ULTRASOUND - BREAST

Alternative Names:  breast ultrasound, breast sonography, ultrasound of the breast

ROLE OF ULTRASOUND

• Ultrasound is a valuable diagnostic tool in assessing the following indications:

• Investigating a palpable lump

• Mammography abnormality

• Follow up of known lesion

• Mastalgia

• Nipple discharge

• Infection or mastitis

• Guidance for biopsy or hookwire localisation

Ultrasound increasingly enlisted as part of a comprehensive screening program along side mammography.

LIMITATIONS

• Extremely large, mobile breasts will be difficult to scan thoroughly.

• Post injury, surgery or biopsy, the resultant haematoma will reduce detail and may obscure pathology.

EQUIPMENT SELECTION AND TECHNIQUE

• Breast u/s requires a high frequency transducer 8-15 MHz.

• Ideally a wide footprint probe.

• A lower frequency transducer may be required for the larger attenuative breasts, inflammatory masses and the axilla.

• The use of a stand off may be required for nipple, superficial/or skin lesions.

• Low PRF colour and spectral doppler capabilities for assessing vascularity of lesions.

PATIENT POSITION

• Patient supine

• You may need to roll the patient slightly to 'spread' the breast evenly. Elevate the side being scanned with a wedge under the shoulder.

• Raise the ipsilateral arm over the patient's head.

It is important to correlate the ultrasound with any palpable lumps indicated by the patient. Accordingly, if the patient can only identify the lump when she is erect than rescan the patient erect.

SCANNING TECHNIQUE

The most common scanning technique is to initially scan using the grid scanning pattern, followed by a radial (clock face) technique for the hard copy imaging.

GRID PATTERN SCANNING

• Begin in the upper outer quadrant, scanning in transverse. Slide inferiorly from top to bottom.

• Move across and repeat the sweep inferior to superior.

• Repeat this across the breast.

• Rotate into a sagittal plane and repeat the pattern.

A variation, particularly in larger or mobile breasts, is to apply the grid pattern quadrant by quadrant.

RADIAL SCANNING (clock-face)

• The breast is scanned and descibed as a clock-face.

• Begin at 12 o'clock in a sagittal plane with the toe of the probe at the nipple.

• Scan by rotating the probe around the nipple.

• Depending on breast size, a second pass further from the nipple may be required.

• If pathology is identified, rotate the probe 90degrees in the 'antiradial' plane.

BREAST IMPLANTS

• May be scanned with the patient positioned as above.
• Treat the scan as a 2-fold examination:

1.  

   1. The breast tissue

   2. The deeper implant wich may need lower frequency or a curved probe to investigate.

BREAST ULTRASOUND SAMPLE PROTOCOL (TYPICALLY)

This sample protocol is meant for educational purposes and the exact technique will depend on the patient's clinical indication for the examination and the radiologist's guidance.

A breast series should include the following minimum images:

1. 12 O'Clock

2. 2 O'Clock

3. 4 O'Clock

4. 6 O'Clock

5. 8 O'Clock

6. 10 O'Clock

7. Nipple

8. Axillary tail

9. Axilla

• Document any pathology found in 2 planes, including measurements and any vascularity.
• Note the size, depth and distance from the nipple.

Schedule Your Breast Ultrasound Today!

• If you are looking for professional radiology services at your imaging site/center, call us at 1-800-626-8315 or contact us for a consultation. 

• If you live in Los Angeles, Century City, Glendale, Mid-Wilshire and need to schedule a radiology examination such as a MRI, CT Scan, Ultrasound, X ray, or PET scan, contact us to schedule an appointment. 

• If you are in search of other things, we're surprisingly resourceful!  Call us 1-800-626-8315 or contact us via our contact form.