Breast MR Positioning: Effect on Image Quality

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after May 31, 2023:

Magnetic Resonance Imaging: 3.00
Image Production: 0.50
Physical Principles of Image Formation: 0.50
Procedures: 2.50
Body: 2.50

Outline

1. Introduction
2. Positioning in Breast MR Imaging
   1. Use of Dedicated Breast MR Imaging Technologists
   2. Review of Prior Images
   3. Coil Setup
   4. Technique of Positioning the Patient in the Coil
      1. Guide the Patient into the Coil and Center the Breasts over the Center Bar
      2. Check Breast Position from the Lateral, Medial, and Top-Down Positions
      3. Repeat the Positioning Check with the Other Breast
   5. Position the Nipple in Profile
   6. Check the Triplane Localizer Images
3. Artifacts Due to Improper Positioning and Their Causes
   1. Poor Superior Positioning
   2. Poor Fat Suppression
   3. Poor Medial Positioning
   4. Skin Folds
   5. Large Breasts
   6. Inferior Bulge
   7. Fat Saturation Pad
   8. Prior Surgery
   9. Implants
4. Missed Cancer Due to Poor Positioning
5. Pseudo Cancer Due to Improper Positioning
6. Effect of Arm Position
7. Positioning for MR Imaging-guided Procedures
   1. Review of Prior Diagnostic Images
   2. Using Padding to Roll the Patient
   3. Using Sponges to Bolster Breast Tissue
   4. Raising the Grid to Access Posterior Lesions
   5. Awareness of Altered Landmarks
8. Examples of Difficult Access during MR Imaging-guided Intervention
   1. Core Biopsy of a Far Posterior Mass
   2. Wire Localization of an Axillary Mass
   3. Biopsy of Patients with Implants
   4. Biopsy of Medial Lesions
9. Conclusion

Objectives

Upon completion of this course, students will:

1. know when the importance of positioning for breast imaging was first realized
2. know the most common reason for accreditation failure in mammography
3. be able to list reasons for the success of MRI in detecting invasive malignancies of the breast
4. understand the difficulties of positioning in breast MR imaging compared with other areas of the body
5. be aware of the effect compression of breast tissue has on the enhancement of malignancies
6. understand the authors’ recommendations for breast MR imaging technologists
7. know what help can be provided by reviewing prior MR imaging studies
8. be aware of artifacts that may result from using cloth linens
9. understand how to position a patient for breast MRI using both hands
10. know when the sternum should be positioned over the center bar of the breast coil
11. know the best view for checking that the nipple is in profile
12. understand the problems that might be caused if the nipple is not in profile
13. know what to check on the triplane localizer before continuing the breast MR exam
14. understand the artifact that can result from positioning the breast too far superiorly in the coil
15. know the appropriate time to deal with skin folds
16. know the term that describes the situation when large breasts overfill a coil
17. be aware of artifacts that may be encountered in large-breasted patients
18. be familiar with ways to avoid artifacts when imaging large breasts
19. check for abdominal tissue in the breast coil before imaging
20. know the chemical makeup of the fat saturation pad
21. know where the use of fat saturation pads was first described
22. be aware of the anatomy where fat saturation pads were first used
23. know which type of anatomy benefits from the use of fat saturation pads
24. be familiar with the characteristics of the liquid in fat saturation pads
25. know which type of fat saturation pad is used for breast imaging
26. know how often a fat saturation pad is used, in the experience of the authors
27. understand how prior surgery or radiation therapy to the breasts can affect breast MRI
28. know a method of dealing with bulging breast implants
29. know why breast MRI is commonly done with the arms above the head
30. be aware of the occasions that benefit from positioning the patient with arms at their side
31. be able to list features to review on prior diagnostic images
32. be familiar with lesions that can be accessed better with the patient rolled into an oblique position
33. know when bolstering can help increase the safety of breast biopsy
34. describe an approach for biopsy in a patient with implants
35. describe a lesion location that requires the contralateral breast be moved out of the way