While checking in a screening patient, the mammographer notices a white residue in both axillae. The patient says she applied antiperspirant powder this morning. What is the best action?

Have her remove it with a cleansing wipe before positioning

Add magnification views of both axillae to clarify findings

Reschedule the screening for a day without antiperspirant

Image as usual and note the powder on the history form

On a CC view of a breast with dense tissue concentrated posteriorly, the AEC sensor was left in its most anterior position over fatty tissue. What is the most likely result?

The dense posterior tissue is underexposed and noisy

The image shows grid lines across the chest-wall edge

The dense posterior tissue is overexposed and saturated

The whole image is blurred from a long exposure time

A CC image of a heterogeneously dense breast appears grainy, and the exposure indicator shows a low dose to the detector. The AEC area had been placed by the technologist on a unit with a selectable AEC position. What is the most likely cause?

The AEC area was placed under fatty tissue

The AEC area was placed under the densest tissue

A Mo/Mo combination was chosen for a thick breast

The compression paddle was tilted toward the nipple

A new irregular, high-density mass with spiculated margins and associated skin retraction is found in a 66-year-old. Which BI-RADS assessment and management best fit these findings?

Category 5; biopsy is recommended

Category 0; recall for ultrasound only

Category 4A; biopsy is recommended

Category 3; 6-month follow-up imaging

A small mass lies 3 cm above the nipple level on the right MLO. On the right 90-degree ML view it lies 5 cm above the nipple level. Where should the mass project on the right CC?

In the medial half of the breast

Directly behind the nipple line

Only on an exaggerated lateral CC

In the lateral half of the breast

A patient's lay summary says she has dense breast tissue. She calls the breast center asking what this means for her. What is the best response from the mammographer?

Dense tissue can hide cancers, so she can ask her provider about added screening

Dense tissue means a cancer is present, so she should schedule a biopsy right away

Dense tissue means she should stop mammography and switch to ultrasound only

Dense tissue is a normal finding that never affects how well a mammogram works

A CC image shows a thin, curving white line that extends from the breast across the area outside the skin line. It is not present on the MLO of the same breast. What is the most likely cause?

A skin fold at the lateral edge

A 63-year-old has a red, scaly, crusting rash on one nipple that has not healed with topical creams over two months. Which condition must be excluded?

Periductal mastitis with duct ectasia

A finding is seen only on the right CC. The radiologist orders a rolled CC with the top of the breast rolled laterally (RL). On the RL image the finding has moved laterally compared with the original CC. Where is the finding most likely located?

In the superior part of the breast

Directly in the central subareolar plane

In the inferior part of the breast

Outside the breast, on the skin surface

Mammography Exam

Free Mammography Practice Questions

10 sample questions for the Mammography Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Standard Views and Positioning Evaluation, Breast Pathology and BI-RADS, Mammography Equipment and Digital Image Acquisition, Image Display, Informatics, Radiation Dose and MQSA, Technique, Image Evaluation and Artifacts, Breast Anatomy, Physiology and Cytology, Additional Views, Special Patients and Implant Imaging, Breast Ultrasound, MRI and Other Imaging Methods, Breast Cancer Risk, Clinical History and Treatment.

