Rad334 - PPT.2

Mammography and
Breast Imaging
RAD334
Introduction to Mammography
Mrs. Zahra Juma

Radiologic Technology Program – Allied Health Department
CHSS, UOB
Objectives
 To explain mammography types and discuss the screening

mammography.
 To explain breast self examination.
 To discuss patient considerations and preparation.
 To discuss patient dosage concerns.
What is your perception
of Mammography?
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.
 Screening mammography: It is typically done every year for all the

females over 40 years of age, to check the breasts for any early signs
of breast cancer.
 Diagnostic mammography: it is different from screening

mammograms in that they focus on getting more information about
a specific area (or areas) of concern usually due to a suspicious
screening mammogram or a suspicious lump.
The Need for
Screening
Screening mammograms of asymptomatic
women are vital in the early detection of breast
cancer.
Major considerations that support early detection include
the following:
 The disease is critical.
 It has a recognizable presymptomatic stage.
 There are reliable tests that exist.
 Therapy in presymptomatic stages reduces morbidity and mortality.
 Facilities are available for the diagnosis and treatment.

Breast cancer is a disease directly related to age. Therefore, as women
age, the need for mammography becomes more critical.
Guidelines for Screening Mammography
At the beginning of age 40, women are eligible for routine screening mammography
service.
 Screening mammograms are recommended for women aged 40 to 49 be done

every 1 to 2 years by all professional health organizations except the American
College of Physicians (ACP).
 Four major reasons to screen women aged 40 to 49:

• It is effective.
• Cancer tends to have a rapid growth rate in women aged 40 to 49.
• There is an increased incidence of developing cancer in women in their 40s.
• Annual screening means a reduced mortality rate.
Breast Cancer
Death
Rates for Females
in the
United States
At Risk Patients for Breast Cancer
 Being a female.
 Previous incidence of breast cancer.
 Genetic predisposition to developing the disease based on a positive

family history. bilateral cancer in such instances presents a higher risk than
unilateral cancer.
Breast Self-Examination (BSE)
 When you use your eyes and hands to determine if there
are any changes to the look and feel of your breasts.
 The vast majority (63%) of breast cancer will not be

detected by BSE until it has advanced in its growth to a size
more than 1 cm.
 Mammography is capable of detecting cancer at a much

smaller size than BSE or CBE (clinical breast examination).
 Women should still perform BSE to compensate for any

inaccuracy on the part of the mammographic findings.
Breast Self-Examination (BSE)
 The breasts are symmetrical. If a lump is discovered, there
should be a matching lump in the same location in the
opposite breast.
 The lumps may be of different sizes because the left breast
tends to be approximately 10% larger than the right; therefore,
a lump in the larger breast is expected to be slightly larger.
 Cancer in the upper half will often be felt best when examined
in the upright position.
 Cancer in the lower half of the breast will be felt best when
the patient is supine.
 Thus, the breasts should be examined in both upright and
supine positions.
 Approximately 74% of breast cancer is in the upper half of the
breast.
Fear of Radiation
 An average glandular dose is 160 mR\exposure.
 It has been estimated that 1 rad of absorbed radiation to the tissue of the breast
would increase the risk of cancer by 1%.
 A woman could have 180 mammograms done before her natural risk would
increase by that same 1%.
 The lifetime risk of death from developing breast cancer due to radiation received
during routine mammograms is cited as being equivalent to the risk associated
with traveling 2500 miles by air, 1500 miles by train, or 220 miles in a car.
“To our knowledge, no woman has ever been
shown to have developed breast cancer as a
result of undergoing mammography”
Patient
Considerations
The Examination Environment
 Creating a comfortable and relaxed environment in both

waiting and examination rooms will make the patient feel
better about the examination.
 Many facilities warm the breast tray of the x-ray unit with a
heating pad or hot water bottle; Check with the manufacturer of
the x-ray unit whether this can interfere with the reliability of automatic
exposure control (photo-timing) devices and FFDM detectors.
 The use of a cushioned pad on the breast tray. Use only

cushioned pads that have been designed specifically for mammography
and be sure that it is used for only a single examination, thus avoiding
the introduction of beam attenuation and artifacts.
About the Staff
 Discerning whether the patient has a clinical finding before
scheduling her mammogram is very important. Since the
mammogram is not 100% accurate in finding all cancers, any lump or
other symptoms identified by the patient, or her physician should be
addressed specifically. Extra views may need to be taken to verify a
diagnosis on tissue that might otherwise be overlooked because of
dense tissue or tissue overlap.
 Privacy is a very important issue that should be taken into

