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THE REQUISITES

Breast Imaging
The Requisites Series
SERIES EDITOR TITLES IN THE SERIES
James H. Thrall, MD Breast Imaging
Radiologist-in-Chief Emeritus Cardiac Imaging
Massachusetts General Hospital Emergency Imaging
Distinguished Juan M.Taveras Professor of Radiology Gastrointestinal Imaging
Harvard Medical School Genitourinary Imaging
Boston, Massachusetts Musculoskeletal Imaging
Neuroradiology Imaging
Nuclear Medicine
Pediatric Imaging
Thoracic Imaging
Ultrasound
Vascular and Interventional Imaging
 THE REQUISITES

Breast Imaging
THIRD EDITION
Debra M. Ikeda, MD, FACR, FSBI
Professor
Department of Radiology
Stanford University School of Medicine
Stanford, California

Kanae K. Miyake, MD, PhD

Program-Specific Assistant Professor
Department of Diagnostic Imaging and Nuclear Medicine
Kyoto University Graduate School of Medicine
Kyoto, Japan
Visiting Assistant Professor
Department of Radiology
Stanford University School of Medicine
Stanford, California
3251 Riverport Lane
St. Louis, Missouri 63043

THE REQUISITES: BREAST IMAGING,THIRD EDITION ISBN: 978-0-323-32904-0

Copyright © 2017 by Elsevier Inc.

Previous editions copyrighted 2011 and 2004

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Library of Congress Cataloging-in-Publication Data

Names: Ikeda, Debra M., author. | Miyake, Kanae K., author.

Title: Breast imaging / Debra M. Ikeda, Kanae K. Miyake.
Other titles: Requisites series.
Description:Third edition. | St. Louis, Missouri : Elsevier, [2017] |
Series: Requisites | Includes bibliographical references and index.
Identifiers: LCCN 2016032302 | ISBN 9780323329040 (hardcover : alk. paper)
Subjects: | MESH: Mammography | Breast Diseases--diagnosis | Ultrasonography,
Mammary | Magnetic Resonance Imaging--methods
Classification: LCC RG493.5.R33 | NLM WP 815 | DDC 618.1/907572--dc23 LC record available at
https://lccn.loc.gov/2016032302

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 For my mother, Dorothy Yoshie Kishi Ikeda
Pearl City, Hawaii
and
For my father, Otto Masaru Ikeda, and brother
Clyde Seiji Ikeda
Puowaina (Punchbowl), Honolulu, Hawaii
Debra M. Ikeda

For my mother, Chikako Miyake

Gifu, Japan
and
For my father, Akihide Miyake
Tokiwacho, Kyoto, Japan
Kanae K. Miyake
Contributors
Bruce L. Daniel, MD Ellen B. Mendelson, MD, FACR, FSBI, FSRU
Professor of Radiology Lee F. Rogers Professor of Medical Education in Radiology
Stanford University School of Medicine Professor of Radiology
Stanford, California Department of Radiology
Feinberg School of Medicine, Northwestern University
Frederick M. Dirbas, MD Chicago, Illinois
Associate Professor of Surgery
Stanford University School of Medicine Kanae K. Miyake, MD, PhD
Leader, Breast Disease Management Group Program-Specific Assistant Professor
Stanford Cancer Center Diagnostic Imaging and Nuclear Medicine
Stanford, California Kyoto University Graduate School of Medicine
Kyoto, Japan
Dipti Gupta, MD Visiting Assistant Professor
Assistant Professor Department of Radiology
Section of Breast Imaging Stanford University School of Medicine
Northwestern Memorial Hospital Stanford, California
Chicago, Illinois
Camila Mosci, MD, MSc
R. Edward Hendrick, PhD, FACR, FSBI, FAAPM, FISMRM Professor of Nuclear Medicine
Clinical Professor of Radiology Department of Radiology
University of Colorado-Denver School of Medicine University of Campinas
Aurora, Colorado Campinas, Sao Paulo, Brazil

Kathleen C. Horst, MD Dung H. Nguyen, MD, PharmD

Assistant Professor Clinical Assistant Professor
Department of Radiation Oncology Stanford University
Stanford University School of Medicine Stanford, California
Stanford, California Director of Breast Reconstruction
Stanford Cancer Center
Debra M. Ikeda, MD, FACR, FSBI Palo Alto, California
Professor
Department of Radiology Andrew Quon, MD
Stanford University School of Medicine Medical Director, Clinical PET-CT
Stanford, California Associate Professor of Radiology
Stanford University School of Medicine
Stanford, California

