Radiographic Technique II PDF

Radiographic Technique II AMRR 221 Dr. Elbagir Hamza Manssor, Ph.D. Ass. Professor Department of Applied Radiological Sciences College of Applied Medical Sciences Jeddah University. Lec (10) Mammography Mammography is a specific type of imaging that uses a low-dose x-ray system for examination of...

Radiographic Technique II AMRR 221 Dr. Elbagir Hamza Manssor, Ph.D. Ass. Professor Department of Applied Radiological Sciences College of Applied Medical Sciences Jeddah University. Lec (10) Mammography Mammography is a specific type of imaging that uses a low-dose x-ray system for examination of the breasts. Common uses of the procedure: Diagnostic mammography is used to evaluate a patient with abnormal clinical findings, such as a breast lump or lumps that have been found by the woman or her doctor. ‫ﺴﺘﺨﺪم‬J ‫ﺮ‬LM‫ع ﻣﻌﻴﻦ ﻣﻦ اﻟﺘﺼ‬M‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻟﻠﺜﺪي ﻫﻮ ﻧ‬LM‫اﻟﺘﺼ‬ .‫ﺠﺮﻋﺔ ﻣﻨﺨﻔﻀﺔ ﻟﻔﺤﺺ اﻟﺜﺪﻳﻴﻦ‬h ‫ﺔ‬i‫ﻨ‬j‫ﻧﻈﺎم اﻷﺷﻌﺔ اﻟﺴ‬ :‫اﻻﺳﺘﺨﺪاﻣﺎت اﻟﺸﺎﺋﻌﺔ ﻟﻺﺟﺮاء‬ ‫ﻢ‬i‫ﺼﻲ ﻟﺘﻘﻴ‬i‫ﺸﺨ‬x‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻟﻠﺜﺪي اﻟ‬LM‫ﺴﺘﺨﺪم اﻟﺘﺼ‬J ‫ ﻣﺜﻞ ﻛﺘﻠﺔ‬،‫ﺔ‬i‫ﻌ‬i‫ﺔ ﻏﻴﺮ ﻃﺒ‬L•L‫ﺾ اﻟﺬي ﻟﺪ‚ﻪ ﻧﺘﺎﺋﺞ ﺳﺮ‬L•‫اﻟﻤ‬ .‫ﺒﻬﺎ‬j‫ﺘﻞ اﻟﺘﻲ ﻋﺜﺮت ﻋﻠﻴﻬﺎ اﻟﻤﺮأة أو ﻃﺒ‬Š‫اﻟﺜﺪي أو اﻟ‬ Mammography equipment: • A mammography unit is a rectangular box that houses the tube in which x-rays are produced. • The unit is dedicated equipment because it is used exclusively for x-ray exam of the breast, with special accessories that allow only the breast to be exposed to the x-rays. • Attached to the unit is a device that holds and compresses the breast and positions it so images can be obtained at different angles. :‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻟﻠﺜﺪي‬VW‫ﻣﻌﺪات اﻟﺘﺼ‬ .