Method of mammography

The radial image of the breast can be obtained by X-ray and ultrasound, computer and magnetic resonance imaging. The main x-ray method is mammography.

Mammography - radiography of the breast without the use of contrast agents.

Radiography is performed on X-ray machines specially designed for this purpose, mammographs. The power of their x-ray tubes is 19-32 kV, they have two focal spots with a diameter of 0.3 and 0.1 mm. The tube anode is made of molybdenum, and the exit window is made of beryllium. These design features are necessary to obtain a uniform beam of low-energy radiation and to achieve in the images a differentiated image of breast tissue.

Mammography is produced by compressing the tissues of the breast. Pictures are usually performed in two projections - direct and oblique or straight and lateral. In addition to survey mammograms, in some cases, targeted images of individual sections of the gland are needed. Mammographs are equipped with a stereotaxic device for puncture of the gland and collection of material for cytological or histological analysis.

Mammography is performed in the first phase of the menstrual cycle (from the 5th to the 12th day, counting from the first day of menstruation). Women in menopause can take pictures at any time. Radiation load at mammography does not exceed 0,6-1,210 ° Gy. Complications and pathological reactions in the study does not happen. The risk of cancer of the gland, induced by radiation (radiogenic cancer), is negligible. A priori it is defined as 5-6 cases per million examined, in addition, with a latent period of 10-20 years. But spontaneous breast cancer occurs in 90-100 thousand women, and only because of the periodically conducted mammography, about half of them can be saved from death due to cancer.

Very promising digital mammography. Its advantages include reduction of the radiation load, better detection of small details of the structure of the gland, the possibility of use in automated communication systems and archiving. A mammogram is an important document that must be stored in kind or in the form of digital copies for subsequent retrospective analysis.

On mammograms, all structures of the mammary gland are clearly differentiated. The skin is allocated in the form of a homogeneous dark stripe 0.5-2.0 mm wide. Under it is located fatty tissue, the layer of which gradually widens from the areola to the base of the gland. Against the background of fiber loom the shadows of blood vessels and ligaments of Cooper (the upper pubic ligament). The main part of the image is taken by the image of the connective tissue and the glandular elements in it. In young women, the glandular-connective tissue complex gives a shadow in the form of a triangle facing the top to the nipple and having convex contours. With age, the almost uniform and intense shadow of the "glandular triangle" becomes non-homogeneous due to the light interlayers of adipose tissue. The climacteric and post-menopausal periods are characterized by a gradual atrophy of the glandular tissue and replacement of its fatty tissue. The longest remains of glandular and connective tissue are retained in the upper quadrant of the gland.

In addition to mammography, two methods of artificial X-ray contrasting were widely used: galactography (synonyms: galactographography, breast mammography) and pneumocystography. Galactography is produced by discharge from the nipple. Through a needle in the seething corn dairy duct under a slight pressure, a solution of the radiopaque substance is injected and X-rays are performed. The images show the system of the dairy milk duct with its branches. They are judged on the topography of the duct, the type of its branching, the patency of the ducts, their deformation, displacement, the presence of cystic cavities along their course and, most importantly, the presence of tumor growths in them - papillomas or intracapsular cancer.

In pneumocystography puncture the mammary gland cyst, suck up its contents (directed to biochemical and cytological research) and in turn introduce air. The roentgenograms show the inner surface of the cyst, which makes it possible to detect intracycotic tumor formations. In addition, the introduction of air, provided that the fluid is completely removed from the cyst, is an effective medical procedure.

The complex of X-ray studies also includes the radiography of a preparation obtained with stereotaxic biopsy or an open surgical biopsy of the breast.

The ultrasonic method became an excellent ally of mammography. Its simplicity, harmlessness, the possibility of repeated repetition are well known. It is superior to mammography in the study of dense mammary glands in young women and in the detection of cysts, as well as in the study of regional lymph nodes (axillary, supra- and subclavian, parasternal). Sonograms can be made to pregnant women and women during lactation. On sonograms, a sufficiently clear image of the structure of the mammary gland is achieved. If you perform dopplerography with color mapping, you can get an idea of the state of small blood vessels in the field of pathological formations. Puncture of the breast is often performed under ultrasound guidance.

To x-ray computed tomography of the breast, doctors are rarely treated, mainly in the study of retromammary tissues. But a major contribution to the comprehensive diagnosis of breast diseases was made by magnetic resonance imaging. It helps in the detection of small pathological formations, allows to estimate their blood supply, is indispensable in assessing the condition of the implant after breast prosthesis.

Scintigraphy provides valuable data when necessary to differentiate benign and malignant formations, since such RFPs, like 99mTc-sesambi, accumulate in cancer tumors.

Unlike radiography and sonography, which characterize mainly the morphological structure of the breast, thermography allows us to study its thermal field, i.e. To a certain extent, to judge about the bioenergetic processes taking place in it.

[1], [2], [3], [4], [5], [6], [7], [8],