Mammo Flashcards
(27 cards)
what is mammography
Is the radiographic examination of breasts (usually both) using low energy X radiation (typically around 30kVp)
May be performed either for diagnosis of a clinical finding or for screening of women aged 50-70 yrs. in UK (Age extension RCT trial to include 47-73yrs)
why is the machine offset
The whole tube assembly is off set to reduce dose to the torso and directing the useful x-ray beam to the breast tissues.
what type of kVP is requried and why
Require low kVp as breast tissues are very similar and it is important to see small differences between them.
why is compression applied to the breasts
Compression is applied to the breast to spread out the breast tissues, reducing dose and scatter, it also immobilises the breast reducing movement unsharpness (blur) and spread out over lapping tissues, making it easier to differentiate between normal and abnormal structures.
describe mammo technique - CC projection
- Patient stands at medial edge and rests against faceguard (protective cone.)
- Elevate breast to ensure minimal drag from compression and raise or lower C-arm to comfortable position.
- Breast pulled forward to include medial edge and as much lateral edge tissue as possible.
- Nipple in profile but not to the detriment of the posterior breast tissue. One view must have nipple in profile or a second nipple view must be taken.
- Compression applied
- Mirror images required
why is it important they are mirror images
aids film reading easier to pick up asymmetric densities
describe mommo technique for MLO projection
Assembly adjusted to individual physique, slim woman steeper 50-60 degrees, average angle 45-55 degrees Nipple must be in profile otherwise could hide SAR lesion.
Corner of detector in posterior border of axilla.
Lift breast towards medial and superior borders, to afford better compression and lessen painful drag on the breast.
Eliminate skin folds as could easily hide calcification.
Compress until taut if woman comfortable. Increased pressure beyond this contributes very little to the image
refferal pathway
lumps pain nipple discharge nipple inversion change in contour faily history
refferal pathway - lumps
Any new lump or thickening of tissue. Cysts can occur almost overnight therefore short history of duration likely benign.
refferal - pain
Can be cyclical or continuous but can be persistent and severe and may require drug treatment. Imaging if focal pain to rule out underlying problem.
refferal nupple discharge
Mostly linked to benign conditions but if serous or bloodstained can indicate malignancy.
refferal - nipple inversion
Can be due to age changes. Slit retraction but uneven distortion likely malignancy. Eczema on nipple possible Pagets disease
refferal - chnage in contour
May be due to mass lesion distorting breast.
refferal - family history
Requires discussion for undertaking earlier screening and genetic testing for gene mutation (may need referral to Genetics.)
what is gynaecomastia
Men can develop increase in glandular tissue forming a breast lump, known as gynaecomastia commonly puberty and old age, can be caused by used of steroids, illegal drugs, prescribed medication and can be related to prostate problems, therefore the patient will also undergo a blood test
NHSBSP aims
Inviting women between 50 and 70 years (+ age expansion trial)
High quality, two view, bilateral mammography
Three yearly
Timely recall for assessment
Identification of small breast cancers
Prompt referral if cancer diagnosed
disadvantage of NHSBSP
Increased risk of radiation induced cancers
Not 100% sensitive: Small cancers can hide in dense tissue/ may not be seen maybe mammographically occult/may be minimal sign only detected in hind sight
Cancer may occur in women even with regular breast screening
Increased anxiety for women waiting for results
High levels of false positives
Potential over treatment
risk of mammo causing cancer
increased risk of radiatin induced cancers
However in the relevant age group that risk is said to be outweighed approximately 100:1 by the risk of not detecting a cancer, i.e. mammography saves 100 times more lives than it causes deaths
assessment after screening
Triple assessment
Multidisciplinary team
Rapid referral to Surgical breast team
reporting on mammograms
Reporting categorisation important:
to aid the clinician in decision making,
to standardize interpretation between radiologists
to be used in statistical analyses of mammography practice.
M1 category
normal/no significant abnormality
no significant imaging abnormality
M2 category
benign findings
image findings are bengin
M3 category
indeterminate/probably bengin
there is a small risk of malignancy, further investigation is indicated
M4
findings suspicious of malignancy
there is a moderate rish of malignancy, further investigation is indicated
