Table of Contents
Color insert can be found after page 220.
Reviewers v
Preface xvii
Acknowledgments xix
1 The History of Breast Cancer and Breast Imaging 1
Keywords and Phrases 2
Cancer 3
Early incidence of Breast Cancer 4
Breast Cancer Treatment Throughout the Ages 4
The Discovery of X-Rays 7
Mammography in the United States: Quality Versus Quantity 11
American College of Radiography Accreditation: Standardized Mammography Equipment and Processing 13
The Mammography Quality Standards Act 14
Breast Cancer Screening 14
Summary 18
Review Questions 19
Chapter Quiz 20
Bibliography 21
2 Patient Education and Assessment 23
Keywords and Phrases 24
Patient Care and Communication 27
The Environment 29
Medical History and Documentation 31
Subjective Versus Objective Data 32
Examples of Nonverbal Communication 32
History-Taking Techniques 33
Documentation 33
Breast Examinations 35
Breast Self-Examination 37
Clinical Breast Examination 39
Breast Examination Guidelines 39
Benefits Versus Risks of Breast Imaging 42
Mortality Reduction 42
Risk From Radiation Exposure in Mammography Screening 43
Breast Cancer Screening 45
Advantages and Disadvantages of Mammography Screening 46
Risk Factors for Developing Breast Cancer 46
Types of Risk Assessments 47
Major Risk Factors 49
Minor Risk Factors 53
Facts and Misconceptions About Breast Cancer 56
Summary 62
Review Questions 63
Chapter Quiz 64
Bibliography 65
3 Mammography Equipment, Digital Mammography (2D and 3D) 67
Keywords and Phrases 69
X-Ray Imaging System 73
The Cathode 74
The Anode 74
Heat Dissipation 75
X-Ray Tube 75
Design Characteristics of Mammography Units 76
Electron Interaction at the Target X-Ray Production 76
Characteristic Radiation 77
Bremsstrahlung Radiation 77
X-Ray Interaction with Matter 78
Mammography Imaging 80
Mammography Tube 81
General Radiography Versus Soft Tissue Imaging 81
Filtration 82
The Anode and Target 85
Line-Focus Principle 86
Focal Spot Size 88
Anode Heel Effect 88
Kilovoltage Range 89
Exposure Time, Milliamperes, and Milliampere Seconds 90
Compression Devices 91
Compression Plate 91
Automatic Exposure Control 92
Density Compensation and Backup Timer 93
Grids 93
Beam-Restricting Devices 95
System Geometry (Source-to-image Detector Distance, Object-to-Image Detector Distance) 95
Magnification 96
Monitors 97
Acquisition Workstation 98
Review Workstation 100
Storage Options 100
Picture Archiving and Communication System 102
Advantages and Disadvantages 102
DICOM, HIS, RIS, EMR, and HL7 103
Teleradiology 104
Lossy and Lossless Compression 105
Computer-Aided Detection and Artificial Intelligence 105
Image Quality: Digital Mammography 107
Workflow 109
Digital Mammography 110
Direct Flat-Panel Detector Technology 120
Indirect Flat-Panel Detector Technology 121
Advantages of Digital Mammography 122
Disadvantages of Digital Mammography 123
Three-Dimensional Digital Mammography Technologies 123
Digital Breast Tomosynthesis or Three-Dimensional Mammography 124
Analysis of DBT Imaging 131
Summary 134
Review Questions 137
Chapter Quiz 138
Bibliographys 139
4 Anatomy and Physiology of the Breast 141
Keywords and Phrases 142
The Breast 144
Location of the Breast 144
Surface Anatomy of the Breast 145
Localization Terminology 146
Deep Anatomy of the Breast 147
Vascular Circulation 149
Arterial Circulation 150
Venous Drainage 150
The Lymphatic Drainage of the Breast 151
Nervous Supply 153
Breast Tissue Composition 153
Factors Affecting Tissue Composition 154
Hormone Fluctuation 155
Menopause 156
Hormone Therapy 157
Lactation 158
Parous/Parity 158
The Male Breast 159
General Description 159
Male Breast Cancer: Signs and Symptoms 160
Risk Factors for Breast Cancer in Men 160
Diagnosis, Treatment, and Prognosis 160
Summary 161
Review Questions 162
Chapter Quiz 163
Bibliography 164
5 Breast Pathology: Benign and Malignant Diseases of the Breast 165
Keywords and Phrases 166
Changes in the Breast 171
Breast Augmentation 173
Reduction Mammoplasty 174
Characteristics of Benign and Malignant Breast Lesions 174
Round or Oval Masses 175
Spiculated or Stellate Lesion 177
Architectural Distortion 181
Asymmetric Breast Tissue 181
