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Academic Radiology Oct 2019A linear array of carbon nanotube-enabled x-ray sources allows for stationary digital breast tomosynthesis (sDBT), during which projection views are collected without...
RATIONALE AND OBJECTIVES
A linear array of carbon nanotube-enabled x-ray sources allows for stationary digital breast tomosynthesis (sDBT), during which projection views are collected without the need to move the x-ray tube. This work presents our initial clinical experience with a first-generation sDBT device.
MATERIALS AND METHODS
Following informed consent, women with a "suspicious abnormality" (Breast Imaging Reporting and Data System 4), discovered by digital mammography and awaiting biopsy, were also imaged by the first generation sDBT. Four radiologists participated in this paired-image study, completing questionnaires while interpreting the mammograms and sDBT image stacks. Areas under the receiver operating characteristic curve were used to measure reader performance (likelihood of correctly identifying malignancy based on pathology as ground truth), while a multivariate analysis assessed preference, as readers compared one modality to the next when interpreting diagnostically important image features.
RESULTS
Findings from 43 women were available for analysis, in whom 12 cases of malignancy were identified by pathology. The mean areas under the receiver operating characteristic curve was significantly higher (p < 0.05) for sDBT than mammography for all breast density categories and breast thicknesses. Additionally, readers preferred sDBT over mammography when evaluating mass margins and shape, architectural distortion, and asymmetry, but preferred mammography when characterizing microcalcifications.
CONCLUSION
Readers preferred sDBT over mammography when interpreting soft-tissue breast features and were diagnostically more accurate using images generated by sDBT in a Breast Imaging Reporting and Data System 4 population. However, the findings also demonstrated the need to improve microcalcification conspicuity, which is guiding both technological and image-processing design changes in future sDBT devices.
Topics: Adult; Breast; Breast Neoplasms; Female; Humans; Image Processing, Computer-Assisted; Mammography; Middle Aged; Multimodal Imaging; Nanotubes, Carbon; Radiographic Image Enhancement
PubMed: 30660473
DOI: 10.1016/j.acra.2018.12.026 -
Medical Physics Aug 2022Understanding the magnitude and variability of the radiation dose absorbed by the breast fibroglandular tissue during mammography and digital breast tomosynthesis (DBT)...
BACKGROUND
Understanding the magnitude and variability of the radiation dose absorbed by the breast fibroglandular tissue during mammography and digital breast tomosynthesis (DBT) is of paramount importance to assess risks versus benefits. Although homogeneous breast models have been proposed and used for decades for this purpose, they do not accurately reflect the actual heterogeneous distribution of the fibroglandular tissue in the breast, leading to biases in the estimation of dose from these modalities.
PURPOSE
To develop and validate a method to generate patient-derived, heterogeneous digital breast phantoms for breast dosimetry in mammography and DBT.
METHODS
The proposed phantoms were developed starting from patient-based models of compressed breasts, generated for multiple thicknesses and representing the two standard views acquired in mammography and DBT, that is, cranio-caudal (CC) and medio-lateral-oblique (MLO). Internally, the breast phantoms were defined as consisting of an adipose/fibroglandular tissue mixture, with a nonspatially uniform relative concentration. The parenchyma distributions were obtained from a previously described model based on patient breast computed tomography data that underwent simulated compression. Following these distributions, phantoms with any glandular fraction (1%-100%) and breast thickness (12-125 mm) can be generated, for both views. The phantoms were validated, in terms of their accuracy for average normalized glandular dose (D N) estimation across samples of patient breasts, using 88 patient-specific phantoms involving actual patient distribution of the fibroglandular tissue in the breast, and compared to that obtained using a homogeneous model similar to those currently used for breast dosimetry.
RESULTS
The average D N estimated for the proposed phantoms was concordant with that absorbed by the patient-specific phantoms to within 5% (CC) and 4% (MLO). These D N estimates were over 30% lower than those estimated with the homogeneous models, which overestimated the average D N by 43% (CC), and 32% (MLO) compared to the patient-specific phantoms.
