Mammographic Imaging Procedures and Image Evaluation
What the exam tests
This domain covers standard and additional mammographic views, positioning, image evaluation, and rejection criteria. The candidate must recognize when an image is adequate and when it must be repeated.
Core concepts
- Standard views: craniocaudal (CC) and mediolateral oblique (MLO).
- Additional views: mediolateral (ML), exaggerated CC lateral (XCCL), rolled views, cleavage view, spot compression, magnification, and implant-displaced views.
- MLO positioning: include the pectoral muscle down to the nipple line, the inframammary fold, and the nipple in profile when possible; avoid skin folds.
- CC positioning: include all medial and lateral breast tissue, center the nipple, and keep the posterior nipple line within about 1 cm of the MLO.
- Image evaluation: coverage, compression, contrast, sharpness, motion, artifact, labeling, and laterality markers.
- Implants: use implant-displaced (Eklund) technique to visualize breast tissue.
Traps
- A short pectoral muscle on MLO is a common reason for repeat, but nipple not in profile alone may not require repeat.
- Laterality markers must be correct; never rely on memory.
- Motion and skin folds can mimic or obscure lesions.
- Implant patients still need adequate tissue visualization, not just an implant image.
- Reject/repeat analysis is a quality indicator, not a punishment.
Worked example / rule of thumb
An MLO image shows the pectoral muscle ending 3 cm above the nipple line. The image is inadequate for MLO criteria and should be repeated. Rule of thumb: evaluate coverage first, then compression, then artifacts and labeling.