What do I order to get a craniocaudal (CC) view?

Ordering a Craniocaudal (CC) View

To obtain a craniocaudal (CC) view, order "diagnostic mammography" and specify that you need standard craniocaudal and mediolateral oblique (MLO) views of the breast in question. 1

Standard Ordering Protocol

When ordering breast imaging that includes CC views, the proper terminology and approach depends on your clinical scenario:

For Diagnostic Evaluation

• Order "diagnostic mammography" which automatically includes both standard craniocaudal (CC) and mediolateral oblique (MLO) views 1
• If evaluating a specific clinical concern (palpable mass, nipple discharge, breast implant evaluation), the order should specify "diagnostic mammography of the [right/left] breast" 1, 2
• Place a radio-opaque marker over any palpable finding to ensure the radiologist can correlate the clinical concern with imaging findings 2

For Patients with Breast Implants

• Both standard CC and MLO views AND implant-displaced views should be obtained 1
• The implant-displaced views (also called Eklund views) push the implant posteriorly to better visualize breast tissue 1
• This dual approach is critical because standard views alone may not adequately image breast tissue in patients with implants 1

Additional Views That May Be Ordered Alongside CC Views

Supplemental Views for Problem-Solving

• Spot compression views can be added to evaluate specific areas of concern seen on standard CC views 3, 2
• Magnification views help characterize microcalcifications or mass margins 2
• Rolled views (rolled CC) can differentiate summation artifacts from real lesions by repositioning the breast medially or laterally while keeping the X-ray beam angle the same 4
• 90-degree lateral views help triangulate the location of findings seen only on CC views 3

Digital Breast Tomosynthesis (DBT)

• DBT can be ordered instead of or in addition to standard 2D mammography and includes CC and MLO projections 1
• DBT is particularly useful for characterizing noncalcified lesions and detecting extracapsular silicone in implant patients 1

Common Clinical Scenarios

Palpable Breast Mass (Age ≥40 years)

• Order: "Diagnostic mammography with marker placement over palpable finding" 2
• This automatically includes CC and MLO views of both breasts 2
• Ultrasound should follow regardless of mammography results 2

Nipple Discharge

• Order: "Diagnostic mammography of symptomatic breast" (includes CC and MLO views) 1
• If recent bilateral screening mammography was performed within 6 months, only the symptomatic breast needs imaging 1

Breast Implant Evaluation

• Order: "Diagnostic mammography with implant-displaced views" or "Diagnostic DBT with implant-displaced views" 1
• This ensures both standard CC/MLO and implant-displaced CC/MLO views are obtained 1

Critical Pitfalls to Avoid

• Never order just "mammography" without specifying diagnostic vs. screening - screening mammography may not include the additional views or marker placement needed for diagnostic evaluation 2
• Never dismiss findings on CC view alone - always ensure orthogonal (MLO) or supplemental views are obtained to confirm true pathology 3
• Never order imaging after biopsy - biopsy-related changes will obscure and limit image interpretation 2
• For patients <30 years with palpable mass, do not order mammography first - proceed directly to ultrasound to avoid unnecessary radiation 2