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Positioning Challenge #4 – Inadequate Posterior Nipple Line (CC view)

Kathy Willison – Senior Clinical Product & Onboarding Manager – Published on November 1, 2018

At the top of our list of positioning challenges for the CC view is length of the posterior nipple line (PNL).

How Do I Assess if the PNL Is Correct?

Adequate PNL length is achieved when it is no shorter than 1 cm on the CC view compared to the MLO PNL. A shorter CC PNL length indicates that the posterior tissue may not be optimally visualized.

Helpful Positioning Tips

Here are some tips, provided by our partners at Mammography Educators, LLC, on achieving the PNL Difference < 1 cm metric:

  • With the patient facing the mammography system, stand on the medial side of the breast being imaged and use the flat of your hand, palm up with the fifth finger closest to the ribs, to lift and take advantage of the mobile, inferior breast border.
  • Elevate the IMF until the PNL is perpendicular to the chest wall. This optimizes the inclusion of posterior breast tissue.
  • Elevate the image receptor so that its top is aligned with the bottom of the breast.
  • Use both hands, in an over-and-under position, to draw the breast onto the image receptor to access as much posterior breast tissue as possible.
  • Release the lower hand and, holding the breast in place with the upper hand, have the patient turn her head toward the medial aspect and, if feasible, bring her head forward and around the face shield to access more posterior-medial tissue.
  • Move your hand out towards the nipple as you lower the compression and let the compression paddle take over holding the breast in place.

How Do I Learn About and Manage My Positioning Challenges?

On a day-to-day basis, our own assessment of positioning acumen is subject to the patient population we manage daily. It is impossible to assess both the occurrence and the frequency of particular imaging issues based on anecdotal evaluation and feedback that comes from a limited set of images.

So, what is the best way to address these challenges? The reality is that having an objective, non-visual assessment of positioning features on every single CC and MLO image reduces the variability that occurs through evaluation of randomly selected images or anecdotal feedback. VolparaEnterprise software enables facilities to perform rapid quality control checks that help optimize the productivity and efficiency of imaging resources. This in turn helps decrease costs through the reduction of retakes, increase employee effectiveness, and enhance the patient experience.

To learn more about how you can benefit from the breast imaging analytics and educational resources available through VolparaEnterprise software, visit us November 25−30, 2018, at RSNA (South Hall #2565) or visit to request a demo.