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Radiology
Imaging the Screening Patient
Built from Fundamentals of Diagnostic Radiology
What’s inside
7 sections · 85 slides
Overview
- Breast imaging and its purpose
- The breast screening toolkit
Screening and Guidelines
Why screening works, who should be screened, and what raises risk
- Tumor size, nodes, and survival
- The 1963 New York HIP trial
- Population trials of the 1970s and 1980s
- Real-world (service) screening
- Goals of screening
- When to start and how often
- USPSTF guidance
- ACR and ACS positions
- High-risk factors
- Managing high-risk women
- Everyone is at risk
Technical Factors in Mammography
Physics, compression, radiation, positioning, and image quality
- Dedicated mammography equipment
- Anode materials
- Why we compress the breast
- Full-field digital mammography (FFDM)
- Advantages of FFDM
- DMIST trial findings
- Where radiation risk is known
- Estimating low-dose risk
- Radiation risk in numbers
- Mammography dose limits
- Screening views
- MLO view positioning
- Mediolateral oblique (MLO) view
- CC view positioning
- Craniocaudal (CC) view
- Supplemental views
- Exaggerated craniocaudal lateral (XCCL) view
- The technologist's role
- MLO quality check
- Normal MLO positioning
- CC quality check
- Normal CC positioning
- Motion and blur
- Blur artifact
- Skin products as artifacts
- Deodorant artifact
- Hardware and processing artifacts
Implants and Tomosynthesis
Screening the augmented breast and 3D mammography
- Screening women with implants
- Implant-displaced (ID) views
- Implant-displaced (ID) view
- Implant materials
- Implant location and contracture
- Implant rupture
- Breast implant rupture
- Digital breast tomosynthesis (DBT)
- What DBT adds
- Tomosynthesis slice versus 2D view
- DBT trial evidence
- DBT dose and synthetic 2D
Interpreting the Mammogram
A systematic read, comparison with priors, and breast density
- Signs of malignancy
- The patient history form
- Optimal viewing conditions
- A systematic reading order
- Comparing with prior mammograms
- A new cancer on serial mammograms
- Why priors matter
- Reader volume and accuracy
- Breast density categories
- BI-RADS 5th edition wording
- Breast density categories on MLO views
- How density masks cancer
- Distribution of breast density categories
- Density as a cancer risk factor
- Density notification laws
Supplemental Screening Modalities
Ultrasound and functional imaging beyond mammography
- Why supplemental imaging
- Screening breast ultrasound
- Limits of screening ultrasound
- Automated breast ultrasound
- Structural versus functional imaging
- MRI in breast screening
- Contrast-enhanced spectral mammography (CESM)
- CESM image
- Breast-specific gamma imaging (BSGI)
Summary
Key numbers and the role of screening mammography
- >90%
- Conclusion
- References
- References
- References
- References
- References
- References
- Brant and Helms' Fundamentals of Diagnostic Radiology