vi
Foreword
The first two editions of Breast Imaging: The Requisites
were both outstanding texts and captured the philoso-
phy of the Requisites in Radiology series by presenting
complex material in a concise, logical, and straightforward
way, making the material very accessible to the reader. Drs.
Ikeda and Miyake and their contributors have again suc-
ceeded in achieving these attributes for the third edition
of their book. Important new material has been added, and
material on all enduring methods has been updated.
In light of the trend toward standardized reporting in
radiology, it is noteworthy that breast imaging has been
an exemplar within the specialty for the use of standard-
ized reporting through the use of BI-RADS®. Indeed, un-
derstanding the use of this reporting system is crucial to
successful clinical practice in breast imaging. To this end,
Drs. Ikeda and Miyake have systematically incorporated
the revised BI-RADS® 2013 system that encompasses ul-
trasound and MRI reporting as well as mammography, and
they explain how to use the BI-RADS® 2013 lexicon cor-
rectly. Readers will find this material of daily practical use.
Screening and diagnostic applications of x-ray mammog-
raphy remain the most commonly performed procedures
in breast imaging, but the technology for performing these
studies has changed dramatically over the last decade, with
widespread use of digital imaging and increasing use of
tomosynthesis. These advances in technology are compre-
hensively described in the third edition of Breast Imaging:
The Requisites. Many positive consequences related to the
use of digital mammography and tomosynthesis have been
more firmly established since the previous edition, such
as improved cancer detection and reduced callback rates.
Beyond x-ray–based mammography, no area of special-
ization in radiology has seen more expansion of scope or
complexity than breast imaging. The specialty now en-
compasses the use of all medical imaging methods—x-ray,
ultrasound, MRI, nuclear medicine—and addresses a spec-
trum of applications that includes screening, diagnosis,
surveillance, interventions, and assessment of therapeutic
efficacy. Functional and molecular information is now in-
corporated into the practice of breast imaging. Separate
chapters of Breast Imaging: The Requisites are devoted
to each of these topics. The chapters are laid out in a logi-
cal fashion, with a succinct summary statement of key ele-
ments at the end.
New material in the third edition incorporates substan-
tial advances in our understanding of the challenges of
diagnosing breast cancer and therewith development of
optimal strategies for employing different imaging meth-
ods. For example, strategies for enhanced surveillance us-
ing ultrasound and MRI have been informed by advances
in our understanding of the genetics of breast cancer and
genotype-related risks. Likewise, strategies incorporating
nuclear medicine, ultrasound, and MRI methods have been
developed to help better detect disease in women with
dense breast tissue.
High-quality images are a fundamental basis for success-
ful radiology practice. Presentation of high-quality images is
even more important in textbooks in order to provide the
reader with clear, easily comprehended examples of image
findings. Drs. Ikeda and Miyake and their contributors have
achieved a high standard in this regard. Readers will again
find that this edition of Breast Imaging: The Requisites is
generously illustrated with very high-quality material.
While the technology and scientific understanding of
breast imaging continue to advance, the special relation-
ship of breast imaging specialists and their patients has not
changed. Breast imaging radiologists have a special respon-
sibility as stewards of patient care in going from screen-
ing to diagnosis, to assessment of surgical specimens, to
clinical staging, and finally to assessment of therapeutic
outcome and long-term follow-up. The intimate relation-
ship between radiologists and their patients with breast
disease is unique in radiology practice. As in the previous
editions of Breast Imaging: The Requisites, Drs. Ikeda and
Miyake have captured the importance of this relationship
and especially the philosophy that the fundamental goal is
to save women’s lives.
The Requisites in Radiology series is well into its third
decade and is now an old friend to a large number of ra-
diologists around the world. The intent of the series has
always been to provide residents, fellows, and clinical
­
practitioners with reliable, factual material, uncluttered
with conjecture or speculation, that can serve as a durable
basis for daily practice. As series editor, I have always asked
writers to include what they use in their own practices
and what they teach their own trainees and to not include
extraneous material just for the sake of “completeness.”
Reference books are also valuable but serve a different
purpose.
I would like to congratulate Drs. Ikeda and Miyake for
sustaining the goals of the Requisites series and for pro-
ducing another outstanding book. Readers will benefit
from the authors’ knowledge and also from their experi-
ence and wisdom in one of the most challenging areas of
medical practice.
James H. Thrall, MD
Radiologist-in-Chief Emeritus
Massachusetts General Hospital
Distinguished Taveras Professor of Radiology
Harvard Medical School
Boston, Massachusetts
vii
Preface
The specialty of breast imaging is a uniquely challenging and per-
sonal combination of imaging, biopsy procedures, clinical corre-
lation, advances in technology, and compassion. A breast cancer
diagnosis is intensely personal and potentially devastating for the
patient. The radiologist’s job is to detect and diagnose the can-
cer and gently support the patient through discovery, diagnosis,
treatment, and follow-up.The radiologist’s role has changed from
simply identifying cancers to being deeply involved in diagnosis,
biopsy, and follow-up. Instead of sitting alone in a dark room, the
radiologist is truly part of a team of oncologic surgeons, patholo-
gists, radiation oncologists, medical oncologists, plastic surgeons,
geneticists, and, most importantly, the patient.
This is a very simple book. Its purpose is to help the first-year
resident understand why the mammogram, the ultrasound, and
the MRI look the way they do in benign disease or in cancer.
The other purpose is to help senior residents/fellows pass their
boards.With careful scrutiny of each chapter, residents will know
clinical scenarios in which cancers occur; develop a systematic
method of analyzing images; be able to generate a differential
diagnoses for masses, calcifications, and enhancement; and know
how manage patients.
Even though the book is simple, the pictures and tools in the
book can be adapted to your general clinical practice.Thus, when
you come upon a tough case out in the “real world,” look to the
skills that you learned in this book to solve problems. Use all
the tricks you learned on each tough case, because there will
be tough cases. Adversity is inevitable. If you welcome adversity
as your personal challenge and opportunity, and if you use com-
mon sense, you will most certainly succeed. Remember, the goal
of imaging is for the good of the patient—to diagnose and treat
breast cancer so that the patient will live. Therefore, with each
challenging case, view the adversity of the difficult diagnosis as
your responsibility, your challenge, and your opportunity. Keep
using the tools in this book until you overcome your problem.
As Bruce Daniel told me when I was flailing around in the most
difficult of MRI-guided procedures, within the realm of common
sense, “Never give up!”
viii
Two days before Christmas in 1986, in my junior year as a
resident, my 62-year-old mother’s mammogram showed a 7-mm
suspicious spiculated nonpalpable breast mass. The mass was
detected because the University of Michigan had hired Visiting
Professor Dr. Ingvar Andersson from Malmo, Sweden (principal
investigator of the randomized, controlled, population-based
Malmo Mammographic Screening Project), who updated our
equipment, started a QA program, and taught faculty/trainees
state-of-the-art breast imaging interpretation. Because of him, my
mother underwent a brand-new diagnostic technique brought
from Sweden: fine-needle aspiration under x-ray guidance using a
grid coordinate plate. The aspirate showed cancer. We were dev-
astated. My mom had a second opinion for surgery on Christmas
Eve and underwent mastectomy 2 days after Christmas. On New
Year’s Eve, we got the good news that it was a very small invasive
tumor, that there were negative axillary lymph nodes, and that
she had a good prognosis.
Naturally, I wanted to learn everything about breast imaging
because of my experience of what happens within families when
a loved one is diagnosed with breast cancer. I knew that diagno-
sis and treatment of early-stage breast cancers can result in a long,
healthy life for the woman. I knew that we, as radiologists, could
train to find and diagnose early breast cancer, profoundly affect-
ing women and their families for the better. So I learned breast
imaging from excellent teachers. Dr. Miyake and I want you to
learn breast imaging, find the little cancer like my mother’s tu-
mor, and save her life again.
My mom is now 92 years old and living in Hawaii. Remember
our story. I want everyone who reads this book to have the op-
portunity to perceive and diagnose small cancers, intervene, and
have this outcome. When this outcome is not possible, I want
everyone who reads this book to use their knowledge to help
their patient through her journey. Someday we may not need this
book because there will be further advances in science. Until that
happy day comes, we ask those who read this book to use your
knowledge to help women.
Debra M. Ikeda, MD, FACR, FSBI
Acknowledgments
I would like to thank my mentors, Dr. Edward A. Sickles and
Dr. Ingvar Andersson, who inspired me, taught me breast cancer
imaging, and have always supported my career. I especially thank
my wonderful husband, Glenn C. Carpenter, who is so generously
supportive, giving me the “gift of time” to work on the book. Most
of all, I wish to thank my awesome co-editor, Dr. Kanae Kawai
Miyake, who wrote, reviewed, and cropped images; trained as-
sistants; provided an incredible database for our project; and
has been so wonderful to work with as a meticulous, organized
scientist, making sure every image, reference, and statement had
appropriate scientific or clinical relevance. I was truly blessed
when Dr. Kaori Togashi supported Dr. Miyake’s sabbatical from
Kyoto University to work at Stanford. I have rarely seen anyone so
dedicated and devoted to making complex ideas so very simple
that even I can understand them! Dr. Miyake has done outstand-
ing work to improve and update this book, and it could not have
been done without her tenacity and generous nature. Our col-
laboration and friendship is an experience I will never forget.
Dr. Debra M. Ikeda
It was a great pleasure for me to be a part of this book, having the
opportunity to share these educational cases with readers world-
wide. I have been working with Dr. Ikeda as a Visiting Assistant
Professor at Stanford since October 2013, since which time we
have been working on Breast Imaging together. I still remember
that I read a previous edition of this book when I was a young
radiologist and used to keep it on my desk so that I could refer
to it when I met difficult cases. It was an indescribable honor for
me to be able to contribute to the new edition.
The previous edition was an excellent book, providing fun-
damental knowledge and useful tips to diagnose breast cancer,
written in a reader-friendly manner. I was moved to tears when
I read Dr. Ikeda’s preface, filled with her sense of responsibil-
ity for patients, her strong fighting spirit to battle against breast
cancer, and her consideration for all breast radiologists. Through
editing the new edition, I have realized that she is truly such a
person. She is a wonderful expert, an enthusiastic teacher, and
an affectionate woman. Her noble intention and tenacious efforts
inspired me, and her dedication and leading ideas made the book
evolve. I hope that our book will provide practical help to pa-
tients and doctors fighting against breast cancer as they face the
difficulties that lay ahead of them. I greatly thank Dr. Debra M.
Ikeda for including me in this work.
I thank Dr. Kaori Togashi, the current chair of Department of
Radiology at Kyoto University, Japan, who has always supported
me and encouraged me as a radiologist and a nuclear medicine
physiologist. I thank Dr. Junji Konishi, a former chair of Depart-
ment of Radiology at Kyoto University, who helped me have the
wonderful opportunity to work at Stanford. I thank my mentors,
Dr. Yuji Nakamoto and Dr. Shotaro Kanao, who taught me PET
and breast imaging while I was at Kyoto University. I thank my
beloved little son, Toma Kawai, who brings happiness into my
life, and my husband and best friend, Toshiyuki Kawai, who al-
ways supports my work and walks the path of joyful life together
with me. I thank my dad, Akihide Miyake, who has affectionately
looked over our family from the sky since the age of 36, and my
mom, Chikako Miyake, who bravely raised three kids and always
wishes happiness and good health to all.
Dr. Kanae K. Miyake
No book is completed without tremendous efforts on the
part of many people. We wish to acknowledge our co-authors,
Dr. R. Edward Hendrick, Dr. Ellen B. Mendelson, Dr. Dipti Gupta,
Dr. Bruce L. Daniel, Dr. Kathleen C. Horst, Dr. Frederick M. Dirbas,
Dr. Dung Hoang Nguyen, Dr. Andrew Quon, and Dr. Camila Mosci
for their invaluable scientific and educational contributions in
their book chapters. We wish to thank our assistants Adrian C.
Carpenter, Catherine M. Carpenter, and John Chitouras for their
dogged, painstaking, but cheerful help with the massive files of
images, references, tables, and text. We thank Mark Riesenberger
for his fabulous HIPAA compliant, web-based IT support, without
which we would have been frozen 2 years ago. We thank our
Elsevier editors Robin Carter, Angie Breckon, and Julia Roberts
for their support and (sometimes) gentle prodding to complete
the book.
We thank Dr. Jafi Lipson, Dr. Sunita Pal, and Dr. Jennifer Kao
for sharing ideas of what might be good tools or illustrations for
teaching residents and providing images. We thank our physician
contributors at Kyoto University, Japan, Dr. Shotaro Kanao and
Dr. Yuji Nakamoto for their beautiful images and written contri-
butions to the book to increase our knowledge of MRI and PET.
We thank Dr. Kaori Togashi, Radiology Chairman at Kyoto
University, who generously supported Dr. Kanae Kawai Miyake
in writing this book and in her research. We both wish to emu-
late her superb example as a chairman, scientist, physician, and
compassionate mentor to radiologists and women. We thank
Dr. S. Sanjiv (Sam) Gambhir, Radiology Chairman at Stanford
­University, and the late Dr. Gary M. Glazer for their vision and sup-
port of Stanford Breast Imaging, who were always and constantly
seeking ways to provide the best technology and the earliest de-
tection and keenly pursuing newest research for our women to
save them from breast cancer.
We thank all the scientists, doctors, engineers, and physicists
who support our breast cancer patients and women and who
battle breast cancer on their behalf. We especially wish to recog-
nize the struggle of our many breast cancer patients and women
undergoing screening; this book was written for them, directed
to all who wish to help them by learning about breast imaging.
Thank you.
Dr. Debra M. Ikeda and Dr. Kanae K. Miyake
ix
Contents
Chapter 1
Mammography Acquisition: Screen-Film,
Digital Mammography and Tomosynthesis,
the Mammography Quality Standards Act,
and Computer-Aided Detection 1
R. Edward Hendrick, Debra M. Ikeda, and Kanae K. Miyake
Chapter 2
Mammogram Analysis and Interpretation
Debra M. Ikeda and Kanae K. Miyake
Chapter 3
Mammographic Analysis of Breast Calcifications 75
Debra M. Ikeda and Kanae K. Miyake
Chapter 4
Mammographic and Ultrasound Analysis
of Breast Masses 122
Kanae K. Miyake and Debra M. Ikeda
Chapter 5
Breast Ultrasound Principles 171
Dipti Gupta and Ellen B. Mendelson
Chapter 6
Mammographic and Ultrasound-Guided Breast
Biopsy Procedures 218
Debra M. Ikeda and Kanae K. Miyake
x
Chapter 7
Magnetic Resonance Imaging of Breast Cancer
and Magnetic Resonance Imaging–Guided Breast
Biopsy 259
Kanae K. Miyake, Debra M. Ikeda, and Bruce L. Daniel
Chapter 8
Breast Cancer Treatment-Related Imaging
30 and the Postoperative Breast 321
Kathleen C. Horst, Kanae K. Miyake, Debra M. Ikeda, and
Frederick M. Dirbas
Chapter 9
Breast Implants and the Reconstructed Breast 357
Kanae K. Miyake, Debra M. Ikeda, Dung H. Nguyen, and
Bruce L. Daniel
Chapter 10
Clinical Breast Problems and Unusual Breast
Conditions 397
Debra M. Ikeda and Kanae K. Miyake
Chapter 11
18F-FDG PET/CT and Nuclear Medicine
for the Evaluation of Breast Cancer 439
Camila Mosci, Kanae K. Miyake, and Andrew Quon
Index 466
Video Contents
Chapter 1
Video 1-1A: Digital Breast Tomosynthesis,
Projection Images
Video 1-1B: Digital Breast Tomosynthesis,
Reconstructed Slices
Video 1-2: Digital Breast Tomosynthesis of the
American College of Radiography
Mammography Phantom
Chapter 2
Video 2-1: Digital Breast Tomosynthesis in
Mediolateral Oblique Projection:
Cancer in a “Danger Zone”
Video 2-2A: Digital Breast Tomosynthesis,
Mediolateral Oblique Projection:
Workup for a Possible Mass—Cancer
Video 2-2B: Digital Breast Tomosynthesis,
Craniocaudal Projection: Workup for a
Possible Mass—Cancer
Video 2-3A: Digital Breast Tomosynthesis,
Mediolateral Oblique Projection:
Workup for a Possible Mass—Cancer
Video 2-3B: Digital Breast Tomosynthesis,
Craniocaudal Projection: Workup for a
Possible Mass—Cancer
Video 2-4A: Digital Breast Tomosynthesis,
Mediolateral Oblique Projection:
Workup for a Possible Mass—
Summation Artifact
Video 2-4B: Digital Breast Tomosynthesis,
Craniocaudal Projection: Workup for a
Possible Mass—Summation Artifact
Video 2-5A: Digital Breast Tomosynthesis Showing
Asymmetry
Video 2-5B: Digital Breast Tomosynthesis with
Spot Compression, Original View:
Workup for a Possible Mass—
Summation Artifact
Video 2-5C: Digital Breast Tomosynthesis with
Spot Compression, Magnified
View: Workup for a Possible Mass—
Summation Artifact
Video 2-6A: Digital Breast Tomosynthesis,
Mediolateral Oblique Projection:
Characterization of a True Finding in
the Extremely Dense Breast—Cancer
Video 2-6B: Digital Breast Tomosynthesis,
Craniocaudal Projection:
Characterization of a True Finding in
the Extremely Dense Breast—Cancer
Chapter 3
Video 3-1A: Systematic Search to Find Calcifications
on Tomosynthesis, Standard View
Video 3-1B: Systematic Search to Find
Calcifications on Tomosynthesis,
Magnified View
Video 3-2: Skin Calcifications on Tomosynthesis
Video 3-3: Noncalcified Vessels Leading to
Calcified Vessels on Magnified
Tomosynthesis
Chapter 4
Video 4-1: Tomosynthesis for Evaluating Masses,
Mediolateral Oblique Projection
Video 4-2: Tomosynthesis showing
Circumscribed Mass in Dense Breast
Tissue
Video 4-3A: Spiculated Mass on Tomosynthesis,
Original View
Video 4-3B: Spiculated Mass on Tomosynthesis,
Magnified View
Video 4-4A: Tomosynthesis Showing Spiculated
Mass in the Outer Left Breast,
Original View
Video 4-4B: Tomosynthesis Showing Spiculated
Mass in the Outer Left Breast,
Magnified View
Video 4-5A: Tomosynthesis Showing Summation
Artifact, Original View
Video 4-5B: Tomosynthesis Showing Summation
Artifact, Magnified View
Video 4-6A: Asymmetry: Summation Artifact on
Tomosynthesis, Original View
Video 4-6B: Asymmetry: Summation Artifact on
Tomosynthesis, Magnified View
Video 4-6C: Asymmetry: Summation Artifact on
Spot Compressed Tomosynthesis,
Original View
Video 4-6D: Asymmetry: Summation Artifact on
Spot Compressed Tomosynthesis,
Magnified View
Video 4-7A: Focal Asymmetry/Mass: Atypical
Ductal Hyperplasia on Spot
Compressed Tomosynthesis,
Original View
Video 4-7B: Focal Asymmetry/Mass: Atypical
Ductal Hyperplasia on Spot
Compressed Tomosynthesis,
Magnified View
xi
xii Video Contents
Video 4-8: Architectural Distortion: Radial Scar
on Tomosynthesis
Video 4-9A: Associated Feature: Nipple Retraction
on Tomosynthesis, Original View
Video 4-9B: Associated Feature: Nipple
Retraction on Tomosynthesis,
Magnified View
Video 4-10A: Spiculated Mass: Invasive Ductal
Carcinoma on Tomosynthesis,
Original View
Video 4-10B: Spiculated Mass: Invasive Ductal
Carcinoma on Tomosynthesis,
Magnified View
Video 4-11A: Spiculated Mass: Postbiopsy Scar on
Tomosynthesis, Original View
Video 4-11B: Spiculated Mass: Postbiopsy Scar on
Tomosynthesis, Magnified View
Video 4-12A: Spiculated Mass: Radial Scar on Spot
Compressed Tomosynthesis,
Original View
Video 4-12B: Spiculated Mass: Radial Scar on
Spot Compressed Tomosynthesis,
Magnified View
Chapter 6
Video 6-1: Vacuum-Assisted Ultrasound Biopsy
Video 6-2: Tomosynthesis-Guided Needle
Localization
Video 6-3: Tomosynthesis for the Evaluation of
Specimen
Chapter 9
Video 9-1: Silicone-Specific Magnetic Resonance
Images of Intact Silicone Implants—
Radial Fold
Video 9-2: Silicone-Specific Magnetic Resonance
Images of Intracapsular and
Extracapsular Rupture
Video 9-3: Silicone-Specific Magnetic Resonance
Images of Direct Silicone Injections
Video 9-4: Tomosynthesis of Direct Paraffin
Injections
Video 9-5: Mediolateral Oblique Tomosynthesis
of Breast after Reduction Mammoplasty
Video 9-6: Tomosynthesis Showing Skin
Calcifications around Replaced Nipple
after Reduction Mammoplasty
Chapter 1
Mammography Acquisition
Screen-Film, Digital Mammography and Tomosynthesis,
the Mammography Quality Standards Act, and
Computer-Aided Detection
R. Edward Hendrick, Debra M. Ikeda, and Kanae K. Miyake
CHAPTER OUTLINE
TECHNICAL ASPECTS OF MAMMOGRAPHY IMAGE
ACQUISITION
Screen-Film Mammography Image Acquisition
Digital Mammography Image Acquisition
Tomosynthesis Acquisition
Views and Positioning
Image Labeling in Mammography
IMAGE EVALUATION AND ARTIFACTS
QUALITY ASSURANCE IN MAMMOGRAPHY AND THE
MAMMOGRAPHY QUALITY STANDARDS ACT
Mammography is one of the most technically challenging areas
of radiography, requiring high spatial resolution, excellent soft-­
tissue contrast, and low radiation dose. It is particularly challeng-
ing in denser breasts because of the similar attenuation coeffi-
cients of breast cancers and fibroglandular tissues. The Digital
Mammographic Imaging Study Trial (DMIST) and other recent
studies have shown that digital mammography offers improved
cancer detection compared with screen-film mammography
(SFM) in women with dense breasts (Pisano et al., 2005b). As of
March 2015, 96% of the mammography units in the United States
are digital units, and some sites are using digital breast tomosyn-
thesis (DBT) systems for screening and diagnostic mammogra-
phy. Computer-aided detection (CAD) systems specific to mam-
mography are also in common use.
Randomized controlled trials (RCTs) of women invited to
mammography screening conducted between 1963 and 2000
based on SFM have shown that early detection and treatment of
breast cancer have reduced the proportion of late-stage breast
cancers and led to a 20% to 30% decrease in breast cancer mor-
tality among these women. More recent observational studies of
screening programs in Europe have shown that screening mam-
mography reduces breast cancer mortality by 38% to 48% among
women screened compared with unscreened women (Broed-
ers et al., 2012). A similar observational study in Canada showed
breast cancer mortality reduced by 44% among screened women
aged 40 to 49, 40% in screened women aged 50 to 59, 42% in
screened women aged 60 to 69, and 35% in screened women
aged 70 to 79 compared with unscreened women (Coldman
et al., 2007). The different mammography screening recommen-
dations of several major organizations are shown in Box 1.1 (Lee
et al., 2010; Oeffinger et al., 2015; Siu, 2016).
In all of these studies, image quality was demonstrated to
be a critical component of early detection of breast cancer.
Screen-Film Mammography Quality Control
Full-Field Digital Mammography Quality Assurance and
Quality Control
Digital Breast Tomosynthesis Quality Assurance and Quality
Control
COMPUTER-AIDED DETECTION
CONCLUSION
KEY ELEMENTS
SUGGESTED READINGS
To standardize and improve the quality of mammography, in
1987 the American College of Radiology (ACR) started a vol-
untary ACR Mammography Accreditation Program. In 1992,
the U.S. Congress passed the Mammography Quality Standards
Act (MQSA; P.L. 102-539), which went into effect in 1994 and
remains in effect with reauthorizations in 1998, 2004, and
2007. The MQSA mandates requirements for facilities perform-
ing mammography, including equipment and quality assur-
ance requirements, as well as personnel qualifications for
physicians, radiologic technologists, and medical physicists
involved in the performance of mammography in the United
States (Box 1.2).
This chapter outlines the basics of image acquisition using
SFM, digital mammography, and DBT. It reviews the quality assur-
ance requirements for mammography stipulated by the MQSA
and also describes the essentials of CAD in mammography.
BOX 1.1 Mammography Screening
Recommendations for Normal Risk Women from
Several Major Organizations
American College of Radiology and Society of Breast Imaging:
Annual screening starting at age 40 and continuing until a
woman’s life expectancy is less than 5-7 years
American Cancer Society: Annual screening ages 45-54, then bi-
ennial screening until a woman’s life expectancy is less than
10 years, with the option to begin annual screening at age 40
and to continue annual screening beyond age 54.
United States Preventive Services Task Force: Biennial screening
ages 50-74.
  
