{
"id": "mammography-procedures",
"modality": "Mammography",
"category": "Procedures",
"title": "Mammography Procedures: Positioning, Views and Interventional",
"minutes": 9,
"slides": [
{
"id": 1,
"diagram": "title",
"heading": "Mammography Procedures",
"bullets": [
"65 of 115 scored questions (56.5%)",
"Localization, CC, MLO and true laterals",
"Problem-solving views and implant imaging",
"Stereotactic biopsy and wire localization"
],
"narration": "Welcome to Mammography Procedures. This is the biggest category on the boards: 65 of the 115 scored questions, about 57 percent. It also covers anatomy and pathology, but this lesson focuses on positioning and procedures. We'll start with localization language, then the two screening views, the craniocaudal and mediolateral oblique, plus true laterals and how to triangulate. Next come problem-solving views and imaging patients with implants. We'll finish with interventional work: stereotactic biopsy and wire localization. Let's begin.",
"svg": ""
},
{
"id": 2,
"diagram": "clock-face",
"heading": "Localization and mobility",
"bullets": [
"Clock face is read as if facing the patient",
"UOQ: 9-12 o'clock right, 12-3 o'clock left",
"UOQ holds the most tissue and most cancers",
"Move mobile lateral/inferior tissue to fixed borders"
],
"narration": "Before positioning, know the language. Clock positions are read as if you're facing the patient, so the two breasts are mirror images. The upper outer quadrant is 9 to 12 o'clock on the right breast and 12 to 3 o'clock on the left, so right 10 o'clock and left 2 o'clock are both upper outer. That quadrant holds the most tissue and the most cancers. For positioning, the medial and superior borders are fixed, while the lateral and inferior borders are mobile. Always move mobile tissue toward fixed tissue, and you'll include the most breast.",
"svg": ""
},
{
"id": 3,
"diagram": "cc-view",
"heading": "Craniocaudal (CC) view",
"bullets": [
"Lift the IMF first, then set receptor height",
"Include all medial tissue and maximum lateral",
"Nipple in profile; retroglandular fat seen",
"CC PNL within 1 cm of the MLO PNL"
],
"narration": "For the craniocaudal, or C C, view, start by lifting the mobile inferior breast to the highest natural point of the inframammary fold, then raise the receptor to meet it. Set it too high or too low and you'll cut off posterior tissue. The C C must show all the medial tissue and as much lateral tissue as possible. The nipple should be in profile and the retroglandular fat visible. Check depth with the posterior nipple line: on the C C, it should be within 1 centimeter of the posterior nipple line measured on the M L O.",
"svg": ""
},
{
"id": 4,
"diagram": "mlo-view",
"heading": "Mediolateral oblique (MLO)",
"bullets": [
"Receptor parallel to pectoral muscle, 30-60 deg",
"Steeper for tall thin, flatter for short broad",
"Most tissue of any view, incl. UOQ and axillary tail",
"Pec to nipple level, convex border, IMF open"
],
"narration": "The mediolateral oblique, or M L O, starts with the receptor angled parallel to the patient's pectoral muscle, usually 30 to 60 degrees. Use a steeper angle for tall, thin patients and a flatter angle for short, broad patients. The M L O shows the most breast tissue of any single view, including the upper outer quadrant and axillary tail. On a good M L O, the pectoral muscle reaches the level of the nipple or lower, with a convex or straight anterior border, and the inframammary fold is open. A concave pec margin means a tense patient or the wrong angle.",
"svg": ""
},
{
"id": 5,
"diagram": "triangulation",
"heading": "True laterals, triangulation",
"bullets": [
"LM for medial lesions, ML for lateral lesions",
"Side nearest the receptor is sharpest",
"90 vs MLO: medial lesions rise, lateral sink",
"90-degree lateral shows milk of calcium layering"
],
"narration": "True laterals are taken at 90 degrees. Choose the lateromedial, or L M, for a medial lesion and the mediolateral, or M L, for a lateral lesion. The reason: the side nearest the receptor is sharpest, with the least magnification. Triangulation is a favorite question. Compared with the M L O, on the 90-degree lateral a medial lesion moves up and a lateral lesion moves down. Think muffins rise, lead sinks. The 90-degree lateral is also the view for milk of calcium, which layers into a crescent or teacup shape, and for checking clip or wire depth.",
"svg": ""
},
{
"id": 6,
