ARDMS Breast
Study online at https://quizlet.com/_hbxbrf
1. Transducer frequency selection in breast imaging:: A 7.0 to 12.0 MHz fre-
quency transducer or higher is optimal
Need high frequency transducer for superior axial and lateral resolution (detail) while
maintaining penetration to the chest wall
A broadband (wide frequency range) is optimal
2. Probe design:: A LINEAR ARRAY is optimal
Produces a rectangular image
Allows direct contact when scanning perpendicular to the chest wall
Accurate measurements can be recorded by avoiding beam divergence artifact (this
is achieve with a rectangular image vs. sector image)
Interventional procedures (i.e. cyst aspiration, biopsy, and needle localization, etc.)
can be accurately guided with a linear array probe
3. Imaging Depth:: Depth should be sufficient to visualize the breast tissue from
skin to chest wall. Breast size will vary from one patient to the next. However, an
imaging depth between 3 and 6 cm should be adequate.
4. Focusing:: Multi-focus or variable (adjustable) electronic focusing will achieve
optimal breast detail
The use of multiple focal zones will provide excellent resolution the full depth of the
image. This may significantly reduce the frame rate, although. Multiple focal zones,
however, are still recommended.
If a single focus is used, the focal zone should be set at the depth of the area of
interest (such as a mass), or at or below the mammary layer for general scanning.
5. Gray scale:: Generally, for breast imaging, a broad gray scale map or dynamic
range is used. This provides a wide range of gray shades to be displayed, while
demonstrating subtle tissue differences. A map with too few gray shades may not
accurately demonstrate low-level echoes with in a cyst or solid lesions.
6. Doppler Technique:: In order to optimize doppler imaging, the sonographer
should establish a technique for low velocity flow states. This includes: low velocity
scale, low filter setting, optimal doppler gain setting, increased PRF for high veloci-
ties
7. Reverberation: Artifactual linear echoes parallel to a strong interface. Has a
distinct "stepladder" or "Venetian blind" appearance
8. Side or Grating lobe: Secondary sound sources off the main sound beam that
place artifactual echoes within a cyst
9. Slice Thickness: Unwanted echoes from the thickness of the sound beam in the
elevation plane that place artifacts within a cyst
10. Nipple Shadowing: Shadowing in the subareolar region may be eliminated by
angling the transducer posterior to the nipple or by using the "rolled nipple" technique
, ARDMS Breast
Study online at https://quizlet.com/_hbxbrf
11. Volume Averaging: Decreases contrast resolution and spatial resolution (both
axial and lateral). Places unwanted echoes within cysts.
12. Anatomic layer (from superficial to deep): 1. Skin
2. Subcutaneous layer
3. Mammary layer
4. Retromammary layer
5. Muscle layers (Pectoralis major and minor)
6. Chest wall (ribs and intercostal muscles)
13. Skin: The skin is composed of the epidermis and the dermis. The thickness of
the skin should measure 0.5 to 2 mm. The skin is slightly thicker in younger women
and thins with age.
