Instructions:
- Review only 2D/2D synthetic images (not tomosynthesis images)
- If a view is repeated (e.g., 2 RCC views), review best image
- Denominator Exceptions/Exclusions: breast implants, exams with tiled/mosaic images
- Criteria are assessed bi-laterally
NOTE: The follow criteria are used for quality improvement within the Mammography Positioning improvement collaborative. They are not to be used for Mammography Accreditation.
Major criteria:
7 criteria assessed bilaterally (14 assessments total). To pass, an examination must meet all 14 major criteria assessments.
Criteria | Meets | Does Not Meet | Notes |
Motion
| No motion | Motion |
|
Breast cut off | No portion of breast cut off | Cut off (e.g., axillary tail cut off, medial or lateral tissue cut off on CC) | Note: If IMF cut off, that should be assessed as part of the IMF criterion (see below) |
Other body parts projected over breast
| No other body part obscuring breast tissue | Other body part obscuring breast being imaged (e.g., contralateral breast, hand, shoulder, chin) |
|
Nipple in profile
| Nipple in profile on at least 1 view of each breast (CC or MLO) | Nipple not in profile on at least 1 view of each breast (CC or MLO)
|
|
Posterior Nipple Line (PNL)
| PNL on CC is within 1 cm of PNL on MLO | PNL on CC is not within 1 cm of PNL on MLO
| Note: PNL to be measured from the base of the nipple to the pectoralis muscle at 90 degrees. If the nipple is rolled, measure from the skin line. |
MLO: Visualization of posterior tissue
| Posterior tissue on image | Poor visualization; no posterior tissue on image | Note: Posterior tissue typically entails the retroglandular fat plane. In patients with minimal retroglandular fat, consider the posterior depth of the fibroglandular tissue in reference to prior exams if available. |
CC: Visualization of posterior tissue
| Posterior tissue on image (pectoralis muscle can be seen in 30% of women) | Poor visualization; no posterior tissue on image | Note: Posterior tissue typically entails the retroglandular fat plane. In patients with minimal retroglandular fat, consider the posterior depth of the fibroglandular tissue in reference to prior exams if available. |
Minor Criteria:
6 criteria assessed bilaterally (12 assessments total). To pass, an examination must meet at least 9 of the 12 minor criteria assessments.
Criteria | Meets | Partially Meets | Does Not Meet |
CC: Exaggeration | No exaggeration. Nipple is midline/centered on image | Nipple is slightly lateral or medial to midline with no loss of lateral or medial posterior tissue | Excessive exaggeration; nipple is lateral or medial to midline with loss of lateral or medial posterior tissue |
MLO: Inframammary fold (IMF) | Open IMF without folds | Slightly open IMF and/or small folds | Inadequate IMF; IMF closed or not included and/or large folds obscuring underlying breast tissue |
Skin Folds
| No folds | Small folds not obscuring breast tissue Note: If the skin folds are in the IMF, assess as part of the IMF criterion (see above). | Large folds or folds that obscure breast tissue Note: If the skin folds are in the IMF, assess as part of the IMF criterion (see above). |
MLO: Sagging breast | Breast is lifted and not sagging | Slight sagging that does not interfere with image interpretation | No lift to breast, severe sagging
|
MLO: Amount of pectoralis major muscle | Pectoralis is down to PNL or below, muscle is wider superiorly and gradually narrows inferiorly | Pectoralis is close to PNL (within 1 cm) | Inadequate pectoralis; pectoralis is not close to PNL (>1 cm), little to no muscle visualized (muscle is narrow/thin), anterior border of muscle is concave |
MLO: Breast positioning on image receptor/detector | Breast is centered and imaged entirely on detector
| Breast is positioned slightly too high on detector; breast is slightly off center. | Breast is positioned too high on detector; breast is not centered - includes too much abdomen and not enough axilla. |