‫بسم هللا الرحمن الرحيم‬

RIBAT UNIVERSITY

FACULTY OF RADIOLOGY AND NUCLEAR

MEDICINE

MAMMOGRAPHY

 ADIL TAWFIG ABDALLHA MOHAMMED

 15/02/2021
 D/ SHAZA MAHGOB
 CONTENT:

 INTRODUCTION TO MAMMOGRAPHY

 HISTORY OF MAMMOGRAPHY

 COMPONENT OF MAMMOGRAPHY

 TYPES OF MAMMOGRAPHY

 TYPES OF MAMMOGRAPY PROJACTION

 DISEASIS DETECTED BY MAMMOGRAPHY

 REFERENSE
  INTRODUCTION TO MAMOGRAPHY:
Intro to mammography

An introduction to mammography

A mammogram is a radiological tool used to image breast tissue. It can detect calcifications, cysts,
fibroadenoma (non-cancerous breast lumps) and cancer. Simply an x-ray of the bMammography,
which combines specialized X-ray equipment with techniques for positioning breasts, is used both
for the screening of women who have no signs or symptoms of breast cancer as well as for the
diagnosis of lumps or tissues to determine whether they are cancerous. Before mammography
physicians had relied on physical exams and biopsies.1 However, physical exams could not detect
emerging tumors and biopsies (of lumps that could be detected by physical examination) were
expensive, invasive, potentially disfiguring, and sometimes inaccurate. Mammography has made
large-scale screening feasible and diagnosis through biopsy less invasive and more
accurate.reast, mammography helps to evaluate and diagnose conditions.

 HISTORY OF MAMMOGRAPHY:
In the 1950s, Raul Leborgne, a Uruguayan radiologist, developed a technique that significantly
improved the sharpness of breast X-rays, revealing well-formed as well as emerging tumors. In a
1953 book, he described a procedure, which entailed adjusting the X-ray beam, flattening the
breast during the X-ray, taking images from multiple angles, and using more sensitive film

Standardizing Diagnostic Mammography:

Charles Gros, head of radiology at a cancer center affiliated with University of Strasbourg
(France), thought Leborgne’s procedure promising but its description inadequate for the typical
radiologist. Gros therefore attempted to provide a more systematic description in his 1963
textbook Diseases of the Breast. Gros also attempted to reduce the training radiologists would
need by developing equipment with the French Xray producer Compagnie Générale de
Radiologie (CGR) that would mechanize some of the steps.8 CGR introduced the equipment in
Europe in 1966, and in the U.S. in 1971.9 (See Figure 2 at the end of this section) Robert Egan, a
radiologist at M.D. Anderson Hospital and Tumor Institute2 in Houston, Texas, developed
Leborgne’s technique in a different direction. In 1956, Anderson’s chief radiologist had asked
Egan, then a new resident at the hospital, to investigate X-ray diagnosis of breast cancer. In
about five years, Egan developed and tested protocols that specified: 1) lower power X-rays than
those used for other kinds
  COMPONENT OF MAMMOGRAPHY:
 Mammography unit consists of an X-ray tube that encapsulates the cathode and
anode. The breast is placed on the detector and is compressed using a parallel-
plate compression device, see Fig. 1. The compression device enhances image
quality by reducing the thickness of tissue that X-rays must penetrate. In addition,
it decreases the amount of scattered radiation and required radiation dose. It also
holds the breast still and prevents the motion blur.


FIGURE 1
  TYPES OF MAMMOGRAPHY:
Leading-Edge Mammography Options
Not all mammograms are the same. There are screening mammograms and diagnostic mammograms, and within those
categories, there are specialized mammograms. Beaumont Breast Imaging Centers offer the leading-edge
mammography options for both screening and diagnosing breast cancer.

Screening Mammogram
A screening mammogram is an imaging test of the breast that uses X-ray technology to look for abnormalities or
changes in breast tissue in women who do not have signs or symptoms of breast cancer. Most screening mammograms
take two X-ray images of each breast. If it’s your first screening mammogram, it’s considered a baseline mammogram.
The results of this test will be used to compare with future mammogram results to look for changes in your breast tissue.
A screening mammogram may help detect breast tumors that cannot be felt during an annual exam or a monthly breast
self-exam.  To be eligible for a screening mammogram, your last mammogram should have been interpreted as
negative. If the radiologists are following a probable benign finding in the breast on mammography, you are no longer
eligible for a screening mammogram until that finding has been documented to be stable (usually 2-3 years).

