mammography?

• first used to examine breast tissues by the german
surgeon- ALBERT SALMON .
• a mammogram is a x ray exam of breast to detect and
evaluate any changes in the breast.

indication
• breast cancer-the first symptoms of breast cancer usually appear
as an area of thickened tissue in the breast. other symptom-pain,
resdness, nipple discharge, inverted nipple, change in the size o
shape of the breast. stages of breast cancer- *stage 0= known as
ductal carinoma in situ, (cells that line the milk ducts of the breast
have become cancer).
*stage 1= tumors measures upto 2 c.m across. it
has not affected any lymph nodes.
* stage 2 = it has started to spread to nearby nodes ,
has not spread to the lymph nodes.
*stage 3 = the cancer has spread to distant organs.

• breast lump: localized swelling.
• nipple discharge.
• breast pain.
• follow up for previously evaluated mammographic
findings.

contra-indication
• pregnancy
• radiation therapy to chest/mediastinal
• active collagen disease: immune system causes
inflammation in our collagen, it is the main structural
protein found in various connective tissue.

mammography x- ray tube
• target materials consists of- molybdenum(42) rhodium(45)
• molybdenium is the best material to be used in
mammography.
• allows production of low energy spectrum of radiation
• low kvp(26-40)

filtration
• materails that are placed in the path of the x ray beam in
order to absorb those x ray with low energy.
• molybdenum- best used for lower kvp
• rhodium
• yttrium (39)

collimation:
• used to shape radiation field.
• less scatter.
• smaller exposed area, better for patient dose.

breast compression
• breast is compressed using a rigid transparent plastic
compression plate.
• breast is compressed for better spatial resolution.
• spatial resolution is the ability of an imaging system to
diffrentiate between two near by objects.
• reduce movement blur.

views :
• standard view:craniocaudal view(cc view), 45 degree
lateral oblique(MLO).
• additional view: extendd CC view,true lateral view, axillary
view, cleavage view, paddle compression view,
magnification view, eklund view.

what is CC View?
• the mammography equipement is positioned with the x
ray beam axis pointing vertically downwards.
• the women faces the machine, with her arms by her side.
• she is standing and is rotated 15-20 degrees to bring the
side under examination close to the horizontal breast -
support table.
• the table is at the level of infra mammary crease(lower
boundary of breast)

• the nipple should be in the midline of the breast and in profile.
• the women head is turned away from the side under the
examination.
• the breast is lifted up and rotated medially 5-10 degrees so that
the nipple is just medial to the midline of the film.
• as the hand is removed, the breast is compressed firmly to a
level that the women can tolerate.
• a remote cotrolled foot compression device allows this to be
achieved more easily.
• compression must be released as soon as the exposure ends.

MLO
• allows visualization of the largest amount of breast tissue.
• the mammographic equipement is routinely angled at 45 degrees from
the vertical.
• the women arm is placed on the top of the table with elbow flexed and
dropped behind it.
• the table height is adjusted so that the lower border of the breast is 2-3
c.m above the edge of the film.
• the breast is gently extended upwards and outwards to ensure it contacts
the breast - support table.
• the compression plate is applied.
• when the compression is almost complete, the breast is checked for skin
folds and radiographer’s hand is removed.

45 degree lateral oblique(MLO).
• lateral side of the breast is probably the most common place for pathological
changes to occur.
• for an ML view, the tube emitting the x-ray is medial and the detector plate is
lateral.
• for the LM view, the tube is lateral and the detector is placed medially.
• lateral views are extremely useful in determining the exact location of an
abnormality in the breast.
• ML view is best for lesions located in the central or lateral breast
• LM view is best for evaluating medial lesions.

extended cranio-caudal view:
• the routine CC view will not showmany abnormilities in the
upper quadrant of the breast, which will be demonstrated
on the medio-lateral oblique projection.
• as all lesions must be demonstrated on two projections,
this extended crnio-caudal projection is useful for
demonstrating the outer quadrant, axillary tail and axilla.
• the women stands close to the equipement, with her
breast aligned slightly side of the midline of the breast
support table.
• the breast is lifted gently and placed on the table

