Sonography Flashcards
(112 cards)
1
Q
What are the two approaches to breast sonography in the diagnosis of disease?
A
- targeted
2. whole breast
2
Q
🎗 This is when BUS is used to eval only a specific area of the breast, usually as a follow up to mammography.
A
Targeted BUS
3
Q
Besides diagnosis, what’s the other use of BUS?
A
to guide interventional procedures with precise accuracy
4
Q
How many indications for breast sonography can you name? (15 total)
A
- eval masses as cystic or solid
- f/u to mammo
- eval masses in <30 yo women
- eval masses in pregnant or lactating women
- eval dense breast tissue
- eval mass seen in only 1 view in mammo
- eval inflammation
- eval irradiated breast
- eval augmented breast
- eval axillary lymph nodes
- eval nipple discharge
- eval when mammo isn’t possible
- serial eval of a benign mass
- eval the male breast
- guide interventional procedures
5
Q
Before beginning the scan, the sonographer should… (4)
A
- review priors,
- obtain a patient history,
- make a visual inspection, and
- note any palpable lumps.
6
Q
🎗 Describe the ideal patient positioning for BUS.
A
- supine or supine oblique
2. with ipsilateral arm above the head
7
Q
🎗 The right breast is best evaluated in ___ position. The left breast is best in the ___ position.
A
right = LPO (left posterior oblique) left = RPO (right posterior oblique)
8
Q
🎗 The ___ aspect of the breast is effectively evaluated with the patient in supine position.
A
medial aspect
9
Q
🎗 For ___ patients, lateral lesions may require steep oblique or decubitus positions.
A
larger breasted
10
Q
🎗 How much transducer pressure should be applied during scanning and why?
A
moderate, helps eliminate artifacts
11
Q
🎗 What scan planes are used in BUS?
A
sag & trans and rad & anti-rad
12
Q
🎗 Which scan plan is parallel with the ducts?
A
Radial
13
Q
🎗T/F? Radial is perpendicular to the ducts.
A
FALSE, anti-radial
14
Q
🎗 Which scan plane does AIUM recommended for BUS?
A
Radial
15
Q
Describe 3 o’clock transverse in rad/anti-rad.
A
3 o’clock radial
16
Q
Describe 6 o’clock transverse in rad/anti-rad.
A
6 o’clock anti-rad
17
Q
Describe 12 o’clock sagittal in rad/anti-rad.
A
12 o’clock radial
18
Q
Describe 9 o’clock sagittal in rad/anti-rad.
A
9 o’clock anti-rad
19
Q
If you find a lesion while scanning in sag/trans, you should…
A
switch to rad/anti-rad to assess the ducts.
20
Q
What does SA denote in a BUS label?
A
subareolar region
21
Q
What does AX refer to in a BUS label?
A
axillary region
22
Q
123 Method: Does it indicate distance or depth?
A
distance from the nipple
23
Q
123 Method: Which number is closest to the nipple?
A
1
24
Q
ABC Method: Does it indicated distance or depth?
A
depth
25
ABC Method: Which letter is deepest?
C
26
🎗 Why use a stand-off pad?
to improve focusing and greater detail in the superficial layers of the breast when using a linear probe (not matrix)
27
🎗 A stand-off pad improves imaging of: (6)
1. superficial tumors or cysts
2. superficial vessels
3. superficial ducts
4. skin lesions
5. skin thickening
* * 6. scanning surgical specimens**
28
🎗 What's the ideal stand-off pad thickness for breast imaging?
1 cm. This places the elevation plane focus of a 10MHz transducer at approx 0.5 cm depth within the breast.
29
🎗 T/F? Younger women are more likely to have tissue that appears hyperechoic.
True
30
🎗 T/F? Older women tend to have tissue that appears hyperechoic.
False
31
🎗 T/F? Lactating women will have breast tissue that appears more hyperechoic.
True
32
🎗 T/F? Very thin patients will have breast tissue that seems more hyperechoic.
True
33
🎗 What are the three major types of breast tissue seen in BUS?
```
Fat (superficial, intraparenchymal, retromammary)
Epithelium (TDLU and acini)
Stromal Tissue (loose - intralobular and periductal, dense - interlobular and cooper's ligaments)
```
34
Breast skin: thickness is ___ and __echoic.