Diagnostic Mammogram
A diagnostic mammogram uses X-ray technology to take images of breast tissue. It is used to help evaluate breast
symptoms, like a lump, focal persistent breast pain, bloody nipple discharge, breast or nipple thickening, or changes in
breast size, shape or skin color. Mammograms may also be used to evaluate potential abnormalities seen during a
screening mammogram. Diagnostic mammograms usually focus on the affected breast (or breasts), and the number of
images taken will depend on various factors. The study is individually tailored for each patient depending on the
symptoms and findings.

Digital Mammography
The field of mammography is always improving as new technology is developed. Digital mammography technology has
improved imaging capabilities. A digital mammography machine takes digital X-ray images of breast tissue that can be
enhanced using computers. Digital mammogram images can be stored and transmitted electronically, which can be
helpful in making mammography more accessible to women in remote areas.

Digital mammography (also called full-field digital mammography or FFDM) allows breast images to be manipulated to
make visualizing breast tissue easier. For example, doctors can change things like the degree of magnification,
brightness, or contrast to aid in visualization. These images can also be transmitted electronically, which is helpful in
sharing medical records and sending images to experts from remote locations. Some studies have found FFDM to be
more accurate in finding cancers in women younger than 50.  Also, it has been found that women undergoing digital
mammography do not have to return for additional studies as often as with standard mammography. All Beaumont
Breast Imaging Centers have digital mammography machines.
  TYPES OF PROJACTION OF MAMMOGRAPHY:
Standard Projections: MLO and CC Mammograms are displayed in conventional manner paired
(to permit bilateral comparison) MLO followed by CC with patient’s right breast on the left side
of the screen and left breast on the right side of the screen. There are two standard
mammographic projections: a mediolateral oblique (MLO) view and a craniocaudal (CC) view.
Correct positioning is crucial to avoid missing lesions situated at the margins of the breast. The
MLO view is taken with the X-ray beam directed from superomedial to inferolateral, usually at
an angle of 30–60°, with compression applied obliquely across the chest wall, perpendicular to
the long axis of the pectoralis major muscle. The MLO projection is the only projection in which
all the breast tissue can be demonstrated on a single image. A well-positioned MLO view should
demonstrate the inframammary angle, the nipple in profile, and the nipple positioned at the
level of the lower border of the pectoralis major, with the muscle across the posterior border of
the film at an angle of 25°–30° to the vertical.

For the CC view, the X-ray beam travels from superior to inferior. Positioning is achieved by
pulling the breast up and forward away from the chest wall, with compression applied from
above. A well-positioned CC view should demonstrate the nipple in profile. It should
demonstrate virtually all of the medial tissue and most of the lateral tissue except the axillary tail
of the breast. The pectoralis major is demonstrated at the center of a CC film in approximately
30% of individuals and the depth of breast tissue demonstrated should be within 1 cm of the
distance from the nipple to the pectoralis major on the MLO projection.

Breast Compression :
Compression of the breast is essential for good mammography, for the following reasons:
• It reduces geometric unsharpness by bringing the object closer to the film.
• It improves contrast by reducing scatter.
• It diminishes movement unsharpness by permitting shorter exposure times and immobilizing
breast.
• It reduces radiation dose, as a lesser thickness of breast tissue needs to be penetrated, scatter
is reduced.
• It achieves more uniform image density: a homogeneous breast thickness prevents
overexposure of the thinner anterior breast tissues and underexposure of thicker posterior
breast tissues.
• It provides more accurate assessment of the density of masses. As cysts and normal glandular
tissue are more easily compressed, the more rigid carcinomas are highlighted.
• It separates superimposed breast tissues so that lesions are better seen. 3
For Diagnostic Additional Projections : XCCL, XCCM, Compression magnification, True Lateral /
90°, Ecklund Supplementary views may be taken to solve specific diagnostic problems. For
example, the CC view can be rotated to visualize either more of the lateral or medial aspect of
the breast, compared to the standard CC projection. Localized compression views can be
performed. This involves the application of more vigorous compression to a localized area using
a compression paddle. These views are used to distinguish real lesions from superimposition of
normal tissues and to define the margins of a mass. A true lateral view may be used to provide a
third imaging plane in order to distinguish superimposition of normal structures from real
lesions, to increase the accuracy of wire localizations of non-palpable lesions, or to ascertain the
presence of layering in the case of milk of calcium or fat-containing oil cyst / galactocele. The
true lateral view is performed with the mammography unit turned through 90° and a
mediolateral or lateromedial X-ray beam. Magnification views are frequently performed to
examine areas of microcalcifications within the breast, to characterize them and to establish
their extent. These magnification views are typically performed in the craniocaudal and lateral
projections. The magnified lateral view will demonstrate ‘teacups’ typical of benign
microcalcifications, described later in the chapter. Mammographic technique may need to be
modified in women with breast implants. Silicone and saline implants are radioopaque and may
obscure much of the breast tissue. Consequently, mammography is of limited diagnostic value in
some women. The Eklund (Implant displaced) technique can be employed to displace the
implant posteriorly, behind the compression plate, maximizing the volume of breast tissue that
is compressed and imaged. Mammography-induced implant rupture is not a consideration.

