Introduction to Mammography

The Basics of mammography

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Introduction to Mammography

Radiological caracteristics of lesions

density absorption

Fibro glandular Tissues 1,035 0,8

Fat 0,93 0,45
Skin 1,09 0,80
Carcinomas 1,045 0,85
Micro calcifications 2,2 12,5

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Introduction to Mammography

Physically speaking we can differentiate:

• 3 types of tissues : - skin

- fat
- fibro – glandular tissues

Radiologically we will see:

• 4 types of lesions : - “black » images

- micro-calcifications
- opacities
- fibrous signals

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Introduction to Mammography

Mammography: Different Types of Examinations

• Screening
- Health program organised by government
- 2 exposures: 1 incidence on each breast

• Diagnostic
- Personal decision process
- Usually 4 exposures: 2 incidences on each breast and
eventually magnified views.

• Interventional procedures
- Stereotactic biopsy procedures

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Introduction to Mammography

Why the need for a dedicated equipment ?

Mammo Specifics

• Soft / thick tissue (no bone, no air)

• Breast cancer revealed by

- very thin details (micro 20 – 400 microns )
- very low contrast lesion (opacities )

• Long exposure time (vs. Rad& RF) up to 6s.

How to avoid motion blurring ?

• High dose (vs. Rad & RF). How to minimize dose ?

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Introduction to Mammography

Why the need for a dedicated equipment ?

Technical answer
Mammo Specifics
• High resolution
• Soft / thick tissue (no bone, no air) - fine focal spot
- magnification
• Breast cancer revealed by • High contrast
- very thin details (micro 20 – 400 microns ) - low kV generator
- special X-Ray beam - anti scattering
- very low contrast lesion (opacities )
grid
- compression device
• Long exposure time (vs. Rad& RF) up to 6s. •
High Power tube
How to avoid motion blurring ? - adapted XR energy
• High dose (vs. Rad & RF). How to minimize dose ?

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Introduction to Mammography

Why a dedicated X-Ray beam ?

Mammo specifics:

A simple dose calculation shows that for a given IQU

Optimum spectrum energy

• depends on breast thickness

• Is between 15 KeV et 25 KeV

We need to use a dedicated Xray beam according to type of breast

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Introduction to Mammography

Glandular Dose at given IQ

relative dose at given IQ
10
7 cm
6 cm
5 cm
4 cm
3 cm
2 cm
1

RX energy (KeV)
0,1
5 15 25 35
If we know the radiological density of the breast we’ll have the possibility
to adapt the proper XR beam for each patient.
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Introduction to Mammography

The X-Ray beam

7 cm
•Molybdenum is well suited:
2 cm

17,4 KeV
- The XR beam is produced between

Quantity of photons
18 and 20 kVe
Mo 19,6 Kev
- Mo provides a big quantity of low energy
photons

Energetic spectrum
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Introduction to Mammography

Why a Rhodium filter ?

17,4 KeV
• the optimal spectrum is not energized Mo
by kV increase 19,6 Kev

Quantity of photons
• The proportion of “useless” RX
increases dramatically

Energetic spectrum

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Introduction to Mammography

Why a Rhodium filter ?

17,4 KeV
IQ loses (contrast)

• the optimal spectrum is not energized 19,6 Kev

Mo
by kV increase

Quantity of photons
IQ increase

• The proportion of “useless” RX

increases dramatically

Energetic spectrum

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Introduction to Mammography

Why a Rhodium filter ?

17,4 KeV
Dose decrease
• the optimal spectrum is not energized 19,6 Kev
Mo
by kV increase

Quantity of photons
IQ increase

• The proportion of “useless” RX

increases dramatically

Energetic spectrum

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Introduction to Mammography

Why a Rhodium target ?

