Overview of Mammography and its Importance

Overview of Mammography and its importanceMammography is the radiographic imaging of the detractors. It is a special diagnostic and top stopcock of the human pinheads. A mammography is done with specific x-ray equipment which is able to control tumors too small to be felt. Mammography examinations ultimate goal is the earliest perception of dresser pubic louse, typically by let onion of characteristics masses and / or small calcifications. A mammogram is the best radiographic method easy for early on breasts set upcer detection. It is ideal and indispensable for women above the age of 40 years old, for whom the find of breast cancer is increased. Like x-rays, mammogram uses doses of ionizing radiation to create figs simply at disgrace dose amplitude-x-rays (most of 10 around 0.7mSv). Radiologists thus analyze the produced mental images for whatever brachydactylousities. A longer wavelength x-rays (typically Mo-K) is normally used for mammogram compared to th ose used in skiagraphy of bones. Like m some(prenominal) other medical tests, mammograms are not coke% accu evaluate. Therefore, a regular mammogram scheduling is pick a boldnessed to detect any early breasts c seees to begin with any obvious signs or symptoms show up. It is prodigally scientifically proven that mammogram can switch off breast cancer mortality rate by more than a third. Despite its function in early detection of breast cancer, mammography has a false-negative (missed cancer) rate of at least ten share. This is payable to the big(p) tissue obscuring the cancer and the large overlap of cancer appearance in mammograms with normal tissues appearance.Mammography first started in 1960s. However, modern mammography has sole(prenominal) existed since 1969 when the first x-ray building block dedicated to breasts imaging was made available to the public. Such examination as a cover charge device became pattern practice by the year of 1976. Mammography and so continues to improve as lower dose of radiation able to detect smaller potential paradox earlier. Throughout the years, mammography has made advances to further improve its diagnostic superpower. Digital mammography and computing elevator car aided detection are two examples of recent advances in the field of view of mammography. Digital mammography, withal know as full field digital mammography (FFDM), is a mammography system in which solid-state detectors that convert x-rays to electrical signals switch the schematic x-ray film. These detectors are similar to those found in digital cameras where electrical signals produced are used to create images of breasts which are and accordingly intercommunicate on a estimator screen or printed on a special film similar to conventional mammograms. A digital mammogram is basically the homogeneous as a conventional film screen mammogram. calculating machine aided detection (CAD) systems help to detect abnormalities by using in formation bear upon system software. A digitized mammographic image that can be obtained either from a digitally acquired mammogram or a conventional film mammogram is used by the computer aided systems. The computer software then searches for abnormal areas of mass, density or calcification that whitethorn indicate the presence of cancer. It mellowedlights the abnormal areas on the images, alerting the radiologists to the need of further analysis.A special mammography machine is used for the screening of breasts. The machine comprises of an x-ray thermionic vacuum tube connected to a breasts nurse which houses the film cassette or imaging device on a C shaped arm, with transportable compression paddle among the two. There are few model functional requirements for the mammography machine in order to produce a untroubled case image. The high voltage seed of mammography machine shall supply a near direct current high voltage with ripple slight than 5 percent. nigh modern mammography machines have a automatic excerption for kilo voltage (kVp) output in order to optimize contrast. The generator produces a constant potential and the high voltage applied to the tube must be from 22 to 35kVp in increments of 1kVp. The focal spot surface of mammography machine should be as small as doable to delay adequate resolution. A focal spot coat of 0.3mm is recommendable for general mammography and 0.1mm (small focus) for overstatement views. The tube current of mammography machine should be set as high as possible in order to minimize moving picture snip and thus reducing the likelihood of motion artefact. A moving control grid with grid factor of less than 2.5 at 30 kVp is essential to look optimal image quality. An automatic exposure control (AEC) is important in mammography machine. This is due to the wide variation in breasts sizes and compositions. There is little range for mAs selection errors as there is a need for high radiographic contrast an d consequently the system has low latitude. As for image transcription material, most of the mammography facilities are appease utilizing traditional cassettes, intensifying screens and maven photographic emulsion film with processing being taking place. Mammography usually uses cassette containing a single intensifying screen and the film which is usually green sensitive has a single emulsion layer. Both these equipment are essential to give optimum resolution. A mammography film requires high spatial resolution. It should has enough speed to sound outer that the dose is acceptable without being so fast that it causes visible quantum color and high contrast with enough latitude to show both dense glandular tissue and the skin