Wednesday, May 11, 2005

THE CC: Not always as Simple as it Seems!

OBJECTIVES

The CC view is always passed over in training as a straightforward, trouble-free projection. This is really not the case. Like many other things, it just gives the impression of being simple. I have some suggestions as to how to alleviate some of the headaches associated with achieving good CC’s on some difficult body types.


The “WEE MOUSY”


The tiny patient presents some unique problems when come to adequately demonstrating all the tissue in the CC projection.
  • Start the bucky lower than your eye tells you will be correct.
  • The small patient looks like her IMF is just about even the lower edge of her areola.
  • In reality the IMF is about equidistant with the superior portion of the breast and can be found just above the level of the 6th rib.
  • This patient’s pectoral muscle is usually thin and slightly angled up towards the lateral side of the clavicle
  • This makes the majority of her breast tissue in the tail-of Spence and mostly just skin and fat over bones on the medial side
  • Angle just slightly toward the lateral aspect on the CC (never more than 5˚), this will help loosen and raise the tiny pectoral up toward the clavicle.





The “14x17”


Who said 24x30 was the largest film size one needs for mammography. The very large patient presents her own set of logistical problems when attempting to capture all the tissue in a precise and organized manner.

Mark the breast carefully:
  • Use nipple markers
  • Use lateral and medial markers
  • Use your projection markers ALWAYS correctly at the axilla side of the image
  • Take your time and map the breast carefully. IT IS VERY EASY TO GET LOST!
  • There is nothing sadder (or madder) than a radiologist lost in a large breast
24X30 #1 ------------------------------- 24X30#2



24X30#3 ------------------------------- 24X30#4




The “MS. PANCAKE”


Ms. Pancake is very often the close companion of Mrs. 14X17 and Mme. Pretzel. Her breasts are empty and flaccid. They lay flat and unnoticed against her rib cage. How to handle this flimsy floppy tissue without wrinkles and folds can be a nightmare.
  • Use an appropriate size bucky. The pancake breasts tend to spread and spread and spread like flowing water.
  • Raise the IMF high enough but be careful of the fragile skin under this patient’s breast
  • Smooth the skin over the clavicle and slide it towards the breast
  • Flatten the tissue of the breast forward towards the nipple to smooth the wrinkle (don’t pull back toward the shoulder)
  • When the CC is in place and the skin is coerced forward; place your hands on either side of the breast and stretch the tissue flat from side to side




The “BANDEAU BATHING SUIT”


The patient with little or no demarcation between her breasts can be a real challenge. The bandeau bathing suit or Uni-Breast leaves little clue as to where the left breast leaves off and the right breast begins. It seems to be impossible to position one breast without the other one getting in the picture or pulling the breast of interest out of place. The answer of course is to work with what you are presented with and not to fight the existing anatomy.
  • Acquire a modified view angled 5˚medially when doing your CC to demonstrate the far medial tissue
  • If necessary, acquire an extra XCCL view to demonstrate the tail-of-Spence.






The “PRETZEL”


This is our most delicate and fragile patient. She is elderly, frail, bent, brittle and thin skinned. Her osteoporosis, arthritis, roto-scoliosis, kyphosis and muscular-skeletal woes make this patient a virtual puzzle to image. It seems a daunting task to obtain a CC view free of jaw, skull, shoulder, sternum or ribs. There are a few tricks that will help you and help this most vulnerable patient as well.
  • DO NOT fret about getting perfect images on this patient
  • Just demonstrate as much as you can without doing any damage
  • Angle slightly when acquiring the CC views to demonstrate tail-of-Spence and miss the chin
  • Acquire FB views to accommodate Kyphosis, if required
  • Use cornstarch or resin powder on your hands to assist with grip and protect the delicate skin
  • HANDLE WITH CARE This patient can break very easily




“PENELOPE THE BODY BUILDER”


