Chest Cardio Breast 10-4-12

8/13/2019 Chest Cardio Breast 10-4-12

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DENSITIES

BONE AIRSOFTTISSUES

WATER FAT


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Criteria for an Ideal Chest Radiograph1. Upright2. Posteroanterior View3. Full / Midinspiration4. Six Feet Target Film Distance


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AIRWAYSTracheaBronchi


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MAJOR FISSURE

MINOR FISSURE


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RUL

RML

RLL

LUL

LLL

RUL

RML

RLL


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S

LAM

P

SL

IL

IL

SL

ant

AP

8 SEGMENTS AP & AM FUSED SEGMENTS


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APA (upper lobe)

Apical, P osterior,Anterior

ML (middle lobe)Medial Lateral

S AMPLe BASALSuperior segment (no last name basal)

Anterior basal, Medial basal, P osterior basal,Lateral basal

RIGHT = 10 SEGMENTS


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LEFT = 8 SEGMENTS

AP , A (upper lobe)

Apico P osterior,Anterior

S AM PL e BASAL

Superior segment(no last name

basal)

Antero- Medial basal,P osterior basal,Lateral basal

LINGULA

Superior, Inferior You have an AP in AM!


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RARV

LA

LV


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THE BUMPS

AA

AAMPA

MPA

LVRA RA LV

SVC

SVC


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PROMINENT MEDIALLYTAPERS PERIPHERALLY

PULMONARY VASCULAR MARKINGS


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PULMONARY VASCULAR MARKINGS

MOREPROMINENTINFERIORLY


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1) PLAIN FILM ANATOMY2) PLAIN FILM INTERPRETATION


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To review the cardiovascular anatomy inplain chest radiographs

To discuss the basics of cardiovascular

assessment in plain chest radiographs


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A pectoralis majormuscle

B axillary lymph nodes:levels I

C axillary lymph nodes:levels II

D axillary lymph nodes:levels III

E supraclavicular lymphnodes

F internal mammarylymph nodes


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Breast profile: A ducts B lobules C dilated section of duct tohold milk

D nipple E fat F pectoralis major muscle G chest wall/rib cage Enlargement:

A normal duct cells B basement membrane C lumen (center of duct)


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Mammography is a special type of x-rayimaging used to create detailed images of thebreast

Mammography uses low dose x-ray; highcontrast, high-resolution film; and an x-raysystem designed specifically for imaging thebreasts
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Mammography is a special type of x-ray imaging thatuses low dose x-ray; high contrast, high-resolution film;and an x-ray system designed specifically formammography to create detailed images of the breast.Although breast x-rays have been performed since the1920s, modern mammography has only existed sinceabout 1970. Modern mammography systems useextremely low levels of radiation: usually about 0.1 to0.2 rad dose per x-ray (rad is the scientific unit of

measure of radiation energy dose ).


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To put mammography dose into perspective, awoman who receives radiation therapy as atreatment for breast cancer will receive severalthousands rads.If a woman had annual screeningmammography for fifty years (two x-ray viewsper breast), beginning at age 40 years and

continuing until age 90, she will have receiveda total of 10 rads to 20 rads per breast over thecourse of 50 years.
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Scientific data has shown that doses 100-1000times greater those used for mammography arerequired to show any statistical increase inbreast cancer frequency.There is no significant risk of radiation damageto breast tissue from mammography and thepotential risk


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Mammography plays a major role in earlydetection of breast cancersMammography can find 85 to 90 percent of

breast cancers in women over 50 and candiscover a lump up to two years before it canbe feltThe benefits of mammography far outweighthe risks and inconvenience
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Mammography can show changes in the breastwell before a woman or her physician can feelthem

Once a lump is discovered, mammography canbe key in evaluating the lump to determine if itis cancerous


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If a breast abnormality is found or confirmedwith mammography, additional breast imagingtests such as ultrasound (sonography) or abreast biopsy may be performed