‫ﻀﻢ اﻷﻧﺒﻮب اﻟﺬي ﻳﺘﻢ ﻓ]ﻪ إﻧﺘﺎج اﻷﺷﻌﺔ اﻟﺴ_ﻨ]ﺔ‬o ‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻟﻠﺜﺪي ﻫﻲ ﺻﻨﺪوق ﻣﺴﺘﻄ]ﻞ‬VW‫وﺣﺪة اﻟﺘﺼ‬ ‫ ﻣﻊ ﻣﻠﺤﻘﺎت‬،‫ﺎ ﻟﻔﺤﺺ اﻟﺜﺪي |ﺎﻷﺷﻌﺔ اﻟﺴ_ﻨ]ﺔ‬V‫اﻟﻮﺣﺪة ﻋ…ﺎرة ﻋﻦ ﻣﻌﺪات ﻣﺨﺼﺼﺔ ﻷﻧﻬﺎ •ﺴﺘﺨﺪم ﺣﺼﺮ‬ .‫ﺧﺎﺻﺔ •ﺴﻤﺢ ﻓﻘﻂ ﻟﻠﺜﺪي |ﺎﻟﺘﻌﺮض ﻟﻸﺷﻌﺔ اﻟﺴ_ﻨ]ﺔ‬ .‫ﺎ ﻣﺨﺘﻠﻔﺔ‬o‫ﻤﻜﻦ اﻟﺤﺼﻮل ﻋﻠﻰ اﻟﺼﻮر ﺑﺰوا‬o ‫ﻀﻌﻪ |ﺤ]ﺚ‬V‫ﻀﻐﻄﻪ و‬V‫ﺤﻤﻞ اﻟﺜﺪي و‬o ‫ﻣﺮﻓﻖ |ﺎﻟﻮﺣﺪة ﺟﻬﺎز‬ Breast compression is necessary in order to: • Press out the breast thickness so that all of the tissue can be visualized; • Spread out the tissue so that small abnormalities won't be obscured by overlying breast tissue; • Allow the use of a lower x-ray dose since a thinner amount of breast tissue is being imaged; • Hold the breast still in order to eliminate blurring of the image caused by motion; • Reduce x-ray scatter to increase sharpness of picture. :‫ﺿﻐﻂ اﻟﺜﺪي ﺿﺮوري ﻣﻦ أﺟﻞ‬ ‫ﺴﺠﺔ؛‬œ‫ﻤﻜﻦ ﺗﺼﻮر ﺟﻤﻴﻊ اﻷ‬o ‫اﺿﻐﻂ ﻋﻠﻰ ﺳﻤﻚ اﻟﺜﺪي ﺣﺘﻰ‬ ‫ﺴﺠﺔ اﻟﺜﺪي اﻟﻤﺘﻔﻮﻗﺔ؛‬œ‫ﻖ أ‬V¢‫ﺸﻮﻫﺎت اﻟﺼﻐﻴﺮة ﻋﻦ ﻃ‬¤‫ﺴﺠﺔ ﺣﺘﻰ ﻻ ﻳﺘﻢ ﺣﺠﺐ اﻟ‬œ‫ﺸﺮ اﻷ‬œ‫ا‬ ‫ﺴﺠﺔ اﻟﺜﺪي؛‬œ‫ﺮ §ﻤ]ﺔ أرق ﻣﻦ أ‬VW‫اﻟﺴﻤﺎح |ﺎﺳﺘﺨﺪام ﺟﺮﻋﺔ أﻗﻞ ﻣﻦ اﻷﺷﻌﺔ اﻟﺴ_ﻨ]ﺔ ﺣ]ﺚ ﻳﺘﻢ ﺗﺼ‬ ‫أﻣﺴﻚ اﻟﺜﺪي ﺳﺎ¬ﻨﺎ ﻣﻦ أﺟﻞ اﻟﻘﻀﺎء ﻋﻠﻰ ﻃﻤﺲ اﻟﺼﻮرة اﻟﻨﺎﺟﻢ ﻋﻦ اﻟﺤﺮﻛﺔ؛‬ .‫ﺎدة ﺣﺪة اﻟﺼﻮرة‬V®‫ﺖ اﻷﺷﻌﺔ اﻟﺴ_ﻨ]ﺔ ﻟ‬¤‫ﻗﻠﻞ ﻣﻦ •ﺸ‬ Preparation for a mammogram: • Remove deodorant, talcum powder, or lotion under the arms or on breasts on the day of the exam. (These can appear on the x-ray film as calcium spots.) • Patient must describe any breast symptoms or problems to the technologist performing the exam. • Previous mammograms must available to the radiologist at the time of the current exam. • In addition, before the examination, the patient asked to remove all jewelry and clothing above the waist and will be given a hospital gown that opens in the front. :‫ﺮ اﻟﺜﺪي |ﺎﻷﺷﻌﺔ اﻟﺴ_ﻨ]ﺔ‬VW‫اﻟﺘﺤﻀﻴﺮ ﻟﺘﺼ‬ (.‫ﻤﻜﻦ أن ﺗﻈﻬﺮ ﻫﺬە ﻋﻠﻰ ﻓ]ﻠﻢ اﻷﺷﻌﺔ اﻟﺴ_ﻨ]ﺔ ﻛ…ﻘﻊ §ﺎﻟﺴﻴﻮم‬o) .