Penelope is a very difficult client. She is large and muscular with a thick layer of adipose tissue. Her breasts are very small but she has huge thick pectoral grids and bulky upper arms. Penelope is not very agile and has trouble cooperating with the positioning. What to do, oh what to do? Our best that is all we can do.
  • Acquire 1 set of CC views on 24x30 films, slightly angled to accommodate the thick, wide pectoral muscle.
  • Acquire a 2nd set of CC views on 18x24 films to demonstrate the nipple in profile and the anterior breast tissue properly compressed.
  • WARNING Penelope often sees herself as delicate. Don't assume she is as sturdy or brave as she appears: She really is a big old Teddy Bear






“PECTORALIS CARNAVATUM” (THE PIDGEON)


Women with this sternal abnormality used to be called “chicken breasted”: Not very politically correct but descriptive. The sternums in woman with this chest configuration have sternal bodies which bow out into a convex curve. The boney protuberance between the breasts seems to crash into the compression paddle long before we get anywhere near the breast tissue. There are again a few simple tricks to work around this thorny problem.
  • Angle 3-5º medially
  • Carefully raise the breast until the paddle can clear the sternal and rib skeleton protuberance
  • Viola, the medial tissue is demonstrated with no skin abrasion, no bruising and very little patient discomfort





“PECTORALIS EXCAVATUM” (THE CROSSED HEART)


This sternal malformation has the patient’s sternum and ribs bowing in toward her spine. This presents another challenge to obtaining a good CC projection. The medial borders of the breasts are pulled together and in toward the sternum with no discernible method of getting the bucky and paddle in-between them. With a little ingenuity we can make this situation less frustrating and more controllable.
  • Angle 3-5º laterally
  • Gently lift and separate the medial edge of the breast up and away from the sternum and ribs
  • Place the medial tissue up on to the bucky
  • Hold the tissue out and laterally
  • Carefully edge the medial corner of the bucky towards the sternum
  • Compress and voila medial border with little or no cut-off


CONCLUSION

Breast imaging presents a difficult and diverse set of challenges. None of it is easy, not even the CC projection. These tips are designed to help. Keep them handy, use them liberally.
Posted by Anne's Helpful Son at 11:43 PM 0 comments

Wednesday, April 06, 2005

14 Really Easy Things To Do Before You Call ' The Man'

1. Check That The Water Tap In Darkroom Is On.
2. Check That The All The Tank Drains Are Closed.
3. Check The Temperature Of The Developer, The Fixer And The Wash By Hand.
4. Check The Levels Of The Liquids In All The Processor Tanks.
5. Check The Actual Water Supply In Your Department
6. Check That The Hot Water Supply Is Not Off
7. Check That The Cold Water Supply Is Not Off
8. Check That The Water Pressure Is Not Too Low
9. Check That The Water Itself Is Not Contaminated( Brackish,Soapy Or Contaminated)
10. Check Your Sensitometer And Densitometer For Setting Problems Or Working Faults.
11. Check The Ph Level Of The Developer With Some Litmus Paper. It Should Be About 10.5.
12. Check The Ph Level Of The Fixer With Some Litmus Paper. It Should Be About 4.5.
13. Run Another Strip Using The QC Film Box And Check The Parameters By Hand.
14. Run Another Strip From A New Box Of Film And Check The Parameters By Hand.

SUMMARY:

Morning can be frantic in a busy breast imaging department, I know that we can use all the help we can get. These easy 14 steps can help isolate the problem and just may be able to eliminate it before our patients start to build into an angry mob.

Good luck my friends, ‘til next time you can always reach me by all the regular channels (see my profile page above).
Posted by Anne's Helpful Son at 9:51 AM 0 comments

Thursday, March 03, 2005

To Mark or Not to Mark; that is the Question?

OBJECIVES

Skin markers: should we use them all of the time? Should we use them some of the time? Should we never use them? Is there a rule?

