Group 11

1. Asiimwe Daniel U/2203269/DMR

2. Kabahendo Edinah kirabo U/2203015/DMR
3. Babirye Grace U/2203275/DMR
4. Akullu Joseph U/2203304/DMR
5. Kidiri Yasin U/2108012/DMR
METHODS OF IMAGING THE
BREAST
1. Mammography
2. Ultrasound (US)
3. Magnetic resonance imaging (MRI)
4. Radionuclide imaging
5. Imaging-guided biopsy/preoperative localization
Mammo machine
 MAMMOGRAPH
Y
Indications and contra indications
Equipment
Technique/ procedure
Normal mammographic findings
Pathological findings
 Indications
1. Focal signs in women aged ≥40 years in the context of triple (i.e.
clinical, radiological and pathological) assessment at a specialist,
multidisciplinary diagnostic breast clinic
2. Following diagnosis of breast cancer, to exclude multifocal/
multicentric/bilateral disease
3. Breast cancer follow-up, no more frequently than annually or less
frequently than biennially for at least 10 years
4. Population screening of asymptomatic women with screening
interval of 3 years, in accordance with NHS Breast Screening
Programme policy: (a) By invitation, women aged 47–73 years in
England, Northern Ireland and Wales, and 50–70 years elsewhere in
UK (b) Women older than 73 years, by self-referral (There is no upper
age limit.)
 cont
1. Screening of women with a moderate/high risk of familial
breast cancer who have undergone genetic risk assessment in
accordance with National Institute for Health and Clinical
Excellence (NICE) guidance
2. Screening of a cohort of women who underwent the
historical practice of mantle radiotherapy for treatment of
Hodgkin disease when younger than 30 years. These women
have a breast cancer risk status comparable to the high-risk
familial history group.
3. Investigation of metastatic malignancy of unknown origin
 contra indications
Asymptomatic women without familial history of breast
cancer, aged younger than 40 years
Investigation of generalized signs/symptoms—e.g. cyclical
mastalgia or nonfocal pain/lumpiness
Prior to commencement of hormone replacement therapy
To assess the integrity of silicone implants
Individuals affected by ataxia-telangiectasia mutated (ATM)
gene mutation with resultant high sensitivity to radiation
exposure, including medical x-rays
 Routine investigation of gynaecomastia
 Technique/ procedure
Standard mammographic examination comprises imaging of
both breasts in two views—namely the mediolateral oblique
(MLO) and craniocaudal (CC) positions. Screening methodology
is bilateral, two-view (MLO and CC) mammography at all
screening rounds. Additional views may be required to provide
adequate visualization of specific anatomical sites:
1. Lateral/medial extended CC
2. Axillary tail
3. Mediolateral/lateromedial
VIEWS
Compression of the breast is an integral part of mammographic
imaging resulting in:
reduction in radiation dose
immobilization of the breast, thus reducing blurring
 uniformity of breast thickness, allowing even penetration
reduction in breast thickness, thus reducing scatter/noise achieving
higher resolution
Adaptation of the technique can provide additional information:
1. Spot compression, to remove overlapping composite tissue
2. Magnification (smaller focal spot combined with air gap), to provide
morphological analysis In the presence of sub pectoral implants, the
push-back technique of Eklund can aid visualization of breast tissue
MLO
Mammography
 Mammography interpretation, abnormal FROM normal