Calcifications 182
Typical Benign Calcifications 186
Suspicious Calcifications 187
Thickened Skin Syndrome 190
Types of Breast Cancer 192
Invasive Lobular Carcinoma 192
Ductal Carcinoma In Situ 192
Other Breast Cancers 192
Summary 195
Review Questions 196
Chapter Quiz 197
Bibliography 198
6 Mammographic Positioning 199
Keywords and Phrases 200
Breast Imaging (Mammography) 201
Breast Compression 202
Applying Compression 203
Standard Projections 204
Positioning Guide 205
MLO: The Mediolateral Oblique Projection 207
CC: The Craniocaudal Projection 209
Supplementary Projections 213
ML: Mediolateral or 90-Degree Lateral Projection 214
LM: Lateromedial Projection 215
LMO: Lateromedial Oblique Projection 216
TAN: Tangential Projection 217
XCCL: Exaggerated Craniocaudal Lateral Projection 219
XCCM: Exaggerated Craniocaudal Medial Projection 220
FB: From Below Projection 220
CV: Cleavage View, Valley View, or Double-Breast Compression View 220
AT: Axillary Tail Projection 222
SIO: Superior-Interior Oblique Projection 223
Rolled Positions 224
Magnification 225
Spot Compression 227
Imaging the Nonconforming Patient 228
Imaging Small Breasts 229
Male Breast Imaging 229
Sectional Imaging of the Extremely Large Breast. Also called Tiled or Mosaic Breast Imaging 230
Imaging Patients With Obese Upper Arms 230
Imaging Patients With an Inframammary Fold That Is Not Horizontal 231
Imaging Patients With Protruding Abdomen 231
Imaging Patients With Thick Axilla 231
Imaging Patients With Kyphosis 231
Imaging Patients With Adhesive Capsulitis (Frozen Shoulder) 232
Imaging Elderly or Unstable Patients 232
Imaging Mentally Challenged Patients 232
Imaging Patients With Pectus Excavatum (Sternum Depressed) or Pectus Carinatum (Pigeon Chest) 233
Imaging Patients With Barrel Chest 233
Imaging Patients With Delicate Inframammary Fold 233
Imaging Patients With Implants 234
Imaging the Postsurgical Site: Postlumpectomy Imaging 236
Postmastectomy Imaging 237
Mammography of the Irradiated Breast 237
Imaging the Stretcher-Bound Patient 238
Imaging the Wheelchair-Bound Patient 238
Specific Imaging Problems 239
Lactating Breasts 239
Nipple Not in Profile 240
Skinfolds or Wrinkling of the Breast 241
Imaging Patients With Uneven Breast Thickness 242
Moles and Scars 242
Imaging Patients With Implanted Devices 243
Triangulation Techniques 244
Before Signing Off 246
Summary 247
Review Questions 251
Chapter Quiz 252
Bibliography 253
7 Ultrasound and Magnetic Resonance Imaging 255
Keywords and Phrases 256
Ultrasound Terminology 256
Magnetic Resonance Imaging Terminology 259
Ultrasound Imaging of the Breast 262
Brief History of Ultrasound 262
The Principle of Ultrasound 263
The Transducer (Probe) 265
Common Ultrasound Terminologies 265
Uses of Ultrasound 270
Management of Nonpalpable Masses 271
Ultrasound Evaluation of Palpable Masses 271
Doppler Effect 271
Color Doppler Ultrasound 272
Ultrasound Characteristics of Benign Lesions 272
Ultrasound Characteristics of Malignant Masses 272
Ultrasound Characteristics of Intermediate Lesions 273
Typical Appearance of Lesions on Ultrasound 273
Imaging Breast With Implants 275
Ultrasound Artifacts 276
Limitations of Breast Ultrasound Imaging 277
Imaging Problems and Solutions 278
Risks of Ultrasound 278
Advantages of Breast Ultrasound 278
Magnetic Resonance Imaging of the Breast 279
Brief History of Magnetic Resonance Imaging 279
Electromagnetic Spectrum 279
Magnetism 280
The Principle of Magnetic Resonance Imaging 281
Equipment 283
Operating Console 284
Computer Parameters 284
Magnetic Resonance Imaging Parameters 285
Use of Contrast Agents 286
Pulse Sequences and Techniques 286
Postprocessing Technique 288
Breast Magnetic Resonance Imaging 289
Magnetic Resonance Imaging Artifacts 290
Advantages and Uses of Breast Magnetic Resonance Imaging 295
Magnetic Resonance Imaging of the Augmented Breast 297
Limits of Breast Magnetic Resonance Imaging 297
Risks and Potential 299
Magnetic Resonance Imaging Quality Assurance 299
Summary 300
Review Questions 302
Chapter Quiz 303
Bibliography 304
8 Other Breast Imaging Modalities 305
Keywords and Phrases 306
Diagnostic Options 308