‫ﻞ اﻟﻌﺮق أو ﻣﺴﺤﻮق اﻟﺘﻠﻚ أو اﻟﻤﺴﺘﺤﻀﺮ ﺗﺤﺖ اﻟﺬراﻋﻴﻦ أو ﻋﻠﻰ اﻟﺜﺪﻳﻴﻦ ﻓﻲ ﻳﻮم اﻻﻣﺘﺤﺎن‬V®‫زاﻟﺔ ﻣ‬µ‫ﻗﻢ ﺑ‬ .‫ﺠﺮي اﻟﻔﺤﺺ‬o ‫ﺾ وﺻﻒ أي أﻋﺮاض أو ﻣﺸﺎ¶ﻞ ﻓﻲ اﻟﺜﺪي ﻟﻠﺘﻘﻨﻲ اﻟﺬي‬V¢‫ﺠﺐ ﻋﻠﻰ اﻟﻤ‬o .‫ﺠﺐ أن ﺗﻜﻮن ﺻﻮر اﻟﺜﺪي |ﺎﻷﺷﻌﺔ اﻟﺴ_ﻨ]ﺔ اﻟﺴﺎ|ﻘﺔ ﻣﺘﺎﺣﺔ ﻷﺧﺼﺎﺋﻲ اﻷﺷﻌﺔ ﻓﻲ وﻗﺖ اﻻﻣﺘﺤﺎن اﻟﺤﺎﻟﻲ‬o .‫ﻔﺘﺢ ﻓﻲ اﻟﻤﻘﺪﻣﺔ‬o ‫ﺸﻔﻰ اﻟﺬي‬¤‫ﺾ إزاﻟﺔ ﺟﻤﻴﻊ اﻟﻤﺠﻮﻫﺮات واﻟﻤﻼ¼ﺲ ﻓﻮق اﻟﺨﺼﺮ وﺳ_ﺘﻢ إﻋﻄﺎؤە ﺛﻮب اﻟﻤﺴ‬V¢‫ ﻃﻠﺐ اﻟﻤ‬،‫ ﻗ…ﻞ اﻟﻔﺤﺺ‬،‫|ﺎﻹﺿﺎﻓﺔ إﻟﻰ ذﻟﻚ‬ Limitations of Mammography: • Interpretations of mammograms can be difficult because a normal breast can appear differently for each woman. • Also, the appearance of an image may be compromised if there is powder or salve on the breasts or if you have undergone breast surgery. • Not all cancers of the breast can be seen on mammography. • Breast implants can also impede accurate mammogram readings. :‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻟﻠﺜﺪي‬VW‫ﻗﻴﻮد اﻟﺘﺼ‬ Recommendation • Screening mammography every year for women, beginning at age 40. .‫ﻞ اﻣﺮأة‬Á‫ﻞ ﻣﺨﺘﻠﻒ ﻟ‬Â‫ﻈﻬﺮ ¼ﺸ‬o ‫ﻤﻜﻦ أن‬o ‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻟﻠﺜﺪي ﺻﻌ…ﺔ ﻷن اﻟﺜﺪي اﻟﻄﺒ]ﻌﻲ‬VW‫ﻗﺪ ﺗﻜﻮن ﺗﻔﺴﻴﺮات اﻟﺘﺼ‬ .‫ ﻗﺪ ﻳﺘﻌﺮض ﻇﻬﻮر اﻟﺼﻮرة ﻟﻠﺨﻄﺮ إذا §ﺎن ﻫﻨﺎك ﻣﺴﺤﻮق أو ﻣﺮﻫﻢ ﻋﻠﻰ اﻟﺜﺪﻳﻴﻦ أو إذا ﻛﻨﺖ ﻗﺪ ﺧﻀﻌﺖ ﻟﻌﻤﻠ]ﺔ ﺟﺮاﺣ]ﺔ ﻓﻲ اﻟﺜﺪي‬،‫ﻀﺎ‬o‫أ‬ .‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻟﻠﺜﺪي‬VW‫ﺔ ﺟﻤﻴﻊ ﺳﺮﻃﺎﻧﺎت اﻟﺜﺪي ﻋﻠﻰ اﻟﺘﺼ‬V‫ﻤﻜﻦ رؤ‬o ‫ﻻ‬ .‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻟﻠﺜﺪي اﻟﺪﻗ]ﻘﺔ‬VW‫ﻀﺎ أن ﺗﻌﻴﻖ ﻗﺮاءات اﻟﺘﺼ‬o‫ﻤﻜﻦ ﻟﺰراﻋﺔ اﻟﺜﺪي أ‬o ‫ﺗﻮﺻ]ﺔ‬ .‫ﻌﻴﻦ‬Å‫ |ﺪءا ﻣﻦ ﺳﻦ اﻷر‬،‫ﺴﺎء‬Æ‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻟﻠﺜﺪي §ﻞ ﻋﺎم ﻟﻠ‬VW‫ﻓﺤﺺ اﻟﺘﺼ‬ Breast Anatomy In the adult female, each of the mammary glands or breasts is a conic or hemispheric eminence located on the anterior and lateral chest walls. Breast size varies from