Positioning The Breast

Lobules
Positioning
15 – 25 lobes within each
breast that are drained
by ducts that lead to the
nipple. Alveoli are
grape-like clusters
within the breast lobes
that produce milk.
Ducts
Drain the lobules and end
in larger ducts called
lactiferous sinuses.
There are 5 – 12 duct
systems within each
breast
The Breast
Pectoralis Muscle
Fibrous Tissue
-Fan shaped muscle that sits
behind the breast, covering
the chest wall
Cooper’s Ligaments are
dense strands of
supporting tissue found
throughout the entire
breast which ends in the
skin itself.
1
Cranio Caudal (RCC,
LCC)
Medial Lateral Oblique
(RMLO,LMLO)
Lateral Medial (90’)
Medial Lateral (90’)
Lateral medial oblique
(RLMO, LLMO)
XCCL
Spot compression
Magnification
Cleopatra
Cleavage
Glandular tissue
where cancer grows
Terminal Ductal Lobular Unit
TDLU white on the mammogram
Ducts and branches
white on mammogram
Fibrous
Collagen, supporting tissue, white on mammo,
concave in appearance
Adipose
Fat, connective tissue black on the mammo, easy to
see abnormality
Breast
Composition
Mammography
Views
Cancer develops from TDLUs
1 mm or less in size
TDLU have different sizes and densities
Can be seen on a mammogram as fat is
inside
Need very high image quality to see
TDLU
Cranial Caudel
CC
Orientation
Cranio Caudal
2
Rt CC
Lt CC
3
Medial Lateral Oblique
MLO
4
MLO
Medial Lateral Oblique
IMF
5
Lateral View:
90 degrees to CC
Medial lesion evaluation- If there is any question of
medial tissue exclusion on the MLO view
Triangulate lesion
If seen on CC view, determine upper or lower
quadrant
If seen only on MLO, determine location medial or
lateral
Milk of calcium
Benign calcifications
Rt MLO
Lt MLO
Mediolateral (ML)
6
Lateromedial (LM)
7
Triangulation
ML
MLO
Where is the lesion?
CC
MLO
ML
8
—Drawing shows how to mount step-oblique mammograms on viewbox and perform
triangulation.
Pearson K L et al. AJR 2000;174:745-752
©2000 by American Roentgen Ray Society
9
Spot Compression
Reduces compressed thickness of
focal area
Better tissue separation
Reduces scatter
No coning for CR mammography
10
CC view
Spot Mag
Magnification
Better resolution if coupled with
small focal spot & spot compression
Longer exposure time:
Less tube output
No grid
Increase by 2 kVp to reduce exposure time
11
Exaggerated Craniocaudad
For postero-lateral tissue
Tube angled up to 5°
Used for localization of lesions in far
lateral breast
Compression of anterior tissue is not
optimized
oops
LX-CC
12
Lateromedial Oblique (LMO)
Useful on patient with:
Khyphosis
Open heart surgery
Pectus Excavatum
Any issue near sternum
Pace maker
LMO: CR enters lower outer breast, exits
upper inner breast (true reverse of MLO)
13
LMO vs
MLO
Is the lesion real?
Where is the lesion?
Which way to roll?
Roll View
MLO
CC
Sumation shadow
14
Cleavage View
CC view
Rolled medial
Rolled lateral
Visualize deep medial tissue
If centered, use manual
exposure
15
Axillary Tail View
16
Small Lesion
with
Calcifications
Compression
Invasive Cancer
17
Implants
Magnification
Spiculated
Lesion
Implants displaced on same
patient (Eklund Technique)
18
Mammography
Radiopaque
Obscures tissue
Hides cancer
Hides leaks
Manual exposure
Difficult to localize
Position of implant
Sub glandular
Sub muscular
Size of implant
Amount of breast tissue
Presence of contracture
Patient Compliance
Positioning the
Augmented Breast
19
Anatomy and Physiology
of the Breast
Implants In Relationship
to Muscle
20
Good positioning is
creativity. If you don’t
place the tissue on the
detector, the radiologist
will never see the cancer.
21