• Mammography, in conjunction with physical examination, is the method of choice for early detection of breast cancer. Other methods should not be substituted for mammography in diagnosis or screening, but may be useful adjuncts in specific diagnostic situations.

• Diagnostic mammography of symptomatic women should always be performed when indicated, utilizing recommended equipment and techniques and well-trained, knowledgeable personnel.

• Screen-film mammography requires dedicated x-ray units, firm compression, and an x-ray spectrum produced by an appropriate combination of x-ray tube target, tube window, filtration, operating potential, screen-film combination, film processors, technique, and viewing conditions. The CC and MLO views are recommended as the standard views for all types of mammography.

• Mammographic equipment should be chosen to provide acceptable image quality at a typical mean glandular dose (for a two-view examination) of 6 mGy, or less for screen-film image receptor with grid for a patient having 4.5 cm thick-compressed breasts of 50 percent adipose and 50 percent glandular tissue composition.

• Image quality and appropriate dose level should be maintained by a QA program conducted by a QA technologist and medical physicist, involving specified periodic measurements and readjustment of all aspects of the imaging and viewing system.

• Mean glandular dose should be determined at least annually at each installation for the techniques used at representative breast thicknesses. This dose can be calculated from data supplied in this Report by measuring beam quality and in-air exposure at the entrance surface of the breast.

• A quality administration program (medical audit) should be used to compare the facility's clinical outcomes with established guidelines.

• Annual mammographic screening examinations appear to provide favorable benefit/risk ratios in terms of breast cancer mortality in women age 50 or above, if acceptable image quality and dose are maintained.

• Results of randomized clinical trials of screening mammography for women age 40 to 49, for which 10 or more years of follow-up is available, have shown evidence of a substantial benefit in reducing mortality which exceeds any risk of radiation-induced breast cancer.

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