIOCAUDAL

9. MIRROR IMAGE
COMPARE SIMILAR
AREAS

10. Mammography

12. Benign breast lesions

13. Malignant breast lesions
• Masses/ tumors
• Calcifications
• Asymmetry
• Architectural
distortion
Signs of Breast Cancer:

15. Examples of benign and malignant
calcifications

16. • Ductography of the breast is an
underused procedure that often
helps define the cause of unilateral,
single-pore, spontaneous nipple
discharge.
• Nipple discharge may be caused by
benign tumors, such as papillomas,
or by carcinoma,

17. Ductography
A B
C D

18. • The term proximal
ducts refers to ducts
within the breast
tissue or in the central
breast, where the
terminal ducts lead
to lobules (acini). The
term distal ducts
refers to ducts
"downstream" (or
toward the nipple)
from the proximal
ducts. Therefore, the
"distal-most ducts"
are directly beneath
the nipple

19. Advantages of US
• Availability :
 Widely available
technology .
 Mobile equipment .
 Cost effective
technique.
 No film developing
 No radiation exposure

20. • Good sound
penetration in
dense glandular
tissue :
 young women ( up to
30 years).
 Benign breast
diseases .
 Post menopausal
women on hormone
replacement
therapy .

21. • Differentiation of cystic and solid masses .
• Good soft tissue discrimination .
• Detect multifocal lesions.
• Precise measurement of tumour extent .
• Accurate guidance of interventional
procedures .
 Needle localization.
 Tissue sampling: FNA & core biopsy

22. Skin
Subcut.fat
Retromamm.
fat
Pectoralis
Rib

23. Fibroadenosis

24. • MRI is highly sensitive in detecting breast cancer, but
high cost and low specificity have continued to limit
the use of MRI as a screening tool. Another problem is
that MRI cannot identify malignant calcifications
• Potential roles for contrast-enhanced
MRI of the breast:
 (1) determining the size and extent of known invasive
cancers.
 (2) identifying multi-centric lesions.
 (3) evaluating the ipsilateral breast of a woman who
comes initially to attention with axillary metastases.
 (4) identifying a recurrent carcinoma in a
conservatively treated breast. .

25. ImagIng In
gynecology

26. Imaging modalities
I.Plain film :
Soft ovoid density
separated by fat planes
Abnormality:
 Soft tissue tumefaction :
distended bladder , ovarian
cyst, fibroid uterus .
 Obliteration of normal fat
planes>>infection.
 Calcifications: fibroid,
ovarian(dermoid).
 Missed IUD.
 Ascites ,hemo/pnemo-
peritonium.

27. Imaging modalities
 HSG .
 Vaginography .
 GIT studies .
 IVU .
 Arteriography (AVM , fibroid embolization).
 Venography: iliac vein thrombosis.
•II. Contrast Studies :

28.  Infertility : tubal obstruction , congenital
uterine anomalies .
 After tubal surgery: patency and
configuration of F.T.
 Recurrent abortion : width and
configuration of internal os , cervical
canal , congenital anomalies , fibroids.
 Abnormal uterine bleeding : fibroids ,
endometrial polyps, adenomyosis,
uterine adhesions .
 Post caesarian section : assess integrity
of uterine scar.
 Intervention : tubal recanalization .
HSG
•Indications:

29.  Timing.
 Empty bladder.
 Position.
 Instrument : metal canula , vaccum uterine
canula , 8f foley catheter .
 Contrast :
•Technique:
•Water soluble: urographin / non ionic.
•Lipidol .

30.  Pregnancy.
 Pelvic infection
 Immediate pre and post mentrual phases.
(Extravasation).
 Sensitivity to contrast media.
Contraindications :

31. Ext.os
Cervical canal
Int.os
Uterine cavity
Myom.
Int.segment
isthmus ampulla
Fimbriaovary

32. Normal HSG
• The Fallopian tubes are
paired structures of 10-
20cm in length.
• Three segments, the
interstitial portion, the
isthmus, and the
ampulla .
• Cornual sphincter: pear
shaped separated from
the uterine body by a
short dark line due to
mucosal fold .

33. Uterine anomalies

34. Intrauterine filling defect
Fibroid

35. Bilateral hydrosalpinx

36. gynecologIc US
I. Scanning technique:
• Uses transducers 3-5MHZ range.
• Requires filling of the urinary bladder (ideal 1-2 cm above
the uterine fundus).
• Obtained in sagittal and transverse planes (oblique image
may be needed)
• To view adnexa move transducer from side to side.
• Main advantage providing an overview of the pelvis.
A-TAS

37. • Performed with 5-9 MHZ
transducers .
• Empty bladder:
To minimize discomfort
Brings uterus and
ovaries into focal zone.
• Probe should be
disinfected , Use gel
applied to transducer
head ,use condom .
• AP& transverse pelvic
planes.
B-TVS

38. 1. Early and second trimester pregnancy.
2. Lower uterine segment in late pregnancy.
3. Ectopic pregnancy.
4. Retroverted or retroflexed uterus.
5. Obese and gaseous patients.
6. Emergency cases where bladder is empty.
7. Follicular monitoring in ovulation induction.
8. Pulsed and colour Doppler.
Indications of TVS

39. Sonographic anatomy
1. Size .
2. Position .
3. Endometrial lining .
4. Myometrium
The uterus

40. Uterus
• Varies with age and
parity .
• Average:
o Length= 6-8 cm .
o Ap = 3-4 cm .
o Transverse= 5cm
Size

41. Endometrium :

42. Myometrium
• Fibroids are very common.
They occur in 2 or 3 out of
every 10 women over age
35.
• It is common to have
more than one fibroid.
Some women may have
as many as a hundred.
• Fibroids occur most often
in women between ages
30 and 50, although
women in their 20s
sometimes have them.
• Three out of every 10
hysterectomies in the
United States are
performed because of
fibroids.

43. • Identified by:
 Internal iliac artery
 Elliptic shape
 Multiple small cysts
representing follicles.
• Size:
4x3x2 cm ,mean
volume=10cc.
• Dominant follicle :
(2-2.5 cm)
The ovaries

45. • CT:
• Assessment and
staging of
neoplasms of pelvic
organs.
• MRI:
• T2: to assess normal
uterine and ovarian
anatomy , associated
pathological conditions
.
• T1: better lesion
characterization
,presence or absence
of LN.

46. Normal MRI