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Flashcards in Breast imaging * Deck (35):
1

where is the breast base anatomically

over 2nd-6th ribs midclavicularly

2

breast is anterior to what two muscles

deep pectoral fascia and low part serrates anterior

3

when is breast imaging used

lumps
unilateral or blood stained nipple discharge
skin tethering of dimpling
signs of inflam
axillary lumps
screening

4

when should breast imaging not be used

pain
tenderness
symmetrical nodularity

5

when should someone with breast pain be imaged and which ix

associated focal/asym modulatory
USS is <40
XRM +/- >40

6

what is a mammogram

low dose x ray designed to specifically maximise contrast between the breast tissues whilst minimising radiation dose

7

why mammography

cost effect
non invasive exam
reproducible
reliably visualises microcalcificaions (<0.5mm)

8

types of mam

film/screen
digital (full field digital mammography FFDM)

9

what is a digital mam

who is digital mam best in

replaces film/screen combination
various image detectors
excellent contrast resolution

better in dense breasts,younger women

10

advantages of digital imaging

better contrast between dense and non dense tissues
shorter exam
fewer technical repeats
fewer films
easier image storage and transfer

11

indications for mam

screening
women >40 with palpable mass
to exclude/confirm malignancy and assess contralateral breast

12

when is a mam not indicated

women <40 screening or symptomatic

13

what should be present in a normal mam

skin and pores
fat of low density
glandular tissue of high density
trabeculae - think sharply defined
blood vessels +/- vascular calcifications
lymph nodes
calcifications - arteria, sebaceous glands (polo mints) eggshell curvilinear (oil cysts)

14

what are some normal calcifications seen on a mam

arterial, sebaceous glands (polo mints) eggshell curvilinear (oil cysts)

15

views for mam

mediolateral oblique (MLO)*
craniocaudal (CC)*
extended CC

laterally or medially rotated CC, rolled CCs
true laterals
axillary tail views
localised compression or paddle views
magnification views

16

MLO

best single view
table at 45 degrees off vertical
XR beam perpendicular to long axis breast
quality criteria for adequacy

17

CC

table horizontal
nipple in profiles
shows medial and most of lateral tissue not axillary tail

18

paddle view

very firm localised compression
less scatter more contrast
demonstration of bodies of mass

19

magnification views

for micro calcification
CC and lateral views
x 1.2 -2.0

20

breast density in normal mams

20% aged 30 have fatty breasts
40% aged 80 have dense breasts

21

BIRADS parenchymal patterns

a. nearly all fat
b. scattered fibroglandular densities (25-50%)
c. heterogeneously dense (51-75% glandular)
d. extremely dense (>75% glandular)

22

features of malignant calcifications

clutters or segmental
scattered or diffuse r usually benign

rhomboid forms

linear/branching/Y shaped forms

23

USS indications

characterisation of mamographic findings
palpable lesions in women <40
nipple discharge
breast implants or augmentation
inflam conditions such as abscess
evaluation of response to chemotherapy

24

USS equipment

high centre frequency 12-13MHz
linear phased array transuducer

25

cystic lesions

cysts - fluid collections
clustered cysts
complex cysts
aspirate

26

solid nodules that are benign

circumscribed
hypo echoic/hyperechoic
wider than they are tall
homogenous
peripheral/no vascularity
often multiple

27

solid nodules that are malignant

poorly circumscribed
hypoechoic
heterogeneous
taller than they are wide
speculate
oedema/peritumoral fat

28

types of elastography

MRI based
USS based

29

USS based elastography

sonoelasticity vibration)
single/multi step compression
sheer wave elastography

30

devices for vacuum assisted biopsy

mammotome
SUROS
EnCor

31

disadvantages of mam

decreased sensitivity in dense breasts so in over 50s

32

advantages of MRI

good contrast
no compression
no ionising radiation
accuracy independent of breast density

33

MRI contraindications

cardiac pacemakers, cochlear implants, ferromagnetic aneurysm clips, renal impairment
pregnancy, lactation

34

MRI indications

implants
diagnosis of malig dx
staging
residual disease
response assessment - chemo
recurrent disease
screening

35

MRI indications for screening

high risk groups:
previous irradicaition
BRCA 1, 2, TP53 mutation
personal history of breast cancer