CONCLUSIONS
The developed phantoms can be used for dosimetry simulations to improve the accuracy of dose estimates in mammography and DBT.
Topics: Breast; Breast Neoplasms; Female; Humans; Mammography; Phantoms, Imaging; Radiometry; Tomography, X-Ray Computed
PubMed: 35635844
DOI: 10.1002/mp.15785 -
Asian Pacific Journal of Cancer... Jan 2022While the past decades have seen a rise in the number of cases diagnosed with cancer, breast cancer in particular has become the most frequently diagnosed cancer in...
Analysing the Insights and Assessing the Impact of a Digital Mammography and Tomosynthesis Based 2-year Long Prospective Breast Screening Programme Organised in Western India.
BACKGROUND
While the past decades have seen a rise in the number of cases diagnosed with cancer, breast cancer in particular has become the most frequently diagnosed cancer in women over the past decade. The figures for associated mortality are on a decline in most Western and developed nations, but in contrast they continue to remain high in transitional nations like India.
MATERIALS AND METHODS
After receiving approval by IEC and IRB, we set-up a prospective 2-year long screening programme combined with outreach camps to ensure representation of the larger population and include urban, rural and tribal population. Strict screening criteria were enforced and trained female paramedical staff were assigned to the camp for patient counselling and breast cancer awareness. Investigation was performed at the tertiary care institute utilising both full-field digital breast mammography and tomosynthesis. Biopsy was advised for highly suspicious lesions.
RESULTS
The study encompassed n=1017 Indian women and revealed that 39% (n=397) of them belonged to 41-50 years age group. BIRADS categorisation of the lesions revealed that while majority (57%; n=580) women had no detectable abnormality, nearly 22% (n=224) had lesions suspected to be benign while 10% (n=99) of them had lesions with a suspicion of high index of malignancy. 43% (n=437) of the populace had dense breasts (type-C). Most of the BIRADS-5 lesions (36/38) were confirmed as malignant on histopathology.
CONCLUSION
We propose a model for screening mammography and also presents the results of this programme which we implemented to screen populace from a large and densely populated geographic region. The model was successful in being self-sustainable and received a good turnout on the back of community outreach breast awareness camps and by incentivizing the women by performing mammograms completely free of cost and also providing them reports.
Topics: Adult; Breast Neoplasms; Early Detection of Cancer; Female; Humans; India; Mammography; Middle Aged; Program Evaluation; Prospective Studies
PubMed: 35092402
DOI: 10.31557/APJCP.2022.23.1.327 -
Current Oncology (Toronto, Ont.) Aug 2022Quality medical practice is based on science and evidence. For over a half-century, the efficacy of breast cancer screening has been challenged, particularly for women...
Quality medical practice is based on science and evidence. For over a half-century, the efficacy of breast cancer screening has been challenged, particularly for women aged 40-49. As each false claim has been raised, it has been addressed and refuted based on science and evidence. Nevertheless, misinformation continues to be promoted, resulting in confusion for women and their physicians. Early detection has been proven to save lives for women aged 40-74 in randomized controlled trials of mammography screening. Observational studies, failure analyses, and incidence of death studies have provided evidence that there is a major benefit when screening is introduced to the general population. In large part due to screening, there has been an over 40% decline in deaths from breast cancer since 1990. Nevertheless, misinformation about screening continues to be promoted, adding to the confusion. Despite claims to the contrary, a careful reading of the guidelines issued by major groups such as the U.S. Preventive Services Task Force and the American College of Physicians shows that they all agree that most lives are saved by screening starting at the age of 40. There is no scientific support for using the age of 50 as a threshold for screening. All women should be provided with the facts and not false information about breast cancer screening so that they can make "informed decisions" for themselves about whether to participate.
Topics: Breast Neoplasms; Communication; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening
PubMed: 36005183
DOI: 10.3390/curroncol29080445 -
Journal of Digital Imaging Aug 2023This work aimed to investigate whether global radiomic features (GRFs) from mammograms can predict difficult-to-interpret normal cases (NCs). Assessments from 537...