0.5 - 2mm, hyper
35
Breast fat is ___echoic.
iso- or midlevel. All structures use fat's echogenicity as a reference.
36
Cooper's ligaments are ___echoic and may produce this artifact.
hyper-, shadowing (because they're so dense)
37
Glandular Epithelium is ___echoic and made up of ___.
iso to mildly hypo-, TDLUs and acini
38
🎗 Dense fibroglandular tissue is ___echoic and a combo of ___ tissues.
hyper-, glandular epithelium and connective tissue
39
Lactiferous ducts are ___echoic unless they're fluid filled. Then they're __echoic.
hypo-, an-
40
Pectoralis muscles are ___echoic and found ___.
hypo- with hyper- striations, deep to the retromammary layer
41
Ribs are ___echoic with this artifact and found ___.
hyper- with shadowing, deep to retromammary layer
42
🎗 Lymph nodes are ___echoic and ___ shaped.
hypo- cortex and hyper- hilum, kidney shaped
43
Calcifications are ___echoic.
markedly hyper-
44
Cysts are ___echoic if simple and ___echoic if complicated.
an-, hypo-
45
Benign lesions are ___echoic with similar echogenicity to __ and ___ tissues.
mildly hypo-, iso-, or mildly hyper-
| fat and epithelium
46
Malignant lesions are ___echioc and general __ echogenic than benign lesions.
mild to markedly hypo-, less echogenic
47
T/F? BUS cannot distinguish between benign and malignant.
true
48
T/F? Benign diseases tend to cross fibrous planes.
false
49
T/F? 🎗 Malignant diseases tend to cross fibrous planes.
true, growing toward the skin
50
Cancers use these two systems to infiltrate the breast.
superficial venous and lymphatic
51
Name three dynamic imaging opportunities.
1. compression
2. echo-palpitation
3. fremitus
52
🎗 How does a cyst respond to compression?
will change shape
53
🎗 How does a benign lesion respond to compression?
benign lesions tend to be soft (lipoma) so will likely change shape
internal echoes may become more uniform
54
🎗 How does a malignant lesion respond to compression?
malignant lesion tend to be hard - will not change shape
55
T/F? Debris within cysts or ducts may be better visualized with compression.
true
56
🎗 Echo-palpitation is a technique used to ___.
isolate a palpable mass.
57
Echo-palpitation allows the sonographer to ___ and to ___ simultaneously.
1. be sure to be scanning the correct structure
| 2. assess the mobility of the lesion
58
Define 'fremitus'.
the vibration of tissues during speech
59
Breakdown fremitus maneuver in BUS
1. isolate tissue in question
2. Engage power doppler
3. have patient talk or hum
4. normal tissue will vibrate creating a signal
5. tumors do not vibrate or create a signal
60
Fremitus maneuver is especially helpful evaluating: (5)
1. normal fat lobules
2. normal tissue vs isoechoic lesion
3. ill-defined borders
4. non visualized posterior margin
5. benign vs malignant characteristics
61
What's the main benefit of using 3D breast imaging?
using the coronal plane to identify spiculation
62
What are the limitations of hand-held ultrasound? (3)
1. operator skill level
2. exam variability
3. long exam times
63
What are the benefits of Automated Breast Ultrasound? (4)
1. decreased reliability on operator skill level
2. images the entire breast
3. displays coronal plane
4. decreased exam time
64
Name the three sonographic features of benign breast disease.
1. rounded (cysts)
2. oval/ellipsoid (benign tumors)
3. horizontal orientation (wider than tall)
65
🎗 T/F? Benign tumors tend to grow within or along the tissue plane.
true
66
Smooth, well-defined, and circumscribed margins indicate that the tumor is ...
... displacing adjacent tissues rather than invading them.
67
Why is a pseudocapsule indicative of a benign process?
Pseudocapsules are caused by the compression of adjacent tissues. Malignant processes would invade instead of compress.
68
What kinds of echogenicity suggest benign breast disease? (4)
1. anechoic (cyst)
2. hyperechoic (lipoma)
3. *isoechoic (solid benign)
4. *homogeneous
* sometimes
69
Name two artifacts that suggest benign breast disease.
