Mammography

by Justin G. Malimban

HISTORY
1913
A. Solomon, a Berlin pathologist, imaged 3000 gross
mastectomy specimens
Observed micro-calcifications in breast carcinomas
1930
Stafford Warren, MD published the first article on
mammography

1960s
Robert Egan, MD = Father of Mammography
Developed low kV technique

HISTORY
1965
Charles Gros, MD
Developed the 1st x-ray
machine exclusively
designed to perform
mammograms
CGR Senographe

HISTORY
1973
Picker (Mammorex)
Siemens (Mammomat)
Philips (Diagnost)

1974
GE (MMX)

Current dedicated
mammography unit

MAMMOGRAPHY
A radiographic examination that is specially designed
for detecting breast pathology
According to the Philippine Cancer Society, 1 in 13
Filipino women develop breast cancer over a lifetime
Philippines has the highest incidence rate in Asia and is
among the top 10 countries with most cases of breast
cancer*
16% of the 50,000 cases of cancer are due to breast
cancer*
1 out of four die within the first 5 years and no less than
40% die within 10 years*
*taken from Philippine Society of Medical Oncology

MAMMOGRAPHY
Early detection and diagnosis of breast cancer is the
main aim of breast imaging
A matter of looking for masses (tumors),
microcalcifications and architectural distortions
High contrast resolution is needed for detection of
cancer because they have nearly the same density as
their surrounding tissue
Excellent spatial resolution is needed for detection of
microcalcifications

BREAST TISSUE
Consists mainly of glandular tissue, adipose tissue (fat),
connective tissue and blood vessels.
X-ray attenuation of these are very similar and is also similar to
cancerous tissues
of adipose tissue are composed of carbon (Z=6), of
glandular tissue are composed of nitrogen (Z=7) and oxygen
(Z=8).
Only calcifications show clearly higher x-ray attenuation
coefficients
40% of breast cancer patients present microcalcifications
composed of Ca (Z=20) and P (Z=15)
Reduce applied x-ray energy to provide sufficiently high soft
tissue contrast

 Low x-ray energies

provide the best
differential attenuation
between tissues
However, this entails
higher tissue dose and
longer exposure times

X-RAY SPECTRUM
Molybdenum (Z=42) is used
commonly as the anode material
in mammography
Exhibit characteristic peaks at
17.4 and 19.6 keV
Rhodium (Z=45) with
characteristic peaks at 20.2 and
22.7 keV is used for thicker and
denser breasts
Molybdenum or Rhodium filters
are employed to further reduce
the low and high end parts of the
spectrum

FILTRATION
High energy x-rays in
the bremsstrahlung
spectrum diminishes
subject contrast
Low energy x-rays
have inadequate
penetration and
contribute to patient
dose without providing
useful image

FILTRATION
K-edge filtration
Increase in attenuating
coefficients of photons
occurring at a photon
energy just above the
binding energy of the
K-shell
Due to photoelectric
absorption

 0.03 mm Molybdenum filter with

Molybdenum target (Mo/Mo)
0.025 Rhodium filter with Rhodium
target (Rh/Rh)
Commonly used in imaging of
denser breasts because it
produces a slightly higher
effective energy than Mo/Mo
Molybdenum target with Rhodium
filter (Mo target/Rh filter)
Molybdenum filter with Rhodium
target should never be used

Focal Spot
0.3 mm and 0.1 mm
Smaller focal spot
reduces geometric
blurring
Collimation
18 x 24 cm2
24 x 30 cm2
SID
65 cm

ANTI-SCATTER GRID
Scatter production = image
degradation
Grids improve contrast by
allowing primary x-rays to pass
through their interspace
material while the lead strips
absorb the secondary scatter
Grid ratio: 5:1
Increases the contrast by ~40%
but increases patient dose by 23x

COMPRESSION
More uniform and less breast
thickness
Less scattered radiation
Reduces motion unsharpness
Reduces geometric unsharpness
Lower dose
Less superimposition
Principal drawback is patient
discomfort

MODES OF OPERATION
Breast images are usually
taken in craniocaudal view
(right) and mediolateral
oblique view (left)
Magnification technique is
frequently used to obtain a
clearer assessment of the
borders and the tissue
structures of a suspicious
mass
The breast is positioned
closer to the x-ray focus

REFERENCES

Andolina, V., Lille, Shelly. and Willison, K. Mammographic Imaging 2nd

Edition. Philadelphia, PA: Lippincott Williams and Wilkins. 2001

Oppelt, A. Imaging Systems for Medical Diagnostics: Fundamentals,

Technical Solutions, Applications for Systems Applying Ionizing
Radiation, Nuclear Magnetic Resonance and Ultrasound. Publicis
Corporate Publishing. 2005