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MAMMOGRAPHY
LECTURE #1
Positioning & Anatomy
RADIOGRAPHIC IMAGING OF THE BREAST
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Mammograms
don’t look fun
but they can
save a life!
Man – o - gram 3
 A mammogram can find breast cancer when 4

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
   
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POSITIONING
Routine Images -
aka “screening mammo”
(not screaming)
CC -cranio caudad
MLO – mediolateral oblique
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More Lecture on MAMMO Equipment

With Xray & Mammo QC
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Compression Important:
Evens Density of Breast
Reduces Motion
AEC choice depends of size
and composition of breast
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CC
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Marker? Which side is axilla?
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MLO – RT BREAST
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POSITIONING
 CC – CRANIOCAUDAD
 MLO – MEDIAL LATERAL OBLIQUE

 “TRUE” LATERAL
 ETC
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TRUE LAT CONE-MAG

                           
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Magnification = increase OID

 Anatomy of the Breast 36

 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
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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
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See Mammo Study Guide

TDLU ?

COOPER’S Ligaments
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 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)
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 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
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 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)
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Breast Scintomotography
Isotope matches tumor to node involvement

More on Breast Pathology & Procedures next lecture…..

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Quadrants of the breast 44
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TYPES OF
BREAST TISSUE
GLANDULAR STROMAL
 DUCTS
 FATTY TISSUE
 LOBES
 CONNECTIVE
 LOBULES
 TDLU
TISSUE
 (COOPER’S
LIGAMENTS –
SUSPENSATORY
 MOSTLY SEEN UPPER
OUTER QUADRANT LIGAMENTS
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Breast Classifications

Breast Changes with Age

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Fibro-glandular Breast
 Fibro-glandular
 Dense with very little

fat
 Females 15-30 years of

age
 Or 30 years or older

without children
 Pregnant or lactating
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Fibro-fatty Breast
 Fibro-fatty
 Average density

 50% fat & 50%

fibro-glandular
 Women 30-50 years

of age
• Or women with 3
or more children
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Fatty Breast

 Fatty
 Minimal density

 Women 50 and

older
(postmenopausal),
men and children
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THE MALE BREAST

Male Mammography and Cancer

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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.
Gynecomastia 55

 Benign excessive development of male mammary gland

 Occurs in 40% of male cancer pt’s
 Survival rates with treatment are 97% for 5 years
Gynecomastia: 56

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
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 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.
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Position?
Best Seen ?
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male breast
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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
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male mastectomy
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THE AUGMENTED
BREAST

Difficulty with IMPLANTS

Breast Implants 63

Is it worth the risk?

Complication with Breast 64

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
Elkland Method for Imaging with 65

Breast Implants
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“PUSH BACK” TECHNIQUE

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Other Imaging of the Breast 70
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Xero mammography (early years
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OTHER CHALLENGES TO
MAMMOGRAPHY
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