7 cm

17,4 Kev 2 cm
20,2 Kev

Mo

Quantity of photons
• the useful spectrum is more energetic
Rh

• the energetic spectrum is close to

molybdenum

Energetic spectrum

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Introduction to Mammography

Optimal choice (contrast ) according to

thickness and dose level
Breast thickness

8
7 Rh/Rh

6
Mo/Rh
5
4 Mo/Mo
3
Average glandular dose
2

0,1 0,2 0,3 0,4 0,5

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Introduction to Mammography

The X-Ray Beam

Contrast
Rhodium target utility 19,6 Kev

17,4 Kev 19,6 Kev 17,4 KeV

Breast density
Nb of photons

Mo Rh

Dose
X-Ray Spectrum Breast density
… Whatever the exam,
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Introduction to Mammography

The Tube - Focal spot size

• Geometric unsharpness increases with focal spot

Large Focal Spot Small Focal Spot

Object Object

Shadow Shadow

• The small focal spot is used to magnify suspicious

regions - geometric shadow is extremely low.
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Introduction to Mammography

The Filtration

Radiation intensity
• Energy peak represent
from 1/3 to 1/2 of total Unfiltered
radiation

• Mo filtration
contributes to :
- Suppression of low energies
(<10keV) which are absorbed
by the breast ( increase dose but
do not contribute to the image Filtered
formation)
- Suppression of high energies
(>20keV) which blacken the film.
0 25 50 75 100
Photon energy KeV
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Introduction to Mammography

The Grid Focal Spot

• Scattered radiation
reduces contrast

• Scattered radiation can

be absorbed by a grid to
maintain contrast:
- The lead strips stop the
scattered radiation Scattered
- The strips are angled to radiation
point to the focal spot
- The grid is moved by a motor
to avoid strip projection on
the film
Grid

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Introduction to Mammography

The Compression
• Eliminates motion
blurring compression
• Reduces geometric device
unsharpness
• Reduces the formation
of scattered radiation
• Reduces skin doses
• Enables imaging of the
entire breast including
Breast
deep layers
Support
plate
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Introduction to Mammography

The Magnification View

• Any suspicious image should be the object to this
type of view

• It is a localised view performed by:

-Selecting the small focal spot => less geometric shadow

increased details visibility

-Positioning the breast on a magnification device

- No grid is necessary => less dose, decreased scatter radiation

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Introduction to Mammography

The Magnification View focal spot

diaphragm
• The bigger is the air gap:

- The bigger is the primary beam

magnification factor compression
device
- The smaller is the region
scattered radiation
radiographed => difficult to
localize the region of interest magnification
device
- The lesser the quantity of
secondary beam
scattered radiation reaching
the film => less dose film/screen
cassette

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Introduction to Mammography

Automatic exposure mode “AOP”

Automatic selection of parameters: kV, mAs, anode, filtre

User AOP
Selection of priority
Measurement of Automatic
radiological Control of mAs
 A.O.P. "Contrast" selection of
density with AEC
 A.O.P. "Standard" parameters
 A.O.P. "Dose"

… Optimum image quality at lower dose whatever the breast density

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Introduction to Mammography

The Stereotactic applications

• Fine Needle Aspiration (FNA - Cytology)
The radiologist places the needle at the point of interest in the breast and aspirates cells
through a syringe

• Core Biopsy (Histology)

The radiologist places a needle at the point of interest in the breast to take tissue samples
using a biopsy gun.

• Hook Wire Placement

Once diagnosis has been made, the radiologist placces a hook wire taht will mark the lesion
and guide the surgeon during the operation.

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Introduction to Mammography

The Stereotactic applications

Fine Needle Aspiration Fine Needle Aspiration Core Biopsy
15 ° 15 ° 15 °
0° X Ray Tube 0° X Ray Tube 0° X Ray Tube

Biopsy Gun
Syringe
Hook

needle holders + Bushings

Needle Coax

Compression paddle
Compressed Breast
Target (lesion)
Breast Support tray

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puncture volume
Introduction to Mammography

The Stereotactic Procedure

+0°
- 15 °
+ 15 °

Film or
Digital detector

A A A

B B B
C C C

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Introduction to Mammography

The Stereotactic Procedure

+ 15 ° - 15 °
+0°
Film or
Digital detector

A A A
Z
B B B
C C C

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Introduction to Mammography

Thanks for listening

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