Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
110 Cards in this Set
- Front
- Back
|
From MQSA: * How many initial education category 1 CME hours are needed? * How many exams for initial experience are needed? * How many hours in a new modality are needed? * Exams needed for continuing experience? |
* 60 category 1 CME * 240 exams in 6 months * 8h training in new modality * 960 exams in 24 mo |
|
|
What are the BI-RADS categories? |
0: Incomplete, need additional imaging or comparison to priors 1: Negative 2: Benign 3: Probably benign (<2% malignancy in 1 yr) 4: Suspicious (2-95% chance) 5: Highly suggestive of malignancy (>95%) 6: Biopsy-proven malignancy |
|
|
BI-RADS shape? (3) (same on mammo, US and MRI) |
Oval Round Irregular |
|
|
BI-RADS margins on mammo? (5) |
Circumscribed Obscured Microlobulated Indistinct Spiculated |
|
|
BI-RADS density? (4) |
High, equal, low, or fat-containing |
|
|
What are the "typically benign" BI-RADS calcifications? (9) |
Skin
Vascular Coarse or popcorn-like Large rod-like Round Rim Dystrophic Milk of calcium Suture |
|
|
What are the "suspicious morphology" BI-RADS calcifications? (4) |
Amorphous Coarse heterogenous Fine pleomorphic Fine linear/branching |
|
|
What are the BI-RADS "distributions" of calcifications? (5) |
Diffuse Regional Grouped Linear Segmental |
|
|
What are the BI-RADS "associated features?" (7) |
Skin retraction Nipple retraction Skin thickening Trabecular thickening Axillary adenopathy Architectural distortion Calcification |
|
|
How to describe the location of the lesion on BI-RADS? |
Laterality Quadrant and clock face Depth Distance from the nipple |
|
|
BI-RADS orientation on US? (2) |
Parallel Not parallel |
|
|
BI-RADS margins on US? (5) |
Circumscribed
Indistinct Angular Microlobulated Spiculated |
|
|
BI-RADS echo pattern? (6) |
Anechoic Hyperechoic Complex cystic and solid Hypoechoic Isoechoic Heterogenous |
|
|
BI-RADS posterior features on US? (4) |
No posterior features Enhancement Shadowing Combined pattern |
|
|
BI-RADS associated features on US? (6) |
Architectural distortion Duct changes Skin thickening/retraction Edema Absent/internal/rim vascularity Soft/intermediate/hard elasticity |
|
|
BI-RADS margins for MRI? (3) |
Circumscribed Irregular Spiculated |
|
|
BI-RADS mass internal enhancement characteristics for MRI? (4) |
Homogeneous Heterogeneous Rim enhancement Dark internal septations |
|
|
BI-RADS non-mass enhancement distribution on MRI? (6) |
Focal Linear Segmental Regional Multiple regions Diffuse |
|
|
BI-RADS non-mass internal enhancement patterns? (4) |
Homogenous Heterogenous Clumped Clustered ring |
|
|
BI-RADS associated findings on MRI? |
Nipple retraction/invasion Skin retraction/thickening/invasion Axillary adenopathy Pectoralis invasion Chest wall invasion Architectural distortion |
|
|
MRI fat-containing lesions? (4) |
LNs (normal or abnormal) Fat necrosis Hamartoma Post-op collection with fat |
|
|
Kinetic curve description? |
Initial: slow/med/fast Delayed: persistent/plateau/washout |
|
|
Expected number of cancers that should be found in 1,000 initial screening mammograms? |
6-10 (Some say 3-8) |
|
|
What is the accurate positioning of a breast on the MLO view? |
Pulled up and out (football) Open inframammary fold (neutral on CC) Small amount of upper abdomen should be visible |
|
|
The posterior nipple line on CC and MLO are permitted to be how different? |
1 cm |
|
|
Per MQSA, medical outcomes for interpreting physicians must be reviewed how often? |
Every 12 months |
|
|
How often should the nipple be in profile on a mammo study? |
On at least one view |
|
|
Positive mammo follow ups need to occur how often? |
Within a year |
|
|
How quickly do patients need to be informed of their results? |
30 days |
|
|
What causes ghosting artifact? |
Cardiac or respiratory motion (use the correct phase-encoding direction) |
|
|
Tell me about BRCA: Inheritance? Chromosome? Lifetime cancer risk? Other cancer associations? |
Tumor suppressor genes Autosomal dominant BRCA-1 on ch 17 BRCA-2 on ch 13 50-85% lifetime cancer risk Ovarian and prostate cancer |
|
|
What is the benchmark for the cancer detection rate? |
2-10/1,000 |
|
|
What is the BI-RADS recall rate? |
<10% |
|
|
What are the standards of the mammography and compression plates? |
Sizes are both 18 x 24 and 18 x 30 Force of 25-45 lbs Moving grid Collimate to receptor |
|
|
What does correct film labeling entail? |
Patient's first and last name Unique patient identifier Name and address of facility Mammography unit Date of exam View and L/R near axilla Arabic cassette number Techs initials |