Molecular imaging Technologies 308
Nuclear Medicine 309
Positron Emission Tomography 309
Radionuclide Imaging With Single-Photon Emission Computed Tomography 313
Breast Scintigraphy, Scintimammography, or Breast Molecular Imaging 313
Breast-Specific Gamma Imaging 314
Lymphoscintigraphy: Sentinel Node Mapping 316
Radiation Dose Related to Nuclear Imaging 318
Digital Mammography Technologies 319
Digital Subtraction Mammogram 319
Dual-Energy Mammography 319
Ultrasound Technologies 319
Automated Ultrasound and Three-Dimensional Breast Ultrasound 320
Elastography 322
Contrast-Enhanced Ultrasound 322
Magnetic Resonance Imaging Technologies 323
Magnetic Resonance Spectroscopy 323
Other Available Technologies 323
Diffuse Optical Tomography 323
Microwave Imaging 324
Computed Tomography (CT) Breast Scanning 325
Summary 325
Review Questions 328
Chapter Quiz 329
Bibliography 330
9 Interventional Procedures 331
Keywords and Phrases 332
The Need for Interventional Techniques 333
Cytologic Analysis 334
Histologic Analysis 334
General Patient Preparation 335
Cyst Aspiration 336
Stereotactic Localization and Biopsy 337
Add-On Units 337
Dedicated Prone Units 338
Blended Technology 339
Stereotactic Procedure 339
Limitations 340
Preoperative Needle Localization 340
Localization Procedure Using Mammography 340
Seed Localization 343
SAVI SCOUT® Radar Localization System 343
Breast Biopsy 344
Fine-Needle Aspiration Biopsy 345
Core Biopsy Methods 346
Core Gun Biopsy 347
The Vacuum-Assisted Biopsy 348
The Automatic Tissue Excision and Collection 350
Radiofrequency Biopsy 350
Open Surgical Biopsy 351
Modality-Based Core Biopsy 352
Comparison of the Various Biopsy Methods 354
Specimen Radiography 356
Specimen Radiography Units 356
Ductography or Galactography 357
Nipple Aspiration 357
Ductal Lavage 358
Pathology Review 359
Mammoplasty 359
Cosmetic Intervention 360
Reduction Mammoplasty 360
Mastopexy 360
Augmentation Mammoplasty 361
Biohazard Waste 363
Summary 363
Review Questions 368
Chapter Quiz 369
Bibliography 370
10 Treatment Options 371
Keywords and Phrases 372
Breast Cancer Treatment 374
Staging Breast Cancer 377
Mastectomy as an Option 378
Lumpectomy as an Option 380
Lymph Node Biopsy 381
Comparisons of Surgical Treatment Options 382
Other Options to Consider 382
Radiation Therapy 382
Indications for Radiation Therapy 384
Classifications of Radiation Therapy 384
Side Effects of Radiation Therapy 385
Intensity-Modulated Radiation Therapy 385
Image-Guided Radiation Therapy 386
Internal Radiation or Partial Radiation 387
Intraoperative Electron Radiation Therapy 389
Chemotherapy 390
The Cell Cycle 390
Uses of Chemotherapy 390
Drugs Used in Chemotherapy 391
Chemotherapy Regimens 391
Method of Giving Chemotherapy 391
Side Effects of Chemotherapy 392
Targeted Treatment 393
Hormone Therapy 393
Treatment for HER2-Positive Cancer 397
Treatment for Triple-Negative Cancers 397
Other Treatment Options 398
Ablative Hormone Therapy 398
Antiangiogenesis 398
Circulating Breast Cancer Cells 399
Gene Therapy 399
Methods of Gene Therapy 400
Hematopoietic Stem Cell Transplantation 400
Immunotherapy or Biotherapy 400
Photodynamic Therapy 401
Thermal Ablation 402
Cryotherapy 402
Prophylactic Surgery 402
Surgical Reconstruction Using Implants 403
Preparation for Surgery 403
Nipple and Areola Reconstruction 403
Implant Procedures 404
Immediate Reconstruction 404
Delayed Reconstruction 404
Other Reconstruction Options 405
Autologous Fat Grafting 407
Pain Medication and Pain Management 408
Conclusion 408
Summary 409
Review Questions 412
Chapter Quiz 413
Bibliography 414
11 Quality Assurance and Quality Control 415
Keywords and Phrases 416
Quality Assurance 417
Benefits of Quality Assurance 418
Agencies Responsible for Safety and Quality of Imaging Practices Within the United States 418
Responsibilities of the Various Quality Control Personnel 419
The Radiologist 419
Lead Interpreting Physician (Radiologist) 420
Interpreting Physician (Radiologist) 420
The Technologist 420
The Medical Physicist420
Quality Control Testing 421
General Quality Control Tests 422
Physicist Tests 435
Summary 447
Review Questions 450
Chapter Quiz 451