The primary role of mammography is to detect cancer at an early stage

when the lesion is small. The steps used to interpret an abnormality
detected on mammography are outlined in the following sections.
1. Identify any suspicious features
2.Differentiate true abnormalities from apparent ones
3. Categorize the abnormality using a common Birad
4. Localize the abnormality
 1. Identify any suspicious
features
FUNDAMENTAL MAMMOGRAPHY FINDINGS
There is no “typical” appearance of the breast in any age group, Depending on the
amount of fat and fibro glandular tissue, the breast will appear less dense (more
fat), more dense (less fat), or a combination of both.
Four basic signs of breast disease can be seen on mammography. They are:
Masses
Asymmetry
Architectural distortion
Calcifications
Other important findings are skin changes and abnormal lymph nodes
Masses
A mass is defined as a space-occupying
lesion seen in at least two different
radiographic projections. Masses are
described by their shape (e.g., oval),
margins (e.g.,spiculated), and density
(e.g.,fatcontaining).These appearances
help radiologists decide how suspicious
a mass is for malignancy . • In general, a
mass that is irregular, spiculated,
and high-density is more likely to
be malignant whereas a mass that is
oval, circumscribed, and low-density is
more likely to be benign
Asymmetry
Asymmetry is a unilateral deposit
of fibroglandular tissue that does
not meet the definition of a mass.
Asymmetries on mammography
appear as an area of tissue that does
not have a corresponding similar-
appearing pattern in the opposite
breast. Asymmetries can be
described as global, focal,
developing, or simply
asymmetric. Most asymmetry is
benign, but it may be a sign of
breast cancer
 Architectural
Distortion
describes an alteration in the
expected architecture of a breast
with no discrete mass visible. It
is one of the most subtle signs of
breast cancer. It can be thought
of as spiculation without a mass
or a “tethering in” of the tissue.
Digital breast tomosynthesis
has been shown to be
particularly helpful in identifying
architectural distortion
Calcifications
Calcifications in the breast fall
into two major categories:
those that appear typically
benign (e.g., rod-like) and those
that are suspicious for
malignancy (e.g., pleomorphic).
They are also described by their
arrangement or distribution in
the breast: diffuse calcifications
throughout the breast are less
likely associated with
malignancy than grouped or
clustered calcifications
2.Differentiate true abnormalities from
apparent ones
Additional mammographic views on DBT and contrast-enhanced digital
mammography (spot compression magnification view is the most
common) or adjuvant imaging techniques (breast ultrasound is the
most common) will help to differentiate true abnormalities from
apparent ones.
Overlapping breast tissues called summation shadows are seen on
only one mammographic view. A true abnormality is seen on more
than one mammographic view and needs further assessment or biopsy
3. Categorize the abnormality using a common
lexicon
The American College of Radiology (ACR) uses a standardized
system called BI-RADS, which stands for Breast Imaging
Reporting and Data System, to help describe findings,
standardize reporting, and provide greater clarity to breast
imaging interpretations.
 4. Localize the abnormality
The abnormality should be localized according to the following:
1. Laterality: Left breast or right breast.
2. Quadrant of the breast and o’clock position:.
3. Depth:
4. Distance from nipple:
Quadrant localization
 The MLO view is then
used to determine
whether the mass is in
the upper (above the
nipple) or lower (below
the nipple) quadrant of
the breast.
 O’clock position
The CC view on
mammography
localizes the lesion by
the o’clock position
 Depth of lesion
(anterior, middle,
and posterior
thirds
A lesion is localized
either in the anterior
third, middle third, or
posterior third of the
breast, depending on its
depth within the breast.
 Distance
from
nipple
The distance of the
mass from the nipple is
measured, the nipple
being the fixed reference
point.
Summary To summarize, the following
location descriptors are used in
mammography: Laterality: Right breast or left breast.
Quadrant and o’clock location: Understand that MLO projections
distinguish between superior (upper) and inferior (lower) quadrants.
CC projections distinguish between lateral (outer) and medial (inner)
quadrants. The four quadrants are used in mammography; a clock face
is used in ultrasound. Understand that the clock face is a mirror image
for lateral (outer) and medial (inner) quadrants, so that 3 o’clock on
the left is 9 o’clock on the right, 2 o’clock on the left is 10 o’clock on the
right and so forth.
Depth of the lesion in the breast – anterior, middle, or posterior thirds
on the mammogram.
pathology seen on mammogram
Benign Conditions:
Cysts: Small fluid-filled sacs that are usually not cancerous.
Fibroadenomas: Noncancerous lumps made up of fibrous and glandular tissue.
Calcifications: Small calcium deposits that can be benign.
Fibrocystic Changes: Lumpy breast tissue that can cause pain and tenderness.
Fat Necrosis: Benign changes in the breast tissue often caused by injury
or surgery.
Malignant Conditions:
Breast Cancer: Appears as a white, high-density area with irregular edges
Paget's Disease: A rare form of breast cancer that can cause skin changes and nip
ple retraction
1. Dense and fatty breast tissue
2. Breast cyst 3.Fibroadenomas
Small fluid- Noncancerous lumps made up of
filled sacs that are usually not fibrous and glandular tissue.
cancerous.
Calcifications: Small calcium deposits Breast Cancer,apears as a white,
that can be benign. high
density area with irregular edges
Paget's Disease: A rare form of breast cancer that can cause skin changes and
nipple retraction
Ca breast
biras
ACTION
TAKEN
The male
Reference
1. CHAPMAN AND NAKIELNY’S GUIDE TO RADIOLOGICAL PROCEDURES
2. Radiological Procedures {A Guideline) Dr Bhushan N. Lakhkar
3. www.medicalnewstoday.com
4. www.cancer.org
5. radiopaedia.org
6. www.verywellhealth.com
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