Introduction to Breast Imaging

Summary

Discover the science and artistry behind successful breast imaging in this comprehensive course designed for clinical fellows in radiology. Dive into the anatomy of the breast, learn about various imaging modalities, and understand the different pathways to the breast unit. Gain a clearer understanding of how images are acquired across these modalities, and enhance your ability to interpret a mammogram and identify basic pathological features. With a close look at symptom-based and interval screening, common presentations, device technologies, and density scoring, this course offers invaluable insights to all participants aimed at improving diagnosis and treatment. Whether you're interested in mammograms, Tomosynthesis, ultrasounds, or MRI, this session ensures a comprehensive understanding of breast imaging for medical professionals.

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Description

This week we warmly welcome an expert speaker: a Clinical Fellow in Breast Imaging: Dr Nazia Malik, at Addenbrookes Hospital, Cambridge, UK.

This is the second talk in our National Collaborative Radiology Teaching series in conjunction with IR juniors, Leicester University Radiology Society, University of Sheffield Radiology Society and University College London Radiology Society.

This online session should provide an introduction to breast radiology, with some interesting clinical cases. Dr Malik will be covering the multimodality assessment of the breast, including mammograms, ultrasound and MRI.

Scheduled for Thursday, 22nd February 6pm, this is a valuable opportunity for medical professionals and students to enhance their skills and acquire new learning in the field of radiology. Don't miss out!

Learning objectives

Understand and describe the different imaging modalities used in breast radiology, including their indications and limitations.
Interpret mammographic images effectively and identify basic pathological features such as calcifications, masses and breast density.
Develop a detailed understanding of the breast anatomy and how it relates to imaging.
Understand the various pathways to the breast unit, including symptomatic and screening pathways, and their relevance to imaging.
Identify and understand the role of image-guided intervention in breast radiology.

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INTRODUCTION TO BREAST IMAGING C L I N I C A L F E L L O W I N R A D I O L O G Y ( B R E A S T )OBJECTIVES Describe different imaging modalities used to assess breast tissue Describe anatomy of the breast Understand different pathways to the breast unit Understand how images are acquired across these modalities Awareness of image-guided intervention in breast radiology Interpret a mammogram and identify basic pathological featuresB R E A S T A N A T O M Y - O V E R V I E WPATHWAYS TO THE BREAST UNIT SYMPTOMATIC SCREENING • 2 week wait cancer pathway • Women aged 50-70 receive breast • Triple assessment/One stop clinics screening mammogram appointments every 3 years in the UK ⌯ Clinical :History & Examination • Screening performed off-site at a location ⌯ Imaging :Mammogram +/ Ultrasound ⌯ Biopsy close to the patient's address • All screening mammograms are read by 2 • Mammograms for all women over 40 (no screen readers mammo within 6 months)HISTORY AND CLINICAL EXAMINATION • Symptoms • Clinical breast examination • Relevant History ⌯ Personal and family history of breast ⌯ E1 = Normal breast tissue and ovarian cancer ⌯ E2 = Glandular breast tissue with no concerning features ⌯ HRT usage ⌯ Pregnancies & breastfeeding etc. ⌯ E3 = Indeterminate breast examination ⌯ E4 = Suspicious for cancer ⌯ E5 = Clinically represents cancerHOW DO WE IMAGE THE BREAST? Mammogram Tomosynthesis/Digital Bromosynthesis (DBT) Ultrasound Contrast Enhanced Spectral Mammography (CESM/CEM) MRIMAMMOGRAMS • 2 views per breast – CC (craniocaudal) and MLO (mediolateral oblique) – +/- Implant – Eklund view (aka push back) to visualise breast tissue in front of the implant • Additional views – Extended CC view,Spot compression view, Magnification view,lateral view,cleavage view.CRANIO- CAUDAL VIEW (CC)MEDIO- LATERAL tanMLO – Medio OBLIQUE (MLO)TRUE LATERALB R E A S T D E N S I T Y D E N S I T Y S C O R I N G U S I N G T H E B I - R A D S S Y S T E M – T I S S U E % R E P L A C E D B Y D E N S E S T A B C D A –Almost entirely fafibroglandular tissue HdensegeneouslyD – Extremely denseT O M O S Y N T H E S I S ( D B T )WHY DBT? CONVENTIONAL 2D DBT Total dose similar to single view breast exam S T A N D A R D M A M M O G R A P H Y V S D B TULTRASOUND • 15MHz Probe (large 18L6) ⌯ Larger breast (ie deeper penetration) 9 MHz (smaller 9L4) probe • Positioning of the patient to maximise visualisation/ protect your back • Focus onAREA of INTEREST • Additional diagnostic exam • Contrast agent is used to enable visualisation of areas of contrast uptake CESM/CEM • DEnergyposure:Low Energy + High CONTRAST • One single compression per view with dual-energy exposures ENHANCED – compression timetime / Longer (SPECTRAL) • 1.2 times the dose of a standard exam MAMMOGRAPHYCONTRAST AGENT: IODINE • Intravenous injection - Power injector used to administer contrast agent • First view at 2 minutes after the injection starts • Last view 7 minutes after the injection startsMRI – MAGNETIC RESONANCE IMAGING • Prone position with breasts in the BREAST coil • With or without contrast depending on clinical indication • MRI-guided biopsyB I O P S Y/ T I S S U E S A M P L E – V A B , C O R E O R F N AULTRASOUND GUIDED BIOPSYSTEREOTACTIC 2D/TOMOSYNTHESIS BIOPSY • X-ray guided procedure • 2 images taken at 15-degree angles • The machine creates an XY and Z axis • Usually use a vacuum-assisted biopsy needle (9G)X RAY GUIDED BIOPSY C O R E B I O P S Y ( 1 4 G ) O R VAC U U M - A S S I S T E D B I O P S Y ( 9 G )MRI GUIDED VABCASESNORMAL MAMMOGRAMSCALCIFICATIONSSPICULATE MASSU L T R A S O U N DCYSTU L T R A S O U N DBREAST IMPLANTSU L T R A S O U N DMALE MAMMOGYNAECOMASTIA ANY QUESTIONS? H U G E T H A N K S T O L I A N A H O U G H F O R H P R E S E N T A T I O N I SREFERENCES • Triple assessment image website • https://teachmesurgery.com/breast/presentations/triple-assessment/ • Breast density image :https://www.mdpi.com/2075-4418/8/1/20/htm