one individual to another and even in the same woman, depending on her age and the influence of various hormones. The usual breast extends from the anterior portion of the second rib down to the sixth or seventh rib and from the lateral border of the sternum well into the axilla. ‫ﺔ‬i‫ﺔ أو ﺛﺪﻳﻴﻦ ﻫﻲ ﺳﻤﺎﺣﺔ ﻣﺨﺮوﻃ‬i‫ﻞ ﻏﺪد اﻟﺜﺪﻳ‬œ ،‫ﺎﻟﻐﺔ‬ž‫ﻓﻲ اﻷﻧﺜﻰ اﻟ‬ .‫ﺔ‬i¡‫ﺔ واﻟﺠﺎﻧ‬i‫ﺔ ﺗﻘﻊ ﻋﻠﻰ ﺟﺪران اﻟﺼﺪر اﻷﻣﺎﻣ‬L‫أو ﻧﺼﻒ ﻛﺮو‬ ،‫‚ﺨﺘﻠﻒ ﺣﺠﻢ اﻟﺜﺪي ﻣﻦ ﻓﺮد إﻟﻰ آﺧﺮ وﺣﺘﻰ ﻓﻲ ﻧﻔﺲ اﻟﻤﺮأة‬ .‫اﻋﺘﻤﺎدا ﻋﻠﻰ ﻋﻤﺮﻫﺎ وﺗﺄﺛﻴﺮ اﻟﻬﺮﻣﻮﻧﺎت اﻟﻤﺨﺘﻠﻔﺔ‬ ‫‚ﻤﺘﺪ اﻟﺜﺪي اﻟﻤﻌﺘﺎد ﻣﻦ اﻟﺠﺰء اﻷﻣﺎﻣﻲ ﻣﻦ اﻟﻀﻠﻊ اﻟﺜﺎﻧﻲ إﻟﻰ اﻟﻀﻠﻊ‬ .‫ﻄﻴﻦ‬h‫ﺔ ﻟﺒﺌﺮ اﻟﻘﺺ إﻟﻰ اﻹ‬i¡‫اﻟﺴﺎدس أو اﻟﺴﺎﺑﻊ وﻣﻦ اﻟﺤﺪود اﻟﺠﺎﻧ‬ • The surface anatomy includes the nipple, a small projection co taining a collection of duct openings from the secretory glands within the breast tissue. 2nd rib • The pigmented area surrounding the nipple is termed the areola, a circular area of different color surrounding a central point. • The junction of the inferior part of the breast with the anterior chest wall is called the inframammary crease. • The axillary tail is a band of tissue that wraps around the pectoral muscle late ally (Fig. 5). .‫ﺔ داﺧﻞ أ´ﺴﺠﺔ اﻟﺜﺪي‬L‫ وﻫﻮ إﺳﻘﺎط ﺻﻐﻴﺮ ‚ﺤﺘﻮي ﻋﻠﻰ ﻣﺠﻤﻮﻋﺔ ﻣﻦ ﻓﺘﺤﺎت اﻟﻘﻨﻮات ﻣﻦ اﻟﻐﺪد اﻹﻓﺮاز‬،‫ ــﺢ اﻟﺴﻄﺤﻲ اﻟﺤﻠﻤﺔ‬L‫ﺸﺮ‬x‫ﺸﻤﻞ اﻟ‬J .‫ﺔ‬Lº‫ﻂ ﺑﻨﻘﻄﺔ ﻣﺮﻛ‬i‫ﺔ ذات ﻟﻮن ﻣﺨﺘﻠﻒ ﺗﺤ‬L•‫ وﻫﻲ ﻣﻨﻄﻘﺔ داﺋ‬،‫ﺎﻟﺤﻠﻤﺔ اﻟﻬﺎﻟﺔ‬h ‫ﻄﺔ‬i‫ﻐﺔ اﻟﻤﺤ‬ž‫½ﺴﻤﻰ اﻟﻤﻨﻄﻘﺔ اﻟﻤﺼﻄ‬ . .‫ﺪ ﺗﺤﺖ اﻟﺜﺪي‬i‫ﺎﻟﺘﺠﺎﻋ‬h ‫ﺠﺪار اﻟﺼﺪر اﻷﻣﺎﻣﻲ‬h ‫ﺴﻤﻰ ﺗﻘﺎﻃﻊ اﻟﺠﺰء اﻟﺴﻔﻠﻲ ﻣﻦ اﻟﺜﺪي‬J .(5 .‫ﺔ ﻓﻲ وﻗﺖ ﻻﺣﻖ )اﻟﺸ¿ﻞ‬L‫ﻂ ﻣﻦ اﻷ´ﺴﺠﺔ اﻟﺘﻲ ﺗﻠﺘﻒ ﺣﻮل اﻟﻌﻀﻠﺔ اﻟﺼﺪر‬L‫ﻄﻲ ﻫﻮ ﺷﺮ‬h‫اﻟﺬ‚ﻞ اﻹ‬ Fig. 5. Surface anatomy • • • • • • The width of the breast, called the mediolateral diameter, on most patients is greater than the vertical measurement, from top to bottom. The vertical measurement, which may be described as