1
2 Chapter 1 Mammography Acquisition
BOX 1.2 Mammography Quality Standards Act of
1992
Congressional act to regulate mammography
Regulations enforced by the Food and Drug Administration (FDA)
require yearly inspections of all U.S. mammography facilities
All mammography centers must comply; noncompliance results
in corrective action or closure
Falsifying information submitted to the FDA can result in fines and
jail terms
Regulations regarding equipment, personnel credentialing and
continuing education, quality control, quality assurance, and
day-to-day operations
TECHNICAL ASPECTS OF MAMMOGRAPHY
IMAGE ACQUISITION
Mammography is performed on specially designed, dedicated
x-ray machines using either x-ray film and paired fluorescent
screens (SFM) or digital detectors to capture the image. All mam-
mography units are comprised of a rotating anode x-ray tube
with matched filtration for soft-tissue imaging, a breast compres-
sion plate, a moving grid, an x-ray image receptor, and an auto-
matic exposure control (AEC) device that can be placed under
or detect the densest portion of the breast, all mounted on a
rotating C-arm (Fig. 1.1). A technologist compresses the patient’s
breast between the image receptor and compression plate for a
few seconds during each exposure. Breast compression is impor-
tant because it spreads normal fibroglandular tissues so that can-
cers can be better seen on the superimposed structured noise
pattern of normal breast tissues. It also decreases breast thick-
ness, decreasing exposure time, radiation dose to the breast, and
the potential for image blurring as a result of patient motion and
unsharpness.
Women worry about breast pain from breast compression and
about the radiation dose from mammography. Breast pain during
compression varies among individuals and may be decreased by
obtaining mammograms 7 to 10 days after the onset of menses
when the breasts are least painful. Breast pain is also minimized
by taking oral analgesics, such as acetaminophen, before the
mammogram or by using appropriately designed foam pads that
cushion the breast without adversely affecting image quality or
increasing breast dose.
Current mammography delivers a low dose of radiation to the
breast. The most radiosensitive breast tissues are the epithelial
cells, which, along with connective tissues, make up fibroglandu-
lar elements. The best measure of breast dose is mean glandular
dose, or the average absorbed dose of ionizing radiation to the
radiosensitive fibroglandular tissues. The mean glandular dose
received by the average woman is approximately 2 mGy (0.2 rad)
per exposure or 4 mGy (0.4 rad) for a typical two-view examina-
tion. Radiation doses from digital mammography exposures tend
to be 20% to 30% lower than those from SFM. Radiation doses to
thinner compressed breasts are substantially lower than doses to
thicker breasts.
The main patient risk from mammographic radiation is the
possible induction of breast cancer 5 to 30 years after exposure.
The estimated risk of inducing breast cancer is linearly pro-
portional to the radiation dose and inversely related to age at
exposure. The lifetime risk of inducing a fatal breast cancer as a
result of two-view mammography in women aged 45 years old at
exposure is estimated to be about 1 in 100,000 (Hendrick, 2010).
For a woman aged 65 at exposure, the risk is less than 0.3 in
100,000.The benefit of screening mammography is the detection
of breast cancer before it is clinically apparent. The likelihood
of an invasive or in situ cancer present in a woman screened at
Radiation
X-ray tube
shield
Collimator
Field limiting cone Control panel
Remote hand
Compression paddle switch
Bucky (moving grid)
and digital detector or
film cassette holder
C-arm
C-arm
Foot pedals foot pedal
FIG. 1.1 Components of an x-ray mammography unit.
BOX 1.3 Mammography Generators
Provide 24–32 kVp, 5–300 mA
Half-value layer between kVp/100 + 0.03 and kVp/100 + 0.12 (in
millimeters of aluminum) for Mo/Mo anode/filter material
Average breast exposure is 26–28 kVp (lower kVp for thinner or
fattier breasts, higher kVp for thicker or denser breasts)
Screen-film systems deliver an average absorbed dose to the glan-
dular tissue of the breast of 2 mGy (0.2 rad) per exposure
  
