Guidance

Example of a standard examination protocol

Published 18 January 2023

Applies to England

© Crown copyright 2023

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This publication is available at https://www.gov.uk/government/publications/breast-screening-guidance-on-implementation-of-ionising-radiation-medical-exposure-regulations-2017/example-of-a-standard-examination-protocol

The detail provided here is not intended for direct adoption in the clinical environment. Clinical departments should adapt the template to reflect NHS Breast Screening Programme (NHS BSP) guidance, local practice, and be equipment specific.

Protocol for routine 2D breast screening mammogram projections

Diagnostic reference level

Screening mammography mean glandular dose (MGD):

  • National DRL – 2.5 mGy
  • Local DRL – local value applied

Note that this is the average MGD for mediolateral oblique breast exposures of a sample of 50mm to 60mm thick breasts.

Examination

Routine 2D breast screening mammography.

Examination preparation:

Practitioners should:

  • carry out the 3-point identification check using the client screening form
  • cross reference day list
  • confirm that benefit and risk of radiation is understood, for example the person has read the leaflet or poster
  • obtain verbal consent

Room preparation:

Practitioners should:

  • choose the correct women from the modality screening list, for example by scanning the client ID number
  • check equipment and protocol setting

Exposure factors

Acquisition mode Dose Setting Focal Spot AEC sensor Grid Filter
X X X X X X

Projections:

These must involve:

  • bilateral craniocaudal (CC)
  • bilateral mediolateral oblique (MLO)

Positioning:

Practitioners should ensure:

  • optimal positioning to include all breast anatomy
  • adequate compression to provide acceptable image quality with no movement

Post processing

Check image annotations are clearly shown and correct, including:

  • the woman’s identification details
  • anatomical markers (left or right)
  • positional markers (MLO, CC and so on)
  • mammographer identification
  • date and time of examination
  • organisation identifier

Clinical image quality and assessment

A good quality mammogram shows all the breast tissue with high levels of detail and clarity.

Images should be checked for obscuring skin creases and folds which could cause a risk to accurate interpretation.

Image transfer

Check complete set of imaging views have transferred successfully to the required destination.

Dose recording

Check completion of study on the National Breast Screening System (NBSS) including all mandatory fields, for example operator identification, who performed client identification process, justification and authorisation completed, dose recorded and comments where appropriate.

Technical repeats

Mammographers may repeat any image from the standard screening views if it is deemed clinically inadequate.

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