Breast Protocol

Protocol
 Scan from nipple outward then back toward nipple including the Tail of Spence (Axillary Region)
 No pathology present - Store image anywhere along scanning section
 Pathology present - image pathology in both planes, measure, utilize color & spectral Doppler
 Protocols will vary at each site - examples of protocols that may be used are identified below

Example of a Whole Breast Examination of the RIGHT Breast

Area of Concern Plane Label Landmarks
Include the appropriate clock position
and scan plane
(scan plane only for nipple and axilla)
For Each of the Radial Radial  Skin
Following Clock  Premammary Layer
Positions  Mammary Layer
 12:00  Retromammary Layer
 3:00  Pectoralis Muscle
 6:00  Pleura/ lung
 9:00 Antiradial Antiradial  Skin
 10:00  Premammary Layer
 11:00  Mammary Layer
 Retromammary Layer
 Pectoralis Muscle
 Pleura/ lung
Areola/ Nipple Oblique Nipple  Lactiferous Sinus
under nipple
Axilla/ Tail of Spence Antiradial Axilla  Skin, Fat and Muscle

Example of a Whole Breast Examination of the LEFT Breast
Area of Concern Plane Label Landmarks
Include the appropriate clock position
and scan plane
(scan plane only for nipple and axilla)
For Each of the Radial Radial  Skin
Following Clock  Premammary Layer
Positions  Mammary Layer
 12:00  Retromammary Layer
 1:00  Pectoralis Muscle
 2:00  Pleura/lung
 3:00 Antiradial Antiradial  Skin
 6:00  Premammary Layer
 9:00  Mammary Layer
 Retromammary Layer
 Pectoralis Muscle
 Pleura/lung
Areola/ Nipple Oblique under Nipple  Lactiferous Sinus
nipple

AK\backup\Abdomen II\protocols
Breast Protocol

Axilla/ Tail of Spence Antiradial Axilla  Skin, Fat and Muscle

Targeted Examination- Typically used when a pathology is seen on mammogram, previous sonogram, or is palpable

Clock Position Plane Label Landmarks
Identify the area of Concern by the Radial  Clock position  Skin
clock position  Radial  Premammary Layer
 Mammary Layer
 Retromammary Layer
 Pectoralis Muscle
 Pleura/ lung
Identify the area of Concern by the Antiradial  Clock position  Skin
clock position  Antiradial  Premammary Layer
 Mammary Layer
 Retromammary Layer
 Pectoralis Muscle
 Pleura/ lung
Identify the area of Concern by the Radial  Clock position  Anterior, posterior, superior,
clock position  Radial and inferior walls of
“Magnified” pathology
Identify the area of Concern by the Radial  Clock position  Anterior, posterior, superior,
clock position  Radial and inferior walls of
“Magnified” with AP and Length pathology
Measurements
Identify the area of Concern by the Antiradial  Clock position  Anterior, posterior, and
clock position  Antiradial lateral walls of pathology
“Magnified”
Identify the area of Concern by the Antiradial  Clock position  Anterior, posterior, and
clock position  Antiradial lateral walls of pathology
“Magnified” with AP and width
measurements
Identify the area of Concern by the Radial  Clock position  Anterior, posterior, superior,
clock position  Radial and inferior walls of
“Magnified” with Color Doppler of pathology
pathology
Identify the area of Concern by the Radial  Clock position  Anterior, posterior, superior,
clock position  Radial and inferior walls of
“Magnified” with Color Doppler & pathology
Spectral Analysis of pathology

Images Required for BCHS Scan Competency
  All site specific protocol images
  Area of concern radial plane images
  Area of concern antiradial plane images
  Nipple images
  Axilla images
  Pathology images

AK\backup\Abdomen II\protocols
Breast Protocol

Anatomical/Image Correlation/Image Orientation- http://www.obgyn.net/displayarticle.asp?
page=/bh/articles/newbreasthandoutI & www.imagingce.info/.../quadLocal.gif

Normal Measurement Ranges
Structure Area of Plane Measurement Comments
Concern
Skin Near field Sagittal 2-3 mm Measure Anterior to Posterior diameter
(use standoff pad or thick layer of gel)
Ducts Posterior Nipple Sagittal Less than 3 mm Measure Anterior to Posterior diameter
Lymph Axillary or Sagtital & Less than 1.5 Abnormal lymph nodes will appear round rather than oval.
Nodes wherever transverse cm in all planes Length, width, and height measurements should be taken
visualized to determine size in each plane

Sonographic Appearance
Structure Echogenicity
Skin Echogenic
All Anatomy should be compared to Glandular Tissue Isoechoic to Hypoechoic
echogenicity of FAT Fibrous Tissue Hyperechoic
Cooper’s Ligaments Hyperechoic
Fat = medium level gray Ducts Anechoic or Hypoechoic
Muscle Hypoechoic with Striations
Ribs Echogenic with shadowing
Benign Characteristics
Smooth, Macrolobulations Homogeneous Anechoic Hyperechoic Posterior Wider Thin echogenic
thin walls (3 or less enhancement than capsule
lobulations) taller
Suspicious Characteristics-Just takes one!
Irregular Microlobulations Spiculated Angular Branch Heterogeneous Taller Hypoechoic
contour margins pattern than compared to
wider fat
Thickened Micro- Disruption of tissue planes Duct Shadowing Increased echogencity
Cooper’s calcifications extension anterior to mass
ligaments

Transducer- Dependent on amount of breast tissue - high frequency linear transducer with minimum of 7 MHz is recommended

Patient Position
 Patient lies supine or slightly oblique (may need support wedge) with arm over head
 Obliqued more for larger breasts - the breast should lay flat to minimize the thickness of the breast
AK\backup\Abdomen II\protocols
Breast Protocol

Pathology-- If pathology is present you must document the pathology in its entirety. Images should include:
 Gray scale sagittal and transverse images - document distance from NIPPLE not areola
 SHAPE, MARGIN, ECHOGENICITY, LESION BOUNDARY, ATTENUATION, SURROUNDING TISSUE
 Gray scale sagittal and transverse images with 3 measurements (length, width, and height)
 Color Doppler image to document the presence of blood flow and Spectral Doppler image to document type and velocity of blood
flow (Use Power/Color Doppler with humming to identify solid masses—FREMITUS)

AK\backup\Abdomen II\protocols