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Mammography Positioning
Wendie A. Berg, MD, PhD, FACR, FSBI
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KEY FACTS

  • Imaging

    • Clinical Issues

      TERMINOLOGY

      • Abbreviations

        • Craniocaudal (CC)
          • CC view with top of breast rolled laterally (CCRL)
          • CC view with top of breast rolled medially (CCRM)
          • Laterally exaggerated craniocaudal (XCCL)
          • Medially exaggerated craniocaudal (XCCM)
        • Mediolateral oblique (MLO)
        • Lateromedial (LM)
        • Inframammary fold (IMF)
        • Digital breast tomosynthesis (DBT)
      • Definitions

        • Posterior nipple line (PNL): Line drawn from nipple perpendicular to pectoral muscle on MLO view (or edge of image if that comes first) and from nipple to posterior edge of image on CC view
          • To confirm sufficient tissue included on CC view, PNL should agree within 1 cm
        • Interval cancer: Cancer detected due to clinical symptoms in interval between recommended screenings
          • Worse outcomes than screen-detected cancers

      IMAGING

      • Imaging Anatomy

        • Anatomy-Based Imaging Issues

          CLINICAL ISSUES

          • Clinical Importance

            • Consider

              Selected References

              1. Cohen EO et al: Screening mammography findings from one standard projection only in the era of full-field digital mammography and digital breast tomosynthesis. AJR Am J Roentgenol. 211(2):445-51, 2018
              2. Pal S et al: Improving performance of  mammographic breast positioning in an academic radiology practice. AJR Am J Roentgenol. 210(4):807-15, 2018
              3. EQUIP: Enhancing Quality Using the Inspection Program. https://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorecard/ucm526238.htm. Updated November 2017. Accessed November 2018
              4. Huppe AI et al: Mammography positioning standards in the digital era: Is the status quo acceptable? AJR Am J Roentgenol. 209(6):1419-25, 2017
              5. Noroozian M et al: Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology. 262(1):61-8, 2012
              6. Alimoglu E et al: An effective way to solve equivocal mammography findings: the rolled views. Breast Care (Basel). 5(4):241-245, 2010
              7. Bassett LW et al: Digital mammography: clinical image evaluation. Radiol Clin North Am. 48(5):903-15, 2010
              8. Destouet JM et al: The ACR's Mammography Accreditation Program: ten years of experience since MQSA. J Am Coll Radiol. 2(7):585-94, 2005
              9. Majid AS et al: Missed breast carcinoma: pitfalls and pearls. Radiographics. 23(4):881-95, 2003
              10. Taplin SH et al: Screening mammography: clinical image quality and the risk of interval breast cancer. AJR Am J Roentgenol. 178(4):797-803, 2002
              11. Huynh PT et al: The false-negative mammogram. Radiographics. 18(5):1137-54; quiz 1243-4, 1998
              12. Bradley FM et al: The sternalis muscle: an unusual normal finding seen on mammography. AJR Am J Roentgenol. 166(1):33-6, 1996
              13. Eklund GW et al: Assessing adequacy of mammographic image quality. Radiology. 190(2):297-307, 1994
              14. Bassett LW et al: Mammographic positioning: evaluation from the view box. Radiology. 188(3):803-6, 1993
              15. Eklund GW et al: The art of mammographic positioning. Radiol Clin North Am. 30(1):21-53, 1992
              16. Brower TD: Positioning techniques for the augmented breast. Radiol Technol. 61(3):209-11, 1990
              17. Berkowitz JE et al: Dermal breast calcifications: localization with template-guided placement of skin marker. Radiology. 163(1):282, 1987
              Related Anatomy
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              Related Differential Diagnoses
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              References
              Tables

              Tables

              KEY FACTS

              • Imaging

                • Clinical Issues

                  TERMINOLOGY

                  • Abbreviations

                    • Craniocaudal (CC)
                      • CC view with top of breast rolled laterally (CCRL)
                      • CC view with top of breast rolled medially (CCRM)
                      • Laterally exaggerated craniocaudal (XCCL)
                      • Medially exaggerated craniocaudal (XCCM)
                    • Mediolateral oblique (MLO)
                    • Lateromedial (LM)
                    • Inframammary fold (IMF)
                    • Digital breast tomosynthesis (DBT)
                  • Definitions

                    • Posterior nipple line (PNL): Line drawn from nipple perpendicular to pectoral muscle on MLO view (or edge of image if that comes first) and from nipple to posterior edge of image on CC view
                      • To confirm sufficient tissue included on CC view, PNL should agree within 1 cm
                    • Interval cancer: Cancer detected due to clinical symptoms in interval between recommended screenings
                      • Worse outcomes than screen-detected cancers

                  IMAGING

                  • Imaging Anatomy

                    • Anatomy-Based Imaging Issues

                      CLINICAL ISSUES

                      • Clinical Importance

                        • Consider

                          Selected References

                          1. Cohen EO et al: Screening mammography findings from one standard projection only in the era of full-field digital mammography and digital breast tomosynthesis. AJR Am J Roentgenol. 211(2):445-51, 2018
                          2. Pal S et al: Improving performance of  mammographic breast positioning in an academic radiology practice. AJR Am J Roentgenol. 210(4):807-15, 2018
                          3. EQUIP: Enhancing Quality Using the Inspection Program. https://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/FacilityScorecard/ucm526238.htm. Updated November 2017. Accessed November 2018
                          4. Huppe AI et al: Mammography positioning standards in the digital era: Is the status quo acceptable? AJR Am J Roentgenol. 209(6):1419-25, 2017
                          5. Noroozian M et al: Digital breast tomosynthesis is comparable to mammographic spot views for mass characterization. Radiology. 262(1):61-8, 2012
                          6. Alimoglu E et al: An effective way to solve equivocal mammography findings: the rolled views. Breast Care (Basel). 5(4):241-245, 2010
                          7. Bassett LW et al: Digital mammography: clinical image evaluation. Radiol Clin North Am. 48(5):903-15, 2010
                          8. Destouet JM et al: The ACR's Mammography Accreditation Program: ten years of experience since MQSA. J Am Coll Radiol. 2(7):585-94, 2005
                          9. Majid AS et al: Missed breast carcinoma: pitfalls and pearls. Radiographics. 23(4):881-95, 2003
                          10. Taplin SH et al: Screening mammography: clinical image quality and the risk of interval breast cancer. AJR Am J Roentgenol. 178(4):797-803, 2002
                          11. Huynh PT et al: The false-negative mammogram. Radiographics. 18(5):1137-54; quiz 1243-4, 1998
                          12. Bradley FM et al: The sternalis muscle: an unusual normal finding seen on mammography. AJR Am J Roentgenol. 166(1):33-6, 1996
                          13. Eklund GW et al: Assessing adequacy of mammographic image quality. Radiology. 190(2):297-307, 1994
                          14. Bassett LW et al: Mammographic positioning: evaluation from the view box. Radiology. 188(3):803-6, 1993
                          15. Eklund GW et al: The art of mammographic positioning. Radiol Clin North Am. 30(1):21-53, 1992
                          16. Brower TD: Positioning techniques for the augmented breast. Radiol Technol. 61(3):209-11, 1990
                          17. Berkowitz JE et al: Dermal breast calcifications: localization with template-guided placement of skin marker. Radiology. 163(1):282, 1987