{
"id": "mammography-patient-care",
"modality": "Mammography",
"category": "Patient Care",
"title": "Mammography Patient Care: Communication, History and Breast Anatomy Basics",
"minutes": 9,
"slides": [
{
"id": 1,
"diagram": "title",
"heading": "Mammography Patient Care",
"bullets": [
"20 of 115 scored questions (17.4%)",
"Prep, communication and screening guidelines",
"Risk, history, MQSA results, breast anatomy"
],
"narration": "Welcome to Mammography Patient Care. This category is 20 of the 115 scored questions on the mammography boards, about 17 percent. We'll start with how to prepare and talk with your patient, and the screening guidelines she'll ask you about. Then we'll move to risk factors, taking a good history, how results must reach her under federal law, and the breast anatomy basics you need to describe what you see. You'll use these every single day, so let's make them stick.",
"svg": ""
},
{
"id": 2,
"diagram": "prep-checklist",
"heading": "Before the exam",
"bullets": [
"No deodorant, powder or lotion: mimics calcs",
"Two-piece outfit; undress from the waist up",
"Tender breasts: schedule 1-2 weeks after menses",
"Remove neck jewelry, move hair out of the field"
],
"narration": "Good images start before the patient walks in. Tell her to skip deodorant, antiperspirant, powder and lotion, because aluminum and zinc particles can look like microcalcifications. Suggest a two-piece outfit so she only undresses from the waist up. If her breasts are tender before her period, schedule about one to two weeks after the start of menses, when they're usually least sensitive. In the room, remove neck jewelry and move hair out of the field so neither shows up as an artifact.",
"svg": ""
},
{
"id": 3,
"diagram": "compression",
"heading": "Communication and compression",
"bullets": [
"Explain each step and why compression matters",
"Compression: less dose, blur, scatter, overlap",
"Compression can be adjusted; exam can stop",
"Explain repeats as technical, not a finding",
"Never give results; the radiologist reads"
],
"narration": "Explain each step, and especially why compression matters. Firm compression means less of everything bad: less dose, less motion blur, less scatter, and less overlapping tissue. Let her know compression can be adjusted and the exam can stop if she needs it, which builds trust with anxious patients and trauma survivors. If you repeat a view, explain that it's technical, like motion or a missed edge, not a finding. And never give results. Interpretation belongs to the radiologist and the referring provider.",
"svg": ""
},
{
"id": 4,
"diagram": "screening-ages",
"heading": "Screening guidelines",
"bullets": [
"ACS: option at 40-44, yearly 45-54",
"ACS: every 1-2 years from 55 if healthy",
"ACR: yearly from 40; risk assessment by 25",
"High risk, 20% or more lifetime: add yearly MRI",
"ACS: no routine breast self-exam for screening"
],
"narration": "The boards love comparing guidelines. The American Cancer Society says average-risk women have the option to start yearly mammograms at 40 to 44, should go yearly from 45 to 54, then every one to two years from 55 while healthy with at least ten years of life expectancy. The American College of Radiology says yearly from 40, with a risk assessment by age 25. High-risk women, with a lifetime risk of 20 percent or more, add yearly MRI. And the Cancer Society doesn't recommend routine breast self-exam for screening, just breast self-awareness.",
"svg": ""
},
{
"id": 5,
"diagram": "one-in-eight",
"heading": "Risk factors",
"bullets": [
"About 1 in 8 US women; biggest risks: sex and age",
"Longer estrogen exposure raises risk",
"BRCA1/2 and other genes: about 5-10% hereditary",
"Dense tissue: masks cancer and raises risk",
"Men: about 1% of breast cancers"
],
"narration": "About one in eight American women will develop breast cancer, and the biggest risk factors are simply being female and getting older. Most patients have no family history. Longer estrogen exposure raises risk: an early first period, late menopause, never giving birth, or a first birth after about 30. Inherited mutations like BRCA1 and BRCA2 matter, but only about 5 to 10 percent of cancers are hereditary. Dense tissue does double duty: it masks cancers and is an independent risk factor. Men account for about one percent of cases.",
