Siemens MAMMOMAT 1000 Nova User guide

Mammography Applications
for MAMMOMAT 1000/3000 Nova

2
Introduction
This booklet is intended as an application handbook
for use with Siemens MAMMOMAT® 1000 and 3000
Nova.
The booklet contains advice on positioning, instruc-
tions for choice of exposure and proper positioning
of the Automatic Exposure Control (AEC) detector.
There are also instructions on the use of Opcomp®
and Opdose®.
This handbook with helpful hints and directions is
a complement to the operator’s manual. It should
be noted that this is not a textbook and that we
make no claim of complete coverage of the subjects
discussed. The responsibility for medical judge-
ments and directions remains with the attending
physician.
For information on other questions relating to the
operation of your MAMMOMAT 1000/3000 Nova,
please refer to the Operating Instructions.

3
Contents
General advice 5
Positioning 6
Compression 6
AEC-detector 8
Choice of exposure 9
Opdose 10
Image quality 13
Radiation quality 14
Film/screen combinations 15
Processing 16
Positioning 17
Mediolateral oblique view, MLO 17
Cranio-caudal projection, CC 20
Lateral projection 22
Medio lateral, ML 23
Latero medial, LM 24
Specialized mammographic technique 25
Spot compression 25
Magnification 26
Biopsy methods 27
Biopsy hole plate 27
Shadow cross 27
Stereo 28

5
General advice
It is always important to inform the patient how
the examination will be performed. It should be
explained why it is necessary to compress the breast
and that it will be uncomfortable for a short time.
Always keep the patient under observation. If the
patient is very sensitive to pain or very nervous, it is
recommended that two radiographers attend in
the room. Begin each setting by chosing the correct
slide marker for the desired projection. With Siemens
fixed markings, the risk of faulty marking is limited.
The marking for a cranio-caudal projection is always
found on the lateral side of the breast.

GENERAL ADVICE
6
Positioning
Correct positioning of the breast is extremely important. If the
entire breast is not in the X-ray field, or there is something block-
ing the X-ray field, the whole diagnosis can be incorrect. It is also
easier to apply good compression when the positioning is correct.
Compression
Proper and adequate compression is necessary in order to reduce
the radiation dose, displace the tissue apart and avoid blurring
due to motion. Inadequate compression can, for example, mean
that small micro-calcifications do not appear on the X-ray image,
as a result of which the patient risks getting an incorrect diagnosis.
Opcomp
Siemens MAMMOMAT 1000/3000 Nova are fitted with Opcomp.
Opcomp senses for each individual breast when the compression
force is sufficient for optimal image quality. The force can be
increased but this only adds to the discomfort and does not provide
any improvement in image quality. Opcomp is purely an aid. It
is always the operator who decides if the compression is to stop
before, after or on the Opcomp value.
When using Opcomp, the foot switch is to be kept pressed down
during the whole compression process. Using a pumping techni-
que on the foot switch can result in the Opcomp indication failing
to appear.

7
Set the maximum value for the
compression force – 20 kg – unless
your facility has other guidelines.
Select automatic decompression
(however, not when biopsies and
localizations are to be performed).
Apply compression until the breast
is evenly and firmly compressed.
Ensure that no folds form in the skin.
When using Opcomp:
Begin by applying
compression until the
compression plate comes
into contact with the
skin (3-5 kg). Smooth out
any folds in the skin.
Press the foot switch all the way down, continue compression
until the plate stops and the green OC lamp on the stand display is
lit. Keep the patient under observation.
Studies have shown that the Opcomp value on average is 9-12 kg
for the CC view and 13-16 kg for the MLO view. However, some
breasts may require up to 20 kg. This is not harmful. The breasts
withstand this temporary deformation, but pay attention to the
patient. Do not override the patients pain-treshold.
More information on Opcomp can be found in the operating
instructions.
1
2

GENERAL ADVICE
8
AEC-detector
In order to obtain the correct density on the images, the AEC
detector should be moved to the densest area in the breast. Move
the AEC-detector lever to the marking, which corresponds with
the marking in the compression plate. Ensure that the breast com-
pletely covers the position of the AEC detector with a 2 cm margin,
otherwise the chamber will be measuring air. Do not forget to
return the detector to the chestwall-close position after each patient.
The image on the left demonstrates the
cassettes turbo release function. The text
does not mention this aspect of the unit.
Should this image be removed or should
text be added.