|
|
When should screening MRI be performed? |
When lifetime cancer risk is >20% (on Fm Hx) BRCA mutation 8 yrs after chest irradiation (or at 25 yo) |
|
|
What minimum critera must a phantom meet? |
Four fibers Three calcifications Three masses |
|
|
The MLO is suboptimal for what part of the breast? |
Medial part |
|
|
How much gadolinium contrast is used in breast MRI? |
0.1 mmol/kg |
|
|
What variant muscle can be seen in both men and women medially only on the CC view? |
Sternalis muscle |
|
|
BI-RADS? 1. A nonpalpable, circumscribed mass on a baseline mammogram. 2. A nonpalpable, circumscribed mass, new since the last mammogram. 3. A nonpalpable, circumscribed mass, unchanged for 2 years. 4. A nonpalpable, noncircumscribed mass on a baseline mammogram. 5. A palpable, noncircumscribed mass, new since last mammogram. |
1. BI-RADS 3 2. BI-RADS 0 3. BI-RADS 2 4. BI-RADS 0 5. BI-RADS 0 |
|
|
Which breast lesions tend to have earlier lymphatic spread via Sappey plexus? |
Subareolar lesions |
|
|
What are the top two most common locations for breast cancer? |
Upper outer (61%) Upper inner (17%) |
|
|
When is a targeted ultrasound recommended as the initial exam? |
<30 yrs of age, lactating, pregnant |
|
|
What is the "snowstorm" or dirty shadowing on US classic for? |
Extracapsular silicone implant rupture |
|
|
Most common malignancy, other than primary breast cancer, to metastasize to the breast? |
Melanoma |
|
|
Lesion on MRI with multiple small fluid intensity components within a heterogenous mass? |
Phyllodes tumor |
|
|
What percent of type 3 curves with rapid uptake and washout correspond to cancer? |
87% |
|
|
What type of breast cancer is most likely to present as a small spiculated mass on mammogram? |
Tubular carcinoma |
|
|
What are the high risk lesions? |
Atypical ductal hyperplasia (ADH) Atypical lobular hyperplasia (ALH) Lobular carcinoma in situ (LCIS) Peripheral duct papilloma Phyllodes tumor Radial scar |
|
|
You see a mass that looks like cancer in a woman with type I diabetes. Pathology comes back as fibrous stromal proliferation. What is the diagnosis? |
Diabetic mastopathy |
|
|
What type of breast cancer may coexist with a radial scar? |
Tubular carcinoma |
|
|
77yo F with a new microlobulated hypoechoic mass on US is most likely what? |
Mucinous carcinoma |
|
|
What is the BI-RADS and most common diagnosis for an abrupt filling defect on a ductogram? |
BI-RADS 4 Intraductal papilloma |
|
|
Are radial scars benign? |
Yes, but association with ADH and carcinoma is seen in 50% of cases (occurrence 0.1 to 2 per 1,000) |
|
|
What BI-RADS is a hematoma? |
BI-RADS 3 because it can often mimic a malignancy |
|
|
ADH is found on needle biopsy. Whats the next step in management? |
Surgical excision. Concomitant DCIS is found in 25-50% of cases. |
|
|
What is fibrocystic change? |
More common in >30 yo Cysts originate from terminal lobules Cysts fluctuate |
|
|
On stereostatic breast biopsy radial scar is diagnosed, what is the best next step? |
Surgical excision b/c it may contain DCIS or ADH |
|
|
Is phyllodes tumor benign? |
It is a spectrum of benign to malignant Typically no calcifications 21% risk recurrence XRT helps |
|
Diagnosis? |
Invasive lobular carcinoma |
|
|
What modality is best at assessing response to neoadjuvant chemotherapy? |
MRI |
|
|
What is the only reliable criteria for pectoralis muscle cancer involvement on MRI? |
Muscle enhancement |
|
|
What are some stats on recurrent breast cancer after breast conservation therapy? |
Local recurrence rate is 1-4% (or 6-8%) Most occur 4-6 years after treatment MRI is advantageous for assessment Enhancement can be seen 18-24 months at the surgical site on MRI |
|
|
What is the difference between multifocal and multicentric disease? |
Multifocal: >1 lesion in the same quadrant Multicentric: >1 lesion in different quadrants |
|
|
Patient has a palpable cord like mass associated with pain and erythema. What is the diagnosis? |
Mondor's disease (Superficial thrombophlebitis) Tx is NSAIDs and warm compress (no anticoagulation) |
|
|
Poland syndrome is associated with increased risk of which cancers? |
Non-Hodgkin lymphoma Leukemia Breast Lung (Autosomal recessive) |
|
|
Focal fibrosis typically occurs in which type of women? |
Premenopausal or postmenopausal on hormone replacement |
|
|
Mass on MRI with dark internal septations? |
Fibroadenoma |
|
|
How are calcium phosphate and calcium oxalate different on pathology? |