Mo, molybdenum.
age 45 is about 1 in 500.The likelihood that the cancer would be
fatal in the absence of mammography screening is about 1 in 4,
and the likelihood that screening mammography will convey a
mortality benefit is 15% (RCT estimate for women aged 40–49) to
about 45% (observational study estimate). Hence, the likelihood
of screening mammography saving a woman’s life at this age is
about 1 in 4400 to 1 in 13,000, yielding a benefit-to-risk ratio of
8:1 to 23:1. For a woman aged 65 at screening, the likelihood
of a mortality benefit from mammography is about 1 in 2000 to
1 in 4000 (assuming a 25% to 50% mortality benefit), yielding
a benefit-to-risk ratio of approximately 90:1 to 180:1. Screening
mammography is only effective when regular periodic exams are
performed.
The generator for a mammography system provides power
to the x-ray tube. The peak kilovoltage (kVp) of mammogra-
phy systems is lower than that of conventional x-ray systems,
because it is desirable to use softer x-ray beams to increase both
soft-tissue contrast and the absorption of x-rays in the image
receptor. Low kVp is especially important for SFM, in which
screen phosphor thickness is limited to minimize image blur.
Typical kVp values for mammography are 24 to 32 kVp for
molybdenum (Mo) targets and 26 to 35 kVp for rhodium (Rh)
or tungsten (W) targets. A key feature of mammography genera-
tors is the electron beam current (milliampere [mA]) rating of
the system. The higher the mA rating, the shorter is the expo-
sure time for total tube output (milliampere second [mAs]). A
compressed breast of average thickness (5 cm) requires about
150 mAs at 26 kVp to achieve proper film densities in SFM. If
the tube rating is 100 mA (typical of the larger focal spots used
for nonmagnification mammography), the exposure time would
be 1.5 seconds. A higher output system with 150-mA output
would cut the exposure time to 1 second for the same com-
pressed breast thickness and kVp setting. Because of the wide
range of breast thicknesses, exposures require mAs values rang-
ing from 10 to several hundred mAs. Specifications for genera-
tors are listed in Box 1.3.

BOX 1.4 Anode-Filter Combinations for
Mammography
Mo/Mo
Mo/Rh
Rh/Rh
W/Rh, W/Ag, or W/Al
  
Ag, silver; Al, aluminum; Mo, molybdenum; Rh, rhodium; W, tungsten.
The most commonly used anode/filter combination is Mo/Mo
consisting of an Mo anode (or target) and an Mo filter (25–30 μm
thick).This is used for thinner compressed breasts (<5 cm thick).
Most current manufacturers also offer an Rh filter to be used with
the Mo target (Mo/Rh), which produces a slightly more penetrat-
ing (harder) x-ray beam for use with thicker breasts. Some manu-
facturers offer other target materials, such as Rh/Rh, which is an
Rh target paired with an Rh filter, and a W target paired with a
Rh filter (W/Rh or with an aluminum [Al] filter [W/Al]). These
alternative anode/filter combinations are designed for thicker
(>5 cm) and denser breasts. Typically, higher kVp settings are
used with these alternative target/filter combinations to create
a harder x-ray beam for thicker breasts, because fewer x-rays are
attenuated with a harder x-ray beam (Box 1.4). One of the best
parameters to measure the hardness or penetrating capability of
an x-ray beam is the half-value layer (HVL), which represents the
thickness of Al that reduces the x-ray exposure by one-half. The
harder the x-ray beam, the higher is the HVL. The typical HVL
for mammography is 0.3 to 0.5 mm of Al. The Food and Drug
Administration (FDA) requires that the HVL for mammography
cannot be less than kVp/100 ± 0.03 (in millimeters of Al), so that
the x-ray beam is not too soft (ie, does not contain too many low-
energy x-rays that contribute to breast radiation dose but not to
image contrast because they are all absorbed in breast tissue).
For example, at 28 kVp the HVL cannot be less than 0.31 mm of
Al. There is also an upper limit on the HVL that depends on the
target–filter combination. For Mo/Mo, the HVL must be less than
kVp/100 +0.12 (in mm of Al); thus, for 28 kVp, the HVL must be
less than 0.4 mm of Al.
The usual mammography focal spot size for standard contact
(ie, nonmagnification) mammography is typically 0.3 mm. Mag-
nification mammography requires a smaller focal spot, (about
0.1 mm) to reduce penumbra (geometric blurring of structures
in the breast produced because the breast is closer to the x-ray
source and farther from the image receptor to produce greater
“geometric” magnification). The effect of focal spot size on reso-
lution in the breast is tested by placing a line pair (lp) pattern
in the location of the breast at a specific distance (4.5 cm) from
the breast support surface. For SFM, the larger 0.3-mm mam-
mography focal spot used for standard, contact mammography
should produce an image that resolves at least 11 lp/mm when
the lines of the test pattern run in the direction perpendicular
to the length of the focal spot (this measures the blurring effect
of the length of the focal spot) and at least 13 lp/mm when
the lines run parallel to the focal spot (measuring the blurring
effect of the width of the focal spot). Thus, although the SFM
image receptor can resolve 18 to 21 lp/mm, the geometry of
the breast in contact mammography and the finite-sized larger
focal spot reduce the limiting spatial resolution of the system to
11 to 15 lp/mm in the breast. The limiting spatial resolution of
digital mammography systems is less (5–10 lp/mm), caused by
pixelization of the image by the digital image receptor. In digital,
a line is 1 pixel width, and a line pair is 2 pixels. For example, for
a digital detector with 100-micron (0.1-mm) pixel size or pitch
(the center-to-center distance between adjacent pixels), a line
pair consists of 2 pixels or 200 microns (0.2 mm).Therefore, one
can fit five line pairs (at 0.2 mm each) into a 1-mm length, or the
Chapter 1 Mammography Acquisition 3
detector has a limiting spatial resolution of 5 lp/mm. By similar
reasoning, a digital detector with 50-micron pixels has a limiting
spatial resolution of 10 lp/mm.
The x-ray tube and image receptor are mounted on opposite
ends of a rotating C-arm to obtain mammograms in almost any
projection.The source-to-image receptor distance (SID) for mam-
mography units must be at least 55 cm for contact mammogra-
phy. Most systems have SIDs of 65 to 70 cm.
Geometric magnification is achieved by moving the breast
farther from the image receptor (closer to the x-ray tube) and
switching to a small focal spot, about 0.1 mm in size (Fig. 1.2).
Placing the breast halfway between the focal spot and the
image receptor (see Fig. 1.2B) would magnify the breast by a
factor of 2.0 from its actual size to the image size because of
the divergence of the x-ray beam.The MQSA requires that mam-
mography units with magnification capabilities must provide
at least one fixed magnification factor of between 1.4 and 2.0
(Table 1.1). Geometric magnification makes small, high-contrast
structures such as microcalcifications more visible by making
them larger relative to the noise pattern in the image (increas-
ing their signal-to-noise ratio [SNR]). Optically or electronically
magnifying a contact image, as is done with a magnifier on SFM
or using a zoom factor greater than 1 on a digital mammogram,
does not increase the SNR of the object relative to the back-
ground, because both object and background are increased in
size equally. To avoid excess blurring of the image with geo-
metric magnification, it is important to use a sufficiently small
focal spot (usually 0.1 mm nominal size) and not too large a
magnification factor (2.0 or less). When the small focal spot is
selected for geometric magnification, the x-ray tube output is
decreased by a factor of 3 to 4 (to 25–40 mA) compared with
that from a large focal spot (80–150 mA).This can extend imag-
ing times for magnification mammography, even though the
grid is removed in magnification mammography. The air gap
between the breast and image receptor provides adequate scat-
ter rejection in magnification mammography without the use
of an antiscatter grid.
Collimators near the x-ray tube control the size and shape of
the x-ray beam to decrease patient exposure to tissues beyond
the compressed breast and image receptor. In mammography,
the x-ray beam is collimated to a rectangular field to match the
image receptor rather than the breast contour, because x-rays
striking the image receptor outside the breast do not contrib-
ute to breast dose. By federal regulation, the x-ray field cannot
extend beyond the chest wall of the image receptor by more
than 2% of the SID.Thus for a 60-cm SID unit, the x-ray beam can
extend beyond the chest wall edge of the image receptor by no
more than 1.2 cm.
The compression plate and image receptor assembly hold the
breast motionless during the exposure, decreasing the breast
thickness and providing tight compression, better separating
fibroglandular tissues in the breast (Fig. 1.3). The compression
plate has a posterior lip that is more than 3 cm high and usually
is oriented at 90 degrees to the plane of the compression plate
at the chest wall.This lip keeps chest wall structures from super-
imposing and obscuring posterior breast tissue in the image.The
compression plate must be able to compress the breast for up
to 1 minute with a compression force of 25 to 45 lb. The com-
pression plate can be advanced by a foot-controlled motorized
device and adjusted more finely with hand controls. Because
the radiation dose to the breast is decreased in thinner breasts,
breast compression, which thins the breast, also decreases radia-
tion dose.
Screen-Film Mammography Image Acquisition
In SFM, the image receptor assembly holds a screen-film cassette
in a carbon-fiber support with a moving antiscatter grid in front
of the cassette and an AEC detector behind it (see Fig. 1.3A).
4 Chapter 1 Mammography Acquisition

Magnification
stand

A B

C D
FIG. 1.2 Magnification mammography improves resolution. Nonmagnified, or contact, mammography (A) and
geometrically magnified mammography (B). Using a small or microfocal (0.1-mm) focal spot with the configura-
tion shown in (B), higher spatial resolution can be obtained in the breast compared with (A) in which a larger
(0.3-mm) focal spot is used. (C) Craniocaudal mammogram shows a possible benign mass in the inner breast.
(D) Microfocal magnification shows irregular borders not seen on the standard view.