GENERAL ADVICE
9
Choice of exposure
Both Siemens MAMMOMAT 1000 and
Siemens MAMMOMAT 3000 Nova are
equipped with automatic exposure control
(AEC).
Only the kV value is set manually. After
exposure, the mAs value obtained can
be read on the generator control panel.
If desired, both kV and mAs can also be
chosen manually. When the mAs button is
first activated, a value of 100 mAs is shown
on the display. Continue to press the mAs
button until the desired value is shown,
then make the exposure.

GENERAL ADVICE
10
Opdose
Siemens MAMMOMAT 1000 and 3000 Nova are equipped with an
automatic exposure system - Opdose. Opdose suggests the exposure
parameters depending on the thickness of the breast. Both kV
and an anode/ filter combination are suggested in accordance with
what has been preset for the respective thickness interval (see
program table on page 12). That is, the larger the breast the more
the high-energy radiation, which enables the dose and exposure
time to be kept down. The user must confirm the values before an
exposure is made.
Make sure that the
“Auto” button is pressed in.
Position the patient and
apply the compression.
The compression force must
be at least 6 kg for the Opdose
to activate.
1

GENERAL ADVICE
11
On the control panel, an
indicator lamp will now be flas-
hing over the program which is
suggested. Confirm by pressing
the program button for the
suggested program. Make the
exposure.
It is recommended that the
same program is kept for the
entire examination. If you get
a flashing light suggesting a
different program, it is not necessary to accept this suggestion.
Just make the exposure. The program used for the last exposure
is maintained.
As soon as you press a button which is not blinking you leave
the auto-mode for Opdose. Always remember to check that the
auto button is pressed in when you start with the next patient.
The four programs can be set to suit the customer’s requirements
on installation.
Please refer to the Operating
Instructions when changing
program settings.
You can also choose to make the
exposure using a program which is
set manually. On the MAMMOMAT
1000/3000 Nova, you then choose
the kV value, the anode/filter
combination and the film/screen
combination (H/D button).
2

GENERAL ADVICE
12
The program values as preset from the factory are,
for Mo/W tube:
Program Compression kV-value Anode/Filter-
thickness combination
10-29 mm 26 Mo / Mo
230 - 44 mm 27 Mo / Mo
345 - 59 mm 27 Mo / Rh
4≈60 mm 26 W / Rh
for Mo tube:
Program Compression kV-value Anode/Filter-
thickness combination
10-29 mm 26 Mo / Mo
230 - 44 mm 27 Mo / Mo
345 - 59 mm 27 Mo / Rh
4≈60 mm 28 Mo / Rh
The program settings in the table are only suggestions. Each facility
may choose the most suitable setting for the film/screen in use.
The thickness intervals can only be changed by a service engineer.

IMAGE QUALITY
13
Image quality
Several factors affect the image quality. In addition to the pre-
viously mentioned factors such as positioning, compression and
the position of the detector, the cooperation between the doctor,
radiographer and patient is of greatest importance.

IMAGE QUALITY
14
Radiation quality
The radiation quality is determined by the kV value, anode material
and filter.
Low kV means that the image contrast increases. The kV value to
be used is determined by each individual facility. Some film/screen
combinations are recommended to be used with a high kV (28-30)
in order to keep the contrast down.
At 25 kV and large focal spot, the tube current for a Siemens
mammography-X-ray tube with a molybdenum anode is 150 mA.
This is an important factor, since high mA gives a short exposure
time and, consequently, a reduced risk of motion artifacts.
The Siemens MAMMOMAT 3000 Nova can be configured with
an X-ray tube with two different anode materials - molybdenum
and tungsten, plus various filter combinations of molybdenum
and rhodium. At 25 kV, the tube current with tungsten (W) anode
is 188 mA. This, in combination with a rhodium filter, will provide
high energy radiation and also reduce dose to the patient.
See the section on Opdose for instructions on use of the system.
The focus size need not be selected. Fine focus will automatically
be selected when the magnification table is inserted.