Unfortunately, like in much of breast imaging, there is no hard and fast rule. We are the thin ‘pink’ line between radiologist and patient. The clinical information is our responsibility. What we choose to chart, what visual information we impart, how we convey that data is the only link the reading radiologist has to the patients physical characteristics. If we are remiss or misleading in our descriptions of our patient’s breast health, attributes or abnormalities the radiologist can make an error in judgment or under or over call a situation. In some cases this can lead to a tragic mistake.

A controlled skin marking system can help us be clear, concise and accurate about certain clinical breast features. Used with a little common sense, knowledge and proficiency markers on the skin can be invaluable; sometimes even a life saver.

NIPPLE MARKERS:

The practice of placing a tiny spot marker on the nipple when imaging the breast has become a very common practice. The topography of the inside of the breast is very complex: made up of several lobes of tortuous parenchyma.

The radiologist usually uses the nipple marker as a stable guide as to distance and depth. We mammographers use the nipple markers to locate lesions that are not seen well in two projections, to measure the posterior nipple line or to estimate lesion location for diagnostic follow-up, core or open biopsy.

Most facilities place nipple markers on every patient. It is a sensible, easy, efficient method of making the exam a little more explicit.

These markers come in various sizes 1.5, 1.8, 2.0 etc. I use the smallest markers I can get so they are as unobtrusive as possible. So, unless the reading radiologist objects, I recommend nipple markers on all exams.

Example:


MARKING RAISED SKIN LESIONS:

Moles, skin-tags, hemangiomas, warts and any variety of skin lesions sometimes show up on the mammogram and mimic pathology. How can we make it clear to the reading radiologist where the lesions are on the skin, what they are and are they visible on the x-ray or digital image?

If we indicate every mark on the skin of the breast and chest wall we risk our images looking like a Christmas tree. Too many markers can be confusing and even distracting to the radiologist. So, which lesion to mark and which to leave untouched?

All aspects of mammography require a good working knowledge of what is acute and what is innocent. The first place to start is the previous exam if it is available. Peruse the images, indicate which skin lesion showed before and find them on the patient. Next use your diagram to draw all the raised skin lesions and signify what they are (mole, wart, sebaceous cyst, skin tag etc.). Finally only mark lesions that are likely to appear on the image and chart carefully which markers designate which lesions.

As in all instances, the radiologist has the last word on what goes on the image and does not. What ever the decision of the reader on skin markers, the diagram and description of skin lesions is essential.

Example:


  1. Large Mole (crusty): Marked
  2. Small Sebaceous Cyst: Marked
  3. Accessory Nipple: Marked
  4. Small patch of raised acne: Not Marked

SCAR MARKERS:

Widespread breast screening detects early small changes in breast tissue and leads to much increased incidence of breast surgery. Every invasive open breast biopsy produces a scar on the skin with an adjacent scar bed within the breast parenchyma. The distortion and asymmetry caused by this type of breast trauma can lead to serious misdiagnosis if the radiologist is unaware of the surgery. Once again we stand between the patient and the reader as a go between; a translator of our patient’s physical condition. And, once yet again we are faced with the dilemma of which scars to mark and which ones to leave alone.

As a well trained mammographer we should have a working understanding of what surgery does to the breast; what kind of image is produced by which kind of operation? We must ask ourselves: Is this recent or old surgery? Is the surgical bed broad and deep or narrow and superficial? Was the lesion benign or malignant? Was the surgery accompanied by radiation treatment? Is there skin distortion involved with the scarring?

Once again marking every small scar on the patient’s skin can lead to a confusing, misleading over decorated mammogram. So is there a rule? Of course not! There is NEVER a rule!

Start by perusing the pre and post operative images that you have on hand. Note any distortion, skin thickening, asymmetry or opacity related to a relatively new resolving scar bed. This type of scar should be marked with a translucent wire until the “post-operative” distortion has stabilized or resolved completely. Once the scar has been measured and read as “post-op scarring = no change”, subsequent mammograms should not need the scar markers. Old healed scarring should not be marked with a skin marker. These old surgeries have been stable for years and have already been assessed.

