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Mammography Physicsandtechnique 160225101421

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Mammography Physicsandtechnique 160225101421

Uploaded by

Armaan Gupta
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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MAMMOGRAPHY- PHYSICS AND

TECHNIQUE
Dr. Archana Koshy
 There are several breast imaging modalities available
such as Ultrasound, CT,Digital Mammography ,MRI and
scintimammography .

 Mammography remains the cornerstone of breast


imaging .

 Only mammography when correctly performed and


interpreted offers the necessary reliability to diagnose the
curable forms of breast cancers.

 Ultrasound,MRI , CT are useful adjuncts once a lesion


has been detected by physical examination or by
radiographic mammography .
XEROMAMMOGRAPHY
 -X-rays strike an electronically
charged plate of selenium-
coated aluminum.
 The loss of charge at sites of X-
ray interactions leads to latent
image formation which is
converted to visible image by
reading the charge pattern.
 This technique gives a very
sharp but low contrast image.
INDICATIONS
 Screening of asymptomatic women
 Screening of high risk women

 Follow up of patients after mastectomy of same and


opposite breast / same breast with implant .
 Investigations of benign breast diseases with
eczematous skin,nipple discharge , skin thickening .
 Investigation of a breast lump

 Investigation of occult primary with secondaries .

 Male breast evaluation .


PHYSICS
MAMMOGRAPHY EQUIPMENT
 Generator
 Xray tube – fine focus of 0.2-0.5 mm with an
additional 0.1 mm focus for magnification .
 Target – Molybdenum and Rhodium

 Beryllium window – Minimises absorption of


radiation within the tube .
 Molybdenum filter – By transmitting only
characteristic radiation ,absorbs unwanted radiation
and forms a monoenergetic beam.
 Compression device : 1-4 mm thick plastic plate
TARGET

 The xray tubes are designed with Tungsten ,molybdenum,Rhodium


targets .

 Tungsten target is operated under 30 kVp with a 0.5 mm Al filter –


Brehmsstrahlung and 12 keV L-shell characteristic xrays .

 Molybdenum target with Mo/Rh filter is more suitable for


mammography .

 Rhodium target filtered with Rh filter gives a similar spectrum as


molybdenum .

 Since the atomic number is higher , the brehmsstrahlung radiation is


also higher than molybdenum .
FILAMENT

 Positioned within a focussing cup with two focal spot sizes .

 Filament types are either double wound/flat ribbon/circular


filament .

 Focal spot size is very critical in mammography where high


spatial resolution is required .

 Small focal spot is used with small anode angle , which permits
the use of high mA factors .

 Usually the cathode is positioned towards the chest wall , which


makes patient positioning east and takes care of the heel effect .
FILTERS
 Thin beryllium window or borosilicate glass window
is used to reduce inherent filtration , since it offers
low attenuation .

 For a tungsten target Xray tube , Mo or Rh filter is


recommended .

 In case of Rhodium target Xray tube , Rhodium


filter of 0.025 mm is used which gives high quality
xrays with higher penetration .

 Combination is suitable for thicker and dense


breast imaging .
GRIDS
 Stationary grids or grids placed in between the
screen and the film are no longer used as the thin
grid lines compromised on the quality of the image .
 Covered tiny details such as microcalcifications

 Hence oscillating grids are used

 Grid ratio of 4:1 or 5:1

 The grid lines are eliminated by the motion of the


grid .
 Grids improve the image quality and cause a
significant reduction
HEEL EFFECT
 Shape of the breast requires higher intensity of radiation
near the chest wall, to create uniform exposure to the
screen-film .

 The cathode is positioned toward the chest wall and the


anode is toward the nipple .

 Permits easy positioning of the patient .

 Increases the intensity of radiation near the chest wall,


where greater penetration is needed .

 The anode is often grounded with zero potential and the


cathode is given higher potential .
COMPRESSION PEDDLE
(i) Decreases the thickness of the breast , thus reduces the
scattered radiation –improves the contrast .

(ii) Decreases the kinetic blur .

(iii) Reduces geometric unsharpness by homogenously


bringing the object close to the film .

(iv) Makes breast thickness uniform in film density.

(v) Differentiates the easily compressible cysts and fibro-


glandular tissue from the more rigid carcinomas

(vi) Separates the super imposed breast lesions .

(vii) Reduces radiation dose to the breast tissue .