IMAGE QUALITY
15
Film/screen combinations
Mammography film and screens are made to provide high reso-
lution and high contrast. For normal mammography, screens with
the highest possible resolution should be used. Faster screens
can be used for magnification, to reduce the exposure time. The
resolution will be maintained through the small focal spot.
Cassettes and screens should be cleaned regularly, and you
should check your cassettes to ensure that the contact between
film and screen is the best possible.
It is important to keep all surfaces in the dark room clean
(wet wiping) to avoid dust in the cassettes.

IMAGE QUALITY
16
Processing
Even a picture which has been properly exposed and skillfully
executed can easily lose in quality in a poor development process.
The film processing machine is the heart of the mammography
department. Deterioration in image quality can often be traced to
a disorder in the development process.
Modern film processing machines can be programmed for various
processing times, which means that the processing time can be
adapted to mammography film.
The development temperature should be approximately 35°C (95°F).
Chemicals suitable for mammography film should be chosen
and be mixed in small tanks, so that they always are “fresh”.
Replenishment should be adapted to mammography film.
The film processing machine should be inspected daily. The
temperature, film speed, film contrast and film base fog should be
controlled. For this purpose, a sensitometer and a densitometer
are required.

17
Positioning
Mediolateral oblique
view MLO
For routine examinations, the MLO projec-
tion is to be preferred over the 90° lateral
projection. More of the breast tissue can
be seen in the upper outer quadrant and
the axilla. Furthermore, it is easier to carry
out the application with this setting.
Criteria:
The pectoral muscle should be depicted obliquely from above and
be visible down to the level of the nipple or further down. The
shape of the muscle should be depicted weakly convex as a sign
that the muscle is completely relaxed and medially prominent.
The compression should be proper over the whole image area.
The nipple should be depicted in profile and a small stomach fold
should be visible as a sign that the whole breast is reproduced.
CC
MLO

POSITIONING
18
Set the angle for the desired projection (30°- 60°). It is best to
adapt the angle to each patient. The object table should be parallel
with the pectoral muscle. Many clinics want to use the same pro-
jection angle for all patients, in order to be able to reproduce the
image on the next occasion.
Be sure to adjust
the height so that the
top edge of the object
table is on a level with
the axillary fold.
1
2

POSITIONING
19
Place the patient’s hand on the lower
part of the handle.
Turn the patient 45° or more in towards
the stand. Ask the patient to stand steadi-
ly and not to move her feet.
Instruct the patient to lift her elbow but
still keep her hand in the same position.
Ask the patient to bend slightly forward,
then take hold of the lifted arm and the
breast from below.
At the same time as you move the
patient in towards the object table, draw
the breast parenchyma medially.
Ensure that the patient relaxes and ask her to lower her shoulders
and at the same time roll them forward.
Draw the breast forward at the same time as you apply com-
pression and hold on the clavicle with your other hand so that the
compression plate is just clearing the clavicle. When the compression
is sufficient, using Opcomp or your own selection, make sure that
nothing blocks the field of the intended image.
Make sure the patient is
at ease and ask her to stand
absolutely still, before you leave
her to make the exposure.
3
4

POSITIONING
20
Cranio-caudal projection
CC
Criteria:
The whole breast parenchyma should be depicted. The fatty tissue
closest to the breast muscle should appear as a dark stripe on the
X-ray and behind that it should be possible to discern the pectoral
muscle. The nipple should be depicted in profile.
Lift the breast approximately
2 cm and adjust the height so
that the object table touches your
hand.
CC
MLO
1