Having said all that, there is a significant exception to this policy of imaging old healed surgeries without translucent wires. If the patient is experiencing any symptoms in or around the old surgical site, if a recent mammogram shows any change in the symmetry of the parenchyma or if the patient’s health care provider questions any change in the patient’s current breast health then it again becomes imperative to carefully mark the old scar bed.

Whether your radiologist wants the scar beds marked or not it is vital that we chart the scars, new and old, describe the surgery, type and diagnosis.

Charted Diagram of Surgical History:


  1. Partial Mastectomy: 2004/ DCIS
  2. Lymph Node Dissection: 2004/ Positive
  3. Cyst Removal: 1992/ Benign

Mammography Image with Scar Markers in Place:


LESION MARKERS:

The patient’s clinical history both current and past is essential for a proper assessment of the diagnostic image. The reading radiologist gets all his/her clinical information from the mammographer. We are the ones who collect the clinical data, we are ones who examine the patient’s breast, we are the ones who see the ravages of disease and/or treatment, and therefore, we are also the ones who must carefully impart that information.

Signs and symptoms of early breast cancer are subtle. Anyone who chooses to work as a diagnostic mammographer must be willing to accept the responsibility of assessing the clinical condition of the patient and of accurately communicating that data to her medial partner, the radiologist. This skill is essential; the patient’s prognosis can depend on it.

Our first responsibility is to correctly describe any current clinical abnormality you, the patient or the health care provider has observed. We describe clinical lesions as to size, shape, margins, location and attenuation. We chart them as to these certain criteria by using a standard set of symbols on the torso diagram.

All palpable masses should be marked on the skin to indicate to the reader the location of the lesion inside the breast in relation to the palpable mass, the nipple base, any scar bed in the vicinity and the skin line. This is where your skin marking system really proves its value. Using all different markers to ensure that each piece of the locating puzzle is identified uniquely the actual location, size and origin of lesion is much easier of ascertain.

Lesion markers can also designate calcifications for tangential projection to determine the presence of internal breast calcification or skin calcification.

Clinical Image Diagram of Palpable Lesion:

BREAST SYMPTOM SYMBOLS =


  1. Firm, mobile, 3 cm mass
  2. Fibroadenoma removal: 1999/Benign
  3. Large Mole (Crusty)

Mammography Image with Coordinating Skin Marking System:


  1. Nipple Marker
  2. Scar Marker
  3. Lesion Marker
  4. Mole Marker

CONCLUSION:

As mammographers our responsibilities are daunting. We can be overwhelmed by the task at hand. As always, knowledge, experience, team consultation and training are our allies. Don’t be afraid to look something up, don’t be afraid to ask the radiologist, surgeon or nurse for advice. Our patients count on us to represent their circumstances to the proper clinicians accurately, dispassionately and plainly. Use all the tools at your disposal to do that. A comprehensive skin marking system used properly is one of those valuable tools. Use them in consultation with your radiologists to assist is clear, concise accurate diagnosis.
Posted by Anne's Helpful Son at 11:48 AM 0 comments

Wednesday, February 02, 2005

B-B-B-BLURRING (Part 3 of 3)

The definition of blurring or un-sharpness on mammography images is: the amount of lateral border spread along the edges of our image. A distance of border spread that is visually acute is unacceptable.
What causes our images to look blurry? Why do the x-rays sometimes look indistinct? What can we do, where can we seek an answer?
There are three distinct causes of mammography blurring:

  • Motion
  • Geometric
  • Receptor

Receptor:
The receptor in mammography refers to the combination of a screen composed of phosphorescent particles imbedded in the screen layer and an emulsion coated acetate based film.

If the quality and characteristics of the film/screen combination are unable to capture the sharp, high contrast image produced by the x-ray unit we still end up with a substandard image.

