An XCCL is necessary additional view to add to a routine screening exam when ____________.

The necessary indication for an XCCL (eXaggerated Craniocaudal Lateral) view during a routine screening exam relates to the need for additional imaging to ensure comprehensive evaluation of breast tissue. In the context of a patient's baseline exam, the XCCL view can be crucial because it helps to provide a clearer evaluation of the breast's architecture and any potential abnormalities.

When a patient is undergoing their baseline exam, it is important to gather as much information as possible for future comparisons. This view specifically allows radiologists to visualize areas that may be obscured or inadequately assessed by standard projections, ensuring that any potential issues are documented from this foundational examination.

In contrast, while small breasts and the positioning of the nipple can influence the adequacy of standard views, the need for additional views in those cases would not be as standardized or necessary for the initial evaluation of a baseline exam. Excluding specific anatomic regions, like posterolateral tissue, might lead to concerns but would not inherently validate the need for the XCCL view like the baseline imaging does. The XCCL view is particularly adept at addressing imaging concerns that may arise uniquely during baseline assessments.