STANDARDIZATION OF MAMMOGRAPHY POSITIONING

Standardization of modern mammographic positioning techniques helps to improve image quality. We can improve the quality assurance of our departments and ensure versatile, consistent examinations. Each technologist can produce intelligent, comprehensive breast images if we all practice from the same base. Correction rather than repetition is the key.

Many certification processes involve positioning competency testing. This ensures that all certified mammographers will be practicing from a uniform standard. If part of your responsibility is department stability and unvarying excellence of mammograms then a ‘POSITIONING COMPETENCY CHECKLIST’ may be of assistance in your department. 

This type of checklist helps students to check their positioning case by case. It helps all of us check our positioning on those days when NOTHING is working. It can help clinical instructors offer helpful constructive suggestions. Positioning checklists are used to great advantage in many departments to regulate the quality of their positioning. 

Using a standard checklist lets both staff and reviewer know exactly what is required thereby making any necessary routine staff evaluations easier and way less stressful for everyone involved. 

I have a couple of really simple ‘clip and post’ checklists that can help any mammographer ‘check and correct’ her cases on the fly. I use mine all the time I hope you find them helpful too.

POSITIONING COMPETENCY CHECKLIST ‘CC’ PROJECTION

In order to include the maximum amount of breast tissue on the CRANIOCAUDAL projection, the technologist should be able to perform the following steps: 

PERFORMED STEPS	YES	NO
1. Have your patient stand facing the unit with her feet perpendicular to the bucky
2. Externally rotate the patient’s arm on the side being imaged and make sure it is relaxed at her side.
3. Determine the proper film receptor size and photocell position.
4. Stand on the medial side of the imaged breast.
5. Elevate IMF to its maximum height and adjust bucky appropriately.
6. Use both hands to lift and pull breast onto receptor.
7. Center breast over photocell with nipple in profile (if possible).
8. Anchor breast solidly with one hand and never let go!
9. Lift and drape the opposite breast over the corner of the bucky.
10. Place your arm across the patient’s back and rest it on her shoulder to relax it and keep her tilted toward the bucky.
11. Rotate the patient’s head away from the breast being imaged.
12. Have the patient incline towards the unit with her head forward and beyond faceplate.
13. With your hand still on the patient’s shoulder, loosen the skin over clavicle.
14. Pull the lateral tissue anteriorly and medially as the compression takes over.

POSITIONING COMPETENCY CHECKLIST ‘MLO’ PROJECTION

In order to include the maximum amount of breast tissue on the MEDIOLATERAL projection, the technologist should be able to perform the following steps:

PERFORMED STEPS	YES	NO
1. Have your patient stand facing the unit with her feet perpendicular to the bucky
2. Determine proper film receptor size and photocell position.
3. Determine degree of obliquity (parallel to pectoral muscle).
4. Rotate C-arm so that the long axis is parallel to the pectoral muscle.
5. Adjust height of bucky tray so that the top corner is level with the highest point of the axilla.
6. Lift arm of the side being imaged and place shoulder up and over the corner of the bucky.
7. Place corner of the bucky as high up and as far back in the axilla as possible but still anterior to the lattissimus dorsi.
8. Place the patient’s hand of the side being imaged on the C-arm, with her elbow flexed and her shoulder relaxed over the corner of the bucky.
9. Pull the breast and the pectoral as far anteriorly and medially as possible with the flat front surface of your hand.
10. Scoop breast tissue up, your hand grasping the lateral border of the breast with fingers and the medial border with thumb.
11. Hold breast up and out with the thumb supporting the base of the breast and the fingers are holding the medial aspect pointing up and out.
12. NEVER LET GO!
13. Center breast with nipple in profile if possible and apply compression starting with corner of paddle just under the clavicle.
14. With thumb and first two fingers smooth down abdominal tissue to open IMF.