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Breast Positioning during Mammography: Mistakes to be Avoided.

Popli MB, Teotia R, Narang M, Krishna H - Breast Cancer (Auckl) (2014)

Bottom Line: On MLO view, bilaterally, pectoralis shadow was not seen in 0.520% mammograms, its margin was not straight/convex in 0.706%, lower edge of pectoralis was above pectoralis-nipple line in 2.081%, and inframammary fold was not seen in 1.189%.There was inadequate coverage of lower quadrants in 2.787%, and mismatch in PND was seen in 3.864%.In few of the patients, the shortcomings as a result of improper positioning were noted on one view, the rest being normal.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.

ABSTRACT

Aims and objectives: Breast positioning is the key factor affecting a mammogram. If care is taken during positioning, it maximizes the amount of breast tissue being imaged, eliminates most of the artifacts, and increases sensitivity of the mammogram. This retrospective study was carried out in our department to assess correctness, and also the incorrectness of breast positioning, which need to be avoided to obtain an ideal mammogram.

Material and methods: A total of 1369 female patients were included in this study. Mammography was performed on full field detector digital mammography equipment. Craniocaudal (CC) view and mediolateral oblique (MLO) view were carried out for each breast. Four views were done for 1322 patients. The remaining 47 patients had undergone a mastectomy and underwent two views for the other breast. Mistakes in improperly positioned mammogram were assessed with respect to proper visualization of nipple, position of pectoralis major, pectoral-nipple distance (PND), inframammary fold, and adequate coverage of all breast quadrants.

Results: As per prescribed guidelines, mistakes in positioning were recognized in 2.879% of total mammograms. Improper positioning of the nipple was the commonest problem, seen in 3.827% of mammograms, CC view. On MLO view, bilaterally, pectoralis shadow was not seen in 0.520% mammograms, its margin was not straight/convex in 0.706%, lower edge of pectoralis was above pectoralis-nipple line in 2.081%, and inframammary fold was not seen in 1.189%. There was inadequate coverage of lower quadrants in 2.787%, and mismatch in PND was seen in 3.864%. In few of the patients, the shortcomings as a result of improper positioning were noted on one view, the rest being normal.

Conclusion: Positioning is the most important factor affecting the resultant mammography image. During mammography, many cases are improperly positioned and as a result the examination is inconclusive, which reduces the sensitivity of mammography.

No MeSH data available.


Multiple imaging mistakes on an MLO view as a result of compromised positioning (i) nipple not in profile, (ii) edge of pectoralis muscle not well defined, (iii) no formation of “V,” (iv) inframammary fold not seen. Compare with Figures 4 and 5.
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f7-bcbcr-8-2014-119: Multiple imaging mistakes on an MLO view as a result of compromised positioning (i) nipple not in profile, (ii) edge of pectoralis muscle not well defined, (iii) no formation of “V,” (iv) inframammary fold not seen. Compare with Figures 4 and 5.

Mentions: Mistakes in positioning were recognized in 155 of 5382 (2.88%) mammograms. On CC view, nipple was not in profile bilaterally in 23 mammograms and pointing medially or laterally in 80 mammograms (Fig. 2). The unilateral mal-positioning, right or left, was much higher. Abnormal positioning of the nipple was also noted in MLO view (Fig. 6A). Bilaterally, pectoralis was not visualized on MLO view in 14 (Fig. 6B). The edge of the pectoralis muscle was not well defined (straight or convex) in 09 (Fig. 6C) and lower edge of pectoralis was above PNL in 56 mammograms (Fig. 6D). There was inadequate coverage of lower quadrant on MLO view of the right breast in 83, the left breast in 87, and bilaterally in 75 mammograms (Fig. 6E). Mismatch in PND measured on CC view and MLO view was documented in 104 mammograms. Inframammary fold was not visualized in 71 right side, 79 left side, and 32 paired mammograms (Fig. 6F). During the evaluation, in many of the mammograms, more than one pitfall in positioning was noted (Fig. 7).


Breast Positioning during Mammography: Mistakes to be Avoided.

