2.1 Pre-Exam Instructions

Pre-exam instructions are a quality-control step

A mammogram can fail before the first exposure if deodorant is still in the axilla or a necklace still sits on the chest wall. Pre-exam instructions are how the mammography technologist prevents extrinsic artifacts, protects modesty, and captures intake flags that change today's views. Those flags—pregnancy, breastfeeding, implants, and recent breast surgery—plan positioning and technique. They are not a substitute for the full clinical history (indication, symptoms, family history, hormone use) taught in the history portion of this guide.

Treat the minute at the changing room as the last chance to stop a preventable repeat. Repeats add average glandular dose, stretch the schedule, and shake confidence. A deodorant speck that looks like calcium can even generate a callback after the patient has gone home, which is a communication failure as much as a positioning failure.

Skin products that mimic calcifications

Mammography is built to show microcalcifications measured in fractions of a millimeter. Anything dense on the skin can project as tiny bright specks in that same size range, and the interpreting radiologist cannot always tell on the skin from in the parenchyma on a two-view screen.

Aluminum-based antiperspirants and talc-containing powders are the classic traps. Aluminum salts and talc particles are radiopaque. Scattered in the axilla, the inframammary fold (IMF), or on the skin of the breast, they can mimic clustered or pleomorphic calcifications—the finding that most often triggers additional imaging. The safer read is often 'recall,' even when the specks were never in the tissue.

Lotions, oils, glitter, and shimmer body products cause a different failure mode: slip, streaks, or sparkle overlay. The breast may slide under the paddle and produce motion unsharpness. Adhesive products—bandage residue, ECG electrodes, nicotine or hormone patches, fashion tape, decorative gems, and adhesive nipple covers—leave glue and fibers that also mimic calcium or hide parenchyma.

Give a specific instruction, not a vague 'get ready.' Ask the patient to remove deodorant, antiperspirant, powder, lotion, glitter, and adhesives from the breasts, chest, underarms, and inframammary crease. If product was applied after arrival, offer facility wipes and inspect the skin under good light before the first compression. Heavily moisturizing consumer wipes can leave their own film; use the wipes stocked for mammography.

Script: 'Anything on the skin—deodorant, powder, lotion, glitter, or sticky residue—can look like tiny specks of calcium. Those specks can hide a real finding or create a false alarm. Please remove them from your breasts, underarms, and the crease under the breast. I have wipes, and I will check before we start.'

If a patient says she 'already wiped,' still look. Residual white film in the axilla is common. Document if the patient declines cleansing and the skin cannot be cleared, so the radiologist is not left guessing why specks appeared only in the axillary tail.

Clothing, jewelry, gowns, and privacy

Ask the patient to undress from the waist up. Bras—including sport bras and adhesive cups—camisoles, and shirts with buttons, snaps, or metallic print overlay the field. Pants, skirts, and shoes stay on unless they block stance at the unit.

Remove necklaces, chest-wall jewelry, and axillary jewelry that can project over the tail of Spence. Nipple piercings in the field are metallic artifacts; remove them when possible. If a piercing cannot come out, document it so it is not mistaken for a biopsy clip or skin marker.

Provide a front-opening gown, show which way it opens, and offer a second drape. Privacy is part of the instruction set: close the door, knock before re-entry, uncover only the breast being imaged, and keep the contralateral breast covered. Never leave a disrobed patient in a hallway or with the door ajar 'just for a second.'

Script: 'Please undress from the waist up and put this gown on so it opens in the front. You may keep everything on from the waist down. Please take off necklaces and any jewelry on the chest or underarm. I will step out while you change, knock before I come back, and uncover only one breast at a time.'

Confirm two identifiers (name and date of birth) before the patient changes whenever workflow allows, and again at the unit, so you do not gown the wrong person for the wrong laterality.

Intake flags: pregnancy, breastfeeding, implants, surgery

Use a short, consistent intake. This is workflow planning, not the history interview.

Pregnancy. Ask every patient of childbearing potential, privately: 'Is there any chance you could be pregnant?' Screening mammography is typically deferred during pregnancy because the exam uses x-rays. If the referring provider needs diagnostic imaging for a lump or other symptom, follow facility policy, document the discussion, and obtain the views that answer the clinical question. Do not moralize; give a factual reason.

Breastfeeding. Lactating tissue is dense and often tender. Ask the patient to nurse or pump shortly before the appointment when possible. Document lactation so density is not treated as an unexplained new finding. Warn that a diagnostic workup may add ultrasound.

Implants. Confirm presence and, if known, saline versus silicone, plus any implant-related symptoms. Implant-displaced (Eklund) views take more time. Explain that implant-in-place views show the implant and displaced views show native tissue. Never imply that implants mean compression is skipped.

Recent surgery, biopsy, or radiation. Scars, clips, seromas, and dressings change positioning. Do not rip off a surgeon-placed dressing to 'get a better picture.' Work around the wound and document what remains on the skin.

Script: 'I am going to ask a few questions that change how we take pictures today—not your full medical history. Any chance of pregnancy? Are you breastfeeding? Do you have implants, a recent biopsy or surgery, or a dressing on the breast?'

Instruction versus artifact risk

If a step is skipped, know exactly what the image will cost you. Memorize the mapping; ARRT items in this subdomain often pair a missed instruction with the artifact it produces.

If the patient refuses a step (a religious necklace, unwillingness to wipe deodorant), offer a workable alternative—tape the chain high on the neck, cleanse only the image field—then document. Do not argue. The professional standard is a diagnostic image with dignity intact, not a power struggle at the changing room.