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Protocol
Scan from nipple outward then back toward nipple including the Tail of Spence (Axillary Region)
No pathology present - Store image anywhere along scanning section
Pathology present - image pathology in both planes, measure, utilize color & spectral Doppler
Protocols will vary at each site - examples of protocols that may be used are identified below
AK\backup\Abdomen II\protocols
Breast Protocol
Targeted Examination- Typically used when a pathology is seen on mammogram, previous sonogram, or is palpable
AK\backup\Abdomen II\protocols
Breast Protocol
Sonographic Appearance
Structure Echogenicity
Skin Echogenic
All Anatomy should be compared to Glandular Tissue Isoechoic to Hypoechoic
echogenicity of FAT Fibrous Tissue Hyperechoic
Coopers Ligaments Hyperechoic
Fat = medium level gray Ducts Anechoic or Hypoechoic
Muscle Hypoechoic with Striations
Ribs Echogenic with shadowing
Benign Characteristics
Smooth, Macrolobulations Homogeneous Anechoic Hyperechoic Posterior Wider Thin echogenic
thin walls (3 or less enhancement than capsule
lobulations) taller
Suspicious Characteristics-Just takes one!
Irregular Microlobulations Spiculated Angular Branch Heterogeneous Taller Hypoechoic
contour margins pattern than compared to
wider fat
Thickened Micro- Disruption of tissue planes Duct Shadowing Increased echogencity
Coopers calcifications extension anterior to mass
ligaments
Transducer- Dependent on amount of breast tissue - high frequency linear transducer with minimum of 7 MHz is recommended
Patient Position
Patient lies supine or slightly oblique (may need support wedge) with arm over head
Obliqued more for larger breasts - the breast should lay flat to minimize the thickness of the breast
AK\backup\Abdomen II\protocols
Breast Protocol
Pathology-- If pathology is present you must document the pathology in its entirety. Images should include:
Gray scale sagittal and transverse images - document distance from NIPPLE not areola
SHAPE, MARGIN, ECHOGENICITY, LESION BOUNDARY, ATTENUATION, SURROUNDING TISSUE
Gray scale sagittal and transverse images with 3 measurements (length, width, and height)
Color Doppler image to document the presence of blood flow and Spectral Doppler image to document type and velocity of blood
flow (Use Power/Color Doppler with humming to identify solid massesFREMITUS)
AK\backup\Abdomen II\protocols