Mammography Registry (QC)

greater than or equal to 1.20.

Phantom optical density

greater than or qualifies to 0.50

Density difference

greater than or equal to 3000 nit

view box luminance

less than or equal to 50 lux

room luminance 

semiannually

compression force test is done?

as needed, <2% ideal, less than or equal to 5% acceptable

repeat analysis

Monthly

visual checklist should be done?

Monthly on workstations

SMPTE pattern test

AEC

What is commonly used on exposure controls?

Auto KVP/Auto filter

works best based on compression thickness 

AOP

automatic Optimization of parameters

Manual exposure

Required in difficult positions, implants

Brightnes vs. density

nrightness now replaces density control

density setting

alters mAs by 15% increments 

FSS

Small focal spot (0.1 mm) required

Mag factor

1.5 to 2.0

Higher OID 

Lower SID, higher dose

Indications

Microcalcifications, lumpectomy sites, specimens

Ductal ectasia

Duct widening

Lobular hyperplasia

cell overgrowth

post-trauma/surgery

fat necrosis/ oil cyst

milk-filled lesion

galactocele

male breast enlargement

gynecomastia

teacup sign on ML/LM views

Milk of calcium

Ductal carcinoma in situ (DCIS)

stage 0

Invasive ductal carcinoma

most common (90%)

lobular carcinoma

5-10% may not appear on mammo

inflammatory carcinoma

rare, aggressive

paget’s disease

affects nipple area

Sarcoma

rare, connective tissue origin

Mastectomy types

Simple, prophylactic, nipple-sparing, modified radical

lumpectomy contraindications 

prior lumpectomy, multiple sites, large tumors

seroma

fluid complication post-mastectomy

neoadjuvant chemotherapy

shrinks tumor pre-surgery

radiation

kills residual cancer, can shrink tumor

chenotherapy

treats systemic cancer

side effects

appetite loss, fatigue, low RBC

BREAST CANCR RISK FACTORS

BRCA MUTATION

high0risk women: start annual mri at 25-30

screening guidelines-start annual screeening at 40 (ACR/ACS)

Biennial at 40+ (USPSTF)

Incompletete-need more images

Birad 0

Negative

birad 1

Benign finding

birad 2

probably benign- 6 m f/u

birad 3

suspicious/ bx recomennded

birad 4

highy suggestive of malignancy

birad 5 

known bx- proven malignancy

birad 6

FFDM (2D)

direct and indirect types

direct-- amorphous selenium

indirect- cesium iodide divided by photodiodes

DBT (3D tomo)

11-60 degrees, 9-25 exposures

SMPTE pattern

Used to test monitor quality

PACS

picture archiving and communication system 

RIS

Radiology information system

CAD

Computer-aided detection

DICOM

digital imaging and communications in medicine

HL7

Universal healthcare data format

RAID

storage system for 12+ months

what patient says

subjective data

Measurable/factual (eg bruise)

Objective Data

localizations, QC,incomplete views

not countedc

% repeat= repeat exposures/ total exposures x 100

how to calculate repeats

involution

shrinkage

required phantom scores for film/screen and digital

-4 fibers

-3 specks groups

-3 masses

digital systems require a score of

-5 fibers

-4 speck groups

-4 masses

prophylactic msastectomy

surgical procedure where breast is removed to reduce risk of developing breast cancer

nipple sparing

preserves nipple, areola and overlying skin

modified mastectomy 

removes entire breast including nipple, areola, and skin. chest muscles (pec muscles) are usuallu left intact

-previous lumpectomy

-multiple cancer sites in 1 breast

-large tumors in a small breast

Contraindications for lumpectomy

seroma

clear fluid that forms a complication to the mastectomy procedure.

Neoadjuvant chemotherqapy

help shrink cancerous tumors before the surgery

important principles of breast positioning are

-move mobile tissue toward fixed tissue

-avoid moving the compression paddle against fixed tissue

every 3 years

frequency of ACR

ductal estasia

one or more milk duct beneath your nipple widens

lobular hyperplasia

overgrowth of cells in the lobules

invasive ductal caarcinoma

the most diagnosed breast cancer in the US

inflammatory carcinoma

rare and very aggressive breast cancer in which the cancer cells block lymph vessels

Invasive lobular carcinoma

referred to the “sleeper cancer” and patients will complain of breast thickening instead of a lump

Ductal carcinoma in situ

earliest form of breast cancer and confined to a duct

Fat necrosis (oil cyst)

firm round lump dthat develops following surgery, reconstruction, or a needle bx

Galactocele

milk filled lesion

filters are most often made of added filtration

molybdenum

rhodium

alumnium

silver

inherent and added

2 types of filtration

beryllium

exit window of tube housing is made of

oil in the tube

mirror assembly

compression plat4e

is thin sheeets of metal inserted in the x-ray beam could be any of the following

added filtration

role of added filtration

removes soft energy photons which add dose

slows down higher energy photons which reduce contrast

increases

using a grid does what to pt dose

30-50 lp/cm

characteristics of mammography grid

0.3mm

large spot used dfor standard imaging

0.1mm

used for mag imaging 

kvp

influences contrast and exposure latitude 25-35

mA

20-100 typical time is 0.4 to over 1 second

600 mAs

maximum back up time for grid techniques

3 factors for emerging xray beam

kVp

target (anode) material

filter material

bremsstrahlung radiation and characteristic

2 types of radiation are produced when electrons hit the anode

brems

produced with mutliple energies (keV) starting low and ending high; this is the most common type of radiation produced maximum is determined by the kVp we set

Characteristic radiation

X-rays produced are confined to 2 energy spikes determine by the anode (target) material

filter

molybdenum (Mo) and Rhodium (rh)