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Download Breast Protocol Protocol Scan from nipple outward then back toward
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Breast Protocol Protocol Scan from nipple outward then back toward nipple including the Tail of Spence (Axillary Region) No pathology present-Store image anywhere along scanning section Pathology present - image pathology in both planes, measure, utilize color Doppler, & spectral Doppler Protocols will vary at each site, examples of protocols that may be used are identified below Example of a Whole Breast Examination for the RIGHT Breast Area of Concern For Each of the Following Clock Positions 12:00 3:00 6:00 9:00 10:00 11:00 Areola/Nipple Axilla/Tail of Spence Plane Radial Label Include the appropriate clock position and scan plane (scan plane only for nipple and axilla) Radial Antiradial Antiradial Oblique under nipple Antiradial Nipple Skin Premammary Layer Mammary Layer Retromammary Layer Pectoralis Muscle Pleura/lung Skin Premammary Layer Mammary Layer Retromammary Layer Pectoralis Muscle Pleura/lung Lactiferous Sinus Axilla Skin, Fat and Muscle Example of a Whole Breast Examination for the Left Breast Area of Concern Plane Label Include the appropriate clock position and scan plane (scan plane only for nipple and axilla) For Each of the Radial Radial Following Clock Positions 12:00 1:00 2:00 3:00 Antiradial Antiradial 6:00 9:00 Areola/Nipple Axilla/Tail of Spence Oblique under nipple Antiradial Landmarks Landmarks Nipple Skin Premammary Layer Mammary Layer Retromammary Layer Pectoralis Muscle Pleura/lung Skin Premammary Layer Mammary Layer Retromammary Layer Pectoralis Muscle Pleura/lung Lactiferous Sinus Axilla Skin, Fat and Muscle Breast Protocol Targeted Examination-Typically used when a pathology is seen on mammogram, previous sonography, or palpable Clock Position Identify the area of Concern by the clock position Plane Radial Label Clock position Radial Identify the area of Concern by the clock position Antiradial Clock position Antiradial Identify the area of Concern by the clock position “Magnified” Identify the area of Concern by the clock position “Magnified” with AP and Length Measurements Identify the area of Concern by the clock position “Magnified” Identify the area of Concern by the clock position “Magnified” with AP and width measurements Identify the area of Concern by the clock position “Magnified” with Color Doppler of pathology Identify the area of Concern by the clock position “Magnified” with Color Doppler & Spectral Analysis of pathology Radial Clock position Radial Radial Clock position Radial Antiradial Clock position Antiradial Anterior, posterior, and lateral walls of pathology Antiradial Clock position Antiradial Anterior, posterior, and lateral walls of pathology Radial Clock position Radial Anterior, posterior, superior, and inferior walls of pathology Radial Clock position Radial Anterior, posterior, superior, and inferior walls of pathology Images Required for BCHS Scan Competency All site specific protocol images Area of concern radial plane images Area of concern antiradial plane images Nipple images Axilla images Pathology images Landmarks Skin Premammary Layer Mammary Layer Retromammary Layer Pectoralis Muscle Pleura/lung Skin Premammary Layer Mammary Layer Retromammary Layer Pectoralis Muscle Pleura/lung Anterior, posterior, superior, and inferior walls of pathology Anterior, posterior, superior, and inferior walls of pathology Breast Protocol Anatomical/Image Correlation/Image Orientationhttp://www.obgyn.net/displayarticle.asp?page=/bh/articles/newbreasthandoutI & www.imagingce.info/.../quadLocal.gif Normal Measurement Ranges Structure Area of Concern Skin Near field Ducts Lymph Nodes Posterior Nipple Axillary or wherever visualized Plane Sagittal Measurement 2-3 mm Sagittal Sagtital & transverse Less than 3mm Less than 1.5 cm in all planes Comments Measure Anterior to Posterior diameter (use standoff pad or thick layer of gel) Measure Anterior to Posterior diameter Abnormal lymph nodes will appear round rather than oval. Length, width, and height measurements should be taken to determine size in each plane Sonographic Appearance All Anatomy should be Compared to echogenicity of FAT Fat=medium level gray Smooth, thin walls Macrolobulations (3 or less lobulations) Irregular contour Microlobulations Thickened Cooper’s ligaments Microcalcifications Homogenous Structure Skin Glandular Tissue Fibrous Tissue Cooper’s Ligaments Ducts Muscle Ribs Benign Characteristics Anechoic Hyperechoic Echogenicity Echogenic Isoechoic to Hypoechoic Hyperechoic Hyperechoic Anechoic or Hypoechoic Hypoechoic with Striations Echogenic with shadowing Posterior enhancement Wider than taller Suspicious Characteristics-Just takes one! Spiculated Angular Branch Heterogenous margins pattern Taller than wider Disruption of tissue planes Duct extension Shadowing Thin echogenic capsule Hypoechoic compared to fat Increased echogencity anterior to mass Transducer- Dependent on amount of breast tissue, high frequency linear transducer with minimum of 7MHz is recommended Patient Position Patient lies supine or slightly oblique (may need support wedge) with arm over head Oblique more for larger breasts, the breast should lay flat to minimize the thickness of the breast Pathology-- If pathology is present you must document the pathology it in its entirety, images should include Gray scale sagittal and transverse images, document distance from NIPPLE not areola SHAPE, MARGIN, ECHOGENICITY, LESION BOUNDARY, ATTENUATION, SURROUNDING TISSUE Gray scale sagittal and transverse images with 3 measurements (length, width and height) Color Doppler image document the presence of blood flow and Spectral Doppler image document type and velocity of blood flow (Use Power/Color Doppler with humming to identify solid masses—FREMITUS)
