Mammographic technique is very important to obtain diagnostic mammograms, to reduce the number of false negatives and to increase the sensitivity of the procedure. As widely noted in literature, most breast pathology occurs in the upper outer quadrant and is very important that this area is clearly visible in the MLO view. Moreover, the representation of the pectoral muscle in MLO view is a key component in assessing the adequacy of position, and one of the determinants of the effectiveness of optimal positioning, so its presence is mandatory.
The frontal oblique approach technique (FOA) is a mammographic technique as alternative to the traditional one that requires a mammography system that can be tilted in the forward direction too.
The x-ray tube-detector system is 15° tilted and the patient leans forward against the edge of the detector. The mammographer places the breast on the detector surface from a frontal approach unlike the traditional technique, where the x-ray tube-detector system is at 90°, the patient places the chest in contact to the detector edge, while the mammographer places the breast on the detector surface from the patient side. FOA allows to include a significantly greater amount of breast tissue on the mammograms increasing significantly the distance between nipple and pectoral muscle (Pectoral Nipple Line - PNL) compared to the traditional technique. In clinical practice FOA can be helpful to improve identification of deep positioned lesions, to reduce the number of false negatives and to visualize more breast tissue even in presence of implants, due to greater visibility of the posterior profile of the implant when performed without displacement or to the greater ease with which Eklund's technique can be performed.
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