Chapter 1: History of Mammography

1924

When was mammography first proposed?

Stafford Warren

Who published the first article on mammography?

Double-emulsion film

intensifying screens

moving grid

60 kVp

70 mA

2.5-second exposure

25-inch SID

What imaging techniques did Stafford Warren describe in early mammography?

Radiography of mastectomy specimens.

What early breast imaging studies existed before modern mammography?

1930

When did Stafford Warren publish first article?

Robert Egan

Who is known as the father of mammography?

1960s

When did Robert Egan begin teaching mammography techniques?

Established training centers for radiologists and technologists across the United States.

What role did the ACR play in mammography development?

Blown x-ray tubes

accuracy below 98%

skepticism from surgeons

What challenges limited early adoption of mammography?

They recognized the diagnostic potential of mammography.

Why did some radiologists continue practicing mammography despite difficulties?

American College of Radiology (ACR)

What training centers were established for mammography?

They maintained their belief in mammography despite technical limitations and skepticism.

What was the significance of early mammography pioneers?

Early techniques were limited and are considered archaic compared with modern screen-film and digital mammography.

How do early mammography techniques compare with modern techniques?

When breast cancer is detected at the cellular level, current mammography may be considered primitive.

How might future advances change how current mammography is viewed?

1924

When did Dr. Warren produce his first breast images?

Tungsten target tube with a glass window.

What type of x-ray tube was used in early mammography by Dr. Warren?

because of a high half-value layer (HVL), which reduced image contrast.

Why did early tungsten target tubes produce low-contrast mammographic images?

Double-emulsion film used with two intensifying screens.

What image receptor system was initially used in early mammography?

It marked a major shift toward mass screening and lower-dose mammography, influenced by social and feminist movements.

Why were the 1960s important in the history of mammography?

Xeroradiography

What new breast imaging recording system was developed in the early 1960s?

Haloid Corporation

Which company and investigator were responsible for developing xeroradiography?

Facilities could use general-purpose x-ray machines and only change the recording medium to image the breast.

What was an advantage of xeroradiography for x-ray facilities?

1971

When did xeroradiography become commercially available?

John Wolfe

Who was the principal investigator involved in the development of xeroradiography in the early 1960s?

Charles Gros

Who developed the first dedicated mammography unit in Europe?

France

Where was the first dedicated mammography unit developed?

1960s

When was the first dedicated mammography unit developed?

It marked the first major step toward mammography for mass screening.

Why was the development of a dedicated mammography unit significant?

molybdenum target tube

What was the key technological evolution in the new mammography unit?

1969

When was the new dedicated mammography unit introduced commercially in the U.S.?

Incorporated a molybdenum target

Utilized low kVp

Had an integral device for compressing the breast

What are the main features of the dedicated mammography unit introduced in 1969?

Flourished in the 1970s

By the mid-to-late 1980s, it was nearly extinct

What happened to xeroradiography in the U.S. during the 1970s–1980s?

Molybdenum Target Tube

The heart of the unit that evolved from technology developed for quality control efforts in automobile and truck tire production.

To x-ray the breast.

What is the common purpose of xeroradiography, analog mammography, and digital mammography?

Because they often conflict with the high-quality mammography standards of today.

Why is it important to recognize outdated xeroradiographic practices?

The n*pple must always be imaged in profile.

What was a basic protocol and cardinal rule of xeroradiography regarding the n*pple?

Because it is centrally located on the breast for most women.

Why is the nipple usually in profile or nearly in profile upon final compression?

posterior portion of the breast.

Which part of the breast is generally more important to visualize in mammography?

Women who have spontaneous unilateral nipple discharge, since papillomas (the main cause) are usually within 1 cm of the nipple.

What is the first instance when the nipple must be in profile?

When performing a mammogram on a male, because males have small breast buds directly behind the nipple that need to be visualized.

What is the second instance when the nipple must be in profile?

To determine the exact location of a region of interest (ROI) for preoperative wire localization, fine-needle aspiration cytology (FNAC), or stereotactic core biopsy.

What is the third instance when the nipple must be in profile?

To capture all the breast tissue on an image.

What is the main goal of mammography technologists when taking an image?

take an additional film

what does a mammographer do if a lump or lesion is suspected in the nipple area and the nipple is not in profile?

To visualize just the anterior portion of the breast with the nipple in profile.

What is the purpose of the extra film in this situation?

Because it often required excluding the ribs from the image.

Why was it disconcerting for technologists experienced in xeroradiography when using screen-film mammography?

x-ray table

ceiling-mounted x-ray tube

suction cup compression device

What equipment did mammographers use before dedicated mammography units?

integrated compression device

C-arm design, allowing versatility in positioning.

What innovation did the 1965 dedicated mammographic unit introduce?

oblique view

What new position was reported by Scandinavian mammographers in the mid-1970s?

A supplementary view used for definitive lesion localization prior to preoperative wire localization or stereotactic core biopsy

What is the role of the lateral position in modern mammography?

To visualize the skin line.

What was an obsolete requirement from xeroradiography regarding the skin?

Because the primary focus of breast cancer is rarely located in the subcutaneous fat zone.

Why is the skin line less important in modern mammography?

Only about 2%

remaining 98% is superimposed on or under the breast mound.

How much of the skin line is typically visualized tangentially on a mammogram?

For xeroradiography, it was very important

For analog and digital mammography, it is not.

How does the importance of the skin line differ between xeroradiography and modern mammography?

In the subcutaneous fat zone.

Where is the primary focus of breast cancer rarely located?

sponges

What positioning aid was used in xeroradiography to include the ribs on the image?

To support the breast to match the thickness of the ribs so the breast would not “disappear” around the curvature of the ribs when the woman lies on her side.

What was the first purpose of using sponges in xeroradiography?

To help form the breast into a relatively flat surface so compression could be distributed evenly.

What was the second purpose of using sponges in xeroradiography?

They adversely affected the xeromammogram because they contain aluminum, calcium, and zinc particles.

How did deodorants and powders affect xeromammography?

microcalfications

What can clump of aluminum and zinc mimic on a mammogram?

Because the ribs and lung field were included and less compression was used, so respiration could blur the image.

Why did xeromammography require suspension of respiration?

1. The client will not allow adequate compression of the breast.

2. The client has implants.

3. The client has emphysema or another respiratory problem.

Under what circumstances might suspension of respiration still be used in modern mammography?