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Breast X-ray (mammography)
Last reviewed: 05.07.2025
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Diseases of the mammary gland develop quite often. It is enough to note that cancer of this organ is the most frequently detected malignant tumor in women. Diagnostics is based on the results of clinical examination and special studies, which are crucial for detecting the early stages of the disease. In recent years, radiation diagnostics has taken an honorable place in this complex.
Mammography is an X-ray examination of the mammary gland without the use of contrast agents.
X-rays are taken 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 diameters of 0.3 and 0.1 mm. The tube anode is made of molybdenum, and the output window is made of beryllium. These design features are necessary to obtain a uniform beam of low-energy radiation and achieve differentiated images of breast tissue on the images.
Mammography is performed when the breast tissue is compressed. Images are usually taken in two projections - direct and oblique or direct and lateral. In addition to overview mammograms, targeted images of individual sections of the gland are sometimes necessary. Mammographs are equipped with a stereotactic device for puncturing the gland and collecting 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 have images taken at any time. The radiation load during mammography does not exceed 0.6-1.210° Gy. There are no complications or pathological reactions during the examination. The risk of developing radiation-induced cancer of the gland (radiogenic cancer) is negligible. A priori, it is defined as 5-6 cases per 1 million examined, and with a latent period of 10-20 years. But spontaneous breast cancer occurs in 90-100 thousand women, and only thanks to periodic mammography about half of them can be saved from death due to cancer.
Diseases of the mammary glands
There are two groups of radiation examinations of the mammary gland: screening and diagnostic. The first group includes periodic mammography of healthy women to detect hidden diseases, primarily cancer. Figuratively speaking, this is "mammography of healthy women who want to stay healthy." All women who have no signs of breast disease are recommended to undergo a clinical mammographic examination ("baseline mammograms") at the age of 40. Repeated clinical mammographic examinations should be performed at intervals of 2 years, unless the woman is in a high-risk group for developing breast cancer. Mass screening examinations of the female population using mammography (mammographic screening) provide a 30-50% reduction in mortality from breast cancer and a significant reduction in the frequency of mastectomies.
Breast cancer is a chronic and slowly developing disease. The tumor originates from the epithelium of the milk ducts or glandular lobules. Accordingly, there are two main types of cancer: ductal and lobular. The transformation of the epithelium is stereotypical: normal - hyperplasia - atypia - cancer. On average, 6 years pass before a tumor with a diameter of 1 mm is formed, and another 6-10 years pass before it reaches a size of 1 cm.
Microcystic reorganization usually occurs in both mammary glands. Larger cysts produce round and oval shadows of varying sizes - from 0.5 to 3-4 cm with clear, even, arcuate contours. A multi-chamber cyst has polycyclic outlines. The cyst shadow is always uniform, there are no calcifications in it. The radiologist punctures the cyst, aspirates its contents and injects air or a sclerosing compound into it. The cyst is most demonstrative on sonograms.
Mixed forms of mastopathy cause a motley radiographic picture: instead of a sharply defined shadow of the glandular triangle with trabeculae radiating from the base of the gland to the areola, a reorganization of the gland structure is revealed with multiple areas of darkening and lightening of different shapes and sizes. This picture is figuratively called "lunar relief".