MAMMOGRAPHY

Mammography
• Mammography is a radiographic examination that is specially
designed for detecting breast pathology.
• It uses a low-dose x-ray system to examine breasts.
• A mammography exam, called a mammogram, is used to aid in the
early detection and diagnosis of breast diseases in women.
Distinguishing features of mammography
equipment from other x-ray imaging
These features are due to:-
• Cancer produce very small physical changes in the breast that
are difficult to visualize with conventional x-ray imaging.
• Mammography examination requires the highest image quality
than other x-ray procedures.
-This is because the breast consist soft tissues with relatively small
differences in density (or atomic number).
Attenuation of breast tissues
• the attenuation differences between normal tissue and cancerous tissue is highest at very low x-
ray energies
• (l0 to 15 keV) and is poor at higher energies (>35 keV).
Mammography X-ray tube design
Cathode and Filament Circuit
• The mammographic x-ray tube is typically configured with
dual filaments in a focusing cup that produce small focal spot
sizes.
• A small focal spot minimizes geometric blurring and
maintains spatial resolution necessary for micro calcification
detection.
Mammography X-ray Tube Anode
• Most x-ray tubes use tungsten as the anode material,
• But Mostly mammography equipment uses molybdenum anodes
with an atomic number (Z) of 42 or in some designs, a dual material
anode with an additional rhodium with an atomic number (Z) of 45 .
• These materials are used because they produce a characteristic
radiation spectrum that is close to optimum for breast imaging.
Tube assembly
• The x-ray tubes are arranged such that the cathode side of the tube is adjacent to the patient’s
chest wall,
– since the highest intensity of x-rays is available at the cathode side, and the attenuation of x-rays
by the patient is generally greater near the chest wall of the image.
Tube Filtration
• Most x-ray machines use aluminium or "aluminium equivalent" to
filter the x-ray beam to reduce unnecessary exposure to the patient,
• Mammography uses filters that work on a different principle and are
used to enhance contrast sensitivity.
• Molybdenum (same as in the anode) is the standard filter material.
• Added tube filters of the same element as the target reduce the low-
and high energy x-rays in the x-ray spectrum and allow transmission of
the characteristic x-ray energies
Cont.,
• The output of a mammography
x-ray system is composed of
bremsstrahlung and
characteristic radiation.
• The characteristic radiation
energies of molybdenum (17.5
and 19.6 keV) are nearly optimal
for detection of low-contrast
lesions in breasts of 3 to 6.cm
thickness.
Collimation
• Fixed-size metal apertures or variable field size shutters collimate the
x-ray beam.
• For most mammography examinations, the field size matches the film
cassette sizes (e.g., 18 X 24 cm or 24 X 30 cm).
• The exposure switch is enabled only when the collimator is present.
• Many new mammography systems have automatic collimation
systems that sense the cassette size
The automatic exposure control
(AEC)
• It is also called a phototimer, employs a radiation sensor, an amplifier,
and a voltage comparator, to control the exposure.
• Unlike most conventional x-ray machines, the AEC detector is located
underneath the cassette.
• This sensor consists of a single ionization chamber or an array of
three or more semiconductor diodes.
• The sensor measures the residual x-ray photon flux transmitted from
the patient.
Cont.,
• During the exposure, x-ray interactions in the sensor release
electrons that are collected and charge a capacitor.
• When the voltage across the capacitor matches a pre-set reference
voltage in a comparator switch, the exposure is terminated.
Compression
• Breast compression is a necessary part of the mammography
examination.
• Firm compression reduces overlapping anatomy and decreases tissue
thickness of the breast .
• This results in fewer scattered x-rays, less geometric blurring of
anatomic structures, and lower radiation dose to the breast tissues.
• Achieving a uniform breast thickness lessens exposure dynamic range
and allows the use of higher contrast film.
Cont.,
• Compression is achieved with a compression paddle, a flat Lexan plate attached
to a pneumatic or mechanical assembly.
• Suspicious areas often require "spot“ compression to eliminate superimposed
anatomy by further spreading the breast tissues over a localized area.
Cont.,

Dense opacity with specular border in the cranial part of the right breast; Cluster of irregular
microcalcification suggesting a low differentiated carcinoma. (Courtesy of Dr. Van Ongeval,
Department. of Radiology.)
Cont.,
• The two types of digital mammography are:
1. 2D mammography also called full-field digital mammography
(FFDM),
• With 2D digital mammography, the radiologist is viewing all of the
complexities of breast tissue in a one flat image.
• Disadvantage
– Sometimes breast tissue can overlap, giving the illusion of normal breast tissue
looking like an abnormal area
Cont.,
2. 3D mammography/ tomosynthesis
• is a mammography system where the x-ray tube and imaging plate
move during the exposure.
• creates a series of thin slices through the breast that allow doctors to
examine breast tissue detail one slice at a time to help find breast
cancer at its earliest stages.
• allows radiologists to view the breast tissue in one millimeter slices,
so that they can provide a more confident assessment.
• finds cancers missed with conventional 2D mammography