the craniocaudad diameter, averages from 12 to 15 cm at the chest wall. • Mammary tissue is overlying the costocartilages near the sternum, and breast tissue is extending well up into the axilla. • This breast tissue extending into the axilla is called the tail of the breast or the axillary prolongation of the breast. Fig. 6, for a description of the base of the breast. .‫ ﻣﻦ أﻋﻠﻰ إﻟﻰ أﺳﻔﻞ‬،‫ﺎس اﻟﺮأﺳﻲ‬i‫ﺒﺮ ﻣﻦ اﻟﻘ‬Ã‫ ﻓﻲ ﻣﻌﻈﻢ اﻟﻤﺮﺿﻰ أ‬،‫ اﻟﻤﺴﻤﻰ اﻟﻘﻄﺮ اﻟﻤﺘﻮﺳﻂ‬،‫ﻋﺮض اﻟﺜﺪي‬ .‫ ﺳﻢ ﻋﻨﺪ ﺟﺪار اﻟﺼﺪر‬15 ‫ إﻟﻰ‬12 ‫ ﻣﻦ‬،craniocaudad ‫ﺄﻧﻪ ﻗﻄﺮ‬h ‫ اﻟﺬي ‚ﻤﻜﻦ وﺻﻔﻪ‬،‫ﺎس اﻟﺮأﺳﻲ‬i‫ﻳﺘﺮاوح ﻣﺘﻮﺳﻂ اﻟﻘ‬ .‫ﻄﻴﻦ‬h‫ﺪا إﻟﻰ اﻹ‬i‫ وﺗﻤﺘﺪ أ´ﺴﺠﺔ اﻟﺜﺪي ﺟ‬،‫ﺎﻟﻘﺮب ﻣﻦ اﻟﻘﺺ‬h costocartilages ‫ﺗﺘﻐﻠﺐ أ´ﺴﺠﺔ اﻟﺜﺪي ﻋﻠﻰ‬ .‫ﻄﻲ ﻟﻠﺜﺪي‬h‫ﻄﻴﻦ ذ‚ﻞ اﻟﺜﺪي أو اﻟﺘﻤﺪد اﻹ‬h‫ﺴﻤﻰ ´ﺴﻴﺞ اﻟﺜﺪي ﻫﺬا اﻟﺬي ‚ﻤﺘﺪ إﻟﻰ اﻹ‬J .‫ ﻟﻠﺤﺼﻮل ﻋﻠﻰ وﺻﻒ ﻟﻘﺎﻋﺪة اﻟﺜﺪي‬،6 ‫اﻟﺸ¿ﻞ‬ Fig. 6. Placement of patient on a dedicated mammography for a craniocaudal (CC) projection Note: Vertical CR is placed directly over the chest wall structure which allows the posterosuperior breast structures to be appear. Kenneth L. Bont rager 6th Ed Page 584 r­ n­ (CC) ‫ وضع املريض على تصوير الثدي باألشعة السينية املخصص إلسقاط القحفي‬.6 .‫الشكل‬ ‫ العمودي مباشرة فوق هيكل جدار الصدر‬CR ‫ يتم وضع‬:‫مالحظة‬ .‫مما يسمح بظهور هياكل الثدي الخلفية العلوية‬ • • • • • METHODS OF LOCALIZATION Two methods are commonly used to subdivide the breast into smaller areas for localization purposes. The quadrant system, shown in Fig. 7a, is easiest to use. Four quadrants can be described by using the nipple as the center. These quadrants are the UOQ (upper outer quadrant), the UIQ (upper inner quadrant), the LOQ (lower outer quadrant), and the LIQ (lower inner quadrant). A second clock system method, shown on the right in Fig. 7b, compares the surface of the breast to the face of a clock. A problem with the clock method arises when a medial or lateral portion of either breast is described. What is described at 3 o'clock in the right breast has to be described at 9 o'clock in the left breast. .