Breast Imaging Mammography

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State three benefits of breast compression.


a. Allows a more uniform attenuation of x-rays by flattening the base of the breast to the same degree as the more anterior regions, permitting optimal exposure of the entire breast in one image.

b. Reduces dose to the breast by reduced tissue thickness.

c. Brings lesions closer to the image plate for more accuracy when evaluating fine details.

d. Decreases motion unsharpness by immobilizing the breast during the exposure.

e. Increases contrast by reducing the amount of scattered radiation and by decreasing breast thickness.

f. Separates superimposed areas of glandular tissue by spreading apart overlapping tissue, reducing confusion caused by superimposition shadows, and allowing visualization of the borders of circumscribed lesions.


Give one possible cause of painful breasts.

Having fibrocystic breast or breast cyst


On which two margins is the breast more rigidly attached to the chest wall?

Medial and superior are more rigidly attached than the inferior and lateral margins


Why is magnification not useful in evaluating lesion size?

The final image is magnified, and the entire breast will not be imaged.


Why are the CC and MLO projections termed “complementary projections”?

Tissue that is eliminated or poorly imaged on one projection will be imaged on another.


What area of the breast (not imaged well on the MLO) is best imaged on the CC projection?

Anterior, central, medial, and posteromedial


Why are grids not necessary in magnification mammography?

The air gap replaces the grid. The grid will increase exposure time, tube loading, and motion artifact due to long exposure time.


What factor determines tube angulation when imaging on the MLO projections?

The angle of the pectoral muscle


What area of the breast is best imaged on the MLO?

Extreme posterior, upper outer quadrant


Name three common problems when imaging on the MLO.

Drooping breast, abdominal tissue in the image, missing or closed inframammary fold, skin folds in the axilla region


Which supplementary projection will best image the extreme posterior medial breast?

Cleavage (CV)


Which projection is the true reverse of the MLO?

Lateromedial oblique (LMO)


Name the projection most useful in imaging skin calcification.

Tangential (TAN)


Name the projection that best images the posterior lateral aspect of the breast.

Exaggerated craniocaudal lateral (XCCL)


Why is a spatula often useful when imaging the small breast?

The spatula is smaller than a finger, which would get in the way of the compression plate before adequate compression is achieved on the small breast.


The standard Eklund technique (implant-displacement technique) will result in how many exposures when imaging a typical patient?

Eight exposures


Why is imaging the irradiated breast less than 3 months after completion of radiation treatment contraindicated?

Radiation causes edema or coarsening of the fibrous or stromal elements of the breast, plus increased thickness and density of the ductal and glandular elements. These changes will diminish or resolve over time but will affect interpretation on the mammograms.


What is the purpose of the triangulation technique?

To localize a nonpalpable breast lesion when imaging spot compression or magnification


Which of the following is inappropriate or demonstrates poor positioning techniques when imaging on the CC projection?

(A) Demonstrating the nipple in profile

(B) Always demonstrating the posterior lateral breast

(C) The PNL measurement is within 1 cm of the PNL on the MLO

(D) Including both the medial and lateral breast within the collimated field

(B) Always demonstrating the posterior lateral breast


The projection used to demonstrate the posterior lateral aspect of the breast not seen on the CC is:


(B) ML





Key points in imaging on the MLO projection include:

(1) Tube angulation should be between 30 and 70 degrees

(2) The inframammary fold should be closed

(3) Compression must support the anterior breast tissue

(A) 1 only

(B) 2 and 3 only

(C) 1 and 3 only

(D) 1, 2, and 3

(C) 1 and 3 only


In breast imaging, the technique used to increase compression on a small area of interest to spread out the tissue and improve resolution is called:

(A) Cleavage

(B) Axillary tail

(C) Tangential

(D) Spot compression

(D) Spot compression


The tangential projection is often used to:

(A) Image implants

(B) Demonstrate skin lesions

(C) Evaluate the margins of lesions

(D) Remove superimposed tissue when imaging dense breast

(B) Demonstrate skin lesions


When imaging implants, some of the projections taken will include an image of the implant. In these projections, the compression is used:

(1) For immobilization only

(2) To separate the breast tissue

(3) To separate and spread out the implant

(A) 1 only

(B) 2 only

(C) 1 and 3 only

(D) 2 and 3 only

(A) 1 only


This projection best demonstrates the upper inner quadrant and the lower outer quadrant of the breast free of superimposition and can be used when imaging implants, especially encapsulated implants:


(B) AT





The main reason for breast compression is to

(A) Control the radiation dose to the patient

(B) Control patient motion

(C) Reduce the exposure time

(D) Ensure a uniform thickness

(D) Ensure a uniform thickness


After imaging in the breast using the MLO projection, an ML projection was taken. The lesion seen on the MLO moves down on the ML. This indicates that the lesion is located:

(A) Laterally

(B) Medially

(C) Centrally

(A) Laterally


The true lateral projection that will best demonstrate a medial lesions is:

(A) ML



(D) LM

(D) LM