Nipple-- consists of dense connective tissue and erectile muscle, contains many
sensory nerve endings, 15 to 20 collecting ducts opening may be seen (each of
which arise from a breast lobe)
Areola-- circular area of dark pigmentation seen around the nipple, consists of
smooth muscle, slightly thicker than the surrounding skin, contains Montgomery
glands-- sebaceous glands seen as small bumps in the areola
14. Subcutaneous fat (premammary) layer: Lies just beneath the skin extending
to the mammary layer
It is not seen posterior to the nipple
Consists primarily of fat
Amount of fat increases with age, pregnancy, and obesity
Cooper's ligaments appear as prominent structures within the subcutaneous layer
15. Superficial Fascia: The breast tissue is completely contained within the layers
of the superficial fascia
At the breast, the superficial fascia divides into the superficial and deep layers
The superficial layer of the superficial fascia is simply known as the superficial fascia
The superficial fascia is contained within the subcutaneous layer anterior to the
mammary layer
16. Mammary Layer: The mammary layer is also known as the Parenchymal or
glandular layer
A portion of the glandular tissue extends into the axilla-- this is known as the Tail of
Spence
The mammary layer is composed of two types of tissue: Stroma and Epithelium
17. Stroma of Mammary layer: Stroma is the supportive tissue of the breast--
consists of interlobular fat and connective tissue (Cooper's ligaments, loose and
dense connective tissue)
, ARDMS Breast
Study online at https://quizlet.com/_hbxbrf
18. Epithelium of the Mammary layer: The epithelium is the functional tissue--
consists of acini, lobules, TDLU's, lobes, and lactiferous ducts
19. Cooper's ligaments (suspensory ligaments): Part of the stroma and support-
ive tissue of the Mammary layer
Provide the architectural framework of the breast
Run between the superficial and deep layer of the superficial fascia
20. Acini: Also called acinus or acinar cell
Smallest functional unit of the breast
Milk-producing gland
Hundreds of acini in each breast
Each acini gives rise to a ductule or terminal duct
21. Lobule: Is composed of: approximately 30 acini, intralobular terminal ducts, and
intralobular stromal tisue (loose connective tissue)
22. Terminal Ductal Lobar Unit (TDLU): TDLU is made of: lobule, intralobular
terminal ducts, extralobular terminal duct
usually measure 2.0 mm or less
Nearly all breast pathology originates in the TDLU
23. Lobe: Several lobules (TDLU's) make up a lobe
15 to 20 lobes in each breast
One lactiferous duct emerges from each lobe and travels toward the nipple
24. Lactiferous Ducts: Transport milk from the acini to the nipple
Begin with the ductule or terminal duct which arises from the acinar cell:
Intralobular terminal duct-- within the lobule
Extralobular terminal duct-- outside the lobule
Interlobular ducts travel between lobes
The duct enlarges slightly beneath the areola forming the lactiferous sinus
Collecting duct empties milk from the nipple
Lactiferous ducts are lined with a double layer of epithelial cells-- Epithelium and
myoepithelium
The epithelial cells are supported by a Basement Membrane (adventitia) which is
the fibrous outer portion of the duct
25. Function of the myoepithelium of the lactiferous duct:: The function of the
myoepithelium is to propel milk within the ducts toward the nipple
26. Deep Fascia: The deep layer of the superficial fascia is often referred to as the
deep fascia
Located within the retromammary space posterior to the mammary layer
Maintaining integrity of the deep fascia is important in deterring the spread of cancer
to the chest wall
, ARDMS Breast
Study online at https://quizlet.com/_hbxbrf
27. Retromammary Layer:: Space between the posterior margin of the mammary
layer and the pectoral muscles
Contains a thin layer of fat
Amount of fat increases with age, pregnancy, and obesity
Also contains the deep layer of the superficial fascia
This layer allows movement of the breast over the chest wall
28. Pectoralis major muscle: Arises from the clavicle to the costal cartilage of the
sternum attaching to the proximal humerus
29. Pectoralis minor muscle: Arises from the 3rd, 4th, and 5th ribs attaching to the
scapula
Pectoralis major muscle is located anterior to the pectoralis minor musclel Both are
found immediately posterior to the breast tissue.
30. Chest wall: Ribs are located posterior to the pectoral muscles
In small breasted females, it is important to not confuse a fib with an intramammary
tumor on a physical or sonographic evaluation
Intercostal muscles are located between the ribs
Deep to the chest wall layer is the lung
31. Upper Outer Quadrant of the Breast: Glandular tissue is usually thicker in the
upper-outer quadrant of the breast. Therefore, a larger percentage of cancers are
found here.
32. Embryonic Development of the breast: The primitive or early mammary
glands begins development during the 4th week of embryonic development. The
glandular tissue of the breast begins to evolve into epithelial buds that eventually
form approximately 20 epithelial cords (lobes). At 15 weeks gestation, testerone in
the male fetus prohibits further breast development and estrogen in the female fetus
continues to stimulate early development. Once the fetus is born, the breast tissue
is dormant until puberty.
33. Milk line: The breasts develop along a line extending from the axilla to the
inguinal region known as the Milk Line
34. Amastia: absence of one or both breasts
35. Polymastia: Accessory breast or more than 2 breasts
36. Athelia: Absence of the nipple
37. Polythelia: Accessory nipple
The most common breast anomaly!!!!!!
