MAMMOGRAPHY LECTURE 1 rev 2010 Positioning Anatomy RADIOGRAPHIC

MAMMOGRAPHY LECTURE #1 rev 2010 Positioning & Anatomy RADIOGRAPHIC IMAGING OF THE BREAST RTEC 255 -Week # 3 D. Charman, M. Ed. , R. T. (R, M) 1

2 Mammograms don’t look fun but they can save a life!

Man – o - gram 3

A mammogram can find breast cancer when it is very small -- 2 to 3 years before you can feel it. n No screening tool is 100% effective. Good quality mammograms can find 85 -90% of cancers n Some cancers are not found until they reach this size A mammogram can find cancer when it is only this size 4

Do it for those you love…. And who love you 5

POSITIONING Routine Images aka “screening mammo” (not screaming) n. CC - cranio caudad n. MLO – mediolateral oblique 6

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9 More on MAMMO Equipment – week 8 With Xray & Mammo QC

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14 Compression Important: Evens Density of Breast Reduces Motion AEC choice depends of size and composition of breast

15 CC

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Marker? Which side is axilla? 17

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MLO – RT BREAST 21

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30 POSITIONING CC – CRANIOCAUDAD n MLO – MEDIAL LATERAL OBLIQUE n “TRUE” LATERAL n ETC n

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32 TRUE LAT CONE-MAG

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36 Magnification = increase OID

Anatomy of the Breast n n Vary in shape & size Cone shaped with the post surface (base) overlying the pectoralis & serratus muscles n Axillaries tail extends from lat. base of the breasts to axillaries fossa n Tapers ant. from the base ending in nipple, surrounded by areola 37

38 Female Breast n Consists of 15 -20 lobes u Divide into several lobules u Lobules contain acini, draining ducts and interlobular connective tissue. u By teenage years each breast contains hundreds of lobules

39 See Mammo Study Guide TDLU ? COOPER’S Ligaments

40 n n n Breast profile: A ducts B lobules C dilated section of duct to hold milk D nipple E fat F pectoralis major muscle G chest wall/rib cage Enlargement: A normal duct cells B basement membrane C lumen (center of duct)

41 n n n n Lymph node areas adjacent to breast area. A pectoralis major muscle B axillary lymph nodes: levels C axillary lymph nodes: levels D axillary lymph nodes: levels E supraclavicular lymph nodes F internal mammary lymph nodes

Lymph Nodes n Lymphatic vessels of the breast drain laterally and medially u Laterally into the axillary lymph nodes (C & D) t 75& drain toward axilla u Medially into the mammary lymph nodes t 25% toward mammary chain (F) 42

43 Breast Scintomotography Isotope matches tumor to node involvement More on Breast Pathology & Procedures next lecture…. .

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Quadrants of the breast 45

TYPES OF BREAST TISSUE GLANDULAR n DUCTS n LOBES n LOBULES n TDLU n MOSTLY SEEN UPPER OUTER QUADRANT 46 STROMAL n FATTY TISSUE n CONNECTIVE TISSUE n (COOPER’S LIGAMENTS – SUSPENSATORY LIGAMENTS

3 Tissue Types 47

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Breast Classifications Breast Changes with Age 50

51 Fibro-glandular Breast n Fibro-glandular u Dense with very little fat u Females 15 -30 years of age t Or 30 years or older without children u Pregnant or lactating

52 Fibro-fatty Breast n Fibro-fatty u Average density t 50% fat & 50% fibro-glandular t Women 30 -50 years of age • Or women with 3 or more children

53 Fatty Breast n Fatty u Minimal density u Women 50 and older (postmenopausal), men and children

THE MALE BREAST Male Mammography and Cancer 54

55 Male Breast Cancer Statistics: According to the American Cancer Society, about 0. 22 percent of men’s cancer deaths are from breast cancer. n This disease is 100 times more common in women than it is in men. n Thanks to greater awareness and better treatments, the survival rates for both men and women are on the rise. n

Gynecomastia n n n Benign excessive development of male mammary gland Occurs in 40% of male cancer pt’s Survival rates with treatment are 97% for 5 years 56

Gynecomastia: Prominent Male Breasts n n n n 57 Most Common Causes : Puberty (hormonal growth and changes during adolescence) Estrogen exposure (female hormone present in the body and the environment) Androgen exposure (body-building hormones) Marijuana use Medication side effects (older men) One symptom of Klinefelter's syndrome, a condition in which a male has an extra X chromosome

Gynecomastia 58 is a benign male breast (non-cancerous) condition n Some men who have prominent breasts, or uneven breasts, often feel some embarrassment about their body image. n This condition can also cause emotional conflict over sexual identity. n

59 Position? Best Seen ?

60 male breast

61 Male Mammography 1300 men get breast cancer per year u 1/3 die n Most are 60 years or older n Nearly all are primary tumors n Symptoms include: u Nipple retraction u Crusting u Discharge u Ulceration n

62 male mastectomy

63 THE AUGMENTED BREAST Difficulty with IMPLANTS

Breast Implants Is it worth the risk? 64

Complication with Breast Augmentation 65 Mammography has a 80 -90% true positive rate for detecting breast cancer in those women without implants u Decreases to 60% with implants t Because 85% of breast tissue is obscured n More images are needed than the standard two projections n There is a risk of rupturing the implant n Loss of sensation from surgical scars n

Elkland Method for Imaging with Breast Implants 66

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68 “PUSH BACK” TECHNIQUE

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Other Imaging of the Breast 71

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Xero mammography (early years 73

OTHER CHALLENGES TO MAMMOGRAPHY 74

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