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Ministry of Health of Ukraine Ukrainian Medical Stomatological Academy Ministry of Health of Ukraine Ukrainian Medical Stomatological Academy Guidelines Individual work of students During preparation for Practical classes educational qualifications "Master of Medicine", "Master of Pediatrics" professional qualifications "Doctor", "Pediatrician" Educational discipline Radiology Module № І Theme lesson: Radiation methods of research and radiation anatomy of the breast. Radiation signs of breast diseases. Course ІІІ Faculty Medical №1, №2 Poltava 1. Actuality of the topic. At present, when methods have appeared that are not associated with radiation exposure to gonads (ultrasound, MRI, radionuclide analysis), it is impossible to imagine obstetrics, gynecology, mammology without them. Diseases of the mammary glands are the most common in women. Therefore, students should know the radiation signs of the normal state of the mammary gland and the signs of their pathological conditions. 2. The objectives of the studies: 1. To analyze the possibilities of various methods of radiation research in the study of the state of the mammary glands 2. Explain the radiation signs of the normal state of the mammary glands; 3. To interpret the signs of some pathological conditions of the mammary glands. 4. Analyze the normal state of the mammary glands; 5. To classify some pathological conditions of the mammary glands 3.1. Basic knowledge, skills, skills necessary to study the topic (interdisciplinary integration). Name of previous disciplines To know Physics Demonstrate the physical basics of imaging Anatomy and ray anatomy To describe the features of the structure and radiation image of the mammary glands. Histology Show schematically the histological structure of the mammary glands. Physiology Determination of physiological processes that occur in the mammary glands. 4. Tasks for independent work in preparation for the lesson and in the lesson. 4.1. A list of key terms, parameters, characteristics that must learn the student in preparation for the lesson: Term Definition Mastitis A nonspecific inflammatory disease of the breast that can be acute or chronic along the course. In 80-90% of cases, acute mastitis develops during lactation (lactation mastitis) Abscess is a local, encapsulated collection of pus in the breast tissue. Ductography X-ray examination carried out with the introduction of 0.5-2 ml of a water-soluble iodine-containing contrast agent into the lactiferous ducts of the mammary gland through the nipple. Pneumocystography is a technique consisting in puncture of a cyst, removing fluid from it, followed by the introduction of air, after which survey mammograms are performed in frontal and lateral projections. 4.2. Theoretical questions for the lesson: 1. Methods of radiation examination of the mammary glands (advantages, disadvantages) 2. Radiation signs of diseases of the mammary glands: • lipomas; • fibroadenoma; • malignant tumors; • cysts; • mastopathy. 4.3. Practical works (tasks) are performed in the class: 1. List the methods of radiation diagnostics used in the diagnosis of diseases of the mammary glands (indications and contraindications). 2. Name the radiation signs of the normal state of the mammary glands on mammograms, ultrasound, MRI; 3. Name the radiation signs of breast diseases on mammograms, ultrasound, MRI; • lipomas; • fibroadenoma; • malignant tumors; • cysts; • mastopathy. Theme contents. Mammography - X-ray of the breast without the use of contrast agents. It is performed on special X-ray diagnostic devices specially designed for this purpose - a mammograph. During the shooting, breast compression is applied so that the thickness of the breast tissue is the same in all zones. Due to this, the scattering of the radiation beam is reduced, the radiation dose is reduced and the image clarity is improved. Unpleasant sensations can be reduced by conducting research in the first half of the cycle: from 5-6 to 12-14 days from the beginning of menstruation. Despite the development of new technologies, mammography remains the “gold standard” of research of the mammary glands, in particular the early stages of breast cancer. When breast cancer is detected in the early stages, the effectiveness of treatment increases to 90%. X-ray examination of the breast includes: - Overview mammography; - Sighting mammography with direct magnification of the image; - Sighting mammography with local compression; - X-ray of the soft tissues of the axillary areas (axillography); - Ductography; - Double contrasting of ducts; - Pneumocystography; - Targeted fine needle aspiration biopsy; - Stereotactic puncture biopsy; - Stereotactic vacuum biopsy; - Intra-tissue marking of education; - X-ray of the removed sector of the breast - Tomosynthesis When conducting