Bibliography 452
12 The US Mammography Quality Standards Act (MQSA) 453
Keywords and Phrases 454
Purpose of the Mammography Quality Standards 456
Interim Regulation 456
Final Regulations 456
Accreditation and Certification 457
Lawful Mammography Services in the United States 458
Quality Assurance Regulations of MQSA 458
Clinical Images 458
Withdrawal of Accreditation 461
Suspension or Revocation 461
Adverse Reporting 462
Adverse Events 462
Digital Mammography 462
Quality Control 464
Monitors 464
Printer 465
Mobile Units 465
Infection Control 466
Certificate Placement 466
Consumer Complaints Mechanism 467
Self-Referrals 468
Record Keeping 468
Content of Records and Reports 468
Assessment Categories 469
MQSA Assessment Categories 469
Communication of Results to the Patient 470
Medical Outcome Audit 471
MQSA and Health Insurance Portability and Accountability Act 472
Final Regulation Documentation 472
Requirements for the Radiologic Technologists 473
Requirements for the Interpreting Physician 474
Requirements for the Medical Physicist 479
Breast Cancer Screening Nowadays 483
Enhancing Quality Using the Inspection Program Initiative 484
Details on EQUIP Questions 485
Summary 486
Review Questions 490
Chapter Quiz 491
Bibliography 492
Appendix A Photostimulable Phosphor (PSP) Technology or Computed Mammography (CM) 493
Keywords and Phrases 494
Photostimulable Phosphor Technology 494
Layers of Photostimulable Phosphor 495
Quality Control Specific to Computed Mammography 498
Computed Mammography Photostimulable Phosphor Erasure 498
Test for the PSPs 498
Visual Checklist Specific to CM 499
Summary of Photostimulable Phosphor Technology 500
The Image Plate 500
Process of Photostimulable Phosphor Image Capture 500
The Computer Processing or Photostimulable Phosphor Reader 501
Image Extraction Process 501
Types of Photostimulable Phosphor Reader: Processing Technology 501
The Photomultiplier Tube, Photodetector, or Charge-Coupled Device 502
Functions of the High-Intensity Light Source 502
Functions of the Analog-to-Digital Converter 502
Functions of the Computer in the Photostimulable Phosphor Digital System 502
Functions of the Digital-to-Analog Converter 502
Summary 503
Chapter Quiz 504
Answers and Explanations 505
Appendix B Analog Imaging, Quality Assurance, and Quality Control 507
Keywords and Phrases 508
Analog Imaging 509
Double Versus Single Emulsion 509
Mammography Films 510
Mammography Screens 511
The Characteristic Curve 511
The Cassette 512
Image Quality: The Screen-Film System 513
Kilovoltage Range 516
Automatic Exposure Control 516
Quality Assurance 517
Benefits of Quality Assurance 518
Quality Control Testing 518
Technologists 518
General Analog Technologist Quality Control Tests 518
Testing Details: General 534
Phantom Images: Analog Imaging 534
Visual Checklist: Analog 535
Repeat/Reject Analysis: Analog 535
Viewbox and Viewing Conditions: Analog 536
Compression: Analog 537
Light Field and X-Ray Field Congruence: Analog 539
Darkroom Cleanliness 539
Processor Quality Control 540
Screen Cleaning 544
Analysis of Fixer Retention in Film 545
Darkroom Fog and Safelight Testing 546
Screen-Film Contact and Identification 547
Summary 549
Review Questions 551
Chapter Quiz 552
Bibliography 555
Answers to Review Questions 557
Chapter 1 The History of Breast Cancer and Breast Imaging 557
Chapter 1 Quiz 558
Chapter 2 Patient Education and Assessment 558
Chapter 2 Quiz 560
Chapter 3 Mammography Equipment, Digital Mammography (2D and 3D) 561
Chapter 3 Quiz 564
Chapter 4 Anatomy and Physiology of the Breast 565
Chapter 4 Quiz 565
Chapter 5 Breast Pathology: Benign and Malignant Diseases of the Breast 566
Chapter 5 Quiz 567
Chapter 6 Mammographic Positioning 568
Chapter 6 Quiz 569
Chapter 7 Ultrasound and Magnetic Resonance Imaging 570
Chapter 7 Quiz 571
Chapter 8 Other Breast imaging Modalities 572
Chapter 8 Quiz 572
Chapter 9 Interventional Procedures 573
Chapter 9 Quiz 574
Chapter 10 Treatment Options 575
Chapter 10 Quiz 576
Chapter 11 Quality Assurance and Quality Control 577
Chapter 11 Quiz 577
Chapter 12 The US Mammography Quality Standards Act (MQSA) 578
Chapter 12 Quiz 580
Index 583