TABLE 1.1 Mammography Focal Spot Sizes and Source-
to-Image Distances
Mammography Nominal Focal Source-to-Image
Type Spot Size (mm) Distance (cm)
Contact film screen 0.3 ≥55
Magnification 0.1 ≥55
The Mammography Quality Standards Act requires magnification factors between
1.4 and 2.0 for systems designed to perform magnification mammography.
Screen-film image receptors are required to be 18 × 24 cm and
24 × 30 cm in size to accommodate both smaller and larger
breasts (Box 1.5). Each size image receptor must have a mov-
ing antiscatter grid composed of lead strips with a grid ratio
(defined as the ratio of the lead strip height to the distance
between strips) between 3.5:1 and 5:1. The reciprocating grid
moves back and forth in the direction perpendicular to the grid
lines during the radiographic exposure to eliminate grid lines
in the image by blurring them out. One manufacturer uses a
hexagonal-shaped grid pattern to improve scatter rejection; this
grid is also blurred by reciprocation during exposure. Use of
a grid improves image contrast by decreasing the fraction of
scattered radiation reaching the image receptor. Grids increase
the required exposure to the breast by approximately a factor
of 2 (the Bucky factor), because of the attenuation of primary,
as well as scattered, radiation. Grids are not used with magnifi-
cation mammography. Instead, in magnification mammography,
scatter is reduced by collimation and by rejection of scattered
x-rays due to a significant air gap between the breast and image
receptor.
The AEC system, also known as the phototimer, is calibrated
to produce a consistent film optical density (OD) by sampling
the x-ray beam after it has passed through the breast support,
grid, and cassette. The AEC detector is usually a D-shaped sen-
sor that lies along the midline of the breast support and can
be positioned by the technologist closer to or farther from the
chest wall. If the breast is extremely thick or inappropriate
technique factors are selected, the AEC will terminate exposure
at a specific backup time (usually 4–6 seconds or 300–750 mAs)
to prevent tube overload or melting of the x-ray track on the
anode.
Screen-film cassettes used in mammography have an inherent
spatial resolution of 18 to 21 lp/mm. Such resolution is achieved
typically by using a single-emulsion film placed emulsion side
 Chapter 1 Mammography Acquisition 5

Compression Compression
paddle paddle

Posterior Posterior
Carbon-fiber surface Carbon-fiber surface
lip 3 cm lip 3 cm
of image receptor of image receptor
support support

90 degrees Grid 90 degrees Grid

Cassette Detector
panel

AEC Screen Film

A detector B
FIG. 1.3 Schematic of a compression paddle and image receptor of screen-film mammography (A) and of digital
mammography (B), showing the components of the cassette holder, the compression plate, and the breast. The
film emulsion faces the screen. AEC, automatic exposure control. (Adapted from Farria DM, Kimme-Smith C,
Bassett LW: Equipment, processing, and image receptor. In Bassett LW, editor: Diagnosis of diseases of the breast,
Philadelphia, 1997, WB Saunders, pp 32 and 34.)

TABLE 1.2 Variables Affecting Image Quality of Screen-

BOX 1.5 Compression Plate and Imaging Receptor
Both 18 × 24-cm and 24 × 30-cm sizes are required
A moving grid is required for each image receptor size
The compression plate has a posterior lip >3 cm and is oriented 90
degrees to the plane of the plate
Compression force of 25–45 lb
Paddle advanced by a foot motor with hand-compression
adjustments
Collimation to the image receptor and not the breast contour
down against a single intensifying screen that faces upward
toward the breast in the film cassette. The single-emulsion film
with a single intensifying screen is used to prevent the paral-
lax unsharpness and crossover exposure that occur with double-
emulsion films and double-screen systems. One manufacturer has
introduced a double-emulsion film with double-sided screens
(EV System, Carestream Health, formerly Eastman Kodak Health
Group) with a thinner film emulsion and screen on top to mini-
mize parallax unsharpness. Most screen-film processing combi-
nations have relative speeds of 150 to 200, with speed defined
as the reciprocal of the x-ray exposure (in units of Roentgen)
required to produce an OD of 1.0 above base plus fog (1.15–1.2,
because base plus fog OD is 0.15–0.2).
Film processing involves development of the latent image
on the exposed film emulsion. The film is placed in an auto-
matic processor that takes the exposed film and rolls it
through liquid developer to amplify the latent image on the
film, reducing the silver ions in the x-ray film emulsion to
metallic silver, resulting in film darkening in exposed areas.
The developer temperature ranges from 92°F to 96°F. The film
is then run through a fixer solution containing thiosulfate (or
hypo) to remove any unused silver and preserve the film. The
film is then washed with water to remove residual fixer, which
if not removed can cause the film to turn brown over time.The
film is then dried with heated air.
Film processing is affected by many variables, and the most
important is developer chemistry (weak or oxidized chemistry
makes films lighter and lower contrast), developer temperature
(too hot may make films darker, and too cool may make films
lighter), developer replenishment (too little results in lighter,
Film Mammograms
Film too dark Developer temperature too high
Wrong mammographic technique
(excessive kVp or mAs)
Excessive plus-density control
Film too light Inadequate chemistry or replenishment
Developer temperature too low
Wrong mammographic technique
Lost contrast Inadequate chemistry or replenishment
Water to processor turned off
Changed film
Film turns brown Inadequate rinsing of fixer
Motion artifact Movement by patient
Inadequate compression applied
Inappropriate mammographic technique
(long exposure times)
lower contrast films), inadequate agitation of developer, and
uneven application of developer to films (causing film mottling;
Table 1.2).
Film viewing conditions must be appropriate (Fig. 1.4).
Because mammography viewboxes have high luminance levels
(>3000 cd/m2 [3000 nit]), mammograms should be masked so
that no light strikes the radiologist’s eye without passing through
the exposed film. Because of high luminance levels film collima-
tion of x-ray exposure should be rectangular and extend slightly
beyond the edge of the image receptor so that film is darkened
to its edges. Viewbox luminance should be reasonably uniform
across all viewbox panels. In addition, the ambient room illumi-
nation should be low (<50 lux, and preferably less) to minimize
“dazzle glare” from film surfaces. Both viewbox luminance and
room illumination should be checked annually by the medical
physicist as part of the site quality control program, as specified
in the ACR Mammography Quality Control Manual.
Digital Mammography Image Acquisition
In digital mammography, the image is obtained in the same
manner as in screen-film mammography, using a compression
6 Chapter 1 Mammography Acquisition

plate and an x-ray tube, with the screen-film cassette replaced
by a digital detector (see Fig. 1.3B). Digital image acquisition
has several potential advantages in terms of image availability,
image processing, making annotations (Fig. 1.5), and CAD. One
advantage is elimination of the film processor, which elimi-
nates artifacts and image noise added during film processing.
The image contrast of digital mammography is different among
vendors depending on the digital look-up curve, which governs
FIG. 1.4 Film-viewing conditions. Because mammography view-
boxes have high luminance levels (>3000 cd/m2 [3000 nit]),
mammograms should be masked so that no light strikes the radi-
ologist’s eye without passing through the exposed film. Because
of the high luminance, film collimation should be rectangular and
extend slightly beyond the edge of the image receptor so that film
is darkened to its edges. Viewbox luminance should be reasonably
uniform across all viewbox panels. In addition, the ambient room
illumination should be low (<50 lux, and preferably less) to mini-
mize “dazzle glare” from film surfaces. Both viewbox luminance
and room illumination should be checked annually by the medical
physicist as part of the site quality control program (see the ACR
Mammography Quality Control Manual, 1999 edition).
how digital signals are translated into pixel gray scale values.
Figure 1.6 shows digital mammograms that were obtained with
two machines from different vendors demonstrating how the
image contrast varies.
Digital mammography uses indirect or direct digital detec-
tors. Indirect digital detectors use a fluorescent screen made of
materials such as cesium iodide (CsI) to convert each absorbed
x-ray to hundreds of visible light photons. Behind the fluorescent
material, light-sensitive detector arrays made of materials such
as amorphous silicon diodes or charge-coupled devices measure
the produced light pixel by pixel. The weak electronic signal
measured in each pixel is amplified and sent through an analog-
to-digital converter, enabling computer storage of each pixel’s
measured detector signal.
Direct digital detectors use detector elements that capture
and count x-rays directly, although amplification and analog-to-
digital conversion are still applied. Another method to produce
digital mammograms involves amorphous selenium. An amor-
phous selenium plate is an excellent absorber of x-rays and an
excellent capacitor, storing the charge created by ionization
when x-rays are absorbed. After exposure, an electronic device
is used to read out the charge distribution on the selenium
plate, which is in proportion to local exposure. This can be
done by scanning the selenium plate with a laser beam or by
placing a silicon diode array in contact with one side of the
plate, with bias voltage applied, to read out the stored charge.
Each of these methods allows production of high-resolution
digital images.
Another approach to full-field digital mammography (FFDM)
is computed radiography (CR), which uses a photostimulable
phosphor composed of barium fluorobromide doped with
europium (BaFBr:Eu). Computed radiography uses the same
dedicated mammography units as SFM, replacing the screen-film
cassettes and film processor with CR cassettes (in sizes of 18 ×
24 cm and 24 × 30 cm) and a CR processor. The phosphor plate
within the CR cassette is used to absorb x-rays just as the screen
in a screen-film cassette. Rather than emitting light immediately
after exposure (through fluorescence), x-ray absorption in the
phosphor causes electrons within the phosphor crystals to be
promoted to higher energy levels (through photostimulation).

