0:00

Okay case number two. So 45 year

0:03

old female presenting for screening mammogram. So remember screening

0:06

is important as opposed to diag.

0:09

This is not the best image, but

0:12

I'm circling calcifications. Okay, so remember

0:15

a screening exam.

0:18

What by Reds are you going to get? I'm sorry. It's a buy red zero.

0:21

They're gonna get a further work up. My question to

0:24

you is what views are

0:27

you going to recommend to assess these calcifications?

0:31

Do you want to get spot compression in the CC and ml

0:34

but magnification in the CC and mlo or

0:37

spot magnification in the ccnml?

0:42

They kind of all sound the same, but they're very different.

0:47

Okay good. So exactly so it's it's

0:50

C spot magnification in the CC

0:53

and ML and I want to drive this point home because there is

0:56

really no reason to ever get

0:59

a magnification. Mlo. So repeat

1:02

that again slowly. There's no indication to ever

1:05

get magnification views in an mlo projection. You

1:08

always want to get a true lateral projection. And

1:11

the reason is because you want to

1:14

let them layer the reason you're getting a true

1:17

lateral is you think they might be milk of calcium. You

1:20

want to see them layer on the true lateral view. I'm

1:23

going to go over milk of calcium protocol in a minute, but there's no

1:26

indication for mlo that will not let them layer. So

1:29

always always get you're gonna get magnification views

1:32

get a cc and ml you can either get spot magnification

1:35

or you can get full field magnification doesn't matter.

1:38

But the point is you can get Cc or ml.

1:42

So here is the CC.

1:45

Where they look a little bit smudgy if you'd

1:48

say and here's the true lateral where you see this type of

1:51

tea cupping and that's really what we're looking for. This

1:54

would be what by Reds

1:57

would this be then based on what I just showed you.

2:02

Okay, good. I'm glad that some people got this wrong. So

2:05

this is a very classic case of milk of calcium. It's

2:08

benign. It's a bi-reds too. And that's

2:11

the reason we are getting these true lateral views. So

2:14

milk of calcium. Well milk of calcium is

2:17

I'm going to go into it in a minute. I just

2:20

wanted to a moment about magnification views. They're

2:23

always used for milk of cow. I'm sorry, they're always used for calcifications. It

2:26

uses a smaller focal Zone rather than

2:29

the typical mammogram point one millimeters versus 0.3

2:32

millimeters. You don't use a grid like other

2:35

types of magnification instead you're using an air gap, which

2:38

I'm going to show you in a minute.

2:40

So basically, this is the

2:43

picture that of course we're going to lose this picture when it

2:46

we actually show this on online because they

2:49

don't have I don't have copyright to this image. But basically you're

2:52

taking the object away from the detector. I'm

2:55

sorry from the receptor which creates the magnification. So

2:58

this is one type of this is

3:01

a Formula. You need to know from your board. So

3:04

this the

3:06

The the image distance source to

3:09

image distance over the source object distance is what

3:12

creates a calcific the magnification so instead of

3:15

placing it exactly you're

3:18

gonna you're gonna place an air get you're going to remove the breast from

3:21

the detector and that's

3:24

what causes a magnification by bringing it close through the

3:27

receptor. It's going to make a magnification view. So magnification

3:31

views. Like I said, there's no indication for

3:34

an mlo I'm going to repeat that again. No indication for

3:37

mlo mag. The reason you're doing this

3:40

is you want to see if it's milk of calcium. So if it's milk of

3:43

calcium

3:44

It's going to look like layering in the bottom of a teacup on

3:47

that true lateral view. It's this layering

3:50

appearance and it's going to be you're gonna be smudgy or

3:53

even hard to see on the CC. And then what you

3:56

do is you you get the CC mags first

3:59

the tech shakes the breasts and weights five

4:02

minutes and places them in compression. And then you

4:05

get the ml mag and you're basically letting the calcium kind of

4:08

fall to the bottom of the cyst. This is caused by cyst

4:11

calcium insists and it's benign. So

4:14

if you ever see that layering appearance or trying to

4:17

say it's milk of calcium, it's a bi Reds tube benign.

4:21

Okay. Hope that's helpful. So like I said, you can get full field

4:24

or spot magnification views full field

4:27

you want to do if it's a large area of calcifications or

4:30

you're trying to get some Anatomy anatomic landmarks

4:33

to make sure you got the right area spot magnification

4:36

you want to use that if you

4:39

have a mass or asymmetry associated with

4:42

the calcifications and you want that to go away or look

4:45

at a little bit better. So basically you're you're

4:48

applying compression, but you're also getting magnification. The

4:51

the drawback is that they're it's

4:54

a smaller field of view. So you're not you really

4:57

kind of have to be more accurate the tech has to be more accurate with

5:00

what they're magnifying as opposed to a full field map.

5:03

Which lets you see more anatomic landmarks.