In the case of the screen, again the blur is caused by a shadow or penumbra produced by the diffusion of light around the particles used to assist image production. In the film, blurring can be initiated by the emulsion, base or quality of the combination.
Once more the problems can be simply demonstrated by geometry. Light and x-rays travel in roughly straight lines, so their path can be tracked and measured.

Screens:
Mammography screens must be high quality thin phosphorescent screens with tiny crystals. The screen must be pristine, unblemished and well seated into the cassette. The screen must be kept in tight contact with all aspects of the film.

  • The phosphor layer thickness
  • The size of the phosphorescent crystal
  • The addition of light absorbing pigments
  • Film/Screen contact

The Phosphor Layer Thickness:

Thick Layer:



1. Screen crystal
2. Large penumbra reaches film

Medium Layer:


1. Screen crystal
2. Small penumbra reaches film

Ultra Thin Layer

  1. Screen crystal
  2. Virtually no penumbra reached film

Crystal Size:

  1. Large crystal
  2. Substantial amount of diffused light reaches image

  1. Virtually no diffused light reaches image
  2. Tiny crystal

Light Absorbing Pigments:

1. X-ray beam
2. Light diffusing pigment
3. Screen crystal
4. Amount of light actually reaching film

Film/Screen Contact:

  1. Area of film/screen loss of contact
  2. Screen crystal
  3. Large amount of light reaching film
  4. Small amount of light reaching film

Mammography Film:


The film we use in breast imaging is very important to the image we produce. High quality mammography film is an extremely detailed and highly technical product. It is essential that we pair our film type to our screen type. This complicated area of expertise is best left to the professionals at your provider. Some of the particulars are easy to grasp.

  • Mammography film must be single emulsion film. Double emulsions tend to flash back through the acetate and across the two emulsion layers producing a ‘crossover’ blur on the edges of the image.
  • The base of mammography film must be coated with an anti-halation finish to prevent halation (a flash off the shiny base layer).
  • The emulsion of mammography film must be fast enough to capture the high contrast, black and white images we need.
  • The developed film must produce a sensitometry strip with a steep H&D curve rapidly reaching adequate maximum density.

An Adequate H&D Curve for Mammography Film:



SUMMARY
Blurring is a major cause of error in interpretation of mammography images. It is imperative we understand and address all the causes of this difficulty. This ends the series on blurry, indistinct images. I hope it has given you some insight into some of the causes and cures we can employ in this area. Keep on truckin’.

Posted by Anne's Helpful Son at 11:12 PM 0 comments

Monday, January 03, 2005

B-B-B-BLURRING (Part 2 of 3)

The definition of blurring or un-sharpness on mammography images is: the amount of lateral border spread along the edges of our image. A distance of border spread that is visually acute is unacceptable.

What causes our images to look blurry? Why do the x-rays sometimes look indistinct? What can we do, where can we seek an answer?

There are three distinct causes of mammography blurring:

  • Motion
  • Geometric
  • Receptor

Geometric:

Geometric blur is caused by the physical geometry or characteristics of the mammography unit. The indistinct quality of an image produced by the x-ray unit is due to the amount of penumbra or shadowing formed on either side of the image’s edge.

The units that cause the smallest penumbra have certain characteristics:

  • They utilize the smallest focal spot allowable and still achieve adequate exposure (.3)
  • They utilize the longest SID (source to image distance) possible and still maintain reasonable doses
  • They allow the shortest OFD (object film distance) possible

All these characteristics can be easily illustrated by simple geometric diagrams. It is

as simple as high school geometry; it’s not rocket science.