This work aimed to investigate whether global radiomic features (GRFs) from mammograms can predict difficult-to-interpret normal cases (NCs). Assessments from 537 readers interpreting 239 normal mammograms were used to categorise cases as 120 difficult-to-interpret and 119 easy-to-interpret based on cases having the highest and lowest difficulty scores, respectively. Using lattice- and squared-based approaches, 34 handcrafted GRFs per image were extracted and normalised. Three classifiers were constructed: (i) CC and (ii) MLO using the GRFs from corresponding craniocaudal and mediolateral oblique images only, based on the random forest technique for distinguishing difficult- from easy-to-interpret NCs, and (iii) CC + MLO using the median predictive scores from both CC and MLO models. Useful GRFs for the CC and MLO models were recognised using a scree test. The CC and MLO models were trained and validated using the leave-one-out-cross-validation. The models' performances were assessed by the AUC and compared using the DeLong test. A Kruskal-Wallis test was used to examine if the 34 GRFs differed between difficult- and easy-to-interpret NCs and if difficulty level based on the traditional breast density (BD) categories differed among 115 low-BD and 124 high-BD NCs. The CC + MLO model achieved higher performance (0.71 AUC) than the individual CC and MLO model alone (0.66 each), but statistically non-significant difference was found (all p > 0.05). Six GRFs were identified to be valuable in describing difficult-to-interpret NCs. Twenty features, when compared between difficult- and easy-to-interpret NCs, differed significantly (p < 0.05). No statistically significant difference was observed in difficulty between low- and high-BD NCs (p = 0.709). GRF mammographic analysis can predict difficult-to-interpret NCs.
Topics: Humans; Female; Mammography; Breast Density; Random Forest; Breast Neoplasms
PubMed: 37253894
DOI: 10.1007/s10278-023-00836-7 -
Radiologia Mar 2022There have always been concerns about the secondary effects of diagnostic methods that use ionizing radiation. During mammography, the parameters to be concerned about...
Mean glandular dose in the mammary gland and dose of radiation in the thyroid gland and lens in women with and without breast implants during different modalities of mammography.
UNLABELLED
There have always been concerns about the secondary effects of diagnostic methods that use ionizing radiation. During mammography, the parameters to be concerned about are the mean glandular dose and the scatter dose. We evaluated the dose of radiation to the breast, thyroid gland, and lens in digital mammography in women with and without implants, in tomosynthesis in women with and without implants, and in contrast-enhanced mammography.
MATERIALS AND METHODS
The study included 212 women with and without disease who were attended at the Centro Clínico de Estereotaxia, CECLINES, in Caracas, Venezuela, between June 2017 and August 2017; the women were classified into five groups according to the mammographic modality used to evaluate them and whether or not they had implants. The statistical analysis included descriptive statistics for the study population. We used the Mann-Whitney U to compare the mean glandular dose and dose in the thyroid gland and lens between groups.
RESULTS
The mean glandular dose and the dose of radiation received in the thyroid and lens were within the acceptable range. In a few exceptions, the mean glandular dose per view was slightly higher than 3 mGy. The scatter dose to the thyroid gland and the lens during mammography has a very small contribution to the annual dose equivalent.
CONCLUSION
The mean glandular dose and the scatter dose to the thyroid gland and lens delivered during tomosynthesis and 2D mammography in women with implants were higher than those delivered during other mammographic techniques in women without implants.
Topics: Breast Implants; Female; Humans; Mammary Glands, Human; Mammography; Radiation Dosage; Thyroid Gland
PubMed: 35428461
DOI: 10.1016/j.rxeng.2020.10.013 -
JAMA Network Open Apr 2022Increasing use of screening breast magnetic resonance imaging (MRI), including among women at low or average risk of breast cancer, raises concerns about resulting...
IMPORTANCE
Increasing use of screening breast magnetic resonance imaging (MRI), including among women at low or average risk of breast cancer, raises concerns about resulting mammary and extramammary cascades (downstream services and new diagnoses) of uncertain value.
