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Positioning Challenge #3 – Achieving Adequate Pectoralis Muscle Length (MLO view)

Kathy Willison – Senior Clinical Product & Onboarding Manager – Published on October 29, 2018

Last in our series of MLO view positioning issues is achieving sufficient pectoralis muscle length. An Adequate Pec to Posterior Nipple Line (PNL) metric is achieved when the pectoral muscle extends inferiorly to at least 1 cm above the PNL.

Helpful Positioning Tips

To achieve an Adequate Pec to PNL, try these tips provided by our partners at Mammography Educators, LLC:

  • Set the gantry angle based on the patient’s body habitus to ensure you are positioning along the line of the pectoral muscle. In general, the following may apply depending on patient height:
    • 50 degrees—tall
    • 45 degrees—average
    • 40 degrees—shorter
  • Stand on the medial side of the breast to be imaged, with the patient facing the mammography system.
  • Prior to lifting the breast onto the image receptor, ask the patient to sidestep toward you to bring the corner of the image receptor directly in line with the plane of the nipple. This essential step presents the breast and muscle in front of the image receptor and better keeps the pectoral in view.
  • As you apply compression, maintain your hand’s contact with the breast. Slide your hand down and around to the front of the breast in one quick motion and then slide the base of the thumb in an up-and-out direction, towards the nipple.
  • Let the compression paddle gently replace your hand in holding the breast in place.

Resources to Improve Image Quality and Patient Experience

Keeping track of these steps to achieve the best positioning and compression while at the same time delivering the best patient experience possible is what makes technologists so special. Volpara Solutions provides technologists and lead technologists with supporting resources so they can deliver the best care possible.

The VolparaLive! system, the newest such resource, will be showcased at RSNA (South Hall #2565), November 25–30, 2018. Mammography’s first real-time decision support system available at the point of care, the VolparaLive! system automatically analyzes patient positioning and compression for every image and provides feedback to the technologist before the patient leaves the room. The technologist can make an immediate and informed decision about retakes, avoiding patient anxiety due to a technical recall.

To learn more about the VolparaLive! system visit to request a demo at RSNA.