1 RAD 354 Chapt. 19 Mammo Also know as soft tissue radiographyBreast CA is the 2nd leading cause of cancer related death in women (lung CA is first) 1 in every 8 women will get breast CA

2 Two types of Mammo Screening – for asymptomatic patientsDiagnostic – for symptomatic or elevated risk patients Baseline mammo is the first mammo done and is usually done prior to the age of 40

3 Risk factors for Breast CAAge – the oloder the higher the risk Family history – mom/sister with breast CA Genetics – presence of BRCA1/2 genes Menstruation – onset prior to age 12 Menopause – after age 55 Late childbirth age or no kids Education – higher ed= higher risk Socioeconomics = higher risk with higher status

4 Breast anatomy – all SIMILAR atomic mass density!Fibrous Glandular – most radiosensitive breast tissue Adipose – less dense and less dose If a malignancy is present, it usually presents as a distortion of ductal and connective tissue patterns 80% is ductal and many have microcalcifications

5 Imaging breast tissuesLow kVps = 20 – 35 kVp range Target material is tungsten (W), Molybdenum (Mo) or Rhodium (Rh) Filter material is dictated by target material Beryllium or borosilicate If tungsten target – then molybdenum or rhodium filter Inherent filtration is approx. 0.1 mm al equiv. Focal spot sizes mm (large/small)

6 Other mammo infro Heel effect is always used (chest wall at cathode side of tube) Compression always used: increased spatial resolution, lower pt. dose and focal spot blur Grids are usually 4:1 or 5:1 FOCUSED AEC’s require reproducible images at low dose kVp’s of +/- 0.1 OD

7 Mammo Image Receptors Historically there have been many receptors used (direct-exposure, xeroradiography, screen-film and digital receptors Current are only screen-film and digital receptors in this country Digital’s advantage is post image acquisition processing; disadvantage is spatial resolution limitations (pixel size of receptor)

9 Mammo Radiograph

10 RAD 354 Chapt. 20 Mammo QC American College of Radiology (ACR)Mammo Quality Standards Act (MQSA) Mammo is the only Fed. Mandated licensed specialty in all 50 state and U.S. territories

11 QC Team Radiologist – oversees the ENTIRE mammo QC program including CQI processes Physicist – annual evaluation of the imaging systems; advising the mammographer Mammographer – most involved in reality of the QC trio

12 Mammo QC Program Darkroom Cleanliness – dailyProcessor QC – daily (sensitometry/densitometry) OD tolerance Screen Cleanliness – weekly View boxes/viewing conditions – weekly Phantom images – weekly Visual checklist (imaging unit lights, locks, etc.) - monthly

13 QC Program Con’t Repeat analysis – quarterly / 250 pts. (<2%)Fixer/hypo retention – quarterly Radiologist conference – quarterly Darkroom fog – semi annually (safelights, leakage light, wattage of bulbs, distance) Screen film – Semi annually Compression – semi annually (never >40 lbs in auto mose) lbs

14 Breast Anatomy

16 Mammo QC Kit

17 Where I want to go on spring break

18 Where I will be for spring break