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FIG. 1.5 Using digital mammography and picture archiving and communication systems (PACS) for screening re-
call, two spiculated masses representing infiltrating ductal carcinoma on the craniocaudal view (A) were marked
by computer-aided detection and were recalled. The radiologist annotates the images and sends them to PACS
for the technologist to retrieve when the patient returns for workup (B).
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 CHAPTER I.

HISTORY AND LITERATURE.

The commencement of the history of Ichthyology

Aristotle. coincides with that of Zoology generally. Aristotle
(384–322 b.c.) had a perfect knowledge of the
general structure of fishes, which he clearly discriminates from the
Aquatic animals with lungs and mammæ, i.e. Cetaceans, and from
the various groups of Aquatic Invertebrates. He says that “the
special characteristics of the true fishes consist in the branchiæ and
fins, the majority having four fins, but those of an elongate form, as
the eels, having two only. Some, as the Muræna, lack the fins
altogether. The Rays swim with their whole body, which is spread
out. The branchiæ are sometimes furnished with an opercle,
sometimes without one, as is the case in the cartilaginous fishes....
No fish has hairs or feathers; most are covered with scales, but
some have a rough or smooth skin. The tongue is hard, often
toothed; and sometimes so much adherent that it seems to be
wanting. The eyes have no lids; nor are any ears or nostrils visible,
for what takes the place of nostrils is a blind cavity. Nevertheless
they have the senses of tasting, smelling, and hearing. All have
blood. All scaly fishes are oviparous, but the cartilaginous fishes
(with the exception of the Sea-devil, which Aristotle places along with
them) are viviparous. All have a heart, liver, and gall-bladder; but
kidneys and urinary bladder are absent. They vary much in the
structure of their intestines: for whilst the mullet has a fleshy stomach
like a bird, others have no stomachic dilatation. Pyloric coeca are
close to the stomach, variable in number; there are even some, like
the majority of the cartilaginous fishes, which have none whatever.
Two bodies are situated along the spine, which have the function of
testicles, and open towards the vent, and which are much enlarged
in the spawning season. The scales become harder with age. Not
being provided with lungs, they have no voice, but several can emit
grunting sounds. They sleep like other animals. In the majority the
females exceed the males in size; and in the Rays and Sharks the
male is distinguished by an appendage on each side of the vent.”
 Aristotle’s information on the habits of fishes, their migrations,
mode and time of propagation, utility, is, as far as it has been tested,
surprisingly correct. Unfortunately, only too often we lack the means
of recognising the species of which he gives a description. His ideas
of specific distinction were as vague as those of the fishermen
whose nomenclature he adopted; it never occurred to him that such
popular names are subject to change, or may be entirely lost with
time, and the difficulty of deciphering his species is further increased
by the circumstance that popular names are often applied by him to
the same fish, or that different stages of growth are designated by
distinct names. The number of fishes known to Aristotle seems to
have been about 115, all of which are inhabitants of the Ægean Sea.
That one man should have discovered so many truths, and
formed so sure a base for Zoology, is less surprising than the fact
that for about eighteen centuries a science which seemed to offer
particular attractions to men gifted with power of observation, was no
farther advanced. Yet this is the case. Aristotle’s disciples, as well as
his successors, remained satisfied to be his copiers or
commentators, and to collect fabulous stories or vague notions. With
very few exceptions (such as Ausonius, who wrote a small poem, in
which he describes from his own observations the fishes of the
Mosel) authors entirely abandoned original research. And it was not
until about the middle of the sixteenth century that Ichthyology made
a new step in advance by the appearance of Belon, Rondelet, and
Salviani, who almost simultaneously published their grand works, by
which the idea of species was established definitely and for all times.

P. Belon travelled in the countries bordering on

Belon. the eastern part of the Mediterranean, in the years
1547–50; he collected rich stores of positive
knowledge, which he deposited in several works. The one most
important for the progress of Ichthyology is that entitled “De
aquatilibus libri duo” (Paris 1553; small 4to.) Belon knows about 110
fishes, of which he gives rude, but generally recognisable, figures. In
his descriptions he pays regard to the classical as well as vernacular
nomenclature, and states the outward characteristics, sometimes
even the number of fin-rays, frequently also the most conspicuous
anatomical peculiarities.
Although Belon but rarely gives definitions of the terms used by
him, it is generally not very difficult to ascertain the limits which he
intended to assign to each division of aquatic animals. He very
properly divides them into such as are provided with blood, and into
those without it: two divisions, called in modern language Vertebrate
and Invertebrate aquatic animals. The former are classified by him
according to sizes, the further subdivisions being based on the
structure of the skeleton, mode of propagation, number of limbs,
form of the body, and on the physical character of the localities
inhabited by fishes. This classification is as follows:—
I.The larger fishes or Cetaceans.
A. Viviparous Cetaceans with bony skeletons (= Cetacea).
B. Viviparous Amphibians.
1. “With four limbs: Seals, Hippopotamus, Beaver, Otter, and other
aquatic Mammalia.
2. With two limbs: Mermaids, etc.
C. Oviparous Amphibians (= Reptiles and Frogs).
D. Viviparous Cartilaginous fishes.
1. Of an oblong form (= Sharks).
2. Of a flat form (= Rays and Lophius).
E. Oviparous Cartilaginous fishes (= Sturgeons and Silurus).
F. Oviparous Cetaceans, with spines instead of bones (= large marine
fishes, like the Thunny, Sword-fish, Sciænoids, Bass, Gadoids,
Trachypterus).
II.Spinous Oviparous fishes of a flat form (= Pleuronectidæ).
III.Fishes of a high form, like Zeus.
IV.Fishes of a snake like form (= Eels, Belone, Sphyræna).
V.Small Oviparous, spinous, scaly, marine fishes.
1. Pelagic kinds.
2. Littoral kinds.
3. Kinds inhabiting rocky localities.
VI.Fluviatile and Lacustrine fishes.
 The work of the Roman ichthyologist, H. Salviani
Salviani. (1514–72), is characteristic of the high social
position which the author held as the physician of
three popes. Its title is “Aquatilium animalium historia” (Rom. 1554–
57, fol.) It treats exclusively of the fishes of Italy. Ninety-two species
are figured on seventy-six plates which, as regards artistic execution,
are masterpieces of that period, although those specific
characteristics which nowadays constitute the value of a zoological
drawing, were entirely overlooked by the author or artist. No attempt
is made at a natural classification, but the allied forms generally are
placed in close proximity. The descriptions are quite equal to those
given by Belon, entering much into the details of the economy and
usefulness of the several species, and were evidently composed
with the view of collecting in a readable form all that might prove of
interest to the class of society in which the author moved. Salviani’s
work is of a high standard, most remarkable for the age in which he
lived. It could not fail to convey valuable instruction, and to render
Ichthyology popular in the country to the fauna of which it was
devoted, but it would not have advanced Ichthyology as science
generally; and in this respect Salviani is not to be compared with
Rondelet or Belon.

G. Rondelet (1507–1557) had the great advantage

Rondelet. over Belon in having received a medical education at
Paris, and more especially in having gone through a
complete course of instruction in anatomy as a pupil of Guentherus
of Andernach. This is conspicuous throughout his works—“Libri de
Piscibus marinis” (Lugd. 1554, fol.); and “Universæ aquatilium
historiæ pars altera” (Lugd. 1555, fol.) Nevertheless they cannot be
regarded as more than considerably enlarged editions of Belon’s
work. For although he worked independently of the latter, and differs
from him in numerous details, the system adopted by him is
characterised by the same absence of the true principles of
classification. Rondelet had a much more extensive knowledge of
details. His work is almost entirely limited to European, and chiefly
Mediterranean, forms, and comprises not less than 197 marine and
47 freshwater fishes. His descriptions are more complete and his
figures much more accurate than those of Belon; and the specific
account is preceded by introductory chapters in which he treats in a
general manner on the distinctions, the external and internal parts,
and on the economy of fishes. Like Belon, he had no conception of
the various categories of classification—for instance, confounding
throughout his work the terms “genus” and “species;” but he had
intuitively a notion of what his successors called a “species,” and his
principal object was to collect and give as much information as
possible of such species.
For nearly a century the works of Belon and Rondelet remained
the standard works of Ichthyology; but this science did not remain
stationary during this period. The attention of naturalists was now
directed to the products of foreign countries, especially the Spanish
and Dutch possessions in the New World; and in Europe the
establishment of anatomical schools and academies led to the
careful investigation of the internal anatomy of the most remarkable
European forms. Limited as these efforts were as to their scope,
being directed either only to the fauna of some district, or to the
dissection of a single species, they were sufficiently numerous to
enlarge the views of naturalists, and to destroy that fatal dependency
on preceding authorities which had continued to keep in bonds the
minds of even such men as Rondelet and Belon.
The most noteworthy of those who were active in
W. Piso. G. tropical countries are W. Piso and G. Margrav.
Margrav. They accompanied as physicians the Dutch
Governor, Prince Moritz of Nassau, to Brazil (1637–
44). Margrav especially studied the fauna of the country, and
although he died before his return to Europe, his observations were
published by his colleague, and embodied in a work “Historia
naturalis Braziliæ” (Lugd. 1648, fol.), in which the fourth book treats
of the fishes. He describes about 100 species, all of which had been
previously unknown, in a manner far superior to that of his
predecessors. The accompanying figures are not good, but nearly
always recognisable, and giving a fair idea of the form of the fish.
Margrav himself, with the aid of an artist, had made a most valuable
collection of coloured drawings of the objects observed and
described by him, but many years were allowed to pass before it was
scientifically utilised by Bloch and others.
Of the men who left records of their anatomical
Anatomists, researches, we may mention Borelli (1608–79),
1600–1700. who wrote a work “De motu animalium” (Rom. 1680,
4to), in which he explained the mechanism of
swimming, and the function of the air-bladder; M. Malpighi (1628–
94), who examined the optic nerve of the sword-fish; the celebrated
J. Swammerdam (1637–80), who described the intestines of
numerous fishes; and J. Duverney (1648–1730), who entered into
detailed researches of the organs of respiration.

A new era in the history of Ichthyology commences with Ray,

Willughby, and Artedi, who were the first to recognise the true
principles by which the natural affinities of animals should be
determined. Their labours stand in so intimate a connection with
each other that they represent only one stride in the progress of this
science.