Calcium oxalate is only seen with polarized light |
|
|
What is a grape-like anechoic area with internal septations? |
Apocrine cyst cluster BI-RADS 2 unless not well seen, then BI-RADS 3
Can biopsy if a solid component is preset |
|
|
Axillary lymph node levels? |
level I - below/lateral to pec minor level II - lies underneath/posterior to pec minor level III - above/medial to pec minor |
|
|
Most common site of mets for a malignant phyllodes tumor? |
Lung and bone 10% are malignant Uncommon |
|
|
Which type of calcifications have lucent centers? |
Oil cysts and dermal calcifications |
|
|
What anticoagulation medications are safe for breast biopsy? |
All expect clopidogrel
Counsel for hematoma/hemorrhage |
|
|
What is the most common breast surgery-related complication? |
Seroma |
|
|
What are the contraindications to radiation therapy? |
Multicentric disease Pregnancy Prior radiation therapy Collagen vascular disease Poor cosmetic outcome |
|
|
What type of needle should be used for microcalcifications? |
11-gauge or larger vacuum assisted |
|
|
Best indication for galactography? |
Single duct spontaneous bloody, serous or clear nipple discharge (not green or white) |
|
|
What is the maximum dose of 1% lidocaine w/epinephrine for deep local anesthesia? |
7 mg/kg body weight, no more than 500 mg |
|
|
What is the primary purpose of mammo grids? |
Increase contrast |
|
|
What is the typical kV range used in mammography? |
30-32 kV |
|
|
What are the typical tube currents for each focal spot? |
0.3 mm uses 100 mA for ~1 sec 0.1 mm uses 25 mA for ~3 sec |
|
|
How does kVp affect tissue contrast? |
Higher kVp decreases contrast |
|
|
What target/filter combos are good for thick, dense breasts? |
Tungsten/Rhodium (W/Rh) Moly/Aluminum (Mo/Al) |
|
|
What type of dose is mean glandular dose (MGD)? |
Absorbed dose 150-200 mrads (1.5 to 2 mGy is typical) |
|
|
What technique factor has the strongest impact on image quality? |
Target/filter combo |
|
|
What grid ratio is used in full-field mammography? |
4:1 |
|
|
What focal spot size is used for standard CC and MLO views? |
0.3 mm |
|
|
What is the recommended source to image distance in mammography? |
50 to 80 cm |
|
|
What is used to determine focal spot size? |
10 um slit camera |
|
|
Progressive unilateral shrinking breast? |
Invasive lobular breast cancer |
|
|
Sternalis muscle |
|
|
What is the peak time in a woman's life for breast pain and cyst formation? |
Perimenopause |
|
|
Which true lateral view do you get if you only see the lesion on the lateral aspect of the CC view? Medial aspect? What if you only see it on the MLO view? |
Medial: LM Lateral: ML MLO: ML |
|
|
What things can be BI-RADS 3? |
Baseline study: -Fibroadenoma -Focal asymmetry that becomes less dense on compression (i.e. normal breast tissue) -Grouped or clustered round calcifications |
|
|
What's the difference between a mass and focal asymmetry according to the BI-RADS lexicon? |
Mass: space occupying lesion seen in two views Focal asymmetry: A density only seen on one view |
|
|
List distribution of calcifications in order of increasing suspicion |
Scattered Regional Grouped/clustered Linear Segmental (most worrisome) |
|
|
What demographic do you see secretory calcifications in? |
10-20 years postmenopause |
|
|
What is a large area of fat necrosis called? |
Liponecrosis macrosystica
|
|
|
Ddx for amorphous calcifications? |
Fibrocystic change Sclerosing adenosis ADH DCIS |
|
|
Ddx for coarse heterogenous calcifications? |
Fibroadenoma Papilloma Fibrocystic change DCIS (low to intermediate nuclear grade) |
|
|
Ddx for fine pleomorphic calcifications? |
(Most suspicious for cancer) Fibroadenoma Papilloma Fibrocystic change DCIS (high nuclear grade) |
|
|
What are the 5 fat-containing breast lesions? |
Hamartoma (breast with a breast) Galactocele (only during lactation) Oil cyst/Fat necrosis (eggshall calcs) Lipoma Intramammary LN |
|
Water density on mammo. Diagnosis? |
PASH |
|
Young woman. Diagnosis? |
Fibroadenoma |
|
|
DCIS trivia: % Invasive on biopsy? % Invasive on excision? % present with mass and no calcs? |
10%
25% 8% |
|
|
Ddx for architectural distortion without a mass? |
Radial scar (spiculated, lucent center) Surgical scar Lobular carcinoma Invasive ductal carcinoma |
|
|
Contraindications for breast conservation treatment? |
Inflammatory cancer Large cancer relative to breast Multicentric disease Prior XRT Unable to get XRT (collagen vascular disease) |
|
|
What 2 cancers can be T2 bright? |
Mucinous Colloid |
