Breast Implants & Quality Assurance in Mammography

For film mammography, fog can contribute no more than ______ to the optical density with the film is exposed to standard darkroom conditions for 2 minutes

0.05

The Density Difference (DD) value in phantom testing should not vary by more than + or -

0.05

Contraindications for breast conserving surgery include:

1. Recurrence of cancer 2. pregnancy 3. multifocal tumor

What can contribute to implant failure?

1. compression 2. stacking implants 3. filling the implant with alternative substances

In what year did the FDA reclassify breast implants and thus require that they had premarket approval?

1988

Breast implants began to be used for reconstruction after mastectomy in the ______

1990's

As many as 1 in ______ primary reconstruction patients require implant removal within 10 years of implantiation

2

Which view best shows the entire glandular island of the breast with least superimposition?

20* MLO

A normal compressed breast 4.5 cm in thickness, exposure should be what Kv & mAs?

25 kVp and 120 mAs

The exposure limit mandated by the Mammography Quality Standards Act (MQSA) is _______ miligrays (mGy) per view

3

Average glandular dose for a 4.2 cm compressed breast should be no more than ____mGy

3 mGy

Six Sigma principles, if adhered to in short term, are assumed to produce defect levels below ______ defects per million opportunities in the long term

3.4

The C-arm angled for the MLO view for patients who are lean and tall generally measures how many degrees?

55-60

Women who have undergone breast conserving surgery should undergo a new baseline mammogram at least ______ months after surgery and then return to regular screening

6 months

As many as 20% of women who have had breast implants for augmentation will have them removed within _____ years after insertion

8 to 10 years

According to the National Cancer Institute, prophylactic mastectomy may be able to reduce the risk of developing cancer by as much as ________%

90%

The intensity of light that represents individual pixels in the image is?

Brightness

An element unique to saline filled implants is that they:

Can quickly deflate

Most QA assurance documents recommend QC tests of what part of the imaging sequence?

Display, Acquisition , and Processing

Which company claimed bankruptcy in 2004 over legal claims regarding the failure of their silicone gel-filled breast implants?

Dow Corning

T/F Mammography's specificity is defined as the percentage of patients who were correctly diagnosed with cancer out of all patients diagnosed as suggestive of cancer

False, sensitivity not specificity

Which incision location is the best option for the placement of breast implants if future surgeries will be needed?

Inframammary

The Linguine sign indicates?

Intracapsular rupture

Which reconstructive flap procedure uses tissue from the upper back in order to reconstruct the breast tissue?

Latissimus dorsi

The view that best shows the entire breast is?

MLO

The modality best suited to evaluate for "silent ruptures" is:

MRI

The Smallest piece of information on the digital image is?

Pixel

Over elevation of the image receptor on the CC projection excludes what tissues?

Posterior and Superior

The number of cancers found in first time screening examinations is the _____ rate

Prevalent cancer

Who is responsible for implementing the QA program & making sure that everyone meets the training & education regulations?

Radiologist

Which sign indicates a collapsed envelope on ultrasound imaging?

Stepladder

The least visible incision for the placement of breast implants is a(n) _______ incision

Transaxillary

T/F A mammo equipment eval should be performed following the initial installation of a mammo unit, annually after install, and after any major repairs

True

T/F An advantage of saline- filled implants is that they can be inserted unfilled and thus require a smaller surgical inscision

True

T/F Before the Mammography Quality Standards Act, the Health Care Financing Administration was in charge of regulating mammo equipment, personnel, & QA programs, conducting inspections to ensure that Medicare- eligible facilities were compliant with standards

True

T/F Even though the long-term survivorship outcomes are very similar between mastectomy and breast conserving surgery, more women are choosing to have a mastectomy who are eligible for breast conserving surgery

True

T/F Though studies show that there is no increase in breast cancer among women with breast implants, breast implants obscure breast anatomy & make it harder to detect breast cancer

True

To best evaluate the post-surgical non-reconstructed breast according to Rissanen et al is:

US

Which modality is best for imaging posterior implant wall in women with small breasts & small implants?

US

The LMO position:: a. is good for when compression of the post surgical breast is painful b. is used a lot for stereotactic biopsies c. can be used as a 3rd position for patients who have had breast cancer d. helps reduce superimposition of tissue

a. is good for when compression of the post surgical breast is painful

The FDA's definition of a serious adverse event is:

an event that compromises clinical outcomes

All of the following are goals inherent in the placement of breast implants except: a improve appearance of breast b prevent breast cancer c enlarge breast size d. reconstruction

b prevent breast cancer

What test requires corrective action before any further mammo exams can be performed?

breast entrance exposure

Which is false regarding the use of a grid in mammography? a. improved contrast b. decreases scatter c. requires a decrease in exposure d. not used for mag views

c. requires a decrease in exposure

Which of the following statements in false regarding anaplastic large cell lymphoma (ALCL) and breast implants? a. ALCL cells are often found in the effusion fluid, a peri-implant mass, or the fibrous capsule surrounding the implant b. ALCL is a T-Cell lymphoma c. ALCL has been found more frequently in association with textured implants rather than smooth implants d. ALCL is a rare form of breast cancer

d. ALCL is a rare form of breast cancer

The first surgical attempt in 1985 to restore the appearance of the breasts involved the use of what material?

d. a lipoma

Artifacts that can occur in digital mammography are: a. issues with software b. malfunction with detector c. post-processing function failure d. all of above

d. all of above

The importance of compression in the breast imaging examination relates to: a . reducing patient dose b. reducing motion c. displacing the implant to see the most breast tissue d. all of above

d. all of above

According to the FDA: a. Although there is a delay in cancer detection, there is not an increase in breast cancer mortality in women with implants b. breast implants obscure anywhere between 22%-83% of breast tissue normally visualized on mammography c. breast cancer risk does not differ in women with implants compared to women without implants d. all of the above

d. all of the above

Six Sigma is based on the concept that:

defects cost money

One complication of autologous fat grafting occurring in 75% of patients is :

fat necrosis

Which generation of breast implants featured an extremely cohesive silicone gel that aimed to reduce to possibility of gel bleed and migration?

fifth gen

If a patient has prominent lower ribs which technique can be used to aid in positioning for MLO view

flatten the image receptor to 35* to 40*

A major advantage to round breast implants rather than teardrop shaped implants is that round implants:

follow the natural movement of the breast

The outpouching of the inact implant through a tear in the fibrous capsule is a :

hernia

One of the major differences in imaging women with breast implants is that the imaging protocol requires :

implant displacement views

Of the adverse events in the FDA's Manufacturer and User Facility Device Experience (MAUDE) database, most of the incidences were related to:

implant rupture during mammography

What filtration material is best suited for breasts composed of mostly fatty tissue?

molybdenum

The depth of breast tissue seen on the CC view should measure _____ the distance from the nipple to the pectoral muslce seen on the MLO view

no more than 1 cm less than

Which of the following elements is helpful in differentiating a silicone granulomatous mass from a parenchymal mass?

opacity

The Deming or Shewart cycle consists of what steps?

plan, do, study, act

Lean methods focus on :

removing waste

Which sign indicates inner shell rupture of a double-lumen or reverse double - lumen implant on MRI?

salad-oil

Irreversible image compression may only be used when

scanning prior studies for comparison

For imaging women with encapsulated breast implants, the _______ view shows at least some of the upper-inner quadrant that is not captured on the standard CC or MLO views

superolateral to inferomedial oblique (SIO)

The philosophy underlying the Total Quality Management System is:

the customer determines quality

Expected quality is:

the inherent value placed on goods or services

Walter Shewhart's work focused on reducing ______ in a process

variation