Does elevating image receptor increase breast receptor footprint and improve pressure balance?

•Experimental study.•16 female volunteers/32 breasts.•Compares two methods of conducting the cranio-caudal project.•Provides sufficient evidence to indicate which method is likely to be superior.•Has value to clinical mammography.

There is no consensus in the literature regarding the image receptor (IR) position for the cradio-caudal projection in mammography. Some literature indicates the IR should be positioned to the infra mammary fold (IMF); other literature suggests the IR be raised 2 cm relative to the IMF. Using 16 female volunteers (32 breasts) and a pressure sensitive mat we investigated breast footprint and pressure balance with IR at IMF and IR 2 cm above the IMF. Breast area on IR and paddle and interface pressure between IR/breast and paddle/breast were recorded. A uniformity index (UI) gave a measure of pressure balance between IR/breast and paddle/breast. IR breast footprint increases significantly by 13.81 cm2 (p < 0.02) when IR is raised by 2 cm. UI reduces from 0.4 to 0.00 (p = 0.04) when positioned at IMF +2 cm demonstrating an improved pressure balance. Practitioners should consider raising the IR by 2 cm relative to the IMF in clinical practice. Further work is suggested to investigate the effects of practitioner variability and breast asymmetry.