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Fig. 4D —Step-oblique mammography used to identify summation artifacts. Oval density (straight arrow, B-D) seen at first in inner right breast on screening craniocaudal (CC) view but not on screening mediolateral oblique (MLO) view. Note second poorly defined density (curved arrow, B) in central right breast seen only on screening CC view, confidently judged to represent summation artifact without need for further imaging evaluation. Oval density (straight arrow, C), persistent on 0° craniocaudal spotcompression magnification (SCM) view but not seen on 90° lateral SCM view (not shown), was subsequently shown on step-oblique images to represent summation artifact created by looping blood vessel (straight arrow, D). Step-oblique mammograms at 15° MLO projection (D)

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