consideration.
 The technologist should explain the examination to the

patient and question the patient about her breast health.
Patient Preparation
Some radiologists request that their patients to prepare for a mammography
examination in terms of caffeine restriction and deodorant and powder
restriction. These can be explained before the appointment.
Caffeine Ingestion
 Caffeine and other xanthine derivatives cause breast tissue to retain fluid.
 The pressure from this fluid buildup within the breast tissue combined with
compression used during the examination can add to the discomfort that
many women feel during a mammogram.
 Caffeine’s estrogen-like effect can also cause the breast tissue to be lumpier,
which could be detrimental to a clinical examination of the breast tissue.
 Many mammography facilities have asked their patients to refrain from

consuming products that contain caffeine and xanthine derivatives 2 to 4
weeks before their mammograms.
Deodorants and Powders
 Many facilities request that their patients refrain from wearing deodorant and
body powders on the day of their mammographic examination.
 Some personal hygiene products contain minute particles of metal (such as

aluminum chlorohydrate or zinc) or calcium-like particles (as in talcum
powders).
 In modern day mammography, deodorants and powders are usually seen on a

film within skinfolds or creases, where perspiration has caused them to
become caked. These artifacts can usually be differentiated from calcifications
that typify carcinoma.
Deodorants and Powders, Continued
 Caked talcum powder is usually seen as a line that runs in a lateral-to-medial

direction, near the inframammary crease, whereas cancer calcifications will
usually run in a ductal pattern toward the nipple. Caked deodorant will usually
be found in the area of the axilla.
 Ointments or powders can also collect in the creases of a nevus or mole, or in

the nipple area.
 The decision to require patients to refrain from using these products depends
on the radiologist’s preference and expertise.
(A) Calcifications that are typical of carcinoma follow a ductal pattern toward the nipple. (B) Calcifications that
indicate caked talcum powder at the inframammary crease will be visualized in a lateral–medial pattern.
(C) Deodorant, if visualized, will be seen within skinfolds of the axilla. (D) Close-up of the axilla details
deodorant within skinfolds.
How can the examination be explained?
Your thoughts!
Concerns about Dosage
 The risk of death occurring from developing a breast carcinoma due to
radiation received during routine mammograms throughout a woman’s
lifetime shares the same risk of death as the following:
 Traveling 220 miles by automobile (New York to Boston)
 Traveling 2500 miles by airplane (New York to Los Angeles)
 Traveling 1500 miles by train (New York to Miami)
 Smoking 1.5 cigarette
 Unnecessary exposure should be avoided.

 Most women older than 40 should have only one mammographic examination
per year.
 Women younger than 35 should be referred by a physician for a mammogram
because the cellular structures of younger patients are always changing and
may be more susceptible to radiation changes.
The American Cancer Society ACS Mammography Guidelines
Women aged 40 and older should have a screening mammogram every year and
should continue to do so for as long as they are in good health. Women in their
20s and 30s should have a clinical breast exam (CBE) as part of a periodic
(regular) health exam by a health professional, at least every 3 years. After age
40, women should have a breast exam by a health professional every year.
Women at high risk (greater than 20% lifetime risk) should get an MRI and a
mammogram every year. Women at moderately increased risk (15% to 20%
lifetime risk) should talk with their doctors about the benefits and limitations of
adding MRI screening to their yearly mammogram. Yearly MRI screening is not
recommended for women whose lifetime risk of breast cancer is less than 15%.
Patient Education
 Mammography facilities are urged to educate their patients in breast self-
examination (BSE) and breast health. Patient education is offered in a variety of
ways: from a structured class on mammography and BSE to a simple pamphlet.
 Many facilities show videotapes, and others employ a nurse or other professional
to teach BSE personally to each patient. Any of these methods, or a combination
of them, is suitable and necessary.
 Each hospital, clinic, or office should decide which method is most suitable for its
clientele.
END

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Mammography and

Mrs. Zahra Juma

 To explain mammography types and discuss the screening

 Screening mammography: It is typically done every year for all the

 Diagnostic mammography: it is different from screening

 It has a recognizable presymptomatic stage.

 There are reliable tests that exist.

 Therapy in presymptomatic stages reduces morbidity and mortality.

 Facilities are available for the diagnosis and treatment.

 Screening mammograms are recommended for women aged 40 to 49 be done

 Four major reasons to screen women aged 40 to 49:

 Previous incidence of breast cancer.

 Genetic predisposition to developing the disease based on a positive

 The vast majority (63%) of breast cancer will not be

 Mammography is capable of detecting cancer at a much

 Women should still perform BSE to compensate for any

 Creating a comfortable and relaxed environment in both

 The use of a cushioned pad on the breast tray. Use only

 Privacy is a very important issue that should be taken into

 The technologist should explain the examination to the

 Many mammography facilities have asked their patients to refrain from

 Some personal hygiene products contain minute particles of metal (such as

 In modern day mammography, deodorants and powders are usually seen on a

 Caked talcum powder is usually seen as a line that runs in a lateral-to-medial

 Ointments or powders can also collect in the creases of a nevus or mole, or in

 Unnecessary exposure should be avoided.

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