J. Ray (born 1628 in Essex, died 1705), was the

Ray and friend and guide of F. Willughby (1635–72). They
Willughby had recognised that a thorough reform of the
treatment of the vegetable and animal kingdoms had
become necessary; that the only way of bringing order into the
existing chaos was that of arranging the various forms with regard to
their structure; that they must cease to be burdened with inapplicable
passages and quotations of the ancient writers, and to perpetuate
the erroneous or vague notions of their predecessors. They
abandoned speculation, and adhered to facts only. One of the first
results, and perhaps the most important, of their method was, that
having recognised the “species” as such, they defined this term, and
fixed it as the base, from which all sound zoological knowledge has
to start.
Although they had divided their work thus that Ray attended to
the plants principally, and Willughby to the animals, the “Historia
piscium” (Oxford, 1686, fol.), which bears Willughby’s name on the
titlepage, and was edited by Ray, is clearly their joint production. A
great part of the observations contained in it were collected during
their common journeys in Great Britain and on the Continent, and it
is no exaggeration to say that at that time these two Englishmen
knew the fishes of the Continent, especially those of Germany, better
than any other Continental zoologist.
By the definition of fishes as animals with blood, breathing by
gills, provided with a single ventricle of the heart, covered with scales
or naked; the Cetaceans are excluded. Yet, at a later period Ray
appears to have been afraid of so great an innovation as the
separation of whales from fishes, and, therefore, he invented a
definition of fish which comprises both. The fishes proper are then
arranged in the first place according to the cartilaginous or osseous
nature of the skeleton; further subdivisions being formed with regard
to the general form of the body, the presence or absence of ventral
fins, the soft or spinous structure of the dorsal rays, the number of
dorsal fins, etc. Not less than 420 species are thus arranged and
described, of which about 180 were known to the authors from
autopsy: a comparatively small proportion, descriptions and figures
still forming at that time in a great measure a substitute for
collections and museums. With the increasing accumulation of forms
the want of a fixed nomenclature is now more and more felt.

Peter Artedi would have been a great ichthyologist

P. Artedi. if Ray or Willughby had never preceded him. But he
was fully conscious of the fact that both had
prepared the way for him, and therefore he derived all possible
advantages from their works. Born in 1705 in Sweden, he studied
with Linnæus at Upsala; from an early period he devoted himself
entirely to the study of fishes, and was engaged in the arrangement
and description of the ichthyological collection of Seba, a wealthy
Dutchman who had formed the then perhaps richest museum, when
he was accidentally drowned in one of the canals of Amsterdam in
the year 1734, at an age of twenty-nine years. His manuscripts were
fortunately rescued by an Englishman, Cliffort, and edited by his
early friend Linnæus.
The work is divided into the following parts:—
1. In the “Bibliotheca Ichthyologica” Artedi gives a very complete
list of all preceding authors who have written on fishes, with a critical
analysis of their works.
2. The “Philosophia Ichthyologica” is devoted to a description of
the external and internal parts of fishes; Artedi fixes a precise
terminology of all the various modifications of the organs,
distinguishes between those characters which determine a genus
and such as indicate a species or merely a variety; in fact he
establishes the method and principles which subsequently have
guided every systematic ichthyologist.
3. The “Genera Piscium” contains well-defined diagnoses of forty-
five genera, for which he fixes an unchangeable nomenclature.
4. In the “Species Piscium” descriptions of seventy-two species,
examined by himself, are given; descriptions which even now are
models of exactitude and method.
5. Finally, in the “Synonymia Piscium” references to all previous
authors are arranged for every species, very much in the same
manner which is adopted in the systematic works of the present day.
Artedi has been justly called the Father of
Linnæus. Ichthyology. So perfect was his treatment of the
subject, that even Linnæus could no more improve
it, only modify and add to it; and as far as Ichthyology is concerned,
Linnæus has scarcely done anything beyond applying binominal
terms to the species properly described and classified by Artedi.
Artedi had divided the fishes proper into four orders, viz.
Malacopterygii, Acanthopterygii, Branchiostegi, and Chondropterygii,
of which the third only, according to our present knowledge, appears
to be singularly heterogeneous, as it comprises Balistes, Ostracion,
Cyclopterus, and Lophius. Linnæus, besides separating the
Cetaceans entirely from the class of fishes (at least since the 10th
edition of the “Systema Naturæ”) abandoned Artedi’s order of
Branchiostegi, but substituted a scarcely more natural combination
by joining it with Artedi’s Chondropterygians, under the name of
“Amphibia nantes.”
His classification of the genera appears in the 12th edition of the
“Systema,” thus—
Amphibia Nantes.
Spiraculis compositis.
Petromyzon.
Raia.
Squalus.
Chimæra.

Spiraculis solitariis.
Lophius.
Acipenser.
Cyclopterus.
Balistes.
Ostracion.
Tetrodon.
Diodon.
Centriscus.
Syngnathus.
Pegasus.

Pisces Apodes.
 Muræna.
Gymnotus.
Trichiurus.
Anarhichas.
Ammodytes.
Ophidium.
Stromateus.
Xiphias.

Pisces Jugulares.
Callionymus.
Uranoscopus.
Trachinus.
Gadus.
Blennius.

Pisces Thoracici.
Cepola.
Echeneis.
Coryphæna.
Gobius.
Cottus.
Scorpæna.
Zeus.
Pleuronectes.
Chæetodon.
Sparus.
Labrus.
Sciæna.
Perca.
Gasterosteus.
Scomber.
Mullus.
Trigla.

Pisces Abdominales.
 Cobitis.
Amia.
Silurus.
Teuthis.
Loricaria.
Salmo.
Fistularia.
Esox.
Elops.
Argentina.
Atherina.
Mugil.
Mormyrus.
Exocœtus.
Polynemus.
Clupea.
Cyprinus.

Two contemporaries of Linnæus attempted a

Gronow and systematic arrangement of fishes; both had
Klein. considerable opportunities for their study, especially
in possessing extensive collections; but neither
exercised any influence on the progress of Ichthyology. The one, L.
T. Gronow, a German who resided in Holland, closely followed the
arrangements proposed by Artedi and Linnæus, and increased the
number of genera and species from the contents of his own
museum. He published two works, “Museum Ichthyologicum” (Lugd.
1754–6, fol.), and “Zoophylacium” (Lugd. 1763–81, fol.); a
posthumous work, containing numerous excellent descriptions of
new forms was published by J. E. Gray in 1854 under the title of
“Systema Ichthyologicum.” To Gronow also is due the invention of
preparing flat skins of fishes in a dry state, and preserving them in
the manner of a herbarium. The specimens thus prepared by him
belong to the oldest which have been preserved down to our time.
Much less important are the ichthyological labours of J. T. Klein
(1685–1759). They are embodied in five parts (Missus) of a work
entitled “Historia naturalis piscium” (Sedæ, 1740–9, 4to.) He
regarded a system merely as the means of recognising the various
forms of animals, not as the expression of their natural affinities; and
that method seemed to him to be the most perfect by which an
animal could be most readily determined. He eschewed all reference
to minute or anatomical characters. Hence his system is a series of
the most unnatural combinations, and we cannot be surprised that
Linnæus passed in silence over Klein’s labours.

The works of Artedi and Linnæus excited fresh

Pupils and activity, more especially in Scandinavia, Holland,
Successors of Germany, and England, such as has not been
Linnæus equalled in the history of biological science either
before or after. Whilst some of the pupils and
followers of Linnæus devoted themselves to an examination and
study of the fauna of their native countries, others proceeded on
voyages of discovery to foreign and distant countries. Of these latter
the following may be specially mentioned:—O. Fabricius worked out
the Fauna of Greenland, Kalm collected in North America,
Hasselquist in Egypt and Palestine, Brünnich in the Mediterranean,
Osbeck in Java and China, Thurnberg in Japan; Forskål examined
and described the fishes of the Red Sea; Steller, Pallas, S. T.
Gmelin, and Güldenstedt traversed nearly the whole of the Russian
Empire in Europe and Asia. Others attached themselves as
naturalists to the celebrated circumnavigators of the last century, like
the two Forsters (father and son), and Solander, who accompanied
Cook; Commerson, who travelled with Bougainville; and Sonnerat.
Numerous new and startling forms were discovered by those men,
and the foundation was laid of the knowledge of the geographical
distribution of animals.
Of those who studied the fishes of their native country the most
celebrated are Pennant (Great Britain), O. F. Müller (Denmark),
Duhamel (France), Meidinger (Austria), Cornide (Spain), Parra
(Cuba).
The materials brought together by those and other zoologists
were so numerous that, not long after the death of Linnæus, the
necessity was felt of collecting them in a compendious form. Several
compilators undertook this task; they embodied the recent
discoveries in new editions of Artedi’s and Linné’s classical works,
but not possessing either a knowledge of the subject or any critical
discernment, they only succeeded in covering those noble
monuments under a mass of confused rubbish. For Ichthyology it
was fortunate that two men at least, Bloch and Lacépède, made it a
subject of long and original research.