A biopsy involves taking a sample(s) of breasttissue and examining it under a microscope todetermine whether it contains cancer cells
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an x-ray examination of the breasts in a womanwho is asymptomatic (has no complaints orsymptoms of breast cancer)

goal of screening mammography is to detectcancer when it is still too small to be felt by awoman or her physician


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Early detection of small breast cancers byscreening mammography greatly improves awoman's chances for successful treatmentScreening mammography is recommended every oneto two years for women once they reach 40 years ofage and every year once they reach 50 years of age
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The goal of screening mammography is to detect breastcancer when it is still too small to be felt by a physicianor the patient.Research has shown that the early detection of smallbreast cancers by screening mammography greatlyimproves a woman's chances for successful treatment.For example, if breast cancer is caught and treatedwhile it is still confined to the breast ducts (a typecalled ductal carcinoma in situ ; DCIS), the cure rate is

close to 100%.
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Mammography can detect approximately 85% of breastcancers.While screening mammography can detect most breastcancers, it can miss up to 15% of cancers. These cancersmay not be visible on a mammogram film.If a physician detects a breast lump with physicalexamination but the mammography does not revealany abnormality, he or she will mostly likelyrecommend other additional breast imaging (such as

ultrasound) to further investigate the lump.


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Breast cancer may not be visible on a screeningmammogram if:

1) The cancer is very small2) The cancer is in an area that is not easily

imaged with mammography (such as in theaxilla; the underarm region)

3) The cancer is obscured by other shadows


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While mammography can occasionally missbreast cancers, it can also detect cancer severalyears before a lump can be felt.

Therefore, it is important for women 40 yearsof age and older to get a mammogram eachyear and have current mammogramscompared with previous films to determine

whether cancer is beginning to grow.


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Average-sizelump detectedwith routinemammogram(0.43 inches / 1.1cm)


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Physicians may recommend beginningscreening mammography before age 40 (i.e. ifthe woman has a strong family history ofbreast cancer)


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is an x-ray examination of the breast in awoman who either has a breast complaint (forexample, a breast lump or nipple discharge isfound during self-exam ) or has had anabnormality found during screeningmammography
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is more involved and time-consuming thanscreening mammography and is used todetermine exact size and location of breastabnormalities and to image the surrounding

tissue and lymph nodesseveral additional views of the breast areimaged and interpreted during diagnosticmammography


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Women with breast implants or a personalhistory of breast cancer will usually require theadditional views used in diagnosticmammography.
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the technologist will position the patient andimage each breast separatelyeach breast is carefully positioned on a special

film cassette and then gently compressed witha paddle (often made of clear Plexiglas or otherplasticthis compression flattens the breast so that the

maximum amount of tissue can be imaged andexamined
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mammography technologists may placeadhesive markers to the breast skin prior totaking images of the breastpurpose of the adhesive markers is twofold:first, to identify areas with moles, blemishes orscars so that they are not mistaken forabnormalities, and secondly, to identify areas

that may be of concern (e.g. a lump was feltduring physical examination)


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Some centers routinely mark the nipple with asmall dot to provide a clear "landmark" for theradiologist on the mammogram images


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As the x-rays pass through the breast, they areattenuated (weakened) by the different tissuedensities they encounter.Fat is very dense and absorbs or attenuates agreat deal of the x-rays.The connective tissue around the breast ductsand fat is less dense and attenuates or absorbs

far less x-ray energy.


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The developed mammography films are theninterpreted by a radiologist, who compares thenew images of a woman's breast to each otherand to previous mammograms a woman has

had.The radiologist will look for shadows andpatterns of tissue density to detect anyabnormalities.


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The breast is made of fat, fibrous tissue andglands.Breast masses (these include benign andcancerous lesions) appear as white regions on

mammogram film.Fat appears as black regions on a mammogramfilm.Everything else (glands, connective tissue,tumors and other significant abnormalitiessuch as microcalcifications) appear as levels ofwhite on a mammogram.


