Breast Positioning during Mammography: Mistakes to be Avoided

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The aim of mammography is to obtain an optimum image with maximum breast tissue visualization and minimal discomfort to the patient. Advancements in hardware and software have improved image-quality factors such as exposure, sharpness, noise, and contrast; however, positioning and compression have a significant impact on image quality. Both factors are largely operator-dependent. Careful attention during patient positioning can eliminate most mammographic artifacts and increase the performance of mammography. Optimal positioning maximizes the amount of breast tissue seen on image, and adequate compression separates overlapping structures and improves the quality and details of a questionable pathology. In this study, a total of 2,691 craniocaudal (CC) views and an equal number of mediolateral oblique (MLO) views were assessed. Mistakes in improperly positioned mammogram were assessed with respect to proper visualization of nipple, position of pectoralis major, pectoral-nipple distance (PND), inframammary fold, and adequate coverage of all breast quadrants. This study found malpositioning of nipple was a common fallacy. This can be due to anatomical or pathological (retraction) reasons; therefore, a physical assessment of the patient before mammography is essential. The researchers also found that fallacies regarding positioning of the pectoralis muscle were evident in a considerable number of mammograms. The researchers conclude that positioning is the most important factor. Improper positioning can result in an inconclusive result, which reduces the sensitivity of the mammography.

Breast Positioning during Mammography: Mistakes to be Avoided
Breast Positioning during Mammography: Mistakes to be Avoided


Aims and Objectives

Breast positioning is the key factor affecting a mammogram. If care is taken during positioning, it maximizes the amount of breast tissue being imaged, eliminates most of the artifacts, and increases sensitivity of the mammogram. This retrospective study was carried out in our department to assess correctness, and also the incorrectness of breast positioning, which need to be avoided to obtain an ideal mammogram.

Material and Methods

A total of 1369 female patients were included in this study. Mammography was performed on full field detector digital mammography equipment. Craniocaudal (CC) view and mediolateral oblique (MLO) view were carried out for each breast. Four views were done for 1322 patients. The remaining 47 patients had undergone a mastectomy and underwent two views for the other breast. Mistakes in improperly positioned mammogram were assessed with respect to proper visualization of nipple, position of pectoralis major, pectoral–nipple distance (PND), inframammary fold, and adequate coverage of all breast quadrants.


As per prescribed guidelines, mistakes in positioning were recognized in 2.879% of total mammograms. Improper positioning of the nipple was the commonest problem, seen in 3.827% of mammograms, CC view. On MLO view, bilaterally, pectoralis shadow was not seen in 0.520% mammograms, its margin was not straight/convex in 0.706%, lower edge of pectoralis was above pectoralis–nipple line in 2.081%, and inframammary fold was not seen in 1.189%. There was inadequate coverage of lower quadrants in 2.787%, and mismatch in PND was seen in 3.864%. In few of the patients, the shortcomings as a result of improper positioning were noted on one view, the rest being normal.


Positioning is the most important factor affecting the resultant mammography image. During mammography, many cases are improperly positioned and as a result the examination is inconclusive, which reduces the sensitivity of mammography.

Keywords: mammography, positioning, mistakes  


The aim of mammography is to obtain an optimum image along with maximum breast tissue visualization.There should be minimum discomfort to the patient. There are a number of factors that affect the clinical image quality of a mammogram.2 These are positioning of the breast, compression, optimum exposure, sharpness, noise, and contrast. The quality of mammograms has improved remarkably after the introduction of digital mammography system. Also, strict quality assurance monitoring is being followed at present. With advancements in hardware and software, factors affecting image quality such as exposure, sharpness, noise, and contrast are being taken care of. The two factors that still affect the image quality are positioning and compression, both still being monitored by the operator.  

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