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Specialized Gen Rad > Week 12 > Flashcards

Week 12 Flashcards

1
Q

where do most breast diseases develop in

A

glandular parenchyma separated from underlying muscle fascia by retroglandular fat

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2
Q

optimum mammo is achieved by

A
  • pulling breasts away from chest wall
  • compressed appropriately
  • immobilized
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3
Q

what does CC & MLO view show

A

CC = outer & inner quadrants
MLO = superior & inferior quadrants

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4
Q

importance of compression

A

o Reduce dose, motion, scatter, tissue superimposition, thickness
o Improve contrast, resolution
o Separates glandular tissue

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5
Q

what does CC view visualize

A

all but lateral / axillary portion of breast

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6
Q

IR & CR position for CC view

A
  • IR horizontal
  • CR superior to inferior
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7
Q

what is CC view used to locate abnormality

A

locate abnormality medially/laterally; cannot determine if superior or inferior

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8
Q

Bucky of CC view raised to level of __

A

neutral infra-mammary fold

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9
Q

what happens if the bucky used for CC view is raised too high/low

A

o Too low = too much pressure
o Too high = back of breast not imaged

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10
Q

image critique of CC view

A

o Nipple in profile & centered
o No skin folds
o Medial & as much lateral portions of breast included
o PNL measures within 1 cm of MLO of visualization of pectoral muscle

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11
Q

6-10% of missed cancer due to ___

A

chest wall not included

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12
Q

what is MLO view used to visualize

A

maximum amount of breast in single view

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13
Q

IR & CR position for MLO view

A

IR 30 – 60 degrees from horizontal or parallel to pectoral muscle;

CR superomedial to inferolateral

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14
Q

Bucky of MLO view raised to level of __

A

axilla

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15
Q

how to open inframammary fold

A

pulling abdominal tissue down

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16
Q

MLO image critique

A

o Nipple in profile
o No skin folds
o Entire breast from axilla to IMF
o Open IMF
o Deep and superficial tissues separated
o Pectoral muscles wide superiorly with convex anterior border extending to / below PNL
o Fat visualized posterior to all fibroglandular tissues

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17
Q

what should be the priority for breast mammos

A

Breast tissue should be seen as much as possible ideally with nipple in profile but if not possible, add extra view for nipple in profile

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18
Q

what is the labelling sequence of mammo views

A

laterally > technique/view > position

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19
Q

common positioning errors for MLO

A
  • Poor visualization of posterior tissue
  • Sagging breast
  • Inadequate pectoralis major visualized on image
  • Excessive exaggeration in CC
  • Skin folds
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20
Q

what is the importance of visualizing posterior tissue

A

prevent missing diagnosis of cancer

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21
Q

sagging breasts are due to

A

failure to do up and out movement

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22
Q

Inadequate pectoralis major visualized on image due to

A

incorrect angulation / positioning

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23
Q

Excessive exaggeration in CC is due to

A

too much medial / lateral parts shown = nipple not centered

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24
Q

skin fold errors are due to

A

failure to smoothen breast or open up IMF

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25
Q

how to counter small breasts

A
  • IR angled 5 – 10 degrees laterally for CC view
  • MLO bucky must not be raised too high
  • manual setting of exposure as breast cannot cover AEC chamber
  • MLO angulation to 70 degrees
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26
Q

how to counter large breasts

A
  • use larger compression paddle,
  • more than 1 exposure needed,
  • reduced angulation for MLO
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27
Q

how to counter prominent sternum

A

rotate thorax medially

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28
Q

how to counter protuberant abdomen

A

limits visualization of posterior & inferior tissue for MLO views = reduce angulation

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29
Q

how to counter kyphotic patients

A

limits visualization of posterior tissue in CC & seated instead

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30
Q

how to counter prominent pectoral muscles

A

push back pectoral muscles for more compression

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31
Q

how to counter patients who cannot stand

A

specialized mammo chair

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32
Q

how to counter patients with frozen shoulder

A

use LMO done instead of MLO

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33
Q

how to counter patients with breasts implants

A

conventional 4 views and Eklund technique / pinch view

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34
Q

how to counter patients with pacemaker at upper inner quadrant

A

do LMO instead of MLO to avoid compressing pacemaker

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35
Q

MLO

A

mediolateral oblique

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36
Q

CC

A

craniocaudal

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37
Q

ML / LM

A

mediolateral / lateromedial

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38
Q

M

A

magnification

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39
Q

XCCL

A

exaggerated craniocaudal

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40
Q

CV

A

cleavage

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41
Q

AT

A

axillary tail

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42
Q

TAN

A

tangential

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43
Q

RL

A

rolled lateral

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44
Q

RM

A

rolled medial

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45
Q

RS

A

rolled superior

46
Q

RI

A

rolled inferior

47
Q

FB

A

caudocranial

48
Q

LMO

A

lateromedial oblique

49
Q

SIO

A

superolateral - to - inferomedial oblique

50
Q

ID

A

implant displaced

51
Q

RCCID

A

right craniocaudal implant displaced

52
Q

RMMLO

A

right magnification mediolateral oblique

53
Q

LCCRL

A

left craniocaudal rolled lateral

54
Q

what is the criteria for moderate quality mammography

A
  • all breast tissue imaged
  • correct ID
  • good compression
  • no artifacts
  • no skin folds
  • symmetrical
55
Q

what is the criteria for good quality mammography

A

must have:
- all breast tissue imaged
- correct ID
- good compression
- correct exposure
- no movement
- correct processing

varied for these:
- no artifacts
- no skin folds
- symmetrical

56
Q

purpose of spot compression

A

Using small compression device to locate lesion and distance from PNL

57
Q

purpose of magnified view

A
  • To differentiate benign from malignant lesions for better evaluation of margins & architectural characteristics