OBJECTIVE
To estimate rates of cascade events (ie, laboratory tests, imaging tests, procedures, visits, hospitalizations, and new diagnoses) and associated spending following screening breast MRI vs mammography among commercially insured US women.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study used 2016 to 2018 data from the MarketScan research database (IBM Corporation), which includes claims and administrative data from large US employers and commercial payers. Participants included commercially insured women aged 40 to 64 years without prior breast cancer who received an index bilateral screening breast MRI or mammogram between January 1, 2017, and June 30, 2018. We used propensity scores based on sociodemographic, clinical, and utilization variables to match MRI recipients to mammogram recipients in each month of index service use. Data were analyzed from October 8, 2020, to October 28, 2021.
EXPOSURES
Breast MRI vs mammography.
MAIN OUTCOMES AND MEASURES
Mammary and extramammary cascade event rates and associated total and patient out-of-pocket spending in the 6 months following the index test.
RESULTS
In this study, 9208 women receiving breast MRI were matched with 9208 women receiving mammography (mean [SD] age, 51.4 [6.7] years). Compared with mammogram recipients, breast MRI recipients had 39.0 additional mammary cascade events per 100 women (95% CI, 33.7-44.2), including 5.0 additional imaging tests (95% CI, 3.8-6.2), 17.3 additional procedures (95% CI, 15.5-19.0), 13.0 additional visits (95% CI, 9.4-17.2), 0.34 additional hospitalizations (95% CI, 0.18-0.50), and 3.0 additional new diagnoses (95% CI, 2.5-3.6). For extramammary cascades, breast MRI recipients had 19.6 additional events per 100 women (95% CI, 8.6-30.7) including 15.8 additional visits (95% CI, 10.2-21.4) and no statistically significant differences in other events. Breast MRI recipients had higher total spending for mammary events ($564 more per woman; 95% CI, $532-$596), extramammary events ($42 more per woman; 95% CI, $16-$69), and overall ($1404 more per woman; 95% CI, $1172-$1636). They also had higher overall out-of-pocket spending ($31 more per woman; 95% CI, $6-$55).
CONCLUSIONS AND RELEVANCE
In this cohort study of commercially insured women, breast MRI was associated with more mammary and extramammary cascade events and spending relative to mammography. These findings can inform cost-benefit assessments and coverage policies to ensure breast MRI is reserved for patients for whom benefits outweigh harms.
Topics: Breast; Breast Neoplasms; Cohort Studies; Female; Humans; Magnetic Resonance Imaging; Mammography; Middle Aged
PubMed: 35416989
DOI: 10.1001/jamanetworkopen.2022.7234 -
Radiology Dec 2021Background While digital breast tomosynthesis (DBT) is rapidly replacing digital mammography (DM) in breast cancer screening, the potential of DBT density measures for...
Background While digital breast tomosynthesis (DBT) is rapidly replacing digital mammography (DM) in breast cancer screening, the potential of DBT density measures for breast cancer risk assessment remains largely unexplored. Purpose To compare associations of breast density estimates from DBT and DM with breast cancer. Materials and Methods This retrospective case-control study used contralateral DM/DBT studies from women with unilateral breast cancer and age- and ethnicity-matched controls (September 19, 2011-January 6, 2015). Volumetric percent density (VPD%) was estimated from DBT using previously validated software. For comparison, the publicly available Laboratory for Individualized Breast Radiodensity Assessment software package, or LIBRA, was used to estimate area-based percent density (APD%) from raw and processed DM images. The commercial Quantra and Volpara software packages were applied to raw DM images to estimate VPD% with use of physics-based models. Density measures were compared by using Spearman correlation coefficients (), and conditional logistic regression was performed to examine density associations (odds ratios [OR]) with breast cancer, adjusting for age and body mass index. Results A total of 132 women diagnosed with breast cancer (mean age ± standard deviation [SD], 60 years ± 11) and 528 controls (mean age, 60 years ± 11) were included. Moderate correlations between DBT and DM density measures ( = 0.32-0.75; all < .001) were observed. Volumetric density estimates calculated from DBT (OR, 2.3 [95% CI: 1.6, 3.4] per SD for VPD%) were more strongly associated with breast cancer than DM-derived density for both APD% (OR, 1.3 [95% CI: 0.9, 1.9] [ < .001] and 1.7 [95% CI: 1.2, 2.3] [ = .004] per SD for LIBRA raw and processed data, respectively) and VPD% (OR, 1.6 [95% CI: 1.1, 2.4] [ = .01] and 1.7 [95% CI: 1.2, 2.6] [ = .04] per SD for Volpara and Quantra, respectively). Conclusion The associations between quantitative breast density estimates and breast cancer risk are stronger for digital breast tomosynthesis compared with digital mammography. © RSNA, 2021 See also the editorial by Yaffe in this issue.