Small Focal Spot Versus Large Focal Spot:

1. .3 focal spot

2. Object

3. Receptor

4. Tiny penumbra surrounding image

1. .6 focal spot

2. Object

3. Receptor

4. Large penumbra surrounding image

Long Source Image Distance Versus Short Source Image Distance:

1. 66cm SID

2. Object

3. Receptor

4. Tiny penumbra surrounding image

1. 50cm SID

2. Object

3. Receptor

4. Large penumbra surrounding image


Short Object Film Distance Versus Long Object Film Distance:


1. Short Object to Film Distance

2. Object

3. Receptor

4. Tiny penumbra surrounding image

1. Long Object film Distance

2. Object

3. Receptor

4. Large penumbra surrounding image

Summary

Blurring is a major cause of error in interpretation of mammography images. It is imperative we understand and address all the causes of this difficulty. Motion & Geometric are the first two in the series on blurred images. Stay tuned for Receptor problems.

Posted by Anne's Helpful Son at 7:17 PM 0 comments

Friday, December 03, 2004

B-B-B-BLURRING! (Part 1 of 3)

The definition of blurring or un-sharpness on mammography images is: the amount of lateral border spread along the edges of our image. A distance of border spread that is visually acute is unacceptable.

What causes our images to look blurry? Why do the x-rays sometimes look indistinct? What can we do, where can we seek an answer?

There are three distinct causes of mammography blurring:

  • Motion
  • Geometric
  • Receptor

Motion:

To control motion on our images we simply must do all we can to prevent the subject from moving during the exposure.

To control motion we need the correct amount and application of compression. The amount of compression depends upon the tolerance of the patient, the size, shape, consistency and habitus of the breast. The breast should be compressed until the edges feel taut and there is no allowable ‘squeezability’ of the breast.

To achieve adequate compression it is essential to prepare the patient. An informed patient that is aware of the reason for compression, the length of time her breast will be compressed, the fact that you will not go past the point of discomfort into real pain is relaxed, in control and more likely to cooperate. Take as much time as you need before the test to explain, demonstrate, empower and inform. It will save time in the long run.

To achieve high contrast images in breast imaging a low kVp is usually implemented. This is generally the best course of action but it also instigates a longer time of exposure to obtain adequate exposure. The length of time of the exposure is critical to the cessation of motion. If for any reason (age, infirmity, palsy, or weakness) your patient will not be prepared to remain still for such a long exposure it is prudent to initiate a higher kVp in order to shorten the exposure time. This is also true for patients with thick, dense impenetrable breast tissue that would engender an extremely long exposure. A sharp image obtained at higher kVp levels is far better than a blurry image obtained with lower kVp levels.

Finally we must employ a proper compression paddle with the following properties:

  • A rigid lexan construction
  • A 85º - 90º bend @ the chest wall edge
  • The leading edge must be parallel to the film edge
  • There must be at least a 4cm rise at the chest wall
  • It must have a secure locking non-slip attachment to the unit

A Proper Compression Paddle Device:

An Unacceptable Type of Compression Device:

SUMMARY

Blurring is a major cause of error in interpretation of mammography images. It is imperative we understand and address all the causes of this difficulty. Motion is the first in the series on blurred images. Stay tuned for Geometric and Receptor problems.*

Posted by Anne's Helpful Son at 9:42 PM 0 comments

Monday, November 01, 2004

“Lesion, Lesion, Where Is The Lesion?”

The radiologist cannot determine the characteristics of a lesion if it is only shown in one projection. He/she cannot even determine if the lesion is real or illusionary. When a lesion appears only in one view on a four view routine mammogram, we have to ask ourselves several pertinent questions before we start randomly taking useless extraneous projections.

  1. Which projection does the lesion show in?
  2. Where does the lesion fall in that projection?
  3. Is the lesion real or made up of overlapping parenchyma?
  4. What can we do to find the area in another projection?
  5. How can we confirm that we have seen the lesion or overlapping area clearly in another projection?

Most commonly, an apparent lesion will appear in the MLO view and not in the CC projection. This is due to the fact that more breast tissue is imaged in this projection that any other view we take. To locate the area in the CC projection should be a planned excursion not a wild ride of random projections looking for ‘something’ illusive.