38. Amazia: absence of the breast tissue with development of the nipple
39. Two main arteries that supply the breast:: Lateral Thoracic and Internal
Mammary artery
Study online at https://quizlet.com/_hbxbrf
1. Transducer frequency selection in breast imaging:: A 7.0 to 12.0 MHz fre-
quency transducer or higher is optimal
Need high frequency transducer for superior axial and lateral resolution (detail) while
maintaining penetration to the chest wall
A broadband (wide frequency range) is optimal
2. Probe design:: A LINEAR ARRAY is optimal
Produces a rectangular image
Allows direct contact when scanning perpendicular to the chest wall
Accurate measurements can be recorded by avoiding beam divergence artifact (this
is achieve with a rectangular image vs. sector image)
Interventional procedures (i.e. cyst aspiration, biopsy, and needle localization, etc.)
can be accurately guided with a linear array probe
3. Imaging Depth:: Depth should be sufficient to visualize the breast tissue from
skin to chest wall. Breast size will vary from one patient to the next. However, an
imaging depth between 3 and 6 cm should be adequate.
4. Focusing:: Multi-focus or variable (adjustable) electronic focusing will achieve
optimal breast detail
The use of multiple focal zones will provide excellent resolution the full depth of the
image. This may significantly reduce the frame rate, although. Multiple focal zones,
however, are still recommended.
If a single focus is used, the focal zone should be set at the depth of the area of
interest (such as a mass), or at or below the mammary layer for general scanning.
5. Gray scale:: Generally, for breast imaging, a broad gray scale map or dynamic
range is used. This provides a wide range of gray shades to be displayed, while
demonstrating subtle tissue differences. A map with too few gray shades may not
accurately demonstrate low-level echoes with in a cyst or solid lesions.
6. Doppler Technique:: In order to optimize doppler imaging, the sonographer
should establish a technique for low velocity flow states. This includes: low velocity
scale, low filter setting, optimal doppler gain setting, increased PRF for high veloci-
ties
7. Reverberation: Artifactual linear echoes parallel to a strong interface. Has a
distinct "stepladder" or "Venetian blind" appearance
8. Side or Grating lobe: Secondary sound sources off the main sound beam that
place artifactual echoes within a cyst
9. Slice Thickness: Unwanted echoes from the thickness of the sound beam in the
elevation plane that place artifacts within a cyst
10. Nipple Shadowing: Shadowing in the subareolar region may be eliminated by
angling the transducer posterior to the nipple or by using the "rolled nipple" technique
, ARDMS Breast
Study online at https://quizlet.com/_hbxbrf
11. Volume Averaging: Decreases contrast resolution and spatial resolution (both
axial and lateral). Places unwanted echoes within cysts.
12. Anatomic layer (from superficial to deep): 1. Skin
2. Subcutaneous layer
3. Mammary layer
4. Retromammary layer
5. Muscle layers (Pectoralis major and minor)
6. Chest wall (ribs and intercostal muscles)
13. Skin: The skin is composed of the epidermis and the dermis. The thickness of
the skin should measure 0.5 to 2 mm. The skin is slightly thicker in younger women
and thins with age.