Topics: Breast; Breast Density; Breast Neoplasms; Case-Control Studies; Female; Humans; Mammography; Middle Aged; Retrospective Studies
PubMed: 34519572
DOI: 10.1148/radiol.2021210190 -
Biomedica : Revista Del Instituto... Mar 2021Introduction: Mammography quality is directly related to the ability to detect an abnormality and, therefore, quality control is necessary for diagnostic imaging...
Introduction: Mammography quality is directly related to the ability to detect an abnormality and, therefore, quality control is necessary for diagnostic imaging centers. Objective: To evaluate image quality, reading, and mammography service in some diagnostic imaging centers in Manizales, Colombia. Materials and methods: Four diagnostic imaging centers participated voluntarily in the study under confidentiality agreements. Out of 520 women attending the centers, 318 had a mammography. The infrastructure, technology, and human resources of each unit were evaluated based on visual inspections. A radiologist expert in reading and clinical interpretation of mammary images evaluated the quality of the image and the reading. We made the statistical analysis using anova, the kappa index, and the percentage of disagreement. Results: We found images of diminished quality mainly due to the presence of artifacts in 75 % of those evaluated, as well as non-compliance with identification criteria and image labeling. There were difficulties in taking the lateral median oblique projection given the absence of the inframammary. The level of agreement in the BI-RADS reporting was low in the four centers with important differences in the report and description of findings. Conclusion: The city’s diagnostic centers under evaluation are authorized for their operation. However, there are important deficiencies in image quality and reading, which highlights the need to seek quality standards starting from those aspects that can be improved upon.
Topics: Breast Neoplasms; Colombia; Female; Humans; Mammography; Prospective Studies; Quality Control
PubMed: 33761189
DOI: 10.7705/biomedica.5135 -
Scientific Reports Oct 2023Mammography shifted to digital breast tomosynthesis (DBT) in the US. An automated percentage of breast density (PD) technique designed for two-dimensional (2D)...
Mammography shifted to digital breast tomosynthesis (DBT) in the US. An automated percentage of breast density (PD) technique designed for two-dimensional (2D) applications was evaluated with DBT using several breast cancer risk prediction measures: normalized-volumetric; dense volume; applied to the volume slices and averaged (slice-mean); and applied to synthetic 2D images. Volumetric measures were derived theoretically. PD was modeled as a function of compressed breast thickness (CBT). The mean and standard deviation of the pixel values were investigated. A matched case-control (CC) study (n = 426 pairs) was evaluated. Odd ratios (ORs) were estimated with 95% confidence intervals. ORs were significant for PD: identical for volumetric and slice-mean measures [OR = 1.43 (1.18, 1.72)] and [OR = 1.44 (1.18, 1.75)] for synthetic images. A 2nd degree polynomial (concave-down) was used to model PD as a function of CBT: location of the maximum PD value was similar across CCs, occurring at 0.41 × CBT, and PD was significant [OR = 1.47 (1.21, 1.78)]. The means from the volume and synthetic images were also significant [ORs ~ 1.31 (1.09, 1.57)]. An alternative standardized 2D synthetic image was constructed, where each pixel value represents the percentage of breast density above its location. Several measures were significant and an alternative method for constructing a standardized 2D synthetic image was produced.
Topics: Humans; Female; Breast Density; Mammography; Breast Neoplasms; Breast; Case-Control Studies; Radiographic Image Enhancement
PubMed: 37907569
DOI: 10.1038/s41598-023-45402-x