Mark Eliezer Bloch, born in the year 1723 at

M. E. Bloch. Anspach in Germany, practised as a physician in
Berlin; he had reached an age of fifty-six years when
he commenced to write on ichthyological subjects. To commence at
his age a work in which he intended not only to give full descriptions
of the species known to him from specimens or drawings, but also to
illustrate every species in a style truly magnificent for his time, was
an undertaking of the execution of which an ordinary man would
have despaired. Yet he accomplished not only this task, but even
more, as we shall see hereafter.
His work consists of two divisions:—
1. “Oeconomische Naturgeschichte der Fische Deutschlands”
(Berl. 1782–4, 4to. Plates in fol.)
2. “Naturgeschichte der auslændischen Fische” (Berl. 1785–95,
4to. Plates in fol.)
Bloch’s work is unique, and probably will for ever remain so.
Although Cuvier fifty years later undertook a similar general work on
fishes, the subject had then become too extensive to allow of an
attempt of giving illustrations of all the species, or illustrations of a
similar size and costliness.
The first division of the work, which is devoted to a description of
the fishes of Germany, is entirely original, and based upon Bloch’s
own observations. His descriptions as well as figures were made
from nature, and are, with but few exceptions, still serviceable; many
continue to be the best existing in literature.
Bloch was less fortunate and is much less reliable in his natural
history of foreign fishes. For many of the species he had to rely on
more or less incorrect drawings and descriptions of travellers;
frequently, also, he was deceived as to the origin of specimens
which he acquired by purchase. Hence his accounts contain
numerous confusing errors which it would have been difficult to
correct, if not nearly the whole of the materials on which his work is
based had been preserved in the collections at Berlin.
After the completion of his Ichthyology Bloch occupied himself
with systematic work. He prepared a general system of fishes, in
which he arranged not only those described in his great work, but
also those with which he had become acquainted afterwards from
the descriptions of others. The work was ably edited and published
after Bloch’s death by a philologist, J. G. Schneider, under the title
“M. E. Blochii Systema ichthyologiæ iconibus ex. illustratum” (Berl.
1801, 8vo.) The number of species enumerated in it amounts to
1519. The system is based upon the number of the fins, the various
orders being termed Hendecapterygii, Decapterygii, etc. We need
not add that an artificial method like this led to the most unnatural
combinations or severances.
Bloch’s Ichthyology remained for many years the
Lacépède. standard work, and, by the great number of excellent
illustrations, proved a most useful guide to the
student. But as regards originality of thought, Bloch was far
surpassed by his contemporary, B. G. E. de Lacépède, born at
Agen, in France, in 1756, a man of great and general erudition, who
died as Professor of the Museum of Natural History of Paris in 1826.
Lacépède had to contend with great difficulties in the preparation
of his “Histoire des Poissons” (Paris, 1798–1803, 4to, in 5 vols.),
which was written during the most disturbed period of the French
Revolution. A great part of it was composed whilst the author was
separated from collections and books, and had to rely on his notes
and manuscripts only. Even the works of Bloch and other
contemporaneous authors remained unknown, or at least
inaccessible, to him for a long time. Therefore we cannot be
surprised that his work abounds in all those errors to which a
compiler is subject. The same species not only appears under two
and more distinct specific names, but it sometimes happens that the
author understands so little the source from which he derives his
information that the description is referred to one genus and the
accompanying figure to another. The names of genera are unduly
multiplied; and the figures with which the work is illustrated are far
inferior to those of Bloch. Thus the influence of Lacépède on the
progress of Ichthyology was infinitely less than that of his fellow-
labourer; and the labour caused to his successors by correcting the
numerous errors into which he has fallen, probably outweighs the
assistance which they derived from his work.
The work of the principal cultivators of Ichthyology in
Anatomists. the period between Ray and Lacépède was chiefly
systematic and descriptive, but also the internal
organisation of fishes received attention from more than one great
anatomist. Haller, Camper, and Hunter, examined the nervous
system and organs of sense; and more especially Alexander Monro
(the son) published a classical work, “The Structure and Physiology
of Fishes explained and compared with those of Man and other
Animals” (Edinb. 1785, fol.) The electric organs of fishes (Torpedo
and Gymnotus) were examined by Réaumur, Allamand, Bancroft,
Walsh, and still more exactly by J. Hunter. The mystery of the
propagation of the Eel called forth a large number of essays, and
even the artificial propagation of Salmonidæ was known and
practised by Gleditsch (1764).
Bloch and Lacépède’s works were almost
Faunists. immediately succeeded by the labours of Cuvier, but
his early publications were of necessity tentative,
preliminary, and fragmentary, so that a short period elapsed before
the spirit infused by this great anatomist into Ichthyology could
exercise its influence on all workers in this field. Several of such
antecuvierian works must be mentioned on account of their
importance to our knowledge of certain Faunas: the “Descriptions
and Figures of Two Hundred Fishes collected at Vizagapatam on the
coast of Coromandel” (Lond. 1803; 2 vols. in fol.), by Patrick Russel;
and “An Account of the Fishes found in the River Ganges and its
branches” (Edinb. 1822; 2 vols. in 4to), by F. Hamilton (formerly
Buchanan)—works distinguished by a greater accuracy of their
drawings (especially in the latter), than was ever attained before. A
“Natural History of British Fishes” was published by E. Donovan
(Lond. 8vo, 1802–8); and the Mediterranean Fauna formed the study
of the lifetime of A. Risso (“Ichthyologie de Nice.” Paris, 1810, 8vo;
and “Histoire naturelle de l’Europe Meridionale.” Paris, 1827, 8vo). A
slight beginning in the description of the fishes of the United States
was made by S. L. Mitchell, who published, besides various papers,
a “Memoir on the Ichthyology of New York,” in 1815.[2]

G. Cuvier did not occupy himself with the study of

G. Cuvier. fishes merely because this class formed part of the
“Règne animal,” but he devoted himself to it with
particular predilection. The investigation of their anatomy, and
especially of their skeleton, was taken up by him at an early period,
and continued until he had succeeded in completing so perfect a
framework of the system of the whole class that his immediate
successors could content themselves with filling up those details for
which their master had no leisure. Indefatigable in examining all the
external and internal characters of the fishes of a rich collection, he
ascertained the natural affinities of the infinite variety of fishes, and
accurately defined the divisions, orders, families, and genera of the
class, as they appear in the various editions of the “Règne animal.”
His industry equalled his genius: he opened connections with almost
every accessible part of the globe; not only French travellers and
naturalists, but also Germans, Englishmen, Americans, rivalled one
another to assist him with collections; and for many years the
Muséum of the Jardin des Plantes was the centre where all
ichthyological treasures were deposited. Thus Cuvier brought
together a collection the like of which had never been seen before,
and which, as it contains all the materials on which his labours were
based, must still be considered to be the most important. Soon after
the year 1820, Cuvier, assisted by one of his pupils, A.
Valenciennes, commenced his great work on fishes, “Histoire
naturelles des Poissons,” of which the first volume appeared in 1828.
The earlier volumes, in which Cuvier himself took his share, bear
evidence of the freshness and love with which both authors devoted
themselves to their task. After Cuvier’s death in 1832 the work was
left entirely in the hands of Valenciennes, whose energy and interest
gradually slackened, to rise to the old standard in some parts only,
as, for instance, in the treatise on the Herring. He left the work
unfinished with the twenty-second volume (1848), which treats of the
Salmonoids. Yet, incomplete as it is, it is indispensable to the
student.
There exist several editions of the work, which, however, have
the same text. One, printed in 8vo, with coloured or plain figures, is
the one in common use among ichthyologists. A more luxurious
edition in 4to has a different pagination, and therefore is most
inconvenient to use.
As mentioned above, the various parts of the work are very
unequally worked out. Many of the species are described in so
masterly a manner that a greater excellency of method can hardly be
conceived. The history of the literature of these species is entered
into with minuteness and critical discernment; but in the later
volumes, numerous species are introduced into the system without
any description, or with a few words only, comparing a species with
one or more of its congeners. Cuvier himself, at a late period of his
life, seems to have grown indifferent as to the exact definition of his
species: a failing commonly observed among Zoologists when
attention to descriptive details becomes to them a tedious task. What
is more surprising is, that a man of his anatomical and physiological
knowledge should have overlooked the fact that secondary sexual
characters are developed in fishes as in any other class of animals,
and that fishes undergo great changes during growth; and,
consequently, that he described almost all such sexual forms and
different stages of growth under distinct specific and even generic
names.
The system finally adopted by Cuvier is the following:—
A. Poissons Osseux.
I.—a branchies en peignes ou en lames.
1. a mâchoire supérieure libre.
a. Acanthoptérygiens.
Percoïdes.
Polynèmes.
Mulles.
Joues cuirassées.
Scienoïdes.
Sparoïdes.
Chétodonoïdes.
Scomberoïdes.
Muges.
Branchies labyrinthiques.
Lophioïdes.
Gobioïdes.
Labroïdes.

b. Malacoptérygiens.
Abdominaux.
Cyprinoïdes.
Siluroïdes.
Salmonoïdes.
Clupeoïdes.
Lucioïdes.

Subbrachiens.
Sparoïdes.
Pleuronectes.
Discoboles.

Apodes.
 Murenoïdes.

2. a mâchoire supérieure fixée.

Sclérodermes.
Gymnodontes.

II. a branchies en forme de houppes.

Lophobranches.

B. Cartilagineux ou Chondroptérygiens.
Sturioniens.
Plagiostomes.
Cyclostomes.

We have to compare this system with that of Linnæus if we wish

to measure the gigantic stride Ichthyology has made during the
intervening period of seventy years. The various characters
employed for classification have been examined throughout the
whole class, and their relative importance has been duly weighed
and understood. Though Linnæus had formed a category of
“Amphibia nantes” for fishes with a cartilaginous skeleton, which
should coincide with Cuvier’s “Poissons Cartilagineux,” he had failed
to understand the very nature of cartilage, apparently comprising by
this term any skeletal framework of less firmity than ordinary bone.
Hence he considered Lophius, Cyclopterus, Syngnathus to be
cartilaginous fishes. Adopting the position and development of the
ventral fins as a highly important character, he was obliged to
associate fishes with rudimentary and inconspicuous ventral fins, like
Trichiurus, Xiphias, etc., with the true Eels. The important category of
a “family” appears now in Cuvier’s system fully established as that
intermediate between genus and order. Important changes in
Cuvier’s system have been made and proposed by his successors,
but in the main it is still that of the present day.
Cuvier had extended his researches beyond the living forms, into
the field of palæontology; he was the first to observe the close
resemblance of the scales of the fossil Palæoniscus to those of the
living Polypterus and Lepidosteus, the prolongation and identity of
structure of the upper caudal lobe in Palæoniscus and the
Sturgeons, the presence of peculiar “fulcra” on the anterior margin of
the dorsal fin in Palæoniscus and Lepidosteus: inferring from these
facts that that fossil genus was allied either to the Sturgeons or to
Lepidosteus. But it did not occur to him that there was a close
relationship between those recent fishes. Lepidosteus and, with it,
the fossil genus remained in his system a member of the order of
Malacopterygii abdominales.
It was left to L. Agassiz (born 1807, died 1873) to point out the
importance of the character of the structure of the scales, and to
open a path towards the knowledge of a whole new sub-class of
fishes, the Ganoidei.
Impressed with the fact that the peculiar scales of Polypterus and
Lepidosteus are common to all fossil osseous fishes down to the
chalk, he takes the structure of the scales generally as the base for
an ichthyological system, and distinguishes four orders:—
1. Placoids.—Without scales proper, but with scales of enamel,
sometimes large, sometimes small and reduced to mere points
(Rays, Sharks, and Cyclostomi, with the fossil Hybodontes).
2. Ganoids.—With angular bony scales, covered with a thick
stratum of enamel: to this order belong the fossil Lepidoides,
Sauroides, Pycnodontes, and Coelacanthi; the recent Polypterus,
Lepidosteus, Sclerodermi, Gymnodontes, Lophobranches, and
Siluroides; also the Sturgeons.
3. Ctenoids.—With rough scales, which have their free margins
denticulated: Chætodontidæ, Pleuronectidæ, Percidæ, Polyacanthi,
Sciænidæ, Sparidæ, Scorpænidæ, Aulostomi.
4. Cycloids.—With smooth scales, the hind margin of which lacks
denticulation: Labridæ, Mugilidæ, Scombridæ, Gadoidei, Gobiidæ,
Murænidæ, Lucioidei, Salmonidæ, Clupeidæ, Cyprinidæ.
We have no hesitation in affirming that if Agassiz had had an
opportunity of acquiring a more extensive and intimate knowledge of