Guidelines for Positioning

• Communication!!• Exam Identification• Posture• Mobile Borders of the breast• Measurement of PNL• Skin Wrinkles• Nipple in Profile• Markers

Guidelines for Positioning Cont.• AEC placement• Compression

– Decreased dose and scatter– Decreased motion– Increased sharpness– Increased contrast– Separation of breast structures

• Collimation

Craniocaudal Projection

• Areas visualized• Tube position• Patient position• Technologist hand position• Tabar Modification

Assessing Results

• Retro-Glandular Fat Space• Pectoral muscle medially• Skin thickening medially• Cleavage

Medio-Lateral Oblique

• Areas visualized• Tube position• Patient position• Technologist hand position

Assessing Results

• Breast should not droop• Pectoral muscle visualized to nipple (PNL)• IMF Open

DANGER!!

Mediolateral Lateral

• Uses– Localization– 3rd view to open structures

Problem: misses posterior and lateral tissue

Lateromedial Lateral

• Uses– Localization– 3rd projection– Replace MLO for nonconforming patients

Exaggerated Craniocaudal (XCCL)

• May Angle 5-10 degrees

• Hold with ipsi-lateral arm

• Doesn’t open structures like 20 degree OBL

20 degree Oblique

• Views entire glandular island

• Good single view for young patients

• Good additional view for CA patients

Superolateral/Inferomedial (SIO) “Reverse” “SL-IM”

• Tangential of Abnormality

• Additional view for encapsulated implants

• Nonconforming patients

• Perpendicular projection to MLO to rule out mass

Inferolateral/Superomedial (LMO)“True Reverse” “ILSM”

• Replacement for MLO

• Turn c-arm 125 degrees laterally to ipsilateral side

• Raise arm up and across image receptor

• Contra-lateral arm hangs on to handrail

Eklund Method

• Routine CC• CC with Implant Displacement• Routine MLO• MLO with Implant Displacement• Additional Views

– SIO for encapsulated implants– SIO-ID for soft implants

Axilla Position

• C-arm 70-90 rotation• Image receptor slightly above humeral head• Posterior shoulder rests against image receptor.• Compression used to minimize motion• Kvp range from 28-35

Tangential

• Abnormality must be palpable or observable on any two projections

• Draw line from nipple to area of interest• Visualization of UIQ or LOQ done with SIO• Visualization of UOQ or LIQ done with MLO• Skin calcification may only be visualized on one

view so must be localized before a tangential can be performed