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3) supplemental views tailored to the specificproblem are often performed. These caninclude views from each side (lateromedial,LM: from the outside towards the center andmediolateral view, ML: from the center of thechest out), exaggerat ed cranial-caudal,magnification views , spot compression , andothers.if screening mammography has been

performed first and the resulting CC and MLOviews are of sufficient quality, they may notneed to be repeated if diagnostic
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Mediolateral Oblique View (MLO)The mediolateral oblique view (MLO) is takenfrom an oblique or angled view. Duringroutine screening mammography, the MLOview is preferred over a lateral 90-degreeprojection because more of the breast tissue canbe imaged in the upper outer quadrant of the

breast and the axilla


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With the MLO view, thepectoral (chest) muscle shouldbe depicted obliquely fromabove and visible down to thelevel of the nipple or furtherdown. The shape of themuscle should curve or bulgeoutward as a sign that themuscle is relaxed; the medial(middle) portion of the breastshould be prominent in theMLO view. It is importantthat compression be appliedover the whole image area.The nipple should bedepicted in profile and asmall stomach fold should bevisible as a sign that thewhole breast is reproduced.


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Mediolateraloblique (MLO)view mammogramshowing the pectoral muscle,breast, nipple andbreast ducts


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This illustrationshows the cranio-caudal view (CC)and themediolateraloblique view,which is takenfrom an obliqueor angled view.


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With the CC view, theentire breast parenchyma(glandular tissue) shouldbe depicted. The fattytissue closest to thebreast muscle should

appear as a dark strip onthe x-ray and behind thatit should be possible tomake out the pectoral(chest) muscle. Thenipple should bedepicted in profile


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The technologist willapply compression whilemaking sure there are nofolds on the lateral side.She will put her hand onthe patients shoulder to

stretch the skin, ensuringthat nothing blocks the x-ray field. When thecompression is sufficient,she will ask the patient tostand absolutely still andleave to make theexposure


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The medio-lateral view (ML) is taken from the center ofthe chest outward. If no oblique projection is taken, themediolateral position may be preferable to the latero-medial view (LM, images the breast from the outer sideof the breast inward toward the center of the chest)

since the lateral side of the breast, where pathologicalchanges are most commonly found, is then closest tothe film.However, if the physician wants to include as much ofthe medial side of the breast as possible, the LM viewmay be chosen.


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This illustrationshows the MLview, whichimages the breastfrom the medialside (the"middle")outward.


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With a lateral view,the pectoral (chest)muscle should bedepicted as a narrowlight band on at leasthalf of the picture. Thenipple should bedepicted in profileand a clear stomachfold should be visibleunder the breast.


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#1: For the MLview, themammographytechnologist willset the x-ray tubein a 90-degreelateral projection,ensuring that thecorrect slidemarker is used


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#2: The technologist will set theheight to the axillary (armpit) foldand ask the patient to put her armalong the object table and stretchit forward. While grasping thebreast from below and drawing itout, the technologist will applycompression with one hand andplace her other hand on thepatients back, pressing hertoward the stand. If the otherbreast blocks the field, thetechnologist may help the patientkeep it out of the way. In somecases, a wide paper plaster maybe used to hold the other breastaway. The technologist may

attach the plaster from thepatients sternum and fix it, afterdrawing the breast back, onto thepatients back.


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#3: When thecompression issufficient, thetechnologist willask the patient toremain absolutelystill. Then she willleave to make theexposure.


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This illustrationshows how theLM view is taken,from the outerside of the breastinward.


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#1: For the LM view,the mammographytechnologist will setthe tube in a 90-degree projection,ensuring that thecorrect slide markeris used. She will setthe height to theuppermost point ofthe sternum,

positioning thepatient with theobject table betweenher breasts


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#2: The technologist willask the patient to lift herarm and place her hand onthe handle while keepingthe elbow lifted. She willthen ask the patient toplace the point of her chinas far forward as possibleon the edge of the objecttable. Grasping her breastfrom below and drawing itoutwards, the technologistwill apply compression,pressing the patienttoward the table (takingcare to ensure that thepatients arm is notsqueezed).


