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Full Field Digital Mammography (FFDM)

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Full Field Digital Mammography (FFDM)

• Mammography is the process of using low-dose X-rays (usually around 0.7 mSv) to examine the human breast. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses and/or microcalcifications.

Mammography

• X-ray Receptor

  [ The Evolution of Digital Radiography Detection ]

  

  　

  [ Flat Panel Type ]

  

  　

• View Position

  . Standard Views : CC (Cranio Caudal), MLO (Medio Lateral Oblique)

  . Additional Views : Magnification, Spot Compression, CV, ID, XCCL, TAN

  . Special Views : Large breast, Male view, Specimen

  　

  [ Standard Views ]

  • CC (Cranio Caudal View)

    

  • . All the internal tissue included

  • . A nipple located centrally

  • . Pectoralis major included

  • . Retroglandular fat included

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  • MLO (Medio Lateral Oblique View)

    

    . An imaging modality that can include the highest amount of breast

      tissue

    . A line below the nipple included with the pectoralis major extended

    . Applying directly to the subclavicular area and compressing inclusively

      a retro-mammary space

    　

    　

    　

    　

    　

  [ Standard Views ]

  • M (Magnification View)

    

    . Isolating the small-sized lesions or the periphery of a mass from the breast

      tissue and thereby obtaining the visualization with a higher resolution

    . Examining the number or shape of calcifications in a more accurate manner

    . Visualizing the areas that cannot be observed on a simple photography

    . An enlarged photography at a magnigication of x1.5 ~ x2.0

    　

    　

    　

    　

  • CV (Cleavage or Valley View)

    

    . Extending the intra-mammary fold (IMF) of bilateral breasts and then

      positioning them as more anteriorly as possible

    . Slightly spreading bilateral breasts lest they should be folded

    . Securing a sufficient extent of areas between the bilateral breasts

    　

    　

    　

    　

    　

  • ID (Implant Displaced view)

    

    . Special technique and consideration are mandatory for a photography

      of breasts which underwent breast augmentation surgery

    . Taking the upper and lower part of breast synchronously, pulling

      the prosthesis posteriorly and moving up the breast tissue forward

    . For a plain photography CC and MLO one, the degree of compression

      must be set in such a manner that the prosthesis can be tolerated

      under the condition of a passive exposure

    　

    　

  [ Special View ]

  • Large Breast

    An individual photo session recommended for cases in which all the breast tissues cannot be included on one-time photography

  • Male Breast

    A passive manipulation recommended for male breasts whose parenchyma has a smaller amount of tissue and which cover a larger-sized muscle, pectoralis major

  • Specimen

    It must be examined whether the lesions are included in the tissue specimen following a tissue biopsy

    　

• BI-RADS (Breast Image Reporting And Data System) Assessment

  • After evaluation of each digital mammographic examination, the radiologist summarizes the digital examination with the same BI-RADS assessment categories as screen film.

    　

    　

    　

    　

    　

  • Summary BI-RADS Assessments for Mammography

    BI-RADS Assessment	Definition	Likelihood of Malignancy
    Category 0	Need additional imaging evaluation and /or prior mammograms for comparison
    Category 1	Negative - routine follow up , Normal
    Category 2	Benign finding - routine follow up
    Category 3	Probably benign finding  - short-interval follow – up (6,12 month) suggested	Less than 2%
    Category 4	Suspicious abnormality - biopsy shouid be considered	3~93%
    Category 5	Highly suggestive of malignancy – appropriate action recommended	95%  or higher risk
    Category 6	Known biopsy  proven malignancy - appropriate action recommended	Biopsy  proven malignancy

    　

    

    　

    　

Biopsy

• Definition

  A biopsy is the removal of pieces of tissue, which are then sent to a lab for testing. A breast biopsy may be needed when other tests show something in the breast that needs to be checked more closely. If a lump is present, it may be removed at the same time as the biopsy. Lymph nodes around the area may also be checked. Your doctor will review the results of your biopsy with you at your next visit and talk to you about treatment if needed.

  　

• Different types

  • Fine Needle Aspiration (FNA)

    This biopsy is often done in the docor's office for lumps that can be felt.

    - The doctor inserts a small needle that is attached to a syringe into the lump.

    - The needle may be moved around. Tissue and fluid is collected in the syringe.

    - The needle is then removed.

    　

  • Core Needle Biopsy

    This biopsy is done with a larger needle

    - A small cut is made in the skin.

    - The needle is put into the site.

    - Several samples of tissue are collected.

    - The needle is then removed.

    　

  • Stereotactic Biopsy

    This biopsy is done for areas that cannot be felt, but are seen on  mammogram.

    -  You lie face down on a table with an opening for the breast.

    -  The site is numbed.

    -  A small incision is made in the breast.

    -  The breast is squeezed flat and a special type of x-ray is done before and during the biopsy to locate the site.

    -  A needle is put into the breast to remove samples of tissue.

    -  Several samples of tissue are collected.

    -  The needle is then removed.

    -  Open Excisional Biopsy

    　

  • Open Excisional Biopsy

    The entire lump is taken out in surgery.

    - You will be given medicine to numb the breast or to make you sleepy.

    - An incision is made in the breast to remove the lump and some tissue around the lump.

    - The site is closed with a stitch or special tape.

    　

• Benefits & Risks

  • Benefits

    - The procedure is less invasive than surgical biopsy, leaves  little or no scarring and can be performed in less

      than an hour.

    - Stereotactic breast biopsy is an excellent way to evaluate  calcium deposits or tiny masses that are not visible

      on ultrasound.

    - Stereotactic core needle biopsy is a simple procedure that  may be performed in an outpatient imaging center.

    - Compared with open surgical biopsy, the procedure is about  one-third the cost.

    - Generally, the procedure is not painful and the results are as  accurate as when a tissue sample is removed

      surgically.

    - No breast defect remains and, unlike surgery, stereotactic needle biopsy does not distort the breast tissue

      and make it  difficult to read future mammograms.

    - The use of a vacuum-assisted device may make it possible to  remove the entire lesion.

    - Recovery time is brief and patients can soon resume their  usual activities.

    - No radiation remains in a patient's body after an x-ray  examination.

    - X-rays usually have no side effects.

    　

  • Risks

    - bleeding and forming a hematoma, or  a collection of blood at the biopsy site. The risk, however, appears

      to be less than one percent of patients

    - An occasional patient has significant discomfort, which can be  readily controlled by non-prescription pain

      medication.

    - Any procedure where the skin is penetrated carries a risk of  infection. The chance of infection requiring

      antibiotic  treatment appears to be less than one in 1,000.

    　

Tomosynthesis

• Definition

  Tomosynthesis is a  3-dimensional imaging technology and  reduces  the problems caused by Tissue overlap and  Structure noise.

  　

  　

   

  　

  　

• Potential Clinical Benefits

  . Reduced Recall
  . Fewer Biopsies
  . Improved Cancer Detection
  . Reduced Dose
  . Tissue Localization
  . Faster Review Time
  . Reduced Compression Pressure
  . Contrast Enhanced Imaging

  　

  

  　

• Sampling

  

  　

• Geometry

  

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