Practical solutions to common mammographic problems: tailoring the examination.

Abstract

Received January 8. 1988; accepted after revision March 1,1988. Presented at the annual meeting of the American Roentgen Ray Society, San Francisco, CA, May 1988. 1Department of Radiology, Box 0628, Lk iversity of CaliforniaSchool of Medicine, San Francisco, CA 94143. AJR 151:31-39, July 1988 0361 -803X/88/151 1-0031 © American Roentgen Ray Society It is quite common for standard two-view-per-breast mammography to produce inconclusive results, especially among symptomatic patients and in interpreting baseline screening examinations. Many of these cases are read as indeterminate simply because the imaging evaluation is incomplete. In such circumstances, additional views prove invaluable in solving the mammographic “problems” raised on the standard examination. The ability to decide which extra views to obtain, and when to use them, is an important part of the expertise that every mammographer should develop. In discussing the problem-solving approach to mammography, I have assumed the use of dedicated mammographic equipment, capable of imaging in the craniocaudal projection with a vertical X-ray beam, in the lateral projection with a horizontal X-ray beam, and in all intermediate degrees of the oblique projection. I also have assumed that a properly designed breast compression device is used [1 ]. These features are essential for screen-film mammography and preferable for xeroradiography as well [1]. Use of a ceiling-mounted X-ray unit produces acceptable xeroradiographic images in standard projections, but the radiologist using this general-purpose equipment is limited in the ability to take full advantage of many special projections devised to solve mammographic problems. Every busy xeroradiographic breast imaging practice should have at least one dedicated mammographic unit available for such problem-solving examinations. There are so many potential approaches to completing the evaluation of inconclusive mammography examinations that an almost innumerable array of imaging permutations exists from which the radiologist may choose. To simplify the subject, I have concentrated on some of the more commonly encountered mammographic problems, indicating those solutions most likely to succeed. The reader is advised at the outset that every mammographic problem can be solved by a variety of acceptable methods and that my failure to discuss one of your personal favorites indicates only my own preference rather than the inadequacy of a specific alternative approach.