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Normal mammogramin a 40 year old womanwith dense breastparenchyma


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US of breast is not a screening modality butshould be the first examination performed in awoman younger than 30 years of age withpalpable breast mass.Useful in evaluation of masses detected onmammography, palpable masses and implants.


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Ultrasound allows whether mass is cystic orsolid.It is useful for imaging lactating breasts toevaluate abscesses and can be used to guideneedle drainage of abscess.It can be used to guide sampling of solidmasses by fine needle aspiration or core

biopsies and for cyst drainage in cases ofsymptomatic or complex cysts.


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Breast ultrasound can image several differenttypes of breast conditions, including bothbenign (non-cancerous) and malignant(cancerous) lesions.Ultrasound is frequently used to evaluatebreast abnormalities that are found with screening mam mography or diagnosticmammogra phy or during a ph ysicianperformed clinical breast exam .

Ultrasound allows significant freedom inobtaining images of the breast from almost anyorientation.
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Sharp diagnostic ultrasound images are oftenable to show soft layers of breast tissue.Ultrasound may be particularly useful indetecting abnormalities in patients with densebreasts.Density is a term used to describe breast tissuethat has many glands close together. Thoughfairly common (especially in younger women),dense breasts may make breast masses difficult

to detect on a mammogram film.


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This detailedimage of normalbreast tissue usespanoramicultrasoundimaging


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This detailedimage was takenafter a tumor wasremoved


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This image showssuperficial breastducts


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With colorvisualization, thisimage shows thesmall superficialvessels of thenipple


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Breast cysts, tiny accumulations of fluid, are the mostcommon cause of benign (non-cancerous) breast lumpsin women between age 30 and 50.Simple cysts are typically round or oval and havesmooth edges.

Complex cysts can be filled with debris and maysometimes require aspiration to confirm that they areindeed benign cysts.Both single and multiple cysts are very common. Theexact causes of cysts are not known, but they do tend tochange with hormonal variations, either du ring norm almenstrual cycles or f rom post-menopausal hormonereplacement therapy .
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When examining a breast abnormality todetermine whether it is a cyst (or multiplecysts), the radiologist will study the quantity,size, and internal characteristics of the

abnormality.Cysts do not become cancer or increase the riskof cancer. Most of the time, cysts may be leftalone, but sometimes a physician may drain

them with a small needle using ultrasoundguidance. This procedure is called cystaspiration .
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Breastcyst. Imageshows sharpcystic walls andinternal septationby cyst membrane


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Breast cyst. Imageshows subtlecontents withincyst


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Large cyst withlayered debrisand a solidcomponent


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Adjacent breastmasses: one adebris filled cyst,the other a simplecyst.


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Panoramic viewof a simple breastcyst within theglandular layer ofbreast tissue


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This image showsatypicalcharacteristics ofthis cystic breast

structure: asomewhatthickened cysticwall and a 5-millimeterseptation bycystic membrane


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Patient withmultiple cysts andother masses thatindicate breastdisease.Ultrasound showsthe relationship ofthe dominant cystto other masses inthis patient


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One application ofbreast ultrasoundinvolvesdifferentiatingsimple cysts fromsolid masses. Thisimage shows asmall cyst withinthe glandularbreast tissue.


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A breast abscess is a closed pocket of tissuecontaining pus (a creamy, thick, pale yellow oryellow-green fluid).Abscesses are most commonly caused by a

bacterial infection.Abscesses may or may not show up well onultrasound.Breast abscesses may be accompanied by fever,pain, breast tenderness, or increased whiteblood cell count.


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This panoramicultrasound imageshows fullvisualization of abreast abscess.


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Image offibroadenoma


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This image showsa solid irregularbreast mass withcalcification(calcium deposits).Ultrasound doesnot reliably imagecalcifications,

although they canbe seen in somecases.


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This image showsductal invasionassociated withthis malignantbreast mass.


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This image showsa nonpalpablemass within theglandular breast

tissue


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Chest Cardio Breast 10-4-12

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