National Institute of

Biomedical Imaging Mammography

and Bioengineering MARCH 2022

What is a Mammogram?
Mammography is an x-ray imaging method used to examine the breast for the early detection of cancer and other breast diseases. It
is used as both a diagnostic and screening tool.

How does it work?

During a mammogram, a patient’s breast is placed on a flat support plate and compressed with a parallel plate called a paddle. An x-
ray machine produces a small burst of x-rays that pass through the breast to a detector located on the opposite side. The detector
can be either a photographic film plate, which captures the x-ray image on film, or a solid-state detector, which transmits electronic
signals to a computer to form a digital image. The images produced are called mammograms.
On a film mammogram, low density tissues, such as fat, appear translucent (i.e. darker shades of gray approaching the black
background)., whereas areas of dense tissue, such as connective and glandular tissue or tumors, appear whiter on a gray
background. In a standard mammogram, both a top and a side view are taken of each breast, although extra views may be taken if
the physician is concerned about a suspicious area of the breast.

What will the results look like?

A radiologist will carefully examine a mammogram to search for high density regions or areas of
unusual configuration that look different from normal tissue. These areas could represent many
different types of abnormalities, including cancerous tumors, non-cancerous masses called benign
tumors, fibroadenomas, or complex cysts. Radiologists look at the size, shape, and contrast of an
abnormal region, as well as the appearance of the edges or margins of such an area, all of which can
indicate the possibility of malignancy (i.e. cancer). They also look for tiny bits of calcium, called
microcalcifications, which show up as very bright specks on a mammogram. While usually benign,
sites of microcalcifications may occasionally signal the presence of a specific type of cancer. If a
mammogram shows one or more suspicious regions that are not definitive for cancer, the radiologist
may order additional mammogram views, with or without additional magnification or compression,
or they may order a biopsy. Another alternative may be referral for another type of non-invasive
imaging study.

Why does the breast need to be compressed? Breast image generated with
dedicated breast PET/CT.
Compression holds the breast in place to minimize blurring of the x-ray image that can be caused by Orange and purple represent
patient motion. Also, compression evens out the shape of the breast so that the x-rays can travel areas of increased metabolic
through a shorter path to reach the detector. This reduces the radiation dose and improves the activity which indicate the
quality of the x-ray image. Finally, compression allows all the tissues to be visualized in a single presence of a tumor. Source:
plane so that small abnormalities are less likely to be obscured by overlying breast tissue. John Boone, Ph.D., UC Davis.

What is digital mammography?

A digital mammogram uses the same x-ray technology as conventional mammograms, but instead of using film, solid-state
detectors are used to record the x-ray pattern passing through the breast. These detectors convert the x-rays that pass through
them into electronic signals that are sent to a computer. The computer then converts these electronic signals into images that can
be displayed on a monitor and also stored for later use. Several advantages of using digital mammography over film mammography
include: the ability to manipulate the image contrast for better clarity, the ability to use computer-aided detection of abnormalities,
and the ability to easily transmit digital files to other experts for a second opinion. In addition, digital mammograms may decrease
the need for the re-takes, which are common with film mammography due to incorrect exposure techniques or problems with film
development. As a result, digital mammography can lead to lower x-ray exposures. To date, there is no evidence that digital
mammography is better that film mammography for reducing a woman’s risk of dying from breast cancer, however, digital
screening may be more accurate for finding cancers in younger women or women with dense breasts.

~ \ . National Institute of Biomedical Imaging and Bioengineering

lilillf/
Engineering the Future of Health www.nibib.nih.gov
 Mammography, page 2

What is tomosynthesis (3D mammography)?

Digital Breast Tomosynthesis, also known as 3D mammography, is an FDA-approved method for breast cancer screening in which
x-rays of the breast are taken at different angles to generate thin cross-sections. The 3D representation of the breast is similar to
the 3d images created by standard CT technology. Tomosynthesis differs from CT technology in that significantly fewer x-ray
beams are projected through the breast than with CT and the x-ray exposure to the rest of the chest is dramatically reduced.
Hence, the radiation dose delivered to the breast by tomosynthesis is similar to that delivered 2D mammography. While
tomosynthesis uses very low-dose x-rays, it is currently most often used in addition to 2D mammography, making the total
radiation dose higher than standard mammography. Early evaluations of 3D mammography suggest an improved detection of
breast cancers than seen with 2D mammography, but extensive large-scale comparisons of tomosynthesis with 2D
mammography in randomized studies are still in process. Therefore, researchers do not know with full certainty whether 3D
mammography is better or worse than standard mammography at avoiding false-positive results and identifying early cancers in
all types of patients.

Are there risks?

Because mammography uses x-rays to produce images of the breast, patients are exposed to a small amount of ionizing
radiation. For most women, the benefits of regular mammograms outweigh the risks posed by this amount of radiation. The risk
associated with this dose appears to be greater among younger women (under age 40). However, in some cases, the benefits of
using mammography to detect breast cancer under age 40 may outweigh the risks of radiation exposure. For example, a
mammogram may reveal that a suspicious mass is benign and, therefore, doesn’t need to be treated. Additionally, if a tumor is
malignant and is caught early by mammogram, a surgeon may be able to remove it before it spreads and requires more
aggressive treatment such as chemotherapy.

When should I get a mammogram?

Several organizations and professional societies have developed guidelines for mammography screening including the United
States Preventive Services Task Force, the American Cancer Society, and the American College of Radiology. You can read more
about these recommendations on their websites. All recommend that women talk with their doctor about the benefits and
potential harms of mammography, when to start screening, and how often to be screened.

What are examples of NIBIB-funded projects in breast cancer screening?

Dedicated Breast CT: Research funded by NIBIB has led image guidance for biopsy needle placement and minimally
invasive ablation of tumors. For more information on the dbCT
to the development of a dedicated breast CT scanner (dbCT)
click here.
that allows radiologists to view the breast in three dimensions
and has the potential to reveal small tumors obscured behind Near-Infrared, Diffuse Light Imaging with
dense breast tissue. The scanner uses a radiation dose
comparable to mammography by sending X-rays only through
Ultrasonic Guidance: Researchers funded by NIBIB have
the breast and not the chest. At present, more than 600 women developed a novel hybrid ultrasound/optical breast imaging
have been imaged using dbCT in clinical trials. Results from system that uses simultaneous optical (infrared) and
these trials suggest that dbCT is significantly better at ultrasound sensors in a hand-held probe. The method provides
detecting tumors than mammography, though mammography accurate detection of tumor angiogenesis (i.e. formation of
is better at detecting microcalcifications. Recently, positron new blood vessels) and the distribution of these new blood
emission tomography (PET) technology has been incorporated vessels, which can help distinguish benign lesions from early-
into the dbCT platform. A PET scan highlights areas of stage cancers. The method is being tested in a large number of
increased metabolic activity, which could indicate the patients who will also receive ultrasound-guided biopsy. Early
presence of a tumor. Additionally, injection of a contrast agent results indicate that this may be a promising adjunct to
has been shown to improve dbCT’s ability to detect mammography and may help to reduce the number of benign
microcalcifications and could help radiologists distinguish breast biopsies compared to methods that have been in use
benign from malignant tumors. Research is currently focused over the past 20 years. It may also be useful in evaluating the
on ways in which dbCT could be used to provide real-time effectiveness of chemotherapy treatments.

NIBIB Contacts
National Institute of Biomedical Imaging and Bioengineering Phone: 301-496-8859
6707 Democracy Blvd., Suite 200 info@nibib.nih.gov
Bethesda, MD 20892 www.nibib.nih.gov

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