1. Chapter 17

2. Mammography Gold standard for breast cancer detection Most common in women other than skin cancer 2 nd leading cause of cancer death in women 1 in 8 chance of getting breast cancer 1 in 35 chance of dying from it.

3. Mammography Highly regulated Mammography Quality Standards Act (MQSA) All Mammography units must meet federal standards. ACR accredited. State of Nevada requires annual inspections

4. External Breast Anatomy Inframammary fold Inferior breast to the chest wall Axillary Tail Superiolateral aspect

5. External Breast Anatomy Areola Dark area surrounding nipple. Montgomery’s gland or Areolar glands (are Sabaceous glands) Nipple Protrusion containing duct openings

6. Boundaries of the Breast Superiorly: 1 st or 2 nd rib (clavicle) Inferiorly: 6 th or 7 th (IMF-Inframammary fold) Medially: Sternum Laterally: Mid-axillary line at the junction of the latissimus dorsi muscle.

7. Internal Breast Anatomy Pectoralis Major Chest muscle posterior to breast. Retromammary Space Connective tissue attaching breast to pectoralis major.

8. Parenchyma (Breast) Tissue Glandular Tissue Milk production and duct system Adipose Tissue Fatty tissue surrounding glandular tissue Fibrous (Connective) Tissue Surround and support the glandular structures (Cooper’s Ligament)

9. Glandular Tissue 15 – 20 lobes surrounding the nipple Alveoli (Acini) Milk producing units Lobules Groups of alveoli

10. Glandular Tissue Duct Transports breast milk Ampula Reservoir at the end of ducts

11. Mammo Compression Decrease breast thickness Brings breast structures close to the IR Decrease dose and scatter Holds the breast tissue away from the chest wall

12. Compression Decreases motion unsharpness Increase contrast Separate breast structures

13. Positioning Craniocaudal (CC) Mediolateral Oblique (MLO) Others are possible

14. Craniocaudal (CC) IR raised for 90º chest wall angle. Compression applied Correct placement of the photocell in film screen mammography is under the most glandular tissue Typically the anterior third of the breast Pectoral muscle should be seen

16. Mediolateral Oblique CR angled 45º-50º and enters medially. IR raised to the height of the axilla Compression applied Film Screen mammography-position of photocell is under the most glandular tissue typically the anterior third of the breast Pectoral muscle and inframammary fold should be seen.

18. Mammography Advancement Full Field Digital Mammography Computer Aided Detection (CAD) Ultrasound MRI and MR Spectroscopy Nuc Med BSGI Breast Specific Gamma Imaging (Caution-residual radiotracers have been linked to Colon Cancer) 3 D Mammography or Breast Tomosynthesis (Standard mammographic views with approximately 50 individual images. Same compression and positioning.)

19. BREAST TOMOSYNTHESIS BENEFITS 1. Improves radiologists' ability to screen for and detect potential breast cancers. 2. Helps radiologists pinpoint size, shape, and location of abnormalities. 3. Can help distinguish harmless abnormalities from real tumors, leading to fewer callbacks and less anxiety for women. http://www.massgeneral.org/imaging/services/3D_mam mography_tomosynthesis.aspx

20. Getting Registered New Mandates from ARRT Effective July 2009 40 Hours of Initial Training Approx cost -$625 4 day program Candidates must be in compliance with MQSA requirements for technologists, and are required to complete: (a) a specified number of mammographic examinations; (b) quality control procedures; (c) selected special procedures; (d) mammographic review and critique. All procedures must be completed within the 24 months immediately before application for certification. www.achievingqi.com-www.achievingqi.com- Las Vegas, Multiple dates 2011