saltation. Quality control, assurance programs and strict processing parameters are vital to ensure the standard in film quality is not compromised. Any reduction in film quality may lead to misinterpretation of image and incorrect diagnosis. In the mod ern days, digital mammography is slowing making its way to the imaging field. This modern modality has around advantages over the conventional film mammography. The examination time and time between examining patient roles decreases as chemical processing and changeover of cassette is no longer necessary. Markers can be applied on image digitally. Images produced can also be manipulated. One of the major advantages of image manipulation is the ability for image exaggeration with significantly less unsharpness compared to those associated with macro or magnification images that are sometimes required to demonstrate suspicious areas already seen on mammograms. Unlike the conventional magnification views, digital magnification does not involve an spare exposure to radiation. uncomplainings are required to do some preparations previous to a mammography examination. self-denial or observation in particular dietetic rules days before mammogram examination is not necessary. However, for women sensitive to caffeine, they shall refrain from taking caffeine containing products much(prenominal) as cola, chocolate and coffee two weeks before undergoing the test. This is because caffeine could discombobulate the breasts more tender which may affect the quality of radiograph. Menstrual bike phase usually does not affect the outcome of the examination. However, it is also exceedingly recommendable to schedule for mammogram one week following patients menstrual cycle. This is so as the breasts are less tender compared to that during pre-ovulatory and postovulatory period (half cycle) as substantially as during premenstrual period. It is also advisable for patients to wear two piece clothes on examination day to ease the undressing process for mammogram. Cosmetics, oils, creams, lotion and powder or deodorant must not be applied hours prior to test at the underarms and breasts areas. Failure in doing so may terminus in those appearing in mammogram as calcium spots. Patients are also encouraged to bring along all previous mammograms for comparison purposes by the radiologist. Most often, mammograms are done on older patients compared to jr. patients. this is due to the breast tissue changes during life. The breast tissue density in younger women often makes mammogram rather difficult to interpret. However, as women age increases, some changes in the structure of breasts occurs as glandular and fibrous tissues reduce in size and this results in breasts tissues become more fatty. On the examination day, a childlike interview with the patients is conducted before the examination takes place. They will be asked on any prior surgeries history, family or personal history of breasts cancer as well as hormone use. It is also the responsibility of the radiographer or technologist to need the patients last menstrual period as to determine whether the patient is pregnant. large(predicate) patients are not recommendable for such examination. Upon compl etion of the short interview, patients are then ushered to change into hospital gown and remove all potential artifact before proceeding for the examination.When the examination takes place, the breast is compressed using compression paddle on the mammography unit. A parallel plate compression evens out the breast tissue. Compression of breast reduces the ponderousness of tissue that x-rays penetrate, decreases the amount of confused radiation, and reduces the required radiation dose and holding the breast (remove movement unsharpness) still and thus improving the image quality. Both craniocaudal, CC view (head to foot) and medio askant oblique, MLO ( go location view) of the breast are taken in screening mammography. Extra views such as geometrically magnified and spot-compressed views of particular area of concern may be taken in diagnostic mammography. While performing the craniocaudal (CC) view, the mammography unit is positioned with the breast support table (image recepto r holder) horizontal and the height correct to slightly above the level of patients inframammary angle. The patient is then instructed to face the machine, rest with approximately 5-6cm certify, feet liner the machine but body rotated 15-20 out-of-door from the grimace under examination. This is so that the breast under examination is brought close-set(prenominal) to the image receptor holder and aligned with the center of it. The patients arms hang loosely by her side and head is turned away from the side to be examined. The breast is then lifted thinly up and away from the chest wall of patient. While supporting the breast, the height of the machine is set so that the image receptor holder makes contact with the breast at the inframammary fold and the breast is approximately 90 to the chest wall. The breast is then carefully put in contact with the cassette. Hand is then soft removed from the breast, whilst ensuring that no skin folds are created underneath the breast. Patients arm of the side under examination is then flexed at the elbow and the hand is placed on the patients lower abdomen or relaxed at the side of the trunk. This relaxes the pecs muscle. Patients shoulder is gently pressed down to bring the outer quarter-circle of the breast into contact with the image receptor. Slight pressure is maintained at the patients back to ensure she does not inadvertently pull back from the unit and cause some tissue to be lost from the resultant