The Excursion From A Lesion Seen Only In The MLO View To Placement in CC Projection:

  • Measure where the lesion falls in the MLO view. Take three measurements: the distance from the nipple, the distance from the superior edge and the distance from the inferior edge.
  • Obtain a true lateral view of the breast, being sure to include the questionable area in the projection. Take the same three measurements: the distance from the nipple, the distance from the superior edge and the distance from the inferior edge.
  • Hang the images on the viewbox with the Lateral view first, the MLO view in the center and CC view at the end. Be sure that the images are hung so the inferior/superior borders of the Lateral and MLO projections are aligned.
  • Using a long ruler and a grease pencil draw a straight line from the lesion projected on the Lateral image through the same lesion on the MLO image and continue the line straight through the CC projection.
  • Mark a * where the line ends at the distance the lesion measures from the nipple and that is where you will find your lesion on the CC view.

This method of locating the missing lesion is called Triangulation. This triangulation method can be used to find the lesion in any one of three projections. Set the films up in the same manner and draw the line through the two projections the lesion is visible in.


A: 90º Lateral B: MLO



Triangulating The MLO Lesion Into The CC Projection:

A useful rule to remember when using triangulation to locate a lesion in the CC projection is: If the lesion rises in the lateral projection the area will show on the medial aspect of the CC, if the lesion falls in the lateral view it will show-up on the lateral aspect of the CC. “M(medial)uffins rise and L(lateral)ead Falls”

Is The Lesion Real Or Just Overlapping Tissue?

Roll/Turn View With A Real Lesion:

1. Spiculated Mass
2. Dense Parenchyma

A spiculated lesion overlaps a dense parenchymal shadow making the lesion indistinct and difficult to see.

1. Spiculated Lesion
2. Dense Parenchyma
3. Superior Breast Tissue is rolled Medially
4. Inferior Breast Tissue is rolled Laterally

The irregular stellate lesion is thrown clear of the dense parenchymal shadow and therefore is easily seen and a coned compression F/U view can be easily taken.


Roll/Turn View With an Illusionary Or False Lesion:


1. Dense irregular parenchymal shadow
2. Dense irregular parenchymal shadow

Two dense irregular parenchymal densities combine to mimic a stellate lesion on the CC view. It is not clear on the MLO projection: Is it real?

1. Normal Parenchymal Density
2. Normal Parenchymal Density
3. Superior Breast Tissue Rolled toward the Medial Border
4. Inferior Breast Tissue Rolled toward the Lateral Border

Separated by the ‘roll/turn’ projection, it is obvious that the area seen in the CC projection was merely overlapping normal parenchymal tissue.

If It Is Real: Where is it in the MLO Projection?

If we see an irregular density in the CC view, prove by diagnostic F/U that it is an authentic mass, and still cannot verify where it is in the MLO view, how can we find it?



1. Spiculated Lesion
2. Dense Parenchymal Pattern


1. Spiculated Lesion
2. Dense Parenchymal Pattern
3. Superior Breast Tissue Rolled toward Medial Border
4. Inferior Breast Tissue Turned toward Lateral Border


Since we know which way we rolled & turned the superior & inferior borders of the breast. Then we can determine whether the lesion is superior or inferior by which way the lesion moves

In this case, the superior tissue was rolled medially and the spiculated lesion moved medially. Therefore we can conclude that the lesion we are interested in is in the superior aspect of the breast and the dense benign parenchyma was turned laterally in the inferior breast so conversely, it will be found in the inferior aspect of the breast.

1. Spiculated Lesion Located in the Superior Aspect of the Breast in the MLO View
2. Obviously Negative Parenchymal Tissue Located in the Inferior Aspect of the Breast in the MLO View


SUMMARY

It is our responsibility to make the lesions found in the routine mammograms apparent to the reading radiologist. The radiologist very often just tells us, “find the lesion”. If we know how to isolate, separate and identify those suspect areas we can help the radiologist, help the patient, save time, anxiety, technical resources, department finances and finally our mental health.

Posted by Anne's Helpful Son at 7:46 PM 0 comments
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