1. MAMMOGRAPHY Positioning & Anatomy
RADIOGRAPHIC IMAGING OF THE BREAST
dr. Sameer Abdul Lateef

2. Mammography is the process of using low-energy-X-rays (usually around 30 kVp) to examine the human breast and is used as a diagnostic and a screening tool.
The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses and/or micro calcifications. Mammography reduces deaths from breast cancer by screening programs

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. 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

5. 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

6. POSITIONING Routine Images - CC - cranio caudad
MLO – mediolateral oblique

15. POSITIONING CC – CRANIOCAUDAD MLO – MEDIAL LATERAL OBLIQUE
“TRUE” LATERAL

16. TYPES OF BREAST TISSUE GLANDULAR DUCTS LOBES LOBULES STROMAL
MOSTLY SEEN UPPER OUTER QUADRANT
STROMAL
FATTY TISSUE
CONNECTIVE TISSUE
(COOPER’S LIGAMENTS – SUSPENSATORY LIGAMENTS

17. 3 Tissue Types

18. Breast Changes with Age
Breast Classifications
Breast Changes with Age

19. Fibro-glandular Breast
Dense with very little fat
Females years of age
Or 30 years or older without children
Pregnant or lactating

20. Fibro-fatty Breast Fibro-fatty Average density
50% fat & 50% fibro-glandular
Women years of age
Or women with 3 or more children

21. Fatty Breast Fatty Minimal density
Women 50 and older (postmenopausal),

22. How we differentiate between benign & malignant mass

23. Carcinoma of breast

24. Breast carcinoma

25. Fibroadenoma

26. Breast cyst

29. Fibrocystic disease

31. Mammograms of duct ectasia The majority of patients with duct ectasia have no diagnostic mammographic features. Occasionally the ducts are seen as tubular structures extending from the subareolar area, but this is a nonspecific sign. Still ductography can be used. The purpose of mammography in such instances is to exclude underlying malignancy.

33. Ultrasound Duct ectasia can be seen as multiple tubular structures arising from the nipple. The significance of such findings is unclear, however, as it is frequently seen in otherwise normal individuals. Ultrasound therefore has no role to play in the diagnosis of patients with nipple discharge. It should only be performed in patients who are also found to have a palpable mass

34. 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

35. Gynecomastia 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.

36. Other Imaging of the Breast

38. Xero mammography