-The compression device is parallel to the receptor
surface .
-Radiolucent plate that is flat and parallel to the support
table .
- Should match the cassette size
AUTOMATIC EXPOSURE CONTROL
 AEC system employs phototimers to measure the
Xray intensity and quality .
 Kept closer to the image receptor , to minimize the
object to image distance – improves spatial
resolution .

TWO TYPES :
(i)Ionization chamber type
(ii) Solid state diode type
SCREEN FILM SYSTEM
 The Xray film should have high resolution and small
grain size and used along with single intensifying
screen .
 The emulsion surface of the film must face the
screen .
 Prevents loss of resolution due to light diffusion in
the screen .
 Gadolinium Oxysulfide activated with terbium is
used as screen phospor .
DOUBLE EMULSION TECHNIQUE
CRANIO-CAUDAL VIEW
 The casette is placed under the
breast at the level of the
inframammary fold .

 The breast is then pulled until the


inframammary fold is taut .

 Compression is applied and Xray


beam is directed vertically from
above .

 Postero medial aspect should also


be included .
MEDIOLATERAL OBLIQUE VIEW
 Best view to image all of the breast
tissue and the pectoral muscle .

 The C-arm of the mammographic


unit is rotated to 45 degree so that
the cassette is parallel to the
pectoral muscle .

 The film holder is kept high up in the


axillary fossa and the patient s arm
is abducted at the elbow by
80degrees.

 The xray beam enters the breast


from the medial side –compression
is applied to the pectoralis major
muscle .
SUPPLEMENTARY VIEWS
1. Lateral projections (mediolateral/lateromedial)
2. Extended craniocaudal projection
3. Cone down compression view
4. 90 degrees lateral view and angled craniocaudal
views
5. Tangential views in palpable masses
6. Spot and magnification views
7. Cleavage view
8. Modified compression technique .
 Adipose tissue comprises a large portion of most breasts
and is radiolucent.

 The radiographically visible densities include:

(i)varying degree of ducts

(ii)lobular elements

(iii) fibrous connective tissues structures.

 The supportive connective tissue is highly cellular and


richly vascularised with significant water density-
constitutes the essence of breast opacity in
mammography.
 Sexual hormones influence the degree of hydration of the
adult breast.

 The breast is more radiolucent and better contrasted in the


first part of the menstrual cycle

 Pregnancy and lactation make the glandular and connective


tissue structures hypertrophic and more hydrated which leads
to diffuse increase in breast density.
DIGITAL MAMMOGRAPHY
 The stages in digital imaging :

1. Image capture by digital detector

2. Conversion of latent image into digital data set

3. Processing of image data

4. Display of processed image

5. Transmission and archival of data set


IMAGE ACQUISITION DEVICES
 CHARGE COUPLE DEVICE
TECHNOLOGY
 Digital detectors consist of a
phosphor, which is optically
coupled to the CCD.

 ADVANTAGE- The slit


collimation of the X-ray beam
results in a significant
reduction in scatter.
 This eliminates the need for a
grid, leading to potential dose
savings .
SELENIUM-BASED DETECTORS
 Selenium based detectors consist of a thin layer of amorphous
selenium deposited on the imaging plate.

 A uniform positive charge is built up on the surface of the selenium.

 When X-ray photons strike the surface of the selenium, electrons are
freed.

 This leads to a partial discharge of the uniform surface charge


pattern.

 The degree of discharge reflects the local radiation exposure, leading


to a latent image in the form of a charge distribution pattern.

 This charge pattern is then “read” and the resultant electrical signal
digitised.
ADVANTAGES OF DIGITAL
MAMMOGRAPHY
1. Acquired in less than a minute as compared to
conventional mammography .
2. Spot view digital systems are available to help
guide breast biopsy .
3. Superior contrast resolution especially in dense
breast tissues
4. Offers the possibility of three dimensional breast
tomography using relatively low doses .
DRAWBACKS

 Until ways are found to increase the spatial


resolution of digital mammography, conventional
film mammography will remain better able to detect
subtle tissue changes such as microcalcifications.

 In dense breast tissues even digital mammography


may overlook some lesions that are masked by
overlying structures
BI-RADS

 CATEGORY 0 -Need additional Imaging evaluation\

 CATEGORY I - Negative

 CATEGORY 2-Benign finding

 CATEGORY 3-Probably benign findings

 CATEGORY 4-Suspicious abnormality

 CATEGORY 5 -Highly suggestive of a malignancy

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