Mammography

History of Mammography

• First attempted in the 1940s

• In the late 1950’s, Robert Egan, renewed the
interest in mammography with his
demonstration of a successful technique using
Low kVp, High mAs, Direct Exposure Film.
• Robert Egan “Father of Mammography.”

Note:
o The male breast structure is nearly identical to
the female breast, except that the male breast
tissue lacks the specialized lobules, since there
is no physiologic need for milk production by
males.
There are many different parts to female breast

o Both male and female breast tissue consists of a anatomy, including:

few ducts under the nipple and areola until

puberty. During puberty, females develop Adipose tissue:

increased levels of certain hormones which Your breast is mainly made up of fatty tissue (adipose

cause these ducts to grow and lobules to form. tissue). It extends from your collarbone to your armpit
and across your ribcage.

o Most breast cancers in women develop in these

ducts and lobules. Lobes:
Each breast has between 15 to 20 lobes, or sections.

o Males typically have low levels of these These lobes surround your nipple like spokes on wheel.

hormones, and as a result, the breast tissue

does not grow as much. Although male breasts Glandular tissue (lobules):

have ducts, they only have a few lobules and These small sections of tissue found inside lobes have

mainly consist of fat tissue. tiny bulblike glands at the end that produce milk.

o Females typically produce more estrogen than Milk (mammary) ducts:

males. Breast cells in females are highly active These small tubes, or ducts, carry milk from glandular

and receptive to estrogen, while breast cells in tissue (lobules) to your nipples.

males are inactive and not exposed to high

estrogen levels. Nipples:
The nipple is in the center of your areola. Each nipple

o Female hormones - namely, estrogen, has about nine milk ducts, as well as hundreds of

progesterone and prolactin - play a key role in nerves.

breast development and function. The main role

of the breasts is to produce human milk.
Areolae:
The areola is the circular darker-colored area of skin
surrounding your nipple. Areolae have glands
called Montgomery's glands that secrete a lubricating
oil. This oil protects your nipple and skin from chafing
during breastfeeding.

Blood vessels:
Blood vessels circulate blood throughout your breasts,
chest and body.

Lymph vessels:
Part of your lymphatic system, these vessels transport
lymph, a fluid that helps your body's immune system
fight infection. Lymph vessels connect to lymph nodes, CLINICAL BREAST CHANGES

which are found under your armpits, in your chest and Breast changes that needs medical attention:

in other places. 1. Lumps under the arm

2. Nipple changes or discharge
3. Itchy skin, red, scaled, dimpled or puckered

What are the physiological functions of the breast?

Breast changes that are not cancer:

Female hormones - namely, estrogen, progesterone and

prolactin - play a key role in breast development and LUMPS

function. The main role of the breasts is to 1. Before or during menstruation

produce human milk. breasts may feel swollen, tender, or painful. May also
feel one or more lumps during this time because of

Estrogen stretches milk ducts and helps them create extra fluid in the breasts

side branches to carry more milk.

2. During pregnancy

Prolactin promotes the production of progesterone and Usually because the glands that produce milk are

prepares glands for milk production. increasing in number and getting larger. While
breastfeeding, may get a condition called mastitis. This

Progesterone increases the number and size of lobules happens when a milk duct becomes blocked. Mastitis

in preparation for breastfeeding. This hormone also causes the breast to look red and feel lumpy, warm, and

enlarges blood vessels and breast cells after ovulation. tender.

Oxytocin helps release (or eject) breast milk. 3. Approaching Menopause

hormone level change
breasts feel tender, even when you are not having
menstrual period. Breasts may also feel more lumpy
than they did before.

4. Taking hormones
such as menopausal hormone therapy, birth control
pills, or injections) breasts may become more dense.
This can make a mammogram harder to interpret.
5. After menopause
hormone levels drop
lumps, pain, or nipple discharge stop appearing

BREAST CLASSIFICATIONS

1. Fibro-Glandular
Breast asymmetry
o Common age group-15 to 30 years (and
- Refers to when one breast is a different size or shape
childless females over age 30)
than the other
o Pregnant or lactating females
o Radiographically dense
Inverted nipple
o Very little fat
- A condition in which the nipple is pulled Inward into
the breast instead of pointing outward

Supernumerary nipples (Accessory nipples)

- Are common minor congenital malformations that
consist of nipples and/or related tissue in addition to
the nipples normally appearing on the chest.

Accessory Breast Tissue

- Is a relatively common congenital condition in which
abnormal accessory breast tissue is seen in addition to
2. Fibro-Fatty
the presence of normal breast tissue. This normal
variant can present as a mass anywhere along the o Common age group – 30 to 50 years old
course of the embryologic mammary streak (axilla to the o Young women with three or more pregnancies
Inguinal region). o Average density, radiographically
o 50% fat and 50% fibro-grandular
3. Fatty C: Heterogeneously dense indicates that there are some
areas of nondense tissue, but that the majority of the
o Common age group – 50 years old and over
breast tissue is dense. About 4 in 10 women have this
o Postmenopausal
result.
o Minimal density, radiographically
D: Extremely dense indicates that nearly all of the
o Breasts of children and males
breast tissue is dense. About 1 in 10 women has this
result.

