Complimentary Projections

• Medially rotated cranio-caudal projection 


  Breast rotated medially towards the inner area to demonstrate the lateral portion and the midline

  
• Laterally rotated cranio-caudal projection 


  Breast rotated laterally to demonstrate the majority of the axillary tail

  
• Extended cranio-caudal projection


  Demonstrates the majority of the axillary tail
• Medio-lateral projection (ML)


  Demonstrates the breast from the medial to lateral side

  
• Latero-medial projection


  Demonstrates the breast from the lateral to medial side

  
• Axillary tail view


  Demonstrates the axillary tail of the breast

  
• Specialized techniques


  • Used when basic projections indicate a possible abnormality requiring further evaluation
  • Techniques require explanation to the patient about what is being attempted and why
  • Techniques require the patient's assistance and cooperation to obtain satisfactory images

  
• Rolled views/displacement views


  1. Can be performed in any projection

  2. Most commonly used in CC projections when superimposed tissue structures may be obscuring a lesion or may mimic a lesion

  3. Projects the superficial tissues away

  4. Exposes the obscured areas

  5. Determines the reality of a lesion

  6. Demonstrates whether the lesion was superficial or deep

  
• Localized compression or "paddle" views


  Valuable alternative to rolled views
• Accurate localizations of the area of interest

  1. Examine the original mammogram

  2. Measure and note down the depth of the lesion from the nipple, the distance of the lesion above/below nipple level, and the distance from the skin surface to the lesion

  
• Magnification views


  Provide better visualization of the shape/margin of a lesion

  
• Augmented breast


  Positioning techniques that allow for better visualization of an enhanced breast with implants

  
• Positioning of the small breast


  • Increase the angle of the tube and receptor to a maximum 70 degrees if posterior tissue is not imaged on the MLO view
  • Use another position (exaggerated CC or 30° oblique) if unable to visualize posterior tissue with maximum angle
  • Use a rubber spatula to compress and bring the tissue away from the chest wall on the CC view if unable to compress properly

  
• Postmastectomy positioning


  • Obtain images of the remaining tissue after mastectomy, and also image the unaffected breast
  • Care should be taken to minimize discomfort due to radiation treatment or postsurgical scarring
  • A MLO projection and an anteroposterior view of the axilla should be performed on the mastectomy site

  
• Needle localization


  To determine the site of a lesion preoperatively, with precise needle placement being of utmost importance
• Ductography/galactography


  To determine possible reason for abnormal nipple discharge

  
• Fine needle aspiration


  Performed to obtain a specimen for cytologic analysis, to differentiate between benign and malignant lesions
• MRI


  Enables diagnosis of breast malignancy with a more sensitive and specific modality than conventional mammography

  
• Ultrasound


  Most advantageous for distinguishing between solid and cystic lesions without radiation, and for detecting symmetrical versus asymmetrical lesions
• Stereotactic breast biopsy


  Provides a technique to pinpoint a non-palpable abnormality visualized on conventional mammography, using digital radiography for better resolution

  
• Equipment necessary in Paddle views

  • Fine focus
  • Moving grid
  • Small compression paddle
  • AEC towards the chest wall
  • Full field diaphragm
• Equipments required for Magnification

  • Fine focus
  • Magnification table
  • Film holder
  • Small and large paddles
  • Full field diaphragm
• Specialized Techniques

  • Rolled Views / Displacement Views
  • Localized Compression / Paddle Views
  • Accurate Localizations of the Area of Interest
  • Magnification Views
• Modified Studies

  • Augmented Breast
  • Positioning of the Small Breast
  • Postmastectomy Positioning
• Special procedures

  • Needle Localization
  • Ductography/Galactography
  • Fine Needle Aspiration
  • MRI
  • Ultrasound
  • Stereotactic Breast Biopsy
• Indications of Medially Rotated CC

  • Lesions demonstrated at the mediolateral oblique but not on the craniocaudal projections
  • Lesions located in the extreme lateral portion of the breast
  • Large-breasted women who require more than one film in the craniocaudal positions
• Area demonstrated in Medially Rotated CC

  Lateral and Midline portions of the breast
• Breast position in Medially Rotated CC

  • Nipple pointing towards the medial
  • Muscle demonstrated in the lateral portion of the breast
• Complimentary Projections

  • Medially Rotated Craniocaudal
  • Laterally Rotated Craniocaudal
  • Extended Craniocaudal
  • Medio-Lateral Projection
  • Latero-Medial Projection
  • Axillary Tail View
• Indications of Laterally Rotated CC

  • A lesion may be demonstrated in the medio-lateral oblique
  • Lateral aspect has been demonstrated, it is a possibility that the lesion lies medially
• Breast Positioning of Laterally Rotated CC

  • Nipple points toward the lateral
  • Cleavage may be demonstrated
• Indication of Extended CC

  Lesion seen high in the axillary tail on the medio-lateral oblique but not on a cranio-caudal
• Area demonstrated on an Extended CC

  • Axillary tail
  • Upper midline portion of breast tissue
• How many degrees is the machine raised in Extended CC

  5-10 degrees
• Breast positioning of Extended CC

  • Nipple is in profile
  • Anterior edge of the pectoral muscle lateral to the midline of the breast
• Indications of Medio-Lateral Projection

  • Depth localization of lesions
  • Post-stereotactic / ultrasound marker localization
  • Alternative view to clarify possible lesion demonstrated on medio-lateral oblique
  • Demonstration of the inframammary angle
• Area demonstrated in Medio-lateral and Latero-medial Projections

  Majority of the breast tissue with the exception of the axillary tail
• Medio-lateral should demonstrate

  • Nipple in profile
  • Inframammary angle
  • Lower part of the pectoral muscle
• Indications of Latero-medial Projections

  • Demonstrate the medial quadrants
  • Demonstrate inframammary angle in the non-standard women
• Breast Positioning of Latero-medial Projection

  • Nipple in profile
  • Inframammary angle is in view
  • Anterior surface of the pectoral muscle