Question 1 · Standard Views and Positioning Evaluation
While checking in a screening patient, the mammographer notices a white residue in both axillae. The patient says she applied antiperspirant powder this morning. What is the best action?
- A.Add magnification views of both axillae to clarify findings
- B.Reschedule the screening for a day without antiperspirant
- C.Image as usual and note the powder on the history form
- D.Have her remove it with a cleansing wipe before positioning
Show answer and explanation
Answer: D. Have her remove it with a cleansing wipe before positioning
Aluminum and other metals in antiperspirant and powder can mimic calcifications, so the product should be removed before imaging. Simply noting it still risks a recall, and rescheduling is unnecessary when a wipe solves the problem. Adding magnification views exposes the patient to extra dose for an avoidable artifact.
Question 2 · Mammography Equipment and Digital Image Acquisition
On a CC view of a breast with dense tissue concentrated posteriorly, the AEC sensor was left in its most anterior position over fatty tissue. What is the most likely result?
- A.The image shows grid lines across the chest-wall edge
- B.The dense posterior tissue is overexposed and saturated
- C.The whole image is blurred from a long exposure time
- D.The dense posterior tissue is underexposed and noisy
Show answer and explanation
Answer: D. The dense posterior tissue is underexposed and noisy
The AEC ends the exposure when the sensor area receives enough radiation; over fatty tissue that happens early, leaving the dense tissue underexposed with high quantum mottle. That is why the sensor belongs under the densest tissue. Overexposure would result from the opposite error, and grid lines are unrelated to sensor position.
Question 3 · Technique, Image Evaluation and Artifacts
A CC image of a heterogeneously dense breast appears grainy, and the exposure indicator shows a low dose to the detector. The AEC area had been placed by the technologist on a unit with a selectable AEC position. What is the most likely cause?
- A.The AEC area was placed under the densest tissue
- B.A Mo/Mo combination was chosen for a thick breast
- C.The compression paddle was tilted toward the nipple
- D.The AEC area was placed under fatty tissue
Show answer and explanation
Answer: D. The AEC area was placed under fatty tissue
The AEC area must sit under the densest tissue. Placed under fat, the AEC terminates early, leaving the dense tissue underexposed with visible quantum mottle (noise). Placing the sensor under the densest tissue is the correct practice, not a cause of noise.
Question 4 · Breast Anatomy, Physiology and Cytology
A new irregular, high-density mass with spiculated margins and associated skin retraction is found in a 66-year-old. Which BI-RADS assessment and management best fit these findings?
- A.Category 0; recall for ultrasound only
- B.Category 5; biopsy is recommended
- C.Category 4A; biopsy is recommended
- D.Category 3; 6-month follow-up imaging
Show answer and explanation
Answer: B. Category 5; biopsy is recommended
An irregular spiculated mass with skin retraction is highly suggestive of malignancy, BI-RADS 5, with a likelihood of 95% or more, and biopsy is required. Category 4A implies low suspicion, which does not fit these classic malignant features, and category 3 is reserved for probably benign findings.
Question 5 · Additional Views, Special Patients and Implant Imaging
A small mass lies 3 cm above the nipple level on the right MLO. On the right 90-degree ML view it lies 5 cm above the nipple level. Where should the mass project on the right CC?
- A.Directly behind the nipple line
- B.Only on an exaggerated lateral CC
- C.In the medial half of the breast
- D.In the lateral half of the breast
Show answer and explanation
Answer: C. In the medial half of the breast
Moving from the MLO to the 90-degree lateral, medial lesions rise and lateral lesions fall. This lesion moved up from 3 cm to 5 cm, so it is medial and should project in the medial half on the CC. A lesion in the central subareolar area would change little between the two views.
Question 6 · Standard Views and Positioning Evaluation
A patient's lay summary says she has dense breast tissue. She calls the breast center asking what this means for her. What is the best response from the mammographer?
- A.Dense tissue means a cancer is present, so she should schedule a biopsy right away
- B.Dense tissue means she should stop mammography and switch to ultrasound only
- C.Dense tissue can hide cancers, so she can ask her provider about added screening
- D.Dense tissue is a normal finding that never affects how well a mammogram works
Show answer and explanation
Answer: C. Dense tissue can hide cancers, so she can ask her provider about added screening
Dense tissue (heterogeneously or extremely dense) can mask cancers and is a risk factor, so the required notification encourages discussing supplemental screening with her provider. Density does not mean cancer is present, and it does lower mammographic sensitivity. Mammography remains the foundation of screening; ultrasound is supplemental, not a replacement.
Question 7 · Mammography Equipment and Digital Image Acquisition
In contrast-enhanced mammography, the high-energy image is acquired at an energy just above a specific absorption edge. Which material's K-edge is the target?
- A.Tungsten, at about 69 keV
- B.Rhodium, at about 23 keV
- C.Gadolinium, at about 50 keV
- D.Iodine, at about 33 keV
Show answer and explanation
Answer: D. Iodine, at about 33 keV
CEM uses iodinated contrast, and the high-energy exposure is set above the iodine K-edge near 33 keV so that iodine absorbs strongly; subtracting it from the low-energy image highlights enhancement. Gadolinium is the MRI contrast agent. Tungsten and rhodium are target and filter materials, not contrast agents.
Question 8 · Technique, Image Evaluation and Artifacts
A CC image shows a thin, curving white line that extends from the breast across the area outside the skin line. It is not present on the MLO of the same breast. What is the most likely cause?
- A.A skin fold at the lateral edge
- B.A calcified blood vessel
- C.A dead row of detector pixels
- D.The patient's hair in the beam
Show answer and explanation
Answer: D. The patient's hair in the beam
A curving line that crosses the skin line into the air beyond the breast cannot be inside the breast, and appearing on one view only fits hair from the patient's head falling into the field during the CC. A vessel stays within the breast, and a dead pixel row is straight and appears at the same location on every image.
Question 9 · Breast Anatomy, Physiology and Cytology
A 63-year-old has a red, scaly, crusting rash on one nipple that has not healed with topical creams over two months. Which condition must be excluded?
- A.Montgomery gland cyst
- B.Periductal mastitis with duct ectasia
- C.Paget disease of the nipple
- D.Fat necrosis
Show answer and explanation
Answer: C. Paget disease of the nipple
Persistent eczema-like changes of the nipple suggest Paget disease of the nipple, which is usually associated with underlying DCIS or invasive carcinoma, so imaging and skin biopsy are needed. Duct ectasia causes discharge and retraction rather than nonhealing scaling.
Question 10 · Additional Views, Special Patients and Implant Imaging
A finding is seen only on the right CC. The radiologist orders a rolled CC with the top of the breast rolled laterally (RL). On the RL image the finding has moved laterally compared with the original CC. Where is the finding most likely located?
- A.Directly in the central subareolar plane
- B.In the superior part of the breast
- C.In the inferior part of the breast
- D.Outside the breast, on the skin surface
Show answer and explanation
Answer: B. In the superior part of the breast
In a rolled CC the top half of the breast moves in the named direction and the bottom half moves the other way. A finding that moves laterally with a lateral roll of the top is in the superior breast; an inferior finding would move medially. A true summation of overlapping tissue often disappears on the rolled view.

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