Nipple-- consists of dense connective tissue and erectile muscle, contains many
sensory nerve endings, 15 to 20 collecting ducts opening may be seen (each of
which arise from a breast lobe)
Areola-- circular area of dark pigmentation seen around the nipple, consists of
smooth muscle, slightly thicker than the surrounding skin, contains Montgomery
glands-- sebaceous glands seen as small bumps in the areola
14. Subcutaneous fat (premammary) layer: Lies just beneath the skin extending
to the mammary layer
It is not seen posterior to the nipple
Consists primarily of fat
Amount of fat increases with age, pregnancy, and obesity
Cooper's ligaments appear as prominent structures within the subcutaneous layer
15. Superficial Fascia: The breast tissue is completely contained within the layers
of the superficial fascia
At the breast, the superficial fascia divides into the superficial and deep layers
The superficial layer of the superficial fascia is simply known as the superficial fascia
The superficial fascia is contained within the subcutaneous layer anterior to the
mammary layer
16. Mammary Layer: The mammary layer is also known as the Parenchymal or
glandular layer
A portion of the glandular tissue extends into the axilla-- this is known as the Tail of
Spence
The mammary layer is composed of two types of tissue: Stroma and Epithelium
17. Stroma of Mammary layer: Stroma is the supportive tissue of the breast--
consists of interlobular fat and connective tissue (Cooper's ligaments, loose and
dense connective tissue)
, ARDMS Breast
Study online at https://quizlet.com/_hbxbrf
18. Epithelium of the Mammary layer: The epithelium is the functional tissue--
consists of acini, lobules, TDLU's, lobes, and lactiferous ducts
19. Cooper's ligaments (suspensory ligaments): Part of the stroma and support-
ive tissue of the Mammary layer
Provide the architectural framework of the breast
Run between the superficial and deep layer of the superficial fascia
20. Acini: Also called acinus or acinar cell
Smallest functional unit of the breast
Milk-producing gland
Hundreds of acini in each breast
Each acini gives rise to a ductule or terminal duct
21. Lobule: Is composed of: approximately 30 acini, intralobular terminal ducts, and
intralobular stromal tisue (loose connective tissue)
22. Terminal Ductal Lobar Unit (TDLU): TDLU is made of: lobule, intralobular
terminal ducts, extralobular terminal duct
usually measure 2.0 mm or less
Nearly all breast pathology originates in the TDLU
23. Lobe: Several lobules (TDLU's) make up a lobe
15 to 20 lobes in each breast
One lactiferous duct emerges from each lobe and travels toward the nipple
24. Lactiferous Ducts: Transport milk from the acini to the nipple
Begin with the ductule or terminal duct which arises from the acinar cell:
Intralobular terminal duct-- within the lobule
Extralobular terminal duct-- outside the lobule
Interlobular ducts travel between lobes
The duct enlarges slightly beneath the areola forming the lactiferous sinus
Collecting duct empties milk from the nipple
Lactiferous ducts are lined with a double layer of epithelial cells-- Epithelium and
myoepithelium
The epithelial cells are supported by a Basement Membrane (adventitia) which is
the fibrous outer portion of the duct
25. Function of the myoepithelium of the lactiferous duct:: The function of the
myoepithelium is to propel milk within the ducts toward the nipple
26. Deep Fascia: The deep layer of the superficial fascia is often referred to as the
deep fascia
Located within the retromammary space posterior to the mammary layer
Maintaining integrity of the deep fascia is important in deterring the spread of cancer
to the chest wall
, ARDMS Breast
Study online at https://quizlet.com/_hbxbrf
27. Retromammary Layer:: Space between the posterior margin of the mammary
layer and the pectoral muscles
Contains a thin layer of fat
Amount of fat increases with age, pregnancy, and obesity
Also contains the deep layer of the superficial fascia
This layer allows movement of the breast over the chest wall
28. Pectoralis major muscle: Arises from the clavicle to the costal cartilage of the
sternum attaching to the proximal humerus
29. Pectoralis minor muscle: Arises from the 3rd, 4th, and 5th ribs attaching to the
scapula
Pectoralis major muscle is located anterior to the pectoralis minor musclel Both are
found immediately posterior to the breast tissue.
30. Chest wall: Ribs are located posterior to the pectoral muscles
In small breasted females, it is important to not confuse a fib with an intramammary
tumor on a physical or sonographic evaluation
Intercostal muscles are located between the ribs
Deep to the chest wall layer is the lung
31. Upper Outer Quadrant of the Breast: Glandular tissue is usually thicker in the
upper-outer quadrant of the breast. Therefore, a larger percentage of cancers are
found here.
32. Embryonic Development of the breast: The primitive or early mammary
glands begins development during the 4th week of embryonic development. The
glandular tissue of the breast begins to evolve into epithelial buds that eventually
form approximately 20 epithelial cords (lobes). At 15 weeks gestation, testerone in
the male fetus prohibits further breast development and estrogen in the female fetus
continues to stimulate early development. Once the fetus is born, the breast tissue
is dormant until puberty.
33. Milk line: The breasts develop along a line extending from the axilla to the
inguinal region known as the Milk Line
34. Amastia: absence of one or both breasts
35. Polymastia: Accessory breast or more than 2 breasts
36. Athelia: Absence of the nipple
37. Polythelia: Accessory nipple
The most common breast anomaly!!!!!!
38. Amazia: absence of the breast tissue with development of the nipple
39. Two main arteries that supply the breast:: Lateral Thoracic and Internal
Mammary artery
