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!

3. Man – o - gram

4. 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    

5. Do it for those you love…. And who love you

6. Routine Images - aka “screening mammo” (not screaming)
POSITIONING
Routine Images - aka “screening mammo” (not screaming)
CC - cranio caudad
MLO – mediolateral oblique

9. More on MAMMO Equipment – week 8
With Xray & Mammo QC

14. Compression Important:
Evens Density of Breast
Reduces Motion
AEC choice depends of size and composition of breast

15. CC

17. Marker? Which side is axilla?

21. MLO – RT BREAST

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

32. TRUE LAT CONE-MAG
                          

36. Magnification = increase OID

37. 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

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

42. 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)
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

43. Breast Scintomotography Isotope matches tumor to node involvement
More on Breast Pathology & Procedures next lecture…..

45. Quadrants of the breast

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

47. 3 Tissue Types

50. Breast Changes with Age
Breast Classifications
Breast Changes with Age

51. Fibro-glandular Breast
Dense with very little fat
Females 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 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.

56. 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

57. Gynecomastia: Prominent Male Breasts
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

58. 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.

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. Difficulty with IMPLANTS
THE AUGMENTED BREAST
Difficulty with IMPLANTS

64. Breast Implants Is it worth the risk?

65. Complication with Breast Augmentation
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

66. Elkland Method for Imaging with Breast Implants

68. “PUSH BACK” TECHNIQUE

71. Other Imaging of the Breast

73. Xero mammography (early years

74. OTHER CHALLENGES TO MAMMOGRAPHY