1
Q
performed by a healthcare professional/ physician to detect any abnormalities and warning signs
A
Clinical Breast Exam
2
Q
every woman should do once a month at home; do it yourself
A
Breast Self-Exam
3
Q
Screening method:
A
Opportunistic or Programmatic
4
Q
What is screening?
A
refers to a test, examination, evaluation, assessment performed on an asymptomatic individual
5
Q
GOAL of screening?
A
prevent death and suffering/occurrence of diseases through an early intervention
6
Q
General Principle of Screening:
A
- screening is of greatest value for individuals who are most likely to
develop a certain disease - early treatment is more effective than later treatment in reducing mortality
7
Q
Important to determine a person’s risk of developing breast cancer
and use that information to:
A
- Recommend the modality
- Frequency of screening
- Determine whether referrals are needed for genetic testing
/chemoprevention / prophylactic surgery
8
Q
Harms of Screening
A
- raise anxiety if there is false positive screening
- overtreatment of some tumors that would never become apparent
- economic cost: healthcare system/patient
9
Q
Risk Factors
A
Hormone Therapy
Non-modifiable
Postmenopausal
Reproductive Factor
Subtances Use
10
Q
- can’t be changed
- family history
- age, chest radiation history, dense breast tissue, genetic alteration, race
A
NON-MODIFIABLE
11
Q
- obesity
A
POSTMENOPAUSAL
12
Q
Combined estrogen-progesterone in
women with intact uteri
A
HORMONE THERAPY
13
Q
⬆️ age
A
the more susceptible we are to breast CA
14
Q
- Alcohol
- Current smoking
A
SUBTANCE USE
15
Q
- Absence of breastfeeding
- Early menarche
- Late first pregnancy >35 years old
- Nulliparity
A
REPRODUCTIVE FACTOR
16
Q
never been pregnant or given birth
A
NULLIPARITY
17
Q
Highest Probability (%) of developing breast cancer by Age
A
70 and older
18
Q
Defective Genes
A
BRCA1
BRCA2
p53
STK11
CDH1
PALB2
PTEN
Mismatch repair genes
19
Q
Components of Breast Screening Examination
A
I. Breast Awareness
II. Physical Examination
III. Risk Assessment
IV. Screening Mammography
V. MRI
VI. UTS
20
Q
- screening method used in attempt to detect early breast cancer
- checking your own breast for possible lumps, distortions, or swelling
A
BREAST SELF EXAMINATION
21
Q
Benefits of BSE
A
• Education about self-awareness
• Empower women
• General breast health
• Lower risk of death or metastasis
• Lesser advanced-stage cancer
• Raise awareness among women at risk
22
Q
Harm of BSE
A
• False positive result
• Gain anxiety if found abnormality
23
Q
It is advisable to do BSE..
A
once a month after menstruation
24
Q
STEPS TO BREAST SELF-EXAMINATION
A
- Stand infront of a mirror
Shoulder straight
Hands on hip
Look for dimpling, dripping, lump, pulled in nipple (inverted/retracted), rash, skin changes - Raise arms, look for the same changes
- Look for sign of fluid cominf out (blood, milky/ yellow fluid, watery)
- Palpate breast while lying. Use finger pads to palpate.
Cover entire breast, side to side (from collarbone to abdomen: armpit to cleavage) - Feel breast while standing/ sitting. However, many find it easier to feel breast while showering or wet.
25
PATTERNS FOR PALPATION
CIRCULAR
LINES
WEDGES
26
systematic palpation
visual inspection of the entire breast
performed by doctor, nurse practitioner, nurse, or physician assistant
Clinical Breast Examination
27
GOAL of MAMMOGRAPHY
early detection of breast cancer, typically through characteristic detection of masses or microcalcifications
28
highly engineered so we can image the breast
mammographic machine
29
BASIC PROJECTION:
Cranio-caudal (CC)
Medio-lateral Oblique (MLO)
30
other name for MLO
Lundgren's Oblique View
31
(Z) atomic # of tissue:
7-8
32
(Z) atomic # of tumors, calcifications:
20
33
easier to image..
older breast bcs of fatty replacement
34
a lot of scattering (compton) than absorption (photoelectric effect)
causes low differential absorption
35
type of xrays we use:
Characteristic xrays
36
lower xray energy used,
improve contrast resolution
enhance differential absorption
37
Components of equipment:
• Anti scatter grids
• Automatic exposure control
• Breast compressor
• Cassette holder
• Collimator / cone
• Generator
• Support system
• X-ray tube
38
xray energy required for good
contrast:
20 - 40 kVp
39
maximum mA:
200 mA
40
For homogenous x-ray beam,
High Frequency Generator is required
41
Target materials:
Molybdenum 42
Rhodium 45
Tungsten 74
42
most common anode target material used?