‫ﻃﺮق اﻟﺘﻮﻃﻴﻦ‬ .‫ﻘﺘﻴﻦ ﻟﺘﻘﺴ]ﻢ اﻟﺜﺪي إﻟﻰ ﻣﻨﺎﻃﻖ أﺻﻐﺮ ﻷﻏﺮاض اﻟﺘﻮﻃﻴﻦ‬V¢‫ﺸﻴﻊ اﺳﺘﺨﺪام ﻃ‬Î .‫ أﺳﻬﻞ ﻓﻲ اﻻﺳﺘﺨﺪام‬،‫أ‬7 ‫ﻞ‬Â‫ اﻟﻤﻮﺿﺢ ﻓﻲ اﻟﺸ‬،‫ﺎﻋﻲ‬Å¢‫اﻟﻨﻈﺎم اﻟ‬ .‫ﺎع |ﺎﺳﺘﺨﺪام اﻟﺤﻠﻤﺔ §ﻤﺮﻛﺰ‬Å‫ﻌﺔ أر‬Å‫ﻤﻜﻦ وﺻﻒ أر‬o ‫ــﻊ اﻟﺨﺎرﺟﻲ‬Å¢‫ )اﻟ‬LOQ‫ و‬،(‫ــﻊ اﻟﺪاﺧﻠﻲ اﻟﻌﻠﻮي‬Å¢‫ )اﻟ‬UIQ‫ و‬،(‫ــﻊ اﻟﺨﺎرﺟﻲ اﻟﻌﻠﻮي‬Å¢‫ )اﻟ‬UOQ ‫ﺎع ﻫﻲ‬Å‫ﻫﺬە اﻷر‬ .(‫ــﻊ اﻟﺪاﺧﻠﻲ اﻟﺴﻔﻠﻲ‬Å¢‫ )اﻟ‬LIQ‫ و‬،(‫اﻟﺴﻔﻠﻲ‬ .‫ ﺳﻄﺢ اﻟﺜﺪي ﺑﻮﺟﻪ اﻟﺴﺎﻋﺔ‬،‫ب‬7 ‫ﻞ‬Â‫ اﻟﻤﻮﺿﺤﺔ ﻋﻠﻰ اﻟ]ﻤﻴﻦ ﻓﻲ اﻟﺸ‬،‫ﻘﺔ ﻧﻈﺎم اﻟﺴﺎﻋﺔ اﻟﺜﺎﻧ]ﺔ‬V¢‫ﺗﻘﺎرن ﻃ‬ .‫ﺴﻲ أو ﺟﺎﻧﺒﻲ ﻣﻦ أي ﻣﻦ اﻟﺜﺪﻳﻴﻦ‬œ‫ﻘﺔ اﻟﺴﺎﻋﺔ ﻋﻨﺪ وﺻﻒ ﺟﺰء إ‬V¢‫ﻠﺔ ﻓﻲ ﻃ‬Â‫ﺸﺄ ﻣﺸ‬Æ‫ﺗ‬ .‫ﺴﺮ‬Î‫ ﻓﻲ اﻟﺜﺪي اﻷ‬9 ‫ﻤﻦ ﻓﻲ اﻟﺴﺎﻋﺔ‬o‫ ﻓﻲ اﻟﺜﺪي اﻷ‬3 ‫ﺠﺐ وﺻﻒ ﻣﺎ ﻳﺘﻢ وﺻﻔﻪ ﻓﻲ اﻟﺴﺎﻋﺔ‬o Fig.7 a. Breast localization: quadrant Fig.7 a clock system method Pectoralis major muscle SAGITTAL SECTION ANATOMY Retromammary space Nipple Skin 6th rib Inframammary crease Fig 8. Breast sagittal section • A sagittal section through a mature breast is illustrated in Fig. 8, showing the relationship of the mammary gland to the underlying structures of the chest wall. • On this drawing the inframammary crease is at the level of the sixth rib, but a great deal of variation does exist among individuals. • The large pectoralis major muscle is seen overlying the bony thorax. • A sheet of fibrous tissue surrounds the breast below the skin surface. • A similar sheet of tissue covers the pectoralis major muscle. • These two fibrous sheets connect in an area termed the retromammary space. • This retromammary space must be demonstrated on at least one projection during the radiographic study of the mammary gland. Because the connections within the retromammary space are fairly loose, the normal breast exhibits considerable mobility on the chest wall. ‫ـ ــﺢ اﻟﻘﺴﻢ اﻟﺴﺎﻣﺠﻲ‬V‫•ﺸﺮ‬ ‫ﺪل ﻋﻠﻰ ﻋﻼﻗﺔ اﻟﻐﺪة اﻟﺜﺪﻳ]ﺔ |ﺎﻟﻬ]ﺎ¶ﻞ اﻷﺳﺎﺳ]ﺔ ﻟﺠﺪار‬o ‫ ﻣﻤﺎ‬،‫ ﻗﺴﻢ اﻟﺴﻬﻢ ﻣﻦ ﺧﻼل اﻟﺜﺪي اﻟﻨﺎﺿﺞ‬8 ‫ﻞ‬Â‫ﻳﻮﺿﺢ اﻟﺸ‬ .