The Art of Mammographic Positioning

Abstract

It is difficult to obtain high-quality mammograms. Features uniquely inherent to the breast, such as shape, size, density, and low contrast, combine with patient factors such as anxiety, tenderness, and fear of radiation to challenge the skills of the best-trained technologist. The science of breast imaging has helped overcome the inherent low contrast of fat and parenchyma and the disease processes that affect both. Special film screen combinations, use of low kVp techniques, and extended processing have made possible the acquisition of high-contrast breast radiographs. Strict adherence to basic principles of mammographic imaging and quality assurance monitoring have made it possible for any facility, using appropriate equipment, to obtain technically adequate images. However, mammographic positioning does not lend itself to a set of rigid, precisely defined techniques; rather it depends heavily on the technologist’s understanding of the variability of breast anatomy and morphology and the capabilities and limitations of available mammographic equipment. Recognizing the factors which influence opti?mal tissue visualization is an art. Not all x-ray technologists are sufficiently talented to develop the skills or to perform the procedures required for optimal mammographic imaging. No technologist with the required talent can produce optimal mammographic images without specialized training and supervised experience. This chapter is directed to technologists with an interest in high-quality mammography. It is also directed to radiologists, who must understand the art of mammographic positioning in order to recognize high-quality images and to direct corrective measures for deficient images.