What is the main purpose of the MLO view angle in mammography?

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The main concept being tested is that the MLO view is designed to bring the axillary tail (Tail of Spence) and posterior breast tissue into view. By positioning the breast at a medio-oblique angle, the imaging beam travels along the long axis of the breast, stretching tissue over the chest wall. This projection captures the upper outer quadrant, the tail of Spence, and tissue near the posterior chest wall, which are common sites for lesions and can be obscured on other views.

This coverage is why the MLO view is essential alongside the craniocaudal view: it provides a more complete picture of the breast, especially in the lateral and superior regions and near the axilla, improving detection in areas that might be missed otherwise. It’s not limited to imaging the nipple-areola complex, nor is it intended to exclude the axillary tail or focus only on the chest wall without breast tissue.