Molybdenum
43
Advantages of using Molybdenum
- increased number of low-energy photons is produced
- high radiographic contrast is achieved in the image
- specific x-ray energies required for breast imaging are produced
44
Disadvantages of using Molybdenum
- less x-ray photon output due to a lower atomic number—42
- increased mAs is required to maintain image receptor exposure
- increased pt dose
45
low atomic number
- produce low-energy characteristic x-rays
- used in mammography
46
to compensate the low xray photon output of Molybdenum
increase mAs
47
focal spot sizes:
0.3 - typical
0.10 - 0.15 - magnification
48
SID
60 - 65 cm
49
Tube tilt
6 - 24°
50
anode angle
0 - 6°
51
Effective anode angle
at least 22-24° for a 24 × 30-cm field area
52
(Be) Beryllium
- has low atomic no. and lower absorption of less than 5 kVp x-rays
53
1mm of Be is equivalent to..
0.1mm Al material
54
achieves better uniformity of the
transmitted x-rays through the breast
anode heel effect
55
decreases the equipment bulk near the patient’s head
Positioning the cathode over the chest wall of the patient and the
anode over the nipple
56
tilted XRT allows a narrower effective FS improving..
spatial resolution
57
Target and filter combination:
• Mo-42 target with 0.03mm Mo-42 filter
• Rh-45 target with 0.025mm Rh-45 filter
• W-74 target with 0.05mm Rh-45 filter
58
using target & filter combination we can..
protect low xray energy by filtering high xray energy
59
uses 17.6 keV & 19.7 keV to produce characteristic radiation
Moly/Moly Spectrum
Moly/Rhodium Spectrum
60
- good for denser breast
- breast greater than 5 cm thick
Molybdenum/Rhodium Filter
Rhodium/Rhodium Filter
61
Rhodium anode
20.3 keV & 22.7 keV
62
molybdenum filter
20 keV
63
rhodium filter
23.22 keV
64
for breasts less than 5 cm thick
moly/moly filter
65
- used for proper direction of xray beam
- embedded inside
- proper collimation
- rejecting scatter radiation
- protection of chest wall and lungs from unnecessary radiation
Collimator / Cones
66
THREE DESIGN ARE CURRENTLY USED:
Fixed aperture
Interchangeable cones for various sizes of breast
Internal set of collimating blades
67
preferred interspace material?
carbon fiber
68
must be a moving grid?
anti scattered grid
69
3 types of anti scattered grid
linear grid structure
cellular grid structure
air gap & magnification
70
use of grid increases
patient dose
71
4:1 grid ratio
double the patient dose
72
unique grid is developed specially for the mammography:
High Transmission Cellular (HTC) Grid
crossed type grid
73
HTC grid
copper - grid stripe
air - interspace
74
flat surfaced plate used for uniform
compression
compression plate
75
for equal compression to all areas of the breast
slanted S.O.F.T paddles
76
Advantages of Compression Plate
➢ Provides immobilization of the POI during exposure
➢ Produces radiograph of uniform density
➢ Reduces geometric unsharpness due to closer object to IR distance
➢ Reduces scatter and improves contrast
➢ Reduces tissue overlap and improves resolution
➢ Enhances recognition of architectural distortion produced by tumors
77
used to magnify small area of breast for better visualization
better compression for over small area
spot compression
78
Amount of compression:
25 - 40 pounds of pressure
79
- designed to measure x –ray intensity at image receptor and x –ray quality
- place after the image receptor
PHOTOTIMERS or AUTOMATIC EXPOSURE CONTROL
80
A preset value corresponds to a specified..
SNR for digital mammography
Acceptable optic density for film-screen
81
single-coated film-screen combination commonly used
GADOLINIUM OXYSULPHITE
82
MAMMOGRAPHIC CASSETE
18X24/ 24X30 cm
83
digital mammography
full-field digital mammography
84
Direct conversion uses
Amorphous Selenium
85
Indirecr Conversion uses
86
MASTECTOMY
INTRODUCED IN 1898 BY HALSTEAD
87
Developed clinical techniques for mammography
LE BORGNE- URUGUAY GERSHON-COHEN- US
GROS- GERMANY
88
Breast XEROGRAPHY introduction by WOLFE and RUZICKA in
1960
89
INDICATIONS: BCCEFFIT
BREAST CARCINOMA
CALCIFICATION
CYST
EPITHELIAL HYPERPLASIA
FIBROADENOMA
FIBROSIS
INTRADUCTAL PAPILLOMA
TUMOR
90
grid ratio
3:1
5: 1
MAMMOGRAPHY
flashcards
Decks in class (3)
# Cards
