Breast imaging – Mammography technique – Mammography procedure – Obtaining mammographic images – Procedural steps
Procedural steps common to both CC and MLO views
Only a qualified radiographer should carry out a mammography examination. The following steps should be carried out:
- Check the requisition for mammography to confirm the indication, history, and clinical/pathological findings.
- Explain the steps of the mammography procedure to the woman. Explain that the breasts will be placed on the breast support platform and will be compressed with the compression paddle and that the actual X-ray will take a few seconds, during which time she will need to stay still.
- Discuss with her the possible outcomes, the significance of positive and negative findings, and the possible need for additional imaging and diagnostic procedures. Inform her that the entire procedure may take up to 30 minutes to be completed.
- Ask the woman to undress from the waist up. Ensure that appropriate privacy is provided by drawing the curtains around the changing area within the mammography room, closing the door of the room, and restricting entry of any other personnel while the procedure is carried out. Ensure the presence of a female staff member within the room during the entire procedure.
- Place the cassette (image receptor) in the cassette holder before positioning and compression of the breasts (not relevant for digital mammography).
- Place radiopaque identification markers at the upper quadrant of the breast for the MLO view and at the outer quadrant of the breast for the CC view (this is not relevant for digital mammography).
- Position the breast to be examined on the breast support with optimal patient and machine adjustments and then apply compression. Ensure that the woman is comfortable with the compression.
- When adequate compression (8–12 kg) has been achieved, step behind the protective lead shield and take the X-ray.
- Compression releases automatically on completion of the exposure, and a latent image is formed on the image receptor.
- Change the woman’s position between the projections to image the other breast and follow the same procedures to position and compress the breast.
- If the woman needs attention during mammography, an attendant wearing a lead apron should be available for immediate assistance.
- Obtain four standard exposures, two of each breast.
- Additional (supplementary) views may be required in diagnostic mammography.
- When the examination is complete, ask the woman to wait until the radiologist has determined that all the necessary images have been obtained.
- At the satisfactory completion of the procedure, ask the woman to dress and provide her with appropriate instructions about the availability of the report and how to proceed for further consultation.
Benefits of breast compression
- Compression holds the breast away from the chest wall and ensures projection of all the tissues onto the detector.
- It reduces blurring by holding the breast still.
- It spreads out the breast tissue so that small abnormalities are less likely to be hidden by overlapping breast structures.
- It ensures uniform thickness, which enables more uniform exposure.
- It reduces the radiation dose needed to image the breast by reducing the thickness of breast tissue through which the radiation must pass.
- It reduces X-ray scatter and improves image sharpness.
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