Mammography

dr. Rani Maria

Anatomy Landmarks
 Normal breast anatomy

A, Schematic of a normal breast showing the nipple, ducts, and acini containing glands
that produce breast milk. B, Schematic of a normal mediolateral oblique (MLO)
mammogram. Note the normal scalloped edge of glandular tissue, retromammary fat,
concave pectoralis muscle, and normal lymph nodes. C, Normal MLO mammogram.
 Normal breast anatomy

A, Schematic of a normal craniocaudal (CC)

mammogram. Note the normal fat in the medial and
retroglandular regions and the location of the pectoralis
muscles. Most of the residual glandular tissue and the
sternalis muscle remains in the upper outer quadrants.
B, Normal CC mammogram
 Normal Mammography

Mammograms of normal breast density. A, Dense glandular tissue of greater than 75% breast
tissue by volume in a young woman categorized in BI-RADS terms as dense. B, A woman
with heterogeneously dense breast tissue with 50% to 75% glandular tissue.
 Normal Mammography

C, A woman with scattered fibroglandular densities with 25% to 50% glandular tissue.
D, An older woman with a fatty breast composed of less than 25% glandular tissue.
 Mammae normal
Mammae pd wanita dewasa tdd. 12-20
lobus berbentuk konus. Basisnya
menghadap M. pectoralis, apex mengarah
ke areola dan papilla mammae
Jaringan lobuler (glanduler) dan duktal di
dalam lobus disokong oleh jaringan
konektif dan lemak
Jaringan konektif ekstralobuler
menghubungkan lobus-lobus dan jaringan
lemak di antaranya
 Mammae normal
Yang tampak pada mammogram : lobus,
duktus dan jaringan konektif fibrous.
Jaringan lemak : radiolusen
Duktus tampak sebagai struktur linier yang
berhubungan dengan papilla mammae
Mammogram tampak radioopak atau
radiolusen terutama tergantung pada jumlah
jaringan konektif ekstralobuler
 Variasi

Mammogram saat kehamilan dan post partum tampak

berbeda karena komposisi mammae berbeda
Usia muda tampak lebih padat daripada usia tua
Pada individu juga bervariasi pada:
- pertambahan usia : jaringan fibroglanduler
digantikan jaringan lemak (involusi)
- peningkatan atau penurunan berat badan
- HRT (Hormone Replacement therapy)
 Mammografi Deteksi dini Ca mammae
Screening (rekomendasi ACR) : 1x/ tahun u/ usia
>40 th
Sensitivitas : 83-95%
Untuk mendapatkan gambar kualitas baik :
Exposure adekuat
Mencakup jaringan mammae scr.
maksimum
Kontras dan resolusi tinggi
Kompresi adekuat
Tanpa artefak
Projections
 POSISI
Paling penting dan paling sering dipakai:
posisi MLO (Mediolateral-oblique)
Kedua : posisi CC (Cranio-caudal)
Posisi tambahan (cth : CC dengan fokus
ke lateral / XCCL / proyeksi Cleopatra
dan ML) dapat dipakai bila dirasa perlu
 Posisi saat pemeriksaan
Saat memeriksa mammogram orientasi posisi
sangat penting
Kedua mammae diperiksa secara simetris,
dibandingkan kanan-kiri
Mammogram kanan-kiri diposisikan seperti
bayangan cermin (back-to-back)
Harus diamati :
- kedua mammae
- masing-masing mammae
- densitas abnormal, distorsi jaringan, massa
dan kalsifikasi
POSISI PADA PEMERIKSAAN
MLO (45) Lundgrens oblique
Compression plate is applied
to fit into the angle between
the humeral head and the
chest wall

Axilla, axillary tail, glandular

tissue, pectoral muscle and
infra-mammary fold should
be demonstrated

When both MLO projections

are viewed together mirror
image, they should be
symmetrical, matching at the
level of the pectoral muscle
as a deep V and at the
inferior border of the
breasts.
MLO (45) Lundgrens oblique
Cranio-caudal
The table is at the level of
the infra-mammary crease

Film markers are placed on

the axillary side of the film (by
international convention)
close to the womans axilla
and well away from the breast
tissue.
The nipple should be in
profile and shown medial
to the midline of the film.
The medial portion of the
breast should be included
on the film.
There should be no folds
in the breast tissue
Lateral Projections
The equipment is
adjusted to the height
at which the inferior
portion of the breast
will be included.
There should be the
same depth of tissue as
in the craniocaudal
projection
 Axillary Tail
Woman is leant forwards
towards the machine so
that the corner of the
table is deep in the axilla

Radiographer should take

hold of the womans arm
on the side under
examination, from
behind the breast-
support table, and pull
her arm and thus her
humeral head firmly
across the top of the
breast-support table,
This projection is valuable in women where lymph gland ensuring that the corner
involvement of a breast carcinoma is suspected or there is of the film is deep in the
accessory breast tissue, as it demonstrates tissue high into the axilla.
axilla
 Extended CC laterally rotated
Extended cranio-caudal projection is useful for demonstrating the outer quadrant,
axillary tail and axilla

Breast with the nipple area on the

extreme medial edge of the
breast-support table.
 Extended CC medially rotated
Demonstrating lesions in the medial portion of the breast

Breast to be demonstrated is stretched in and rotated to enable the medial posterior

area to be visualized. The breast is held while the initial compression is applied
 Extended CC projection
This projection is of value if a lesion was seen high in the axillary tail on the medio-
lateral oblique but was not shown on the cranio-caudal projection

Anterior edge of the pectoral

muscle lateral to the midline of
the breast should be visualized
Terima kasih