0:01

Let's move on to you in a

0:04

third case.

0:06

A 65 year old woman was diagnosed with

0:09

a three millimeter invasive doctor

0:12

carcinoma at the outside of facility.

0:16

It was a detected on the yes really mammogram.

0:19

So she present to answer

0:22

for surgical Council for long Factory.

0:25

Remember the size over here is very very small.

0:28

It's the only three millimeter.

0:35

So here Asia outside. Yes, we

0:38

need mammogram. They have those are

0:41

the conventional 2D membrane. And also

0:44

those are the Spectrum and gram

0:47

over here as you can see that on the

0:50

convention of mammogram. You cannot see this lesion

0:53

very well, right.

0:56

This one has always been there. I can just give to

0:59

you. This is just the nine funding.

1:02

And be stable for more than two years.

1:06

the

1:08

Abnormality actually, is this one

1:11

over here?

1:12

See that you can see it a much better on

1:15

the contrast enhancing mammogram.

1:23

so question

1:25

Which over there follow you statements is true about

1:28

a contrast enhanced Spectrum.

1:32

Right. It's over here.

1:38

because the answer is to be

1:42

spectral mammogram

1:46

just like a CTE you see radiation should generate

1:49

the Imaging. So that's the why the iodine

1:52

based contrast is used.

1:56

And the cataliniums option C academia-based

1:59

the contrast is often used for the

2:02

MRI.

2:03

and then

2:07

open a is not correct because temporal subtraction

2:10

is often used for the

2:13

MRI for this as spectral

2:16

mammogram. We use that you are energy subtraction.

2:22

And the high energy being kvp range

2:25

is often 45 to

2:28

49 is Obama 33.

2:32

This is the lower energy.

2:35

Kpp over here. So that's why it's

2:38

not correct answer.

2:41

Let's just quickly review the contrast enhancing the

2:44

digital mammography. So normally they will

2:47

obtain the two Imaging one is

2:50

the conventional.

2:52

Mammogram that's what's taking before

2:55

the contrast was given to the patient.

2:58

And then after the contrast was all the

3:01

minister and then a patient will get an additional

3:04

exposure and this additional Imaging

3:07

will be overhand at

3:10

a higher energy, which is more than that

3:13

33 and low energy low energy is

3:17

less than 33 why is like

3:20

that because there are done. Okay education

3:23

33

3:26

That's the why users 33 as ratio

3:29

for?

3:32

high and low energy

3:35

So obviously all depending the yellow energy and

3:38

high energy mammogram. They are

3:41

going to use subtract.

3:43

Just purely medium and it generated a subtraction

3:46

Imaging over here to emphasizes into

3:49

enhancement and also erase the

3:53

same background.

3:57

question

4:00

so outside they did the mammogram guided

4:03

about see

4:05

and those are the immune over here.

4:08

Was the best approach for the needle

4:11

localization for this case based on

4:14

this the other side that pulls the Babs remembrance just for

4:17

your reference. I also give you the prebiopsy mammogram

4:21

over here.

4:25

All right.

4:26

You all get it, right?

4:31

They are going to come superiorly because

4:34

this is a shortest distance

4:37

from the skin.

4:40

Next question. What's the appropriate?

4:44

coordinate for this little localization

4:49

See you right.

4:56

This is a D7 over here because the biopsy clip

4:59

is to you.

5:02

So, what's the appropriate Next Step?

5:06

I'm giving you this Imaging over here.

5:11

Retract the needle you will be the right.

5:17

There's a great and so let's just review this together.

5:21

Here is a

5:23

It over here and where's the

5:26

mission is very hard to use season right? Because

5:29

the two small but there's about the clip

5:32

over here. The bopsy club is

5:36

very closer to this.

5:39

Calcified to be nine region over here.

5:42

I think that's the why the noodle has been

5:45

notified. So choose this level based on this positive biopsy

5:48

mammogram.

5:52

But it's just a two deep over there. I'm glad

5:55

you.

5:57

realize that

5:59

so somehow the other side.

6:02

Ideologies if you didn't realize that they just

6:05

thought that hey the club was there at the same level as this benign

6:08

Mass over

6:11

there. So they just kind of like a localization area.

6:14

one of the data to realize is that

6:17

the club actually bounced back and all so

6:20

deleting yourself when you compared to

6:23

the pre-apsing one is really above

6:26

for this nine Mission

6:29

over here.

6:33

But the good thing is that the realize that

6:37

and ask the surgeon to

6:40

remove additional area.

6:45

So what if you can learn from this case number three sporty sin

6:48

is it's kind of tricky after the biopsy

6:51

because he's the open disappeared and

6:54

if it's the ultrasonic antibiops eating

6:57

will be better because the clinical placement is more

7:00

common, but for the stereotypical developsy

7:03

due to the accordion effect,

7:06

the clip can migrated

7:09

at along this about the track

7:12

like in this case immediately after the

7:15

debacy even migrate down and then during the

7:18

middle localization. They cannot migrate

7:21

back.

7:23

so

7:25

when you have this case just pay close or attention about the

7:28

clip and use all this line mark on

7:31

the yamamogram you have