‫اﻟﺼﺪر‬ ‫ﻦ ﻳﻮﺟﺪ ﻗﺪر ﻛﺒﻴﺮ ﻣﻦ اﻻﺧﺘﻼف ﺑﻴﻦ‬Û‫ وﻟ‬،‫ﻜﻮن اﻟﺘﺠﻌﺪ ﺗﺤﺖ اﻟﺜﺪي ﻋﻠﻰ ﻣﺴﺘﻮى اﻟﻀﻠﻊ اﻟﺴﺎدس‬o ،‫ﻓﻲ ﻫﺬا اﻟﺮﺳﻢ‬ .‫اﻷﻓﺮاد‬ .‫ﺒﻴﺮة ﻓﻮق اﻟﺼﺪر اﻟﻌﻈﻤﻲ‬Û‫ﺴ]ﺔ اﻟ‬Þ‫ﺔ اﻟﺮﺋ‬V‫ﺷﻮﻫﺪت اﻟﻌﻀﻼت اﻟﺼﺪر‬ .‫ﺴﺠﺔ اﻟﻠ]ﻔ]ﺔ |ﺎﻟﺜﺪي ﺗﺤﺖ ﺳﻄﺢ اﻟﺠﻠﺪ‬œ‫ﺗﺤ]ﻂ ورﻗﺔ ﻣﻦ اﻷ‬ .‫ﺴ]ﺔ‬Þ‫ﺔ اﻟﺮﺋ‬V‫ﺴﺠﺔ اﻟﻌﻀﻼت اﻟﺼﺪر‬œ‫ﺗﻐﻄﻲ ورﻗﺔ ﻣﻤﺎﺛﻠﺔ ﻣﻦ اﻷ‬ .‫ﺗﺘﺼﻞ ﻫﺎﺗﺎن اﻟﺼﻔﺤﺘﺎن اﻟﻠ]ﻔﻴﺘﺎن ﻓﻲ ﻣﻨﻄﻘﺔ •ﺴﻤﻰ اﻟﻔﻀﺎء اﻟﺨﻠﻔﻲ ﻟﻠﺜﺪي‬ ‫ ﻧﻈﺮا ﻷن‬.‫ﺠﺐ إﻇﻬﺎر ﻫﺬا اﻟﻔﻀﺎء ﺧﻠﻒ اﻟﺜﺪي ﻋﻠﻰ إﺳﻘﺎط واﺣﺪ ﻋﻠﻰ اﻷﻗﻞ أﺛﻨﺎء اﻟﺪراﺳﺔ اﻟﺸﻌﺎﻋ]ﺔ ﻟﻠﻐﺪة اﻟﺜﺪﻳ]ﺔ‬o .‫ﻈﻬﺮ ﺣﺮﻛﺔ ﻛﺒﻴﺮة ﻋﻠﻰ ﺟﺪار اﻟﺼﺪر‬o ‫ ﻓﺈن اﻟﺜﺪي اﻟﻄﺒ]ﻌﻲ‬،‫اﻻﺗﺼﺎﻻت داﺧﻞ اﻟﻔﻀﺎء ﺧﻠﻒ اﻟﺜﺪي ﻓﻀﻔﺎﺿﺔ إﻟﻰ ﺣﺪ ﻣﺎ‬ Skin Glandular tissue • The relative position of glandular tissue versus adipose (fatty) tissue is illustrated in Fig. 9. The central portion of the breast is primarily glandular tissue. • Varying amounts of adipose or fatty ti sue surround the glandular tissue. • Size variation from individual to individual is due primarily to the amount of adipose or fatty tissue in the breast. • The amount of glandular tissue is fairly constant from one female to another. • Because lactation or the secretion of milk is the primary function of the mammary gland, the amount of glandular and fatty tissue, or the size of the female breast, has no bearing (behavior) on the functional ability of the gland. • The skin covering the breast is seen to be uniform in thickness, except in the area of the areola and nipple where the skin is somewhat thicker. Adipose tissue .‫ﺔ‬o‫ﺴﺠﺔ اﻟﻐﺪ‬œ‫ اﻟﺠﺰء اﻟﻤﺮﻛﺰي ﻣﻦ اﻟﺜﺪي ﻫﻮ ﻓﻲ اﻟﻤﻘﺎم اﻷول اﻷ‬.9 .