PATIENT POSITIONING

FOR IMAGE QUALITY

OPTIMIZATION
 Patient positioning

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An adequate patient positioning permits
to:
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Simplify the image reading process
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Use the specular systematic viewing
techniques in an optimal way (binocular
magnification, Tabar's masks, etc.)
●
Guarantee the best performances of the
image presentation algorithms
 Patient positioning

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From the poor care in positioning result:
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Asymmetric images
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Skinfolds
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Presence of extraneous parts in the image
field (shoulder, hairs, earrings, etc.)
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Often, to worsen the situation:
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Inadequate breast compression
 Symmetry
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Example of correctly aligned images (CC):
 Symmetry
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Example of correctly aligned images (MLO):
 Symmetry
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In case of bad alignment:
 Symmetry
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In case of bad alignment:
specular tools (dual magnify glasses, Tabar's masks, etc.) points to
different areas
 Symmetry
●
The following image presents several problems
due to bad positioning
 Symmetry

Evident reduction of the diagnosable area in the image on the

right compared to the left
 Symmetry

Missing part on the other view, with significant reduction of the

diagnostic possibilities (i.e.: sentinel lymph nodes)
Skinfolds
Skinfolds
Skinfolds
Extraneous parts in the image field

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Unlike analog images, digital images tolerate
less the presence of extraneous parts in the
image field
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The presence of extraneous parts in the image
field negatively affects the functioning of
presentation algorithm, with impact on:
●
Breast border recognition
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Worse contrast and dynamic range because
of "heavier" histogram
Extraneous parts in the image field:
Dynamic Range
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Correctly enhanced image

Optimal dynamic range histogram

Extraneous parts in the image field:
Dynamic Range
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Wrong image: a shoulder in the field

Histogram with reduced dynamic

range

The algorithm recognizes the mistake and tries to correct it by

darkening the area, but it can't cancel it out completely
Extraneous parts in the image field:
Border recognition
●
Hairs and earring in the field

The RAW image (on the left) does not contain artifacts, which
are instead added by the algorithm for the image on the right
Extraneous parts in the image field:
Border recognition
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Another example: hairs and a finger!
 Compression
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Excepting particular cases which have to be
opportunely managed, the compression must
always be high enough in order to:
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Provide an adequate distension of the tissues
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Reduce the scattered radiation
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Reduce motion artifacts
DETAILS VISIBILITY IS IMPROVED
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Under standard conditions:
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Reccomended compression force between
10 and 15 kgf (100 – 150 N)
 References

●
EUREF (2006): European guidelines for quality
assurance in breast cancer screening and
diagnosis, fourth edition – European
Commission
●
Metaltronica (2010): Helianthus Operator's
Manual, Metaltronica s.r.l.