Mammography

• Breast cancer is considered emotional and biological
• It is one of the most treatable cancers when detected early
• Efforts have been focused on developing breast cancer screening and early detection methods
• Mammography is a crucial innovation in breast cancer control, aiming to detect breast cancer before it is palpable
• The combination of early detection, diagnosis, and treatment has led to increased survival rates
• In 1924, male radiologists in Rochester, NY speculated about x-raying the breast to locate tumors
• Dr. Soloman, a German physician in 1913, reported the radiographic appearance of breast cancers
• Otto Kleinschmidt made the first published radiograph of a living person's breast in 1927
• In the 1930s, publications on mammography appeared in South America, the United States, and Europe
• Xerography was introduced in the 1960s, lowering radiation doses and improving image quality
• The duPont Company introduced higher resolution, faster-speed x-ray film, and an intensifying screen in the 1960s
• The Breast Cancer Detection Demonstration Project (BCDDP) in 1973 demonstrated the effectiveness of screening methods
• The Mammography Quality Standards Act (MQSA) was implemented in 1992 to maintain high-quality breast cancer screening programs
• Risk factors for breast cancer include age, hormonal history, and family history
• The breasts are lobulated glandular structures located within the superficial fascia of the thorax
• Male breasts are rudimentary and without function, rarely subject to abnormalities
• Female breasts function as accessory glands to the reproductive system by producing and secreting milk during lactation
• The adult female breast consists of 15 to 20 lobes, each divided into many lobules
• The radiographer must consider breast anatomy and patient body habitus for successful imaging
• The glandular and connective tissues of the breast are soft tissue density structures
• During pregnancy, significant hypertrophy of glands and ducts occurs within the breast
• Analog mammography units require proper space, portability, electrical requirements, and ergonomics for optimal performance
• Compression Device to-Receptor Distance:

  • Should allow adequate space when positioning an obese woman for an oblique view
  • When magnifying an area in a large breast
  • When raising the compression device over the needle during preoperative localizations
• Tube Housing or Face Shield:

  • Should remain as small as possible to facilitate positioning of the client’s head for the craniocaudal view and during magnification views
• Foot Controls:

  • Remote foot controls for vertical movement of the C-arm and the compression device free the hands of the technologist while positioning
  • The amount of compression exerted by the foot pedal control should be minimal
  • The final compression of the breast should be done using a hand-controlled device
• IRSD (Image Receptor Support Device):

  • Permit fast and easy exchange of different size film Buckys or cassettes
  • Both 18 x 24 cm and 24 x 30 cm imaging systems should be available to match the size of the receptor to the size of the breast being imaged
• Control Panel:

  • Should be easy to read and to adjust
  • All units must have automatic exposure control (AEC)
  • When the exposure has ended, the control panel should indicate the exposure factors used
• Density Selection:

  • At least nine density adjustment steps should be available
  • There should be a 10% to 15% difference in optical density between steps
• Kilovoltage:

  • Molybdenum Target Units: range of at least 24 to 32 kVp in no greater than 1 kVp increments
  • Rhodium Target Units: range of at least 28 to 38 kVp in no greater than 1 kVp increments
  • Lower settings may be used in specimen radiography and higher settings for special views
• Milliamperage Selection:

  • May be fixed or variable
  • If the mA value automatically decreases while increasing the kVp, it should occur outside the range of settings routinely used for screen–film mammography: the 25 to 30 kVp range
• Time Selection:

  • Short exposures: the grid is not “caught in motion” when using a grid on a thin adipose-replaced breast
  • Long exposures: the time setting must surpass the reciprocity law failure of the recording system
• Source-Image Detector Distance:

  • Standard imaging SID: 55 cm
  • Magnification imaging SID: 60 cm
• Collimators:

  • Fixed apertures
  • Interchangeable cones of various sizes
  • Internal set of collimating blades
• Needle Localization Capability:

  • Aside-loading cassette holder or Bucky is required if the equipment has preoperative needle localization capabilities
  • The compression device for needle localization either has a series of concentric holes or a large rectangular cutout
• Field Light:

  • The brightness of the light source should be 160 LUX or higher
  • Misalignment of the x-ray/light field can be a maximum of 2% of the SID
• Breast Thickness Scale:

  • Separate scales for grid versus non-grid versus magnification imaging should be available
  • The scales should be accurate to within 0.5 cm
• Alignment:

  • The focal spot, compression device, and image receptor must align perfectly at the chest wall edge to ensure that all posterior breast tissue is included
• Automatic Technique Selection:

  • Units must have a postexposure display that indicates the technical factors used
  • This mode aims to produce an image using an acceptable length of exposure time to reduce motion blurring and/or client dose, without compromising image quality
• Exposure Control:

  • The operator can make an exposure only when completely outside of the X-ray field
• Radiation Shield:

  • Equivalent attenuation to at least 0.08 mm of lead at 35 kVp or the maximum kVp
  • This is to limit operator exposure to well below 0.1 mSv/week based on 40 patients/day, 5 days/week