What is the best projection to use for a patient who has severe kyphosis?

When dealing with a patient who has severe kyphosis, the lateral medial (LM) projection is often the most effective choice. Kyphosis typically leads to significant curvature of the spine, which can impact breast positioning and visibility during mammography. The LM projection allows for better visualization of the breast tissue because it accommodates the anatomical changes caused by kyphosis, providing a more accurate representation of breast tissue and potential abnormalities.

This projection captures the breast from the side, ensuring that the medial portions are well-visualized, which is crucial in patients with kyphosis where the typical craniocaudal (CC) or mediolateral oblique (MLO) views may not effectively display all areas of interest. As a result, using the LM projection helps in obtaining a clearer image, facilitating better assessment and diagnosis.