 mamography is an

x-ray technique
using low voltage x-
rays to study breast
and breast tissue.
 its basic principal is
to rule out breast
cancer.
Types of Mammography

Screening mammography is performed on asymptomatic

women with the use of a two-view protocol, usually medial
lateral oblique and cranial caudad, to detect an unsuspected
cancer.

Diagnostic mammography is performed on patients with

symptoms or elevated risk factors. Two or three views of
each breast may be required.
Risk Factors for Breast Cancer

• Age: The older you are, the higher the risk.

• Family history: Mother, sister with breast cancer
• Genetics: Presence of the BRCA1 or BRCA2 gene
• Breast architecture: Dense breast tissue, obesity
• Menstruation: Onset before age 12 years
• Menopause: Onset after age 55 years
• Prolonged use of estrogen
• Late age at birth of first child or no children
• Previous radiation therapy to the chest at an early age.
• Education: Risk increases with higher level of education.
• Socioeconomics: Risk increases with higher
socioeconomic status.
Advantages of Vigorous Compression
Immobilization of breast ……Reduced motion blur

Uniform thickness….. Uniform x-ray exposure of the image

receptor

Reduced scatter radiation…… Improved contrast

resolution

Shorter OID………. Improved spatial resolution

Thinner tissue………. Reduced patient radiation dose

1. Acquired in less than a minute as compared to
conventional mammography .
2. Spot view digital systems are available to help
guide breast biopsy .
3. Superior contrast resolution especially in dense
breast tissues
4. Offers the possibility of three dimensional breast
tomography using relatively low doses .
Craniocaudal view (CC view)

45* Medio lateral Oblique (MLO view)/

Lundgren’s view

RCC LCC RMLO LMLO

 Best view to image all of the breast tissue and the pectoral muscle .

 The MLO view is taken from the center of the chest to

outward.
 The C-arm of the mammographic unit is rotated to 45 degree so that
the cassette is parallel to the pectoral muscle .

 The film holder is kept high up in the axillary fossa and the patient s
arm is abducted at the elbow by 80degrees.

 The xray beam enters the breast from the medial side –compression
is applied to the pectoralis major muscle .
The CC view is taken from above the breast.

The casette is placed under the breast at the level of the

inframammary fold .

The breast is then pulled until the inframammary fold is taut .

Compression is applied and Xray beam is directed vertically

from above .

Postero medial aspect should also be included .

1. Lateral projections (mediolateral/lateromedial)
2. Extended craniocaudal projection
3. Cone down compression view
4. 90 degrees lateral view and angled craniocaudal
views
5. Tangential views in palpable masses
6. Spot and magnification views
7. Cleavage view
8. Modified compression technique .
 Magnification mammography is routinely
performed following an initial mammogram.
Its purpose is to magnify the breast or a
specific area of breast tissue to better
evaluate a previously unclear abnormality.
 Spot compression (also called cone
compression) may be used to get a closer view of
one area of the breast during diagnostic
mammography.

 To get a clearer image, a small compression plate

separates the breast tissue in an area and pushes
normal breast tissue out of the way.
CLEAVAGE VIEW
The cleavage view, also called the valley
view, shows the medial breast tissues adjacent
to the sternum. The medial breast tissue is
almost always completely included in the CC
view.
 LAT LCV LFB LLM
Left Axillary Left Cleavage Left From Below Left Lateromedial
Tail

LLMO LML LRL LRM

Left Left Medio lateral Left Roll Lateral Left Roll Medial
Extended CC
view medially
rotated
 Mammogram: Changes in
breast tissue

• Calcification: macrocalcification
microcalcification
• Mass
• Breast density
Calcification: Macrocalcification

• Due to changes in breast caused by aging of

breast arteries, old injuries or inflammation
• Coarse/ large Calcium deposit
• Seen in 1 0f 10 women under 50 and about half
over 50
These deposit are related to Non-
cancerous condition and do not require
biopsy
 Calcification: Microcalcifiation

• Tiny specks of calcium

• If seen it’s a matter of concern though not
necessarily it is cancer or does not mean
biopsy
 Mass
• Mass with or without calcification
• Noncancerous mass:
Cystic– fluid filled sacs/ simple cyst
Solid – Fibro adenoma
• Complex or mixed mass: suspect cancer
needs FNAC or biopsy
Breast ultrasound is complementary
Mass on mammogram
Mass on mammography
Mass on mammography
FNAC under ultrasound
guidance
 Breast density
• Density is based on
: how much fibrous and glandular

tissue
: how is the distribution within breast
tissue
: how is breast made up of fatty tissue
Dense breasts are not abnormal but they
are linked to higher risk of breast
cancer
 Findings on mammogram
• Primary signs of breast cancer may
include spiculated masses or clustered
pleomorphic microcalcification

• Secondary signs of breast cancer may

include asymmetrical tissue density, skin
thickening or retraction or focal distortion
of tissue
Mammographic
abnormalities which may
indicate breast cancer

Spiculated
mass
Tissue density on mammogram
Fatty versus dense
1: simple Breast cyst:
 It is ultrasonic image

of breast simple
breast cyst.
 well marginated.
 present with

posterior shadow.
2: Complex breast cyst:
 it has same

characteristics as
simple cyst but is not
as clear
as simple cyst.
 breast cyst on
mamography:
 Ductogram
Galactogram

• Sometimes it is done to find the cause of

any worrisome nipple discharge
• Through a very thin plastic tube contrast is
put in which outlines the duct on x-ray and
can show whether there is a mass inside
the duct
 Galactogram shows
mammary duct
ectasia
mamographic
image: