Positioning in breast MR imaging to optimize image quality.

Improper positioning of the breasts in a dedicated breast coil causes inhomogeneous fat saturation as well as other artifacts that decrease the sensitivity of breast magnetic resonance imaging. Improper positioning can create artifacts that can obscure a malignancy or cause it to be missed. Goals of proper positioning include imaging the maximum area of breast tissue, minimizing skin folds, and achieving homogeneous fat suppression and nondeformed breast parenchyma. Review of prior images gives the technologist an impression of what the positioning and imaging challenges may be in each patient before the patient enters the imaging unit. Checking the triplane localizer images and repositioning as necessary before any diagnostic or interventional imaging is key. Using a fat saturation pad, changing the arm position, or "rolling" the patient may be considered in difficult cases. Padding to support the patient in an oblique position, using angled sponges to increase breast compression thickness, and raising the grid to access posterior lesions may be helpful in targeting difficult-to-access lesions for biopsy. Using the presented positioning techniques and suggestions, in addition to strict attention to detail before imaging, will improve image quality, decrease imaging time and suboptimal images, and limit the need for repeat imaging studies. © RSNA, 2014.