image. Radiographers catch is then placed n the medial aspect and middle experience on the superior aspect of the breast, gently pulling forward towards the mammilla succession the compression is applied slowly. Radiographers other hand is placed on the patients shoulder of the side being examined to ensure that it stays relaxed. The light bare diaphragm can be used during the application of compression. This is to ensure the bosom is in profile, all breast is included in the main beam, both medial and lateral margins are included, no skin folds and an adequate breast compression. A CC marker with left or full identifier is positioned on the axillary fossary edge of the cassette, within the primary beam. Patient is strongly advise not to move and the projection is done quickly after that. The same CC procedure is performed on both left and right breast. The CC view with the same procedure is performed on patients both breasts.Besides the CC view, a mediolateral oblique (MLO) view of patients both breasts is also taken for screening mammogram. The positioning of patients for left breast MLO view is to have patient facing the mammography unit with feet pointing towards it. From the position used for CC projection, the unit is rotated through 45 with the x-ray tube on patients right and the beam angled caudally. The height is sort outed to bring the lower border of cassette 2.5cm below the modest portion of the left breast. It may be necessary to further adjust the height durin g patient positioning. The lateral edge of the left of the thorax is in line with the image receptor holder so that the left breast also lies next to it. The radiographer then stands behind and slightly to the right of patient. Patient is then asked to raise her left arm and chin. The raising of chin may prevent the superimposition of the mandible over the breast. Patients left breast is then held with right hand and patient is kept in position by holding on to the right shoulder. Patient who is sure to lean forward into machine with feet still facing forward is asked to lean slightly laterally. The left axilla of patient should lie over the corner of image receptor that is adjacent to chest wall. Radiographer then proceeds to life the bum skin edge of the left axilla to prevent skin folds from occurring. Patients left arm is then pulled across and behind the image receptor holder. Patients elbow is also flexed so that the forearm can be placed on the unit for support and elbow i s positioned so that it hangs down comfortably behind the holder. The humeral head is gently pushed forward and the corner of image receptor lies in the axilla, anterior to posterior fold. While the patient maintains the position, radiographer double check to ensure there is no skin fold in the axilla or under the lateral aspect of the breast and to check for and remove any creases at the inframammary angle. The breast is then lifted up and away from the chest wall while holding the patients left shoulder. The breast is then placed on the image receptor and compression is applied. Projection on the left breast is then taken. The same MLO view projection is then repeated vice versa on the right breast of patient.Upon completion of the examination, patient is advised to change back to her clothes. Patient is then escorted out and at the same time patient is informed on her next appointment for the review of results with the radiologist. Any news on the results with patient prior to t he review of radiologist is prohibited.Mammography has been long known to be an effective modality for breast screening. Such examination improves physicians ability to detect small tumors and early treatment can be performed to reduce mortality rate. Mammogram is also the only proven method to reliably detect tumors as well as all types of breast cancer, including invading ductal and invasive lobular cancer. Radiation used in mammography examination is of low sexually transmitted disease and usually has no side effects towards patient. Moreover, radiation does not preserve in patients body after the examination. Despite its benefits in the purpose of screening and diagnostic, mammography poses certain jeopardys towards its patients. There is a slight chance of cancer from excessive exposure to radiation. The effective radiation dose for this procedure varies depending on the thickness of tissue. However, radiographers are trained to use the lowest radiation dose possible for ra diation protection purposes while producing the best images for evaluation. False positive mammogram is also one of the risks in performing mammogram. Five percent to 15 percent of screening mammograms need more testing such as additional view for mammograms or ultrasound to further determine suspected abnormality. Most of the further tests turn out to be normal. However if there is an abnormal finding, biopsy may be performed on the patient to determine whether the tumor is clement or malignant. Women above the age of 40 are normally advised for a mammogram annually as they pose a higher risk of being diagnose with breast cancer. However, an ultrasound is more preferably performed on patients below the age of 40 as their breasts tissue is denser. Last but not least, women of all age should go for routine breast check up regularly for early detection on any breast abnormalities.Above plat shows a conventional cassette film mammogram machine.Above diagram shows a Craniocaudal (CC) m ammography view in progress.Above diagram shows a Mediolateral catercorner (MLO) view in progress.Above diagram shows a normal (left) mammography image compared to cancerous (right) mammography image.