• the women is then encourged to lean 10-15degrees
laterally.
• compression is applied , the exposure is made and
compression released immediately.

magnification view
• A magnification view in mammography is performed to evaluate and count
microcalcifications.
• This allows the acquisition of magnified images of the region of interest.
• magnified projections are done in the cranio-caudal and mediolateral
projections.
• the women is placed in the position for the lateral and cranio caudal
projections in turn.
• it is important to realize that the field will cover only the half of the breast
under examination.
• Provides additional information on margins, satellite lesions, and
microcalcifications. Can also be useful for asymmetric tissue .

cleavage view
• A cleavage view (also called "valley view") is a
mammogram view that depict the posteromedial portion of
both breasts (the “valley” between the two breasts) by
placing them on the cassette at the same time and pulling
them anteriorly.
• Modified CC view that improves visualization of area
between breasts. Both breasts are positioned on the
detector.

axillary view
• An axillary view (also known as a "Cleopatra view“) is a
type of supplementary mammographic view. It is an
craniocaudal view for better imaging of the lateral portion
of the breast to the axillary tail.
• This view allows imaging of the axillary tail of the breast. It
resembles the ML view but allows evaluation of breast
tissue more laterally oriented.

spot view
• A spot view (also known as a spot compression view or
focal compression view) is an additional mammographic
view performed by applying the compression to a smaller
area of tissue using a small compression paddle,
increasing the effective pressure on that spot. This results
in better tissue separation and allows better visualization
of the breast tissue in that area.

patient preparation?
• give verbal instruction.
• patient should refrain from using lotions, powder, and
deodrants the day of examination.
• patients clothing from waist up will be removed.

abnormalities:
• cysts: fluid filled sacs.
• calcification: deposition of calcium.
• fibroadenomas: benign tumors.

Why is compression important in
mammography?
• Decreases radiation dose
• Separates glandular tissue
• Decreases superimposition of tissue
• Improves resolution or clarity of the image
• Increases contrast to visualize subtle differences in tissue
• Reduces scatter radiation

digital mammography
• Digital mammography is a specialized form of
mammography that uses digital receptors and computers
instead of x-ray film.
• the X-ray film is replaced by solid-state detectors that
convert X-rays into electrical signals.
• The electrical signals are used to produce images of the
breast that can be seen on a computer screen or printed
on special film similar to conventional mammograms.
• also called full-field digital mammography (FFDM)

Tomosynthesis (3D Mammography)
• Tomosynthesis or “3D” mammography is a new type of
digital x-ray mammogram which creates 2D and 3D-like
pictures of the breasts.
• This tool improves the ability of mammography to detect
early breast cancers.
• The images include thin one millimeter slices.
• The “3D” images reduce the overlap of breast tissue, and
make it possible for a radiologist to better see through
your breast tissue on the mammogram.

• Multiple studies have shown that “3D” mammography
increases the detection of breast cancer by approximately
25%, and decreases the number of false positive call
backs by approximately 15%.

Galactography or ductography
• is a medical diagnostic procedure for viewing the milk
ducts.
• The procedure involves the radiography of the ducts after
injection of a radiopaque substance into the duct system.
• The procedure is used for investigating the pathology of
nipple discharge.

ADVANTAGES
• It is time-efficient.
• It is easier to see slight differences between tissues.
• It requires lower average radiation dosage.
• Reduces the risk of dying from breast cancer.
• Reduces the risk of having to undergo chemotherapy.

LIMITATION
• they are no 100% accurate in showing if a women has
breast cancer.
• mammograms look normal though breast cancer is
present.
• mammograms look abnormal een though there is no
cancer in breast.
• women with dense breasts have more false negative
limitations of mammograms.

