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Keys Steps for an Optimal Mammogram

Notice: Revised breast cancer screening guidelines issued in November 2009.
8 tips to ensure an optimal mammogram
1. Ask to see the FDA certificate that is issued to all facilities that meet high standards of safety and quality set by the American College of Radiology (ACR).
2. Use a facility that either specializes in mammography or performs many mammograms each day (15 and higher).
3. If you are satisfied that the facility you use provides high quality mammography, continue to go there on a regular basis so your mammograms can be compared from year to year.
4. If you change to a different mammography facility, ask for your previous mammogram films to bring with you to the new facility so they may be compared to the new mammogram films that will be taken.
5. If you have sensitive breasts, try having your mammogram performed at times of the month when your breasts will be less tender. In general the week before and during the period is when breasts are most tender, the week after a period is when breasts should be least tender.
6. Do not wear deodorant, talcum, baby powder, lotions or cream under your arms or on your breasts on the day of your mammogram, because these may interfere with the quality of the mammogram image. For example, Aluminum flecks in some powders and deodorants can mimic microcalcifications on the x-ray image.
7. Bring as much data as possible with you about your previous mammograms and breast health history including places and dates of previous mammograms, other breast imaging, biopsies, or treatments you have had before.
8. If you do not hear from your physician or the mammography center within ten days, do not assume your mammogram is normal. Confirm this by calling your physician or the mammogram facility.
Source: American Cancer Society

Breast size, shape and breast tissue density is different for every woman. Achieving an optimal mammogram image requires skill and careful attention to the following factors by the mammography technologist and radiologist. While the work done by the mammography technologist may seem "routine," the skill and care of a good mammography technologist is vital to achieving an optimal mammogram.

Patient Positioning

Correct positioning of the breast during mammography is extremely important. If the entire breast is not in the x-ray path (field), or if there is something blocking the x-ray field (such as a piece of jewelry, shoulder or the opposite breast), the diagnosis can be compromised. It is also easier to apply proper compression when the breast is positioned correctly.

Patient Cooperation

It is also important that the patient be fully informed about each step of the mammogram procedure to ensure that she can fully participate and cooperate in the exam. During the actual x-ray exposure, patients must remain absolutely still and hold their breath to eliminate image blurring due to patient motion. Women are encouraged to take a few moments prior to the exam to talk to the mammography technologist about any questions or concerns.

Compression

Breast compression is necessary to flatten the breast so that the maximum amount of tissue can be imaged and examined. Breast compression may cause some discomfort, but it only lasts for a brief time during the mammography procedure. Patients should feel firm pressure due to compression but no significant pain. If you feel pain, please inform the technologist. During the mammography examination, breast compression should only be applied two to four times per breast for a few seconds each time (see description of views taken during screening and diagnostic mammography).

Breast Compression is Necessary During Mammography in Order to:

  • Flatten the breast so there is less tissue overlap for better visualization of anatomy and potential abnormalities. For example, inadequate compression can lead to poor imaging of microcalcifications, tiny calcium deposits that are often an early sign of breast cancer.
  • Allow the use of a lower x-ray dose since a thinner amount of breast tissue is being imaged
  • Immobilize the breast in order to eliminate image blurring caused by motion
  • Reduce x-ray scatter which also leads to image degradation

Exposure Settings (Dose)

Breast size, shape and breast tissue density is different for every woman. This requires care in selecting the correct x-ray parameters to make an optimal mammogram image. Larger breasts may require higher x-ray dose; smaller breasts can be imaged properly with less dose (click for more information on mammography x-ray dose). The final image needs to have sufficient spatial resolution (detail) to image small structures such as microcalcifications. The image must also have sufficient contrast so that lumps, cysts and other tissue masses may be clearly seen on the mammogram.

Film and Cassette Screen Combinations

Mammography is a special type of x-ray imaging that uses high contrast, high-resolution film and an x-ray system designed specifically for mammography to create detailed images of the breast. Use of high quality film and screen cassettes is critical to creating the best image quality.

Film Processing

The quality of the dark room equipment and/or film processors is also very important to ensure a final mammogram image with high quality. The film must not be over- or under-exposed. The cassettes and system for processing the film must be dust-free and without light leaks.

Click here to learn more about choosing a mammography facility

Updated: November 28, 2009