1. acoustic enhancement
| 2. edge shadowing
70
Enhancement artifact offers good ___ of the posterior tumor wall.
visualization
71
What kind of doppler flow do benign solid masses demonstrate?
little to none
| maybe just a stalk/stem or feeder vessel
72
Ducts generally measure ___ mm and ___ in size as they run toward the nipple.
less than 3 mm; increase
73
🎗 What normal conditions might cause duct dilation or ectasia?
1. lactation
2. 3rd trimester
3. peri-menopausal changes
74
What abnormal conditions might cause duct dilation or ectasia?
mastitis, fibrocyctic changes, papillomas, ductal carcinomas, papillary cancinomas
75
T/F? Large calcifications are typically malignant.
FALSE, they are a benign characteristic
76
Scarring, necrosis, hemorrhage, cysts, or fibroadenomas are benign causes of ___.
calcifications.
77
🎗 As the lymph node becomes more fatty, the __ thins and the __ is more prominent.
cortex; hilum
78
Size of a normal lymph node?
less than 2 cm
79
Normal cortical thickness of a lymph node?
less than 3 mm
80
T/F? Lymph nodes have low resistive doppler waveforms.
true
81
Name the two sonographic features of malignant breast disease.
1. irregular shape
| 2. vertical orientation
82
🎗 The vertical orientation of malignant disease might also be described as...
taller-than-wide
AP>Length
Depth>Width
83
🎗 Why are malignant processes vertical instead of horizontal?
Because they're invading through tissue planes
84
Describe margins with multiple small (<2mm) lobulations.
microlobulation
85
Describe obscured or indistinct margins.
ill-defined
86
🎗 Describe irregular jagged margins.
angular (highly sensitive for malignancy)
87
Describe margins with straight lines which radiate from the center of a tumor.
spiculated (most specific for malignancy)
88
🎗 Describe the extension of a tumor into a duct coursing TOWARD the nipple.
duct extension
89
🎗 Describe the extension of a tumor into a duct coursing AWAY from the nipple (tends to involve multiple ducts).
branch pattern
90
What plane must you be in to assess tumor extension?
radial
91
T/F? Malignant processes will have a thick, echogenic border.
true
92
🎗 What's desmoplasia?
The fibrotic host response to tumor invasion (the development of a thick border to try and contain the disease)
93
A malignant process tends to be __echoic.
mildly to markedly hypoechoic
94
T/F? Malignant processes will be homogeneous.
FALSE, heterogeneous (excepting complex cysts and fibroids)
95
🎗___ may cause limited or lack of visualization of the posterior tumor wall.
shadowing
96
T/F? Most solid, malignant tumors demonstrate some degree of shadowing
true
97
🎗 What common benign structure in the breast tissue may cause shadowing?
cooper's ligaments
98
What less common benign structures may cause shadowing? (3)
calcified fibroadenoma, radial scar, fat necrosis
99
This is the ability of a malignancy to develop new blood vessels
angiogenesis
100
What benign phenomenon may mimic a malignancy's increased blood flow?
inflammation
101
Is a malignancy's increased blood flow on the periphery or internal to the structure?
BOTH
102
T/F? Conventional and power doppler are reliable ways to distinguish benign from malignant.
FALSE
103
🎗Which usual layer do tumor vessels lack?
basement membrane or adventita
104
Name 4 examples of malignancy crossing into superficial planes.
1. skin dimpling
2. skin thickening
3. nipple retraction
4. retraction of cooper's ligaments
105
T/F? malignancies only cross into superficial planes not deep ones.
FALSE
106
Which benign processes interrupt tissue planes?
inflammation and trauma
107
T/F? Sagittal scanning should be performed to assess duct extension and branch pattern
FALSE, radial
108
Are the microcalcifications associated with malignancy more likely to be seen in ultrasound or mammography?
mammography
109
At what measurement is a lymph node considered enlarged?
greater than 2 cm
110
At what measurement is a lymph node considered to have cortical thickening?
greater than 3 mm
111
What three qualities do malignant lymph nodes possess?
1. loss of fatty hilum definition
2. microcalcifications
3. high resistive doppler waveform
112
🎗 As a lymph node becomes cancerous, it generally ___ and loses ___.
enlarges, loses definition of the fatty hilum