Levels of density are described using a results reporting

system called Breast Imaging Reporting and Data
System (BI-RADS). The levels of density are often
recorded in mammogram report using letters. The levels
density are:

A: Almost entirely fatty indicates that the breasts are

almost entirely composed of fat. About 1 in 10 women
has this result.
B: Scattered areas of fibroglandular density indicates
there are some scattered areas of density, but the
majority of the breast tissue is nondense. About 4 in 10
women have this result.
Breast Positioning Craniocaudal (CC) Projection
(Basic CC)

Two Functions of Compression

1. Decreases thickness of breast
2. Reduces OID of breast structures
o CR perpendicular
o IR tray to height of inframammary crease
o Nipple in profile
o Wrinkles and folds smoothed out
o Compression applied
o Markers on axillary side
Criteria:

Breast Positioning
Basic
o Craniocaudal (CC)
o Mediolateral Oblique (MLO)
Special
o Exaggerated craniocaudal (lateral) – XCCL
o Mediolateral (ML) o No motion, nipple in profile
o Implant displaced, Eklund technique (ID-CC) o All pertinent anatomy demonstrated
o Tissue thickness distributed evenly; dense areas
penetrated
o High contrast and optimal resolution; absence
of artifacts
o Market and patient ID visible
Mediolateral Oblique (MLO) Exaggerated Craniocaudal
(Basic CC, MLO) (Special XCCL)

o CR and IR angled 45°

o CR perpendicular or 5° mediolatera;
o Top of IR at axilla
o CC projection with some body rotation
o Compression applied
o Includes axillary aspect
o Nipple in profile
o Compression applied, nipple in profile, marker
o Marker at axilla
at axilla

Criteria:
Criteria:

o Same evaluation criteria as CC projection

o No motion o Axillary aspect of breast visualized

o Breast pulled away from chest wall; nipple in o May see pectoral muscle; nipple in profile

profile o No motion

o Dense areas penetrated; high contrast and o Marker and patient ID visible

optimal resolution; absence of artifacts

o Marker and patient ID visible
Mediolateral (ML) Implant Displaced (ID) Eklund Method
(Special XCCL, ML)

o CR and IR 90° from vertical

o True lateral
o Compression applied
o Nipple in profile; marker at axilla

Criteria:

o Dense areas adequately penetrated; nipple in

profile
o May see pectoral muscle Diagnosis of Breast Carcinoma
o No artifacts; no motion
Methods of Diagnosis
o Marker and patient ID visible
Diagnostic tests and procedures for breast cancer
include: (Imaging tests)

o Breast exam
o Mammograms
o Breast ultrasound
o Breast MRI scan
o Biopsy

Breast Exams
o Clinical Breast Exam (CBE)
o Breast – Self Exam (BSE)

Clinical Breast Exam

o Women in their 20s and 30s should have a
clinical breast exam every 3 years.
o After ag 40, women should have a breast exam
every year.
Breast Self Exam
o BSE is an option for women starting in their 20s.
o Any changes detected should be reported to a
medical expert.
o BSE: Conducted standing or reclining
Mri (Magnetic Resonance Imaging)
Breast Imaging Technques
Mammograms
o An x-ray of the breast
o It uses a very small amount of radiation
Mammograms – screening (screening mammogram) ;
diagnosis (diagnostic mammogram)
Breast Ultrasound
o Uses sound waves to outline a part of the body
o The sund wave echoes are picked up by a
computer to create a picture on a computer
screen
o Used to investigate areas of concerns found by a
mammogram
o Use magnets and radiowaves
o Cross-sectional images of the body
o MRI scans can take a long time
o Used if view areas of concern found on a
mammogram
Biopsy
o A biopsy is done when other tests show that
you might have breast cancer
o It confirms if a mass is cancerous or not
o Mass is removed and studied
Types of Breast Biopsy
o Fine needle aspiration (FNA) biopsy
o Core needle biopsy
o Vacuum-assisted biopsies
o Surgical (open) biopsy
o Lymph node biopsy
Vacuum-Assisted Biopsies
o Done with systems such as ATEC (Automated
Tissue Excision and Collection)
o Guided by MRI
o First the skin is numbed and a small cut
(incision) is made.
o A hollow probe is put through the cut into the
breast tissue
o A piece of tissue is sucked out

Fine Needle Aspiration (FNA) Biopsy

o Very fine needle is used
o Extracts fluids from the lump
o Guided by ultrasound
o Simple but is not 100% accurate

Surgical (open) Biopsy

o Anesthesia is administered
o Incision is made
o Part or whole lump is extracted and studied

Core Needle Biopsy

o Needle is larger than in fine needle biopsy
o Removes more tissues
o Clearer results