SUGGESTED APPROACH TO INTERPRETATION

The first step is to Determine if the study is technically adequate.
• There should be adequate tissue imaged on both the CC and MLO views. The posterior nipple
line is a line drawn from the posterior nipple to the pectoralis muscle - or edge of the film on the
CC view if the pectoralis is not visualized. The posterior nipple lines drawn on the CC and MLO
views should be within 1 cm of each other. On the MLO view, the pectoral muscle should be
visible at least to the level of the nipple.
• The image must be free from blur and artifacts. The trabeculae should be sharp
• Each breast nipple should be in profile in at least one view. Compare each side
• Each projection should be globally compared side-to-side to evaluate for symmetry. Evaluate
and magnify each image
• Each image should be carefully evaluated for signs of malignancy (mass, calcification,
architectural distortion, and asymmetry). Calcifications are best viewed at 1:1 or higher
magnification, while architectural distortion is best seen when the whole breast is visualized.
• When viewing a digital mammogram, every portion of the image should be carefully evaluated
at 1:1 zoom. Compare to prior studies
a. Even if a study appears unremarkable at first glance, comparison to prior exams
can often reveal a subtle progressive change. At least 2 years previous
compared1
 DISEASES THAT DETECT BY MAMMOGRAPHY:
 Screening mammography is a specific type of breast imaging that uses low-dose x-rays to
detect cancer early – before women experience symptoms – when it is most treatable.
REMEMBER ON SCREENING MAMMOGRAM SEARCH FOR: mass, calcifications,
architectural distortion, asymmetry
1. Mass - new or increasing are of concern, particularly if irregular, high density, not
circumscribed
2. Calcifications - assess stability, morphology, distribution. new or increasing are of
concern when not typically benign morphology ie when fine linear, fine linear branching,
fine pleomorphic, coarse heterogeneous, amorphous. Suspicious distribution includes
segmental, linear, grouped, regional
3. Architectural Distortion:
•Normal breast architecture is distorted with no definite mass
•Thin straight lines of spiculations radiating from a point; focal retraction, distortion,
straightening at the anterior or posterior edge of the parenchyma
•May also be seen in association with asymmetry or calcifications
•Determine if concordant history of trauma or surgery
•DDx for architectural distortion = Cancer, Radial scar, Posttraumatic/Surgical scar
4. Asymmetry: Unilateral deposits of fibroglandular tissue not conforming to the
definition of a radiodense mass. Four types:
•1. ASYMMETRY - visible in only one mammographic projection. Typically summation
artefact
•2. GLOBAL ASYMMETRY - large amount of fibroglandular-density tissue over a
substantial portion of breast (at least a quadrant) compared to contralateral breast.
Usually normal variant
•3. FOCAL ASYMMETRY - relatively small amount of fibroglandular-density tissue over a
confined portion of breast (< a quadrant). Concave borders and interspersed fat
distinguish from mass. DDx Superimposition of two normal structures, Mass
•4. DEVELOPING ASYMMETRY - focal asymmetry that is new, larger, or more
conspicuous than previously. 15% are CA. Therefore developing asymmetry can not be
assigned BI-RADS® CATEGORY 3

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 4D

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 FIGURE 2
  REFERENCE:
1. https://www.hbs.edu/ris/Publication%20Files/20-002_06f244d2-a9a2-4918-9573-
4199d5ab58eb.pdf
2. https://www.sciencedirect.com/topics/nursing-and-health-professions/mammography-
system /FIGURE 1
3. https://www.beaumont.org/mammogram/types-of-mammography
4. file:///C:/Users/hp/Desktop/Screening-Need-To-Knows.pdf
5. http://www.scielo.br/scielo.php?pid=S0100-
39842006000400012&script=sci_arttext&tlng=en /FIGURE 2