Popli MB, Teotia R, Narang M, Krishna H - Breast Cancer (Auckl) (2014)

Multiple imaging mistakes on an MLO view as a result of compromised positioning (i) nipple not in profile, (ii) edge of pectoralis muscle not well defined, (iii) no formation of “V,” (iv) inframammary fold not seen. Compare with Figures 4 and 5.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4125373&req=5

f7-bcbcr-8-2014-119: Multiple imaging mistakes on an MLO view as a result of compromised positioning (i) nipple not in profile, (ii) edge of pectoralis muscle not well defined, (iii) no formation of “V,” (iv) inframammary fold not seen. Compare with Figures 4 and 5.
Mentions: Mistakes in positioning were recognized in 155 of 5382 (2.88%) mammograms. On CC view, nipple was not in profile bilaterally in 23 mammograms and pointing medially or laterally in 80 mammograms (Fig. 2). The unilateral mal-positioning, right or left, was much higher. Abnormal positioning of the nipple was also noted in MLO view (Fig. 6A). Bilaterally, pectoralis was not visualized on MLO view in 14 (Fig. 6B). The edge of the pectoralis muscle was not well defined (straight or convex) in 09 (Fig. 6C) and lower edge of pectoralis was above PNL in 56 mammograms (Fig. 6D). There was inadequate coverage of lower quadrant on MLO view of the right breast in 83, the left breast in 87, and bilaterally in 75 mammograms (Fig. 6E). Mismatch in PND measured on CC view and MLO view was documented in 104 mammograms. Inframammary fold was not visualized in 71 right side, 79 left side, and 32 paired mammograms (Fig. 6F). During the evaluation, in many of the mammograms, more than one pitfall in positioning was noted (Fig. 7).

Bottom Line: On MLO view, bilaterally, pectoralis shadow was not seen in 0.520% mammograms, its margin was not straight/convex in 0.706%, lower edge of pectoralis was above pectoralis-nipple line in 2.081%, and inframammary fold was not seen in 1.189%.There was inadequate coverage of lower quadrants in 2.787%, and mismatch in PND was seen in 3.864%.In few of the patients, the shortcomings as a result of improper positioning were noted on one view, the rest being normal.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiological Imaging, Institute of Nuclear Medicine and Allied Sciences, Delhi, India.

ABSTRACT

Aims and objectives: Breast positioning is the key factor affecting a mammogram. If care is taken during positioning, it maximizes the amount of breast tissue being imaged, eliminates most of the artifacts, and increases sensitivity of the mammogram. This retrospective study was carried out in our department to assess correctness, and also the incorrectness of breast positioning, which need to be avoided to obtain an ideal mammogram.

Material and methods: A total of 1369 female patients were included in this study. Mammography was performed on full field detector digital mammography equipment. Craniocaudal (CC) view and mediolateral oblique (MLO) view were carried out for each breast. Four views were done for 1322 patients. The remaining 47 patients had undergone a mastectomy and underwent two views for the other breast. Mistakes in improperly positioned mammogram were assessed with respect to proper visualization of nipple, position of pectoralis major, pectoral-nipple distance (PND), inframammary fold, and adequate coverage of all breast quadrants.

Results: As per prescribed guidelines, mistakes in positioning were recognized in 2.879% of total mammograms. Improper positioning of the nipple was the commonest problem, seen in 3.827% of mammograms, CC view. On MLO view, bilaterally, pectoralis shadow was not seen in 0.520% mammograms, its margin was not straight/convex in 0.706%, lower edge of pectoralis was above pectoralis-nipple line in 2.081%, and inframammary fold was not seen in 1.189%. There was inadequate coverage of lower quadrants in 2.787%, and mismatch in PND was seen in 3.864%. In few of the patients, the shortcomings as a result of improper positioning were noted on one view, the rest being normal.

Conclusion: Positioning is the most important factor affecting the resultant mammography image. During mammography, many cases are improperly positioned and as a result the examination is inconclusive, which reduces the sensitivity of mammography.

No MeSH data available.