MAMMO FINALS

Mammography purpose

To detect and diagnose breast diseases, especially breast cancer

Typical x-ray energy for mammography

Low energy x-rays (20–35 kVp)

Target material in mammography tube

Molybdenum (Mo) or Rhodium (Rh)

Reason for using Mo and Rh targets

Provide characteristic x-rays with optimal contrast for soft tissue

Focal spot size for mammography

Small focal spot (0.1–0.3 mm) for high resolution

Compression purpose in mammography

Reduce tissue thickness, improve image quality, and reduce dose

Automatic exposure control (AEC)

Ensures consistent image density by adjusting exposure

Anode angle in mammography

Small (16–24 degrees) to maintain uniform exposure

Heel effect in mammography

X-ray intensity higher on cathode side, used to match thicker chest wall

Grid use in mammography

Reduces scatter radiation, improves contrast

Typical grid ratio in mammography

4:1 or 5:1

Grid movement type

Reciprocating (moving) grid to avoid grid lines

Filtration purpose

Removes low-energy photons that increase dose without improving image

Common filters used

Molybdenum (Mo), Rhodium (Rh), or Aluminum (Al)

Half-value layer (HVL) range for mammography

0.3–0.4 mm Al equivalent

Focal spot blooming

Occurs when high mA causes focal spot enlargement, reducing sharpness

Spatial resolution in mammography

Typically 15 line pairs per mm

Breast composition

Glandular, fibrous, and fatty tissues

Radiographic density in mammography

Determined by tissue composition and thickness

Breast positioning for CC view

Breast compressed horizontally, x-ray beam perpendicular to detector

Breast positioning for MLO view

Breast compressed obliquely, includes pectoralis muscle

Purpose of MLO projection

Visualize upper outer quadrant and axillary tail

Cranio-caudal (CC) view landmarks

Nipple in profile, medial tissue visualized

Mediolateral oblique (MLO) view landmarks

Pectoralis muscle down to nipple line

Axillary tail of Spence

Extension of breast tissue into axilla, best seen in MLO

Magnification mammography

Uses small focal spot and increased OID for detail visualization

Magnification factor

Typically 1.5x to 2.0x

Compression paddle

Transparent device that flattens breast for imaging

AEC detector placement

Under densest portion of breast (usually posterior)

Mammography detector types

Screen-film, CR, or digital flat panel detectors

Advantages of digital mammography

Wide dynamic range, post-processing, lower repeat rates

Phantom used for QC

Simulates breast tissue to evaluate image quality

Phantom image evaluation

Checks for fibers, specks, and masses visibility

MQSA purpose

Mammography Quality Standards Act ensures consistent image quality and safety

Daily QC test

Processor or detector performance check

Weekly QC test

Phantom image quality test

Monthly QC test

Repeat analysis and visual inspection

Semiannual QC test

Compression force and beam quality (kVp and HVL) measurement

Annual QC test

Comprehensive system performance evaluation

Mean glandular dose limit per exposure

Less than 3 mGy for a standard breast

Typical mammography kVp range

25–32 kVp

Typical mAs range

50–120 mAs depending on breast thickness

Focal spot for magnification imaging

0.1 mm small focal spot

Image receptor sizes

18x24 cm and 24x30 cm

Anode heel orientation

Cathode toward chest wall

Artifact causes in mammography

Dust, improper processing, or detector defects

Motion artifact prevention

Proper compression and short exposure time

Digital breast tomosynthesis (DBT)

3D imaging using multiple low-dose projections

DBT advantage

Improves lesion visibility by reducing tissue overlap

DBT projection angle range

15–50 degrees arc around the breast

DBT reconstruction technique

Reconstructs thin slices (1 mm) through the breast

QC for digital detectors

Flat-field test and SNR check

QC for compression system

Measures applied force (should be 25–45 lb or 111–200 N)

QC for AEC system

Checks consistency of optical density across varying thickness

QC for alignment

Ensures x-ray field and detector field coincide

QC for viewbox or monitor

Luminance and uniformity test

QC for darkroom (film systems)

Safe light test and processor temperature control

Breast implants imaging technique

Eklund (implant displacement) technique

Eklund technique purpose

Pushes implant back to image more breast tissue

Spot compression view

Used to evaluate focal lesions under higher compression

Cleavage view

Used to visualize medial breast tissue

Tangential view

Used to show skin lesions or calcifications

Rolled view

Used to separate overlapping tissue

Lateral view (ML or LM)

Used to localize lesions seen on MLO

Implant-displaced CC and MLO

Used for patients with breast implants

Calcification appearance

Tiny high-density spots; can be benign or malignant

Clustered microcalcifications

Suspicious for malignancy

Architectural distortion

Disruption of normal breast pattern; may indicate cancer

Asymmetry definition

Area seen on one view but not corresponding area on another

Fibroadenoma appearance

Well-defined, oval, homogeneously dense mass

Cyst appearance

Round, well-circumscribed, radiolucent center

Malignant mass characteristics

Irregular margins, high density, spiculated appearance

Skin line artifact

From improper positioning or tight compression

Nipple marker use

To identify nipple location or retroareolar lesions

Lead marker use

Indicates lesion, scar, mole, or nipple