Breast Imaging

Question 1

What are 7 malignant breast cancers?

Answer 1

Invasive ductal
DCIS
Lobular Carcinoma
Tubular
Inflammatory
Triple Negative
Paget’s disease

Question 2

What are 6 symptomatic clinical indications?

Answer 2

New lump
bloody nipple discharge
changes to nipple
skin dimpling
rash around nipple
skin thickening

Question 3

What are 3 asymptomatic clinical indications?

Answer 3

Family history
surgery follow-up
breast screening

Question 4

What is triple assessment clinic?

Answer 4

Clinical exam
imaging (mammogram and/or ultrasound)
Biopsy

Question 5

What is mammography?

Answer 5

Imaging modality that uses low energy x-rays specifically for imaging of breast tissue

Question 6

What does mammography practice utilise?

Answer 6

Standardized views of breasts for assessment of breast lesions

Question 7

What are 4 technical requirements of mammography?

Answer 7

High spatial resolution
contrast between cancerous tissue & normal glandular tissue
minimize radiation dose
high signal-to-noise ratio

Question 8

What are 7 parts of a mammographer?

Answer 8

Generator
x-ray tube
target
beryllium window
molybdenum filter
compression device
AEC - automatic exposure control

Question 9

What does the beryllium window do?

Answer 9

minimises absorption of radiation in tube

Question 10

What does the molybdenum filter do?

Answer 10

absorbs unwanted radiation

Question 11

What are two targets in the equipment?

Answer 11

Molybdenum
Rhodium

Question 12

What is the linear attenuation coefficient?

Answer 12

Constant that describes fraction of attenuated incident photons in monoenergetic beam per unit thickness of a material

Question 13

What is the x-ray spectrum determined by?

Answer 13

x-ray tube anode material
filter material kV

Question 14

What voltage are mammography devices?

Answer 14

24-32kV

Question 15

What are filters used for?

Answer 15

Reduce low energy components of x-ray spectrum

Question 16

Which filter is used for thicker breast tissue?

Answer 16

Rhodium

Question 17

What is a focal spot?

Answer 17

Area in anode where electrons are targeted
smaller focal spot = sharper image production
(lower energie)

Question 18

What is spatial resolution limited by?

Answer 18

Focal spot

Question 19

What acts as the AEC?

Answer 19

Detector

Question 20

What 3 things does the AEC ensure?

Answer 20

signal to noise & contrast to noise
ratios are adequate
doses are within limits

Question 21

How is full field digital mammography different?

Answer 21

X-ray film replaced by digital detector & latent image is converted into a digital data set

Question 22

What are routine projections?

Answer 22

Cranio-caudal
45-degree medio-lateral oblique

Question 23

What should the CC projection should demonstrate?

Answer 23

Whole breast
appropriate depth
nipple in profile
majority of medial & lateral
pectoral muscle on centre of film
no movement

Question 24

What should the MLO projection demonstrate?

Answer 24

Pectoral muscle to level of nipple
no skin folds
inflamammary angle clearly visible
nipple in profile

Question 25

What are benefits of breast compression?

Answer 25

More uniform breast thickness more homogenoous film density separation of structures in breast reduced thickness = reduced dose

Question 26

How much is the compression in CC and MLO?

Answer 26

70-140N CC 100-140N in MLO

Question 27

When are breast ultrasound used?

Answer 27

Symptomatic recall from mammo/MRI Image guidance of procedures assess response to treatment

Question 28

What are 4 roles of ultrasound?

Answer 28

Diagnosis staging (TNM) Guide treatment planning Assess response to treatment

Question 29

Does ultrasound need a AOC?

Answer 29

Yes - its not specific/sensitive enough to screen the breast without a palpable AOC

Question 30

When are MRIs used?

Answer 30

Screening/surveillance Increased breast density imaging characteristics of some cancers may look benign on mammograms specific cancer types

Question 31

What 2 types of breast cancer is MRI used?

Answer 31

TP53 BRCA

Question 32

What are 2 other imaging modalities used?

Answer 32

Digital breast tomosynthesis Contrast enhanced spectral mammography

Question 33

What are DBTs?

Answer 33

Low-dose projection images acquired by rotating x-ray tubes around stationary compressed breast in a limited angular range

Question 34

What is CESM?

Answer 34

Complementary breast imaging modality low energy (26-31kVp) & high energy image (45-49kVp)

Question 35

What is the MoA pf CESM?

Answer 35

IV injection of a contrast dye series of x-ray images high energy & low energy exposure (4 positions) Image examined