"diagram": "problem-solving",
"heading": "Problem-solving views",
"bullets": [
"Spot compression: summation vs real lesion",
"Magnification: calcification shape and margins",
"Tangential: skin calcs or a lump in profile",
"Rolled RL/RM: label names where the top rolled",
"XCCL for lateral tissue; cleavage for medial"
],
"narration": "When a finding needs work-up, the radiologist chooses problem-solving views. Spot compression uses a small paddle to spread tissue; if a finding disappears, it was usually summation of normal tissue. Magnification shows the shape, margins and number of calcifications. A tangential view puts a palpable lump or suspected skin calcification in profile at the skin surface. Rolled views shift tissue layers, and the label names the direction the top of the breast was rolled. Finally, the exaggerated C C lateral shows outer posterior tissue, while the cleavage view shows far posteromedial tissue.",
"svg": ""
},
{
"id": 7,
"diagram": "implant-displaced",
"heading": "Imaging implants",
"bullets": [
"Implant screening: 8 images, 4 per breast",
"Full-implant views: light compression, manual",
"Eklund ID: implant back, tissue pulled forward",
"Subpectoral implants displace more easily"
],
"narration": "Implant screening is usually 8 images, 4 per breast: a standard C C and M L O with the implant in the field, plus implant-displaced C C and M L O views. The full-implant views use light compression and usually manual technique, because automatic exposure control can misread the implant. For the Eklund, or implant displaced, technique, push the implant back against the chest wall, pull the breast tissue forward, and compress only the tissue in front. Label these views I D. Implants behind the pectoral muscle displace more easily than implants in front of it.",
"svg": ""
},
{
"id": 8,
"diagram": "stereo-pair",
"heading": "Stereotactic biopsy",
"bullets": [
"Consent before sedation; time-out first",
"Stereo pair at +15 and -15 degrees for depth",
"Vacuum-assisted needle, about 7 to 11 gauge",
"Specimen radiograph confirms calcs retrieved",
"Clip check: CC and 90-degree lateral"
],
"narration": "Stereotactic biopsy targets calcifications and findings seen only on mammography. Get signed informed consent before any sedating medication, and do a time-out to confirm patient, side and site. Depth is calculated from a pair of images at plus and minus 15 degrees, 30 degrees apart, not plus and minus 30. Vacuum-assisted needles of about 7 to 11 gauge are typical. A specimen radiograph of the cores confirms the calcifications were retrieved. Then a marker clip is placed and checked on a C C and a 90-degree lateral, since it can shift when compression releases.",
"svg": ""
},
{
"id": 9,
"diagram": "wire-localization",
"heading": "Wire localization, specimens",
"bullets": [
"Fenestrated paddle over the lesion",
"Needle parallel to chest wall, shortest route",
"Orthogonal view confirms the needle tip",
"Surgical specimen film: lesion, clip and wire"
],
"narration": "Needle, or wire, localization guides the surgeon before excision. The breast is compressed with a fenestrated paddle, which has an opening over the lesion. The needle is placed parallel to the chest wall, by the shortest route to the lesion, so it never points toward the chest. An orthogonal view, taken 90 degrees to the first, confirms where the needle tip sits before the wire is left in place. Radioactive seeds or reflector devices are alternatives. After surgery, the specimen radiograph confirms that the lesion, the clip and the wire were all removed.",
"svg": ""
},
{
"id": 10,
"diagram": "summary",
"heading": "Lock these in",
"bullets": [
"MLO: receptor parallel to pec; pec to nipple level",
"CC PNL within 1 cm of the MLO PNL",
"90 lateral vs MLO: medial rises, lateral sinks",
"Implants: 8 images including Eklund ID views",
"Stereo pair +/-15 degrees; clip on CC + 90 lateral"
],
"narration": "Let's lock it in. On the M L O, the receptor is parallel to the pectoral muscle, and the pec should reach the level of the nipple. The C C posterior nipple line should be within 1 centimeter of the M L O. On a 90-degree lateral compared with the M L O, medial lesions rise and lateral lesions sink. Implant screening is 8 images, including Eklund implant-displaced views. And stereotactic biopsy uses a pair at plus and minus 15 degrees, with the clip checked on a C C and a 90-degree lateral. Know these five cold.",
"svg": ""
}
]
}