(‫ﺴﺠﺔ اﻟﺪﻫﻨ]ﺔ )اﻟﺪﻫﻨ]ﺔ‬œ‫ﺔ ﻣﻘﺎ|ﻞ اﻷ‬o‫ﺴﺠﺔ اﻟﻐﺪ‬œ‫ﺴﺒﻲ ﻟﻸ‬Æ‫ﻞ اﻟﻤﻮﻗﻒ اﻟ‬Â‫• ﻳﻮﺿﺢ اﻟﺸ‬ Fig. 9. Breast sagittal section .‫ﺔ‬o‫ﺴﺠﺔ اﻟﻐﺪ‬œ‫ﺴﺠﺔ اﻟﺪﻫﻨ]ﺔ أو اﻟﺪﻫﻨ]ﺔ |ﺎﻷ‬œ‫• ﺗﺤ]ﻂ §ﻤ]ﺎت ﻣﺘﻔﺎوﺗﺔ ﻣﻦ اﻷ‬ .‫ﺴﺠﺔ اﻟﺪﻫﻨ]ﺔ أو اﻟﺪﻫﻨ]ﺔ ﻓﻲ اﻟﺜﺪي‬œ‫• ﻳﺮﺟﻊ اﺧﺘﻼف اﻟﺤﺠﻢ ﻣﻦ ﻓﺮد إﻟﻰ آﺧﺮ ﻓﻲ اﻟﻤﻘﺎم اﻷول إﻟﻰ §ﻤ]ﺔ اﻷ‬ .‫ﺔ ﺛﺎﺑﺘﺔ إﻟﻰ ﺣﺪ ﻣﺎ ﻣﻦ أﻧﺜﻰ إﻟﻰ أﺧﺮى‬o‫ﺴﺠﺔ اﻟﻐﺪ‬œ‫• §ﻤ]ﺔ اﻷ‬ ‫ﺲ ﻟﻬﺎ أي ﺗﺄﺛﻴﺮ‬Þ‫ ﻟ‬،‫ أو ﺣﺠﻢ اﻟﺜﺪي اﻷﻧﺜﻮي‬،‫ﺔ واﻟﺪﻫﻨ]ﺔ‬o‫ﺴﺠﺔ اﻟﻐﺪ‬œ‫ ﻓﺈن §ﻤ]ﺔ اﻷ‬،‫• ﻷن اﻟﺮﺿﺎﻋﺔ أو إﻓﺮاز اﻟﺤﻠ]ﺐ ﻫﻲ اﻟﻮﻇ]ﻔﺔ اﻷﺳﺎﺳ]ﺔ ﻟﻠﻐﺪة اﻟﺜﺪﻳ]ﺔ‬ .‫)ﺳﻠﻮك( ﻋﻠﻰ اﻟﻘﺪرة اﻟﻮﻇ]ﻔ]ﺔ ﻟﻠﻐﺪة‬ s­ .‫ﺎ إﻟﻰ ﺣﺪ ﻣﺎ‬Â‫ﻜﻮن اﻟﺠﻠﺪ أ¬ﺜﺮ ﺳﻤ‬o ‫ﺜﻨﺎء ﻣﻨﻄﻘﺔ اﻟﻬﺎﻟﺔ واﻟﺤﻠﻤﺔ ﺣ]ﺚ‬¤‫ |ﺎﺳ‬،‫ﻐﻄﻲ اﻟﺜﺪي ﻋﻠﻰ أﻧﻪ ﻣﻮﺣﺪ ﻓﻲ اﻟﺴﻤﻚ‬o ‫• ﻳﻨﻈﺮ إﻟﻰ اﻟﺠﻠﺪ اﻟﺬي‬ Breast tissue type Three types of tissue: Higher density (Lighter) 1. Glandular. 2. Fibrous or connective tissue. Less density (Dark) 3- Adipose (fat). :‫ﺛﻼﺛﺔ أﻧﻮاع ﻣﻦ اﻷ´ﺴﺠﺔ‬ (‫ﻛﺜﺎﻓﺔ أﻋﻠﻰ )أﺧﻒ‬ .‫ﻏﺪة‬ .‫ﻔﻲ أو اﻟﻀﺎم‬i‫ﺴﻴﺞ اﻟﻠ‬Ü‫اﻟ‬ (‫ﻛﺜﺎﻓﺔ أﻗﻞ )ﻣﻈﻠﻤﺔ‬ .(‫ دﻫﻮن )دﻫﻮن‬-3 • The film/screen mammogram image (Fig. 10) demonstrates differences in tissue densities. • These differences provide the basis for the radiographic image of the breast. • Note that the more dense glandular and fibrous or connective tissues appear as "light" structures or regions. The less dense adipose or fatty tissues appear light to dark gray, depending on the thickness of these tissues. ‫اﻟﺸﺎﺷﺔ‬Ö‫ﻠﻢ‬i‫ﺮ اﻟﺸﻌﺎﻋﻲ ﻟﻠﺜﺪي ﻟﻠﻔ‬LM‫ﺗﻮﺿﺢ ﺻﻮرة اﻟﺘﺼ‬ .‫( اﻻﺧﺘﻼﻓﺎت ﻓﻲ ﻛﺜﺎﻓﺔ اﻷ´ﺴﺠﺔ‬10 ‫)اﻟﺸ¿ﻞ‬ • .‫ﺔ ﻟﻠﺜﺪي‬i‫ﺗﻮﻓﺮ ﻫﺬە اﻻﺧﺘﻼﻓﺎت اﻷﺳﺎس ﻟﻠﺼﻮرة اﻟﺸﻌﺎﻋ‬ • ‫ﺜﺮ‬Ã‫ﺔ أو اﻟﻀﺎﻣﺔ اﻷ‬i‫ﻔ‬i‫ﻻﺣﻆ أن اﻷ´ﺴﺠﺔ اﻟﻐﺪ‚ﺔ واﻟﻠ‬ ‫ ﺗﻈﻬﺮ اﻷ´ﺴﺠﺔ‬."‫ﻔﺔ‬i‫ﻞ أو ﻣﻨﺎﻃﻖ "ﺧﻔ‬Ú‫ﺎ‬i‫ﻛﺜﺎﻓﺔ ﺗﻈﻬﺮ ﻛﻬ‬ ‫ﺎﻟﻠﻮن اﻟﺮﻣﺎدي اﻟﻔﺎﺗﺢ إﻟﻰ‬h ‫ﺔ اﻷﻗﻞ ﻛﺜﺎﻓﺔ‬i‫ﺔ أو اﻟﺪﻫﻨ‬i‫اﻟﺪﻫﻨ‬ .‫ اﻋﺘﻤﺎدا ﻋﻠﻰ ﺳﻤﻚ ﻫﺬە اﻷ´ﺴﺠﺔ‬،‫ﻦ‬Ã‫اﻟﺪا‬ • Fig. 10. Film-screen mammogram Assignment (2) Breast Cancer classifications • Title • Def • Mammogram