Positioning Strategies for Optimal Imaging

Positioning Strategies for Optimal Imaging MAMMOMAT B.brilliant This job aid will review ACR evaluation criteria, proper positioning techniques for CC, MLO views, and ergonomic tips for a sustainable career. ACR Clinical Image Criteria Craniocaudal (CC) View Mediolateral (MLO) View All the medial tissue Breast up and out – no camel nose Adequate posterior tissue IMF clearly marked and open Axillary tissue without exaggerating breast Stomach tucked No skin folds or overlapping shadows Breast centered Nipple in profile centered on image Nipple in profile Pectoralis muscle No skin folds or overlapping shadows Pectoralis muscle should be: • Visible down to the posterior nipple line • Relaxed and convex ACR Clinical Image Criteria – Recommendations PNL • To measure the PNL on the MLO view, accurately determine a 90° angle using the Tools feature on your AWS. • Measure from the base of the nipple to where the pectoralis muscle meets the 90° angle. • Equal breast tissue from CC and MLO within 1 cm The Importance of Compression • Separates overlying breast tissue • Evenly decreases breast thickness • Shows normal tissue vs. malignant tissue • Decreased dose to patient • Less scatter, better image contrast • Holds the breast still so motion artifact can be avoided Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/6/2025 | QR700029747 Healthineers Patient Positioning – Craniocaudal (CC) STEP 1: Modify the unit to the patient. a) Stand on the medial side of the breast being imaged. Ask the patient to turn her head towards you. b) Ensure the patient is positioned facing the unit with their feet perpendicular. c) Adjust the detector to the correct height for the patient. d) Ask the patient to step lightly from the detector. STEP 2: Position the breast. a) Ask the patient to lean slightly forward as you lift the breast with both hands and place it onto the detector. b) Slide your hand out from under the breast and place it on top, gently pulling it forward to include the maximum breast tissue onto the detector. c) Position the nipple in profile and lift the axillary tail forward onto the detector. d) Hold the breast forward with your hand during compression. STEP 3: Final adjustments a) Relax the patient’s shoulder downward. The patient can look up or down and away. b) Pull down on the abdominal skin and place the patient’s hand on the underside of the detector. Have the patient rest their elbow against the side of their body. c) Check the position of the opposite breast and pull it laterally if needed. d) Listen to your patient and be willing to reposition if necessary. Patient Positioning Tips– Craniocaudal (CC) 1. Relax the shoulder. a. Ask the patient to wiggle their hand. b. When the shoulder drops, the neck will relax. 2. Ask the patient to look up or down. a. Follow the patient’s natural movement to avoid overextension. b. Looking down and away can also create a gap between the patient and the face shield. 3. Place the patient’s opposite hand on the detector. a. This will help them feel stable and allow them to follow your direction 4. Confirm the patient’s feet are pointing to the system, and the patient has a good stance. a. This will help them feel balanced. Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/6/2025 | QR700029747 Healthineers Page 2 of 7 Patient Positioning – Mediolateral (MLO) STEP 1: Modify the unit to the patient. a) Stand on the medial side of the breast being imaged. Ask the patient to turn her head towards you. b) Ensure the patient is positioned facing the unit with their feet perpendicular. c) Determine the correct angle of the detector to ensure it is parallel to the pectoralis muscle. Place the hip at the bottom edge of the detector. d) Gently lift the patient’s arm across the top of the detector, ensuring that the shoulder is relaxed and neutral. e) While moving in front of the patient, keep your hand on the patient’s shoulder. STEP 2: Position the breast. a) With your axilla positioned, scoop the lateral breast tissue up and onto the detector. b) Lift the patient’s breast up and out to open the IMF. c) Ensure the breast is centered and the nipple is in profile. d) Hold the breast up and out during compression. STEP 3: Final adjustments a) Relax the patient’s shoulder downward. The upper corner of the compression plate should be just below the clavicle. b) The IMF and axilla should be centered, and feet should be perpendicular to the unit. c) Smooth out abdominal tissue and ask the patient to hold their opposite breast up and back. d) Listen to your patient and be willing to reposition if necessary. Patient Positioning Tips– Mediolateral (MLO) 1. Center the breast. a. Consider raising or lowering the detector. b. Change the angle to match the patient’s pectoralis muscle. 2. Start with the patient’s hips in front of the detector, and feet facing the system. a. It will be easier for the patient to move forward before compression begins. 3. Relax the patient’s body. a. Reposition if they feel a pinch or pain. 4. Make sure the patient feels balanced. a. A good stance will allow the patient to relax back. b. Guide the patient on where to hold. Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/6/2025 | QR700029747 Healthineers Page 3 of 7 Positioning Strategies: The face shield limits the technologist from pulling the patient in. • Set the detector at the appropriate height. The breast should be centered. • Overextension is not necessary. • The face shield can be removed for the MLO with proper positioning instructions. The technologists should guide the patient to avoid artifacts (shoulder, chin, gown, etc.) from showing on the image. • The face shield should only be removed for the CC if absolutely necessary; the risk of artifact is too great. The technologists should guide the patient to avoid artifacts (shoulder, chin, gown, etc.) from showing on the image. Tall patients: When positioning an MLO view, their face lands at the top of the face shield. • Center the breast by raising the detector; this will also raise the face shield. • Use the appropriate angle for the patient’s body habitus. A 45° angle should be a starting point; it may not be correct for all patients. • Bend the patient’s knee closest to the detector. • The patient can look to the side and down to the floor. • Relax the patient's grip on the system. Positioning tips with a stationary face shield: • Set the appropriate detector height for the CC and MLO. • Use the correct angle for the MLO view. • When removing the face shield, the technologists should guide the patient on where to look to avoid overextension and/or artifact. • Suggest looking down; this can bring the face away from the face shield. • Utilize the Ready Button to initiate the exposure; this will minimize the time the patient is compressed. Achieving a more comfortable exam: • Patients do not have to hold their breath. • OpComp will help reach optimal compression for each view. • Multiple tomosynthesis paddles are available. Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/6/2025 | QR700029747 Healthineers Page 4 of 7 Ergonomic Tips for a Sustainable Career Comfort Move • The system will move out of the way, allowing additional room for positioning. • If you would like to see the collimation light, utilize the positioning button. Adjustable Height • Easy to lower the detector to accommodate seated patients. Various Tomosynthesis Paddles • Multiple paddles are available. • Achieve the optimal image. • Avoid patient discomfort. Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/6/2025 | QR700029747 Healthineers Page 5 of 7 Please note that the learning material is for training purposes only! For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training. The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions. Note: Some functions shown in this material are optional and might not be part of your system. Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country. 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Siemensstrasse 1 Siemensstraße 3 40 Liberty Blvd. Forchheim, Germany 91301 91301 Forcheim, Germany Malvern, PA, USA 19355-9998 Phone: +49 9131 84-4746 Phone: +49 9191 18-0 Telephone: +1-888-826-9702 siemens-healthineers .com/radiography siemens-healthineers.com siemens-healthineers .com/en-us Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/6/2025 | QR700029747 Healthineers Page 6 of 7 Unrestricted | Published by Siemens Healthineers AG, 2025 SIEMENS Master Template Effective Date: 3/5/2020 | HOOD05162003074494 Job Aid Effective Date: 10/6/2025 | QR700029747 Healthineers Page 7 of 7