-Better delineation of number, distribution and morphology of calcifications

58
Q

purpose of exaggerated CC view

A
  • Find lesions in deep outer portion of breast including most of axillary tail
  • Lateral views used to triangulate exact lesion location & if abnormality is real or not
59
Q

purpose of cleavage view

A

used when most medial tissue of breast not imaged enough

60
Q

purpose of rolled view

A

Done to separate superimposed glandular tissues

61
Q

what are the 2 images used in contrast enhanced spectral mammography

A

1 regular mammo & 1 showing post contrast recombined image to assess tumor neovascularity

62
Q

use of fine needle aspiration

A

sample sus nodules & pus

63
Q

use of stereostatic biopsy

A

biopsy of indeterminate lesions on mammos

64
Q

use of US biopsy

A

biopsy of indetermineate lesions on mammos

65
Q

use of hookwire localization

A

aid surgical removal of lesion on mammo/US but cannot be felt by surgeon

66
Q

when is mammography used

A

for women 30 and older

67
Q

when is US used

A

For Palpable / mammographic findings

68
Q

why is US controversial

A

low positive predictive value of findings

69
Q

when is MRI used

A

Dedicated coils used prior & following non-iodinated contrast

70
Q

when is MRI spectroscopy used

A

Addition to standard MRI to evaluate chemical composition of lesion

71
Q

pros of mammogram

A
  • Widespread availability
  • Accurate
  • Inexpensive
72
Q

cons of mammogram

A
  • Dose
  • Limited specificity & sensitivity especially in denser breasts
73
Q

pros of US

A
  • Widespread availability
  • Sensitive
  • Inexpensive
74
Q

cons of US

A
  • Limited specificity
  • Operator dependent
75
Q

pros of MRI

A
  • Sensitive
  • Specificity
  • Independent of breast tissue density
76
Q

cons of MRI

A
  • Expensive
  • Limited by weight & body size
  • Cannot do for those with pacemakers
  • Cannot perform in open units
  • Least comfortable despite lack of compression
77
Q

pros of MRI spectroscopy

A

specificity

78
Q

cons of MRI spectroscopy

A
  • Only works for larger lesions (>1 cm)
  • Lack of research
79
Q

why should patient remove talcum/powder

A

mimics microcalcifications

80
Q

beekley skin marker N-spots

A

pellet shaped for nipple

81
Q

beekley skin marker A-spots

A

triangle shaped for palpable mass

82
Q

beekley skin marker O-spots

A

circular shape for moles

83
Q

beekley skin marker S-spots

A

line shaped for surgical scars

84
Q

what is the angle of the flexion where the breast tissue meets the chest wall below the breast?

A

inframammary fold

85
Q

the breast is firmly attached to the deep facia via _____ _____

A

suspensory ligaments

86
Q

largest portion of glandular tissue is in the central and upper outer quadrant of the breast and extends into the _____

A

tail of Spence/axillary tail

87
Q

where are the largest number of cancers found?

A

tail of Spence/axillary tail

88
Q

what keeps breast perky?

A

coopers ligaments

89
Q

what views can coopers ligaments be seen on?

A

CC may see on MLO or LM

90
Q

largely responsible for maintaining the shape and configuration of the breast

A

coopers ligaments

91
Q

what do Cooper’s ligaments appear as on mammograms?

A

lines from skin projecting to chest wall

92
Q

hold milk producing cells

A

glandular tissue / mammary glands

93
Q

refers to a thickening or the density of breast tissue

A

fibrous tissue

94
Q

lobule size depends on what?

A

hormone changes

95
Q

what two things are important in gauging the stage of a woman’s breast cancer?

A

mammary glands and ducts

96
Q

what does staging depend on?

A

cancer location and affected areas

97
Q

where does cancer begin on a cellular level?

A

luminal epithelium

98
Q

*the breasts are almost entirely fatty
*fatty replaced <25% dense

A

BIRADS A

99
Q
  • there are scattered areas of fibroglandular density
  • 25%-50% dense
A

BIRADS B

100
Q

the breast are heterogeneously dense which may obscure small masses

the fibrous tissue is prevalent throughout the breast, but not clustered together

A

BIRADS C

101
Q

the breast are extremely dense, which lowers the sensitivity of mammography

the highest category of breast density

A

BIRADS D

102
Q

what view best demonstrates medial tissue?

A

CC

103
Q

what is the projection limitation of the craniocaudal view?

A

lateral tissue might miss tail of Spence

104
Q

what position best demonstrates lateral tissue?

A

MLO

105
Q

what is the projection limitation of the MLO view?

A

medial tissue

106
Q

what shape do you want the pectoral muscle to have in the MLO view?

A

convex

107
Q

a breast tumor that is __ inch in size has already metastasized

A

2cm

108
Q

2 methods of localization

A

quadrant system and clock system

109
Q

oophorectomy

A

ovaries removed

110
Q

hysterectomy

A

uterus removed

111
Q

what appearance does the breast have if failed to do proper up and out movement

A

camel nose

112
Q

reject rate

A

3%

Specialized Gen Rad (13 decks)

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