Xeroradiography/xeromammography
• X-ray imaging in which a picture of the body is recorded on
paper rather than on film.
• a plate of selenium, which rests on a thin layer of aluminium
oxide.
• Xeromammography is a photoelectric method(electrically
charge particle is released within a materia; when it absorbs
electromagnetic radiation) of recording an x-ray image on a
coated metal plate, using low-energy photon beams, long
exposure time, and dry chemical developers.
• This process was developed in the late 1960s by Jerry
Hedstrom, and used to image soft tissue, and later focused on

Xeroradiography/xeromammography
• photoelectric method.
• records images without film.
• latent image is converted to positive image .

xeroradiography Vs Radiography
• elimination of accidental film exposure, economic benefit,
reduced exposure to radiation dose.
• it involves neither we chemical processing nor the use of
the dark room.
• dis:the process of developement cannot be layed and is it
to completed within 15mins.

components:
• xerographic plate.
• corotron.
• casette.
• toner.
• special paper.

xerographic plate.
• sheet of aluminium in which a layer of amorphus selenium
has been deposited. In addition, there is an interface layer
between the selenium and aluminium and an overcoating
protecting the selenium surface.
• layers: overcoating, selenium, interface, aluminium.

procedure
• the first step in xeroradiographic process is to sensitise
the selenium the selenium layer by applying a uniform
electrostatic(biuld up charges due to conatct with other
crges) charge to its surface in the dark .

principle:
• the XR plate is charged to a high positive potential by
corotron(charging device)
• it is then placed in a cassette and used in a manner similar to that
with conventional film in its casette.
• when x rays strike the selenium, photoconduction(material become
more electrically conductive due to absorption of x rays) occurs and
this produces a charge image of the part examined.
• the image is made visible by bringing into proximity to the plate
charged developer or toner particles.
• the resultant powder image is subsequently transferred to paper and
fused providing an opaque XR interpretation and storage.

process:
• plate is sensitizes before the exposure.
• the charged plate is placed in a light tight casette and is
exposed to x rays.
• the x ray reaching the plate cause the photoconductor
layer to lose its charge in an amount corresponding to the
intensity of x-ray beam.
• the uniform charge is thus dissipated and the remainning
charge patterns form the ltent electrostatic image.

• the exposed plate is placed on the top of a dark box into
which an aerosol of charged tonner particles is sprayed
through a nozzle(produces millions of ink droplets used in
creating the image)
• all toner must be removed before the plate is to be
reused.
• the plate is exposed to a light source that reduces the
bond holding the residual toner to the plate.
• a preclean corotron exposes the plate to an altrnating
current .

image quality
image quality is based on ---
• radiographic mottle
• sharpness
• resolution.
• radiographic mottle- depends on film screen mottle and
film gradiness. screen mottle depends on structure mottle
and quantum mottle.

• radiographic mottle: it is also known as noise. it directly
related to the number of x-ray photons.
• Fewer photons reaching the image receptor will cause an
undesirable fluctuation in image densities, resulting in
images with a grainy, or sandlike, appearance.

sharpness
• ability to define edge of film.
types of unsharpness: geometric unsharpness, motion
unsharpness and photographic or system unsharpness.
geometric unsharpness: *Two principal factors play
simultaneously: the apparent focal spot size and the ratio
between object-film distance (OFD) and focus-film
distance (FFD).
*Fine focal spot sizes will minimise geometric
unsharpness, and therefore give more detailed images.

sharpness
*Keeping the ratio FFD:OFD high will minimise
geometric unsharpness.
Motion unsharpness: *is caused by movement of the
patient, the detector or the source of X-rays during the
exposure.
*Movement of the patient can be minimised in a number
of ways: immobilizing the patient, asking the patient to keep
still or to hold the breath and keeping exposure time short.

photographic unsharpnesss: *result of the detector
system employed.

resolution
• Resolution is the ability of an imaging system to display
two adjacent objects as discrete entities.
• Resolution is also known as spatial resolution