0:01

Um case 11 is new calcification seen

0:04

on screening mammogram is just a close-up

0:07

view not a MAG vehicle close-up

0:10

news or 2D CC and mlo Views

0:13

and Tomo views are shown here.

0:18

So based on the calcification Zone, what

0:21

is the most appropriate biots assessment?

0:26

Okay, great. So this is actually

0:29

skin calcification. So

0:32

the correct answer would be by rats

0:35

to return to screening. So a

0:38

few note about skin calcifications when

0:41

you have chomo. So here you could see

0:44

the Tomo slices if it is

0:47

on the First Slice first few

0:50

slices, I should say then the chances of

0:53

this being skin calculus pretty high.

0:56

Why do I say first few slices because more

1:00

slices are

1:03

added to the compression paddle side and on

1:06

logic, it's always on the

1:09

head.

1:11

And on the medial side, so it's like head and

1:14

the medial side. So what what it means is that the

1:17

first few slices on this is just for

1:20

the halogic because that's what we use. I'm not

1:23

sure if different manufacturers might have different but

1:27

the first few slices are not

1:30

brass is just adding on to that compression

1:33

parallel side. So the skin on the

1:36

skin actually starts feel slices

1:39

later. So there are some of the feet like

1:42

right here. This is actually the skin. So that's

1:45

why I say that skin cows can be there on

1:48

the First Slice for sure or it can

1:51

be on the first few slices if it is on the compression paddles

1:54

side.

1:57

So teaching point about skin cancers that

2:00

usually they're loose in centered and

2:03

they're located along the inframammary fold

2:06

cleavage axilla or nipple.

2:10

There is a sign called tattoo sign that is

2:13

described in the literature where the skin

2:16

counts can look exactly this

2:19

if it's a skincare skin calculate can

2:22

look exactly the same configuration on both CC

2:25

and oblique view. So it's pretty much like identical when

2:28

it's on CC and oblique view. Then

2:31

you have a high probability or high chance that these

2:34

are skin cows.

2:36

But if you don't have classic skin

2:39

calcifications which are like loosen centered

2:42

and no tomosynthesis, then you

2:45

want to do a skim count to make sure there's Derma.

2:48

So here is a case where you

2:51

see there's indeterminate calcification on CC view.

2:54

It was Central posterior and on

2:57

the 90 view was inferior. So probably

3:00

around like six o'clockish on

3:04

on the CC and 90 View and

3:07

obviously it was not on the skin itself.

3:11

So but are quite our thing was like it could

3:14

be potentially could be a skin calcifications.

3:17

So how do you do a skin care workup?

3:21

So we all a lot of us know that we

3:24

put a grid in either CC view

3:27

or 90 view. The question is do you

3:30

this if it's a six o'clock lesion or

3:33

sorry, it's six o'clock calcification. Do you

3:36

put the Grid in CC view or do you put a grid in

3:39

nine GPU?

3:41

From my experience, you know before the Thomas synthesis.

3:44

I usually place the Grid

3:47

on The View that is shortest from the distance.

3:51

So it's I tell my fellows in Residence. It's

3:54

similar to how you do the needle looks

3:57

if you if you do need a looks you always want to do the

4:00

shortest distance from the skin.

4:03

So in other words if it is a let's

4:06

say if it is a six oclock, I would

4:09

put them on a cc position and I would put

4:12

that alpha numeric grid on the inferior part

4:15

of the inferior part of the breast

4:18

on the CC View and then you mark those

4:21

calcifications with baby and then you

4:24

do a tangential View. And in

4:27

this case you could see that the tangential you confirms

4:30

that these are within the skin itself.

4:36

So why do you do all of these because if these calcifications

4:39

can be proven to be skin, then

4:42

they require no additional workup or even

4:45

surveillance and patient can return back to screening.