a plain mammography, the following projections are used: - Mediolateral braid; - Craniocaudal; - Increased craniocaudal lateral projection - Lateral medial lateral; - Caudocranial; - Axillary; - Tangential; - Lateromedial braid Mediolateral oblique (MLO) and craniocaudal (CC) are used as standard projections. For a reliable assessment of mammography data, optimal positioning when taking images is necessary. Aiming radiographs (contact or tangential) are performed mainly for a more detailed study of the structure of individual sections of the mammary gland; to obtain an image of those areas of the mammary gland that were not displayed on the overview images; to establish a connection between the palpable formation with the skin and subcutaneous tissue. For better identification of the smallest details that have an important differential diagnostic value, the production of targeted radiographs with a direct image magnification of 1.5-2 times is shown. Targeted mammography with local compression. If, after performing a standard mammogram, the diagnosis remains unclear or only symptoms suspicious of cancer are detected, targeted radiography with local compression of the breast is used. In a significant part of cases, this allows us to clarify the true nature of the nosological process. Axillography is an x-ray of the soft tissue in the armpit. It can be used to detect metastatic lesions of the lymph nodes in this area in breast cancer and to obtain a complete image of tumors in the subaxillary segment of the gland. Ductography is an X-ray examination performed with the introduction of 0.5-2 ml of a water- soluble iodine-containing contrast agent into the lactiferous ducts of the mammary gland through the nipple. The indication for ductography is the presence of pathological secretion from the nipple, especially bloody and purulent discharge. Contraindications are acute mastitis and palpation of a tumor in the area of the excretory duct of the gland. Pneumocystography is a technique consisting in puncture of a cyst, removal of fluid from it, followed by the introduction of air, after which survey mammograms are performed in frontal and lateral projections. At the same time, against the background of air, the outlines of the inner surface of the cyst become clearly visible, which allows one to reliably establish its irregularities, tuberosities, thickenings, which are signs of a malignant tumor process. The use of pneumocystography, in addition to diagnostic purposes, pursues a therapeutic effect (enhances the adhesive processes in the cyst and reduces the risk of recurrence). Stereotactic puncture biopsy. If a suspicious shadow, determined on a mammogram, is not palpable and is not detected by ultrasound examination and, accordingly, the diagnosis cannot be verified morphologically by puncture under ultrasound control, a puncture biopsy is performed under radiological control ( rheotactic puncture biopsy). Intra-tissue marking of education. Recently, in connection with the identification of an increasing number of suspicious shadows and accumulations of microcalcifications, it is necessary to more often perform interstitial preoperative marking under X-ray control. First, an X-ray of the breast is performed in one of the projections. A needle is inserted to a deliberately great depth through the pathological formation. A control image is taken at an angle of 90 degrees to the first one and the depth of needle insertion is adjusted from it. If the position of the needle is satisfactory, it is removed, while the harpoon remains in the mammary gland. Fine-needle aspiration biopsy (TAB) of palpable breast masses clarifies the diagnosis in 84- 95%. The use of TAB under ultrasound and X-ray control allows obtaining material from altered areas up to 5 mm in diameter and non-palpable formations. At the same time, the accuracy of preoperative diagnostics increases to 95%. Vacuum aspiration biopsy (VAB) is performed both under X-ray and ultrasound guidance. The advantages of a vacuum biopsy are the ability to obtain complete tissue samples, eight times more voluminous than with a conventional puncture biopsy using "spring guns". Tomosynthesis is a special type of mammography that produces a three-dimensional image of the breast. For this, low-dose X-rays are used at different angles. With tomosynthesis, the mammary gland is located in the apparatus and compressed in the same way as with conventional mammography, but the X-ray tube in the apparatus moves in an arc-like manner around the mammary gland. The whole process takes 10 seconds. All information is transmitted immediately to the computer, which synthesizes a three-dimensional image of the breast. The X- ray dose for tomosynthesis is the same as for conventional mammography. X-ray anatomy of the breast An
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