"svg": ""
},
{
"id": 6,
"diagram": "skin-markers",
"heading": "History and skin markers",
"bullets": [
"Red flags: new fixed lump, dimpling, retraction",
"Worrisome discharge: spontaneous, one duct, bloody",
"Document surgery, biopsy, implants, hormones",
"Mark lumps, scars and moles per facility policy",
"Get priors, ideally 2 or more years old"
],
"narration": "Your history guides the radiologist. Red flags include a new hard or fixed lump, skin dimpling, orange-peel skin called peau d'orange, and new nipple retraction. Nipple discharge is worrisome when it's spontaneous, from one duct in one breast, and bloody or clear. Document prior surgery and biopsies, implants, hormone use, pregnancy or lactation, and personal and family history. Mark palpable lumps, scars and moles with radiopaque skin markers following your facility's policy. And get prior mammograms, ideally two or more years old, because slow changes hide against last year's exam.",
"svg": ""
},
{
"id": 7,
"diagram": "mqsa-timelines",
"heading": "Results under MQSA",
"bullets": [
"Lay summary to every patient in plain language",
"Routine: report and summary within 30 days",
"Suspicious or highly suggestive: 7 calendar days",
"Must state dense or not dense (since Sept 2024)"
],
"narration": "Under the Mammography Quality Standards Act, called MQSA, every patient gets a written lay summary in plain language, even if she was told her results verbally. Routine results, both the report to the provider and the summary to the patient, go out within 30 days of the exam. When the assessment is suspicious or highly suggestive of malignancy, both must go out within 7 calendar days of interpretation. And since September 10th, 2024, every summary must say whether her breast tissue is dense or not dense, and advise her to talk with her provider.",
"svg": ""
},
{
"id": 8,
"diagram": "clock-face",
"heading": "Breast landmarks and clock",
"bullets": [
"Extends about rib 2 to 6, sternum to midaxillary",
"Medial, superior fixed; lateral, inferior mobile",
"Clock face read as if facing the patient",
"UOQ: right 9-12, left 12-3; most cancers"
],
"narration": "Now the anatomy basics. The breast extends from about the second to the sixth rib, and from the sternum to the midaxillary line, with the inframammary fold as its lower border. The medial and superior borders are fixed, while the lateral and inferior borders are mobile, so you move mobile tissue toward fixed tissue. Locations use a clock face read as if you're facing the patient. The upper outer quadrant is 9 to 12 o'clock on the right and 12 to 3 on the left, and it holds the most tissue and the most cancers.",
"svg": ""
},
{
"id": 9,
"diagram": "breast-sagittal",
"heading": "Inside the breast",
"bullets": [
"About 15-20 lobes, each drained by a duct",
"Most cancers start in the TDLU",
"Cooper ligaments: pull causes skin dimpling",
"About 75% of lymph drains to the axilla",
"Retromammary fat should show on good images"
],
"narration": "Inside, each breast has about 15 to 20 lobes, each drained by a lactiferous duct to the nipple. Most cancers start in the terminal ductal lobular unit, or T D L U. Cooper ligaments are fibrous supports, and when a tumor pulls on them you see skin dimpling. About 75 percent of lymph drains to the axillary nodes, with medial tissue also draining to the internal mammary nodes. And the retromammary fat space, between the gland and the pectoralis major, should show on a well-positioned image.",
"svg": ""
},
{
"id": 10,
"diagram": "summary",
"heading": "Lock these in",
"bullets": [
"No deodorant: particles mimic calcifications",
"ACR yearly from 40; ACS yearly 45-54",
"MQSA: 30 days routine, 7 days if suspicious",
"Dense tissue masks cancer and raises risk",
"UOQ: right 9-12, left 12-3 o'clock"
],
"narration": "Let's lock it in. No deodorant or powder, because the particles mimic calcifications. The American College of Radiology says yearly from 40, while the American Cancer Society says yearly from 45 to 54. Under MQSA, results go out within 30 days, or within 7 calendar days if suspicious or highly suggestive. Dense tissue both masks cancer and raises risk. And the upper outer quadrant is 9 to 12 o'clock on the right and 12 to 3 on the left. Now hit Practice this chapter and test yourself.",
"svg": ""
}
]
}