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Journal of Medical Radiation Sciences Sep 2020As an efficient, effective and moderately inexpensive modality, mammography has been implemented as a cancer screening tool and in diagnostic management. However,... (Review)
Review
INTRODUCTION
As an efficient, effective and moderately inexpensive modality, mammography has been implemented as a cancer screening tool and in diagnostic management. However, appropriate breast compression is necessary for optimal outcomes. Current key measures of compression force are subjective and variable, giving rise to the concept of a 'personalised' pressure-standardisation protocol.
METHODS
A scoping review of the literature was performed using the Arksey and O'Malley framework to explore the existing force- and pressure-standardisation protocols in clinical application. A comprehensive search strategy and standardised study selection and evaluation were completed. This synthesis of existing knowledge can lead to the implementation of mechanically standardised mammographic compression pressure as a feasible tailored approach to clinical practice. Four databases (PubMed, MEDLINE, Embase and Scopus) were searched from the databases' inception to 13 December 2019 for relevant information, and eighteen articles were selected for analysis.
RESULTS
In addition to current protocol comparison, emerging key concepts include the reasoning behind standardisation, the benefits of improved diagnostic outcomes/decreased pain with negligible change in image quality and average glandular dose (AGD), and the recommendation of a 10kPa (approximate) pressure-standardisation protocol. Research to date is largely based abroad (Netherlands), with a strong focus on screening practices. Consequently, several gaps in the current literature were identified as potential directions for future investigation.
CONCLUSIONS
As a suggested mammographic guideline, compression pressures of approximately 10kPa aid in image acquisition reproducibility both within and between women; pain levels decrease, with minimal variations to breast thickness, AGD and image quality.
Topics: Breast; Humans; Mammography; Pain; Pressure; Reference Standards
PubMed: 32420700
DOI: 10.1002/jmrs.400 -
Journal of Digital Imaging Apr 2017Nowadays, the optimization in digital mammography is one of the most important challenges in diagnostic radiology. The new digital technology has introduced additional...
Nowadays, the optimization in digital mammography is one of the most important challenges in diagnostic radiology. The new digital technology has introduced additional elements to be considered in this scenario. A major goal of mammography is related to the detection of structures on the order of micrometers (μm) and the need to distinguish the different types of tissues, with very close density values. The diagnosis in mammography faces the difficulty that the breast tissues and pathological findings have very close linear attenuation coefficients within the energy range used in mammography. The aim of this study was to develop a methodology for optimizing exposure parameters of digital mammography based on a new Figure of Merit: FOM ≡ (IQF)/AGD, considering the image quality and dose. The study was conducted using the digital mammography Senographe DS/GE, and CDMAM and TORMAM phantoms. The characterization of clinical practice, carried out in the mammography system under study, was performed considering different breast thicknesses, the technical parameters of exposure, and processing options of images used by the equipment's automatic exposure system. The results showed a difference between the values of the optimized parameters and those ones chosen by the automatic system of the mammography unit, specifically for small breast. The optimized exposure parameters showed better results than those obtained by the automatic system of the mammography, for the image quality parameters and its impact on detection of breast structures when analyzed by radiologists.
Topics: Adult; Breast; Female; Humans; Mammography; Middle Aged; Organ Size; Phantoms, Imaging; Radiation Dosage; Radiographic Image Enhancement
PubMed: 27896452
DOI: 10.1007/s10278-016-9928-3 -
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 -
Revista Da Associacao Medica Brasileira... 2015The authors discuss the main innovations in the diagnosis and treatment of breast cancer, particularly in diagnostic imaging and screening, and in locoregional and... (Review)
Review
The authors discuss the main innovations in the diagnosis and treatment of breast cancer, particularly in diagnostic imaging and screening, and in locoregional and systemic therapies.
Topics: Axilla; Breast Neoplasms; Drug Therapy; Female; Humans; Lymph Node Excision; Lymph Nodes; Mammography; Mastectomy; Sensitivity and Specificity
PubMed: 26841165
DOI: 10.1590/1806-9282.61.06.543 -
Sensors (Basel, Switzerland) Jan 2023Convolutional Neural Networks (CNN) have received a large share of research in mammography image analysis due to their capability of extracting hierarchical features...
Convolutional Neural Networks (CNN) have received a large share of research in mammography image analysis due to their capability of extracting hierarchical features directly from raw data. Recently, Vision Transformers are emerging as viable alternative to CNNs in medical imaging, in some cases performing on par or better than their convolutional counterparts. In this work, we conduct an extensive experimental study to compare the most recent CNN and Vision Transformer architectures for whole mammograms classification. We selected, trained and tested 33 different models, 19 convolutional- and 14 transformer-based, on the largest publicly available mammography image database OMI-DB. We also performed an analysis of the performance at eight different image resolutions and considering all the individual lesion categories in isolation (masses, calcifications, focal asymmetries, architectural distortions). Our findings confirm the potential of visual transformers, which performed on par with traditional CNNs like ResNet, but at the same time show a superiority of modern convolutional networks like EfficientNet.
Topics: Mammography; Neural Networks, Computer; Image Processing, Computer-Assisted; Databases, Factual
PubMed: 36772268
DOI: 10.3390/s23031229 -
Breast Cancer Research and Treatment Apr 2013The transition from screen-film to digital mammography may have altered diagnostic evaluation of women following a positive screening examination. This study compared...
The transition from screen-film to digital mammography may have altered diagnostic evaluation of women following a positive screening examination. This study compared the use and timeliness of diagnostic imaging and biopsy for women screened with screen-film or digital mammography. Data were obtained from 35,321 positive screening mammograms on 32,087 women aged 40-89 years, from 22 breast cancer surveillance consortium facilities in 2005-2008. Diagnostic pathways were classified by their inclusion of diagnostic mammography, ultrasound, magnetic resonance imaging, and biopsy. We compared time to resolution and frequency of diagnostic pathways by patient characteristics, screening exam modality, and radiology facility. Between-facility differences were evaluated by computing the proportion of mammograms receiving follow-up with a particular pathway for each facility and examining variation in these proportions across facilities. Multinomial logistic regression adjusting for age, calendar year, and facility compared odds of follow-up with each pathway. The median time to resolution of a positive screening mammogram was 10 days. Compared to screen-film mammograms, digital mammograms were more frequently followed by only a single diagnostic mammogram (46 vs. 36 %). Pathways following digital screening mammography were also less likely to include biopsy (16 vs. 20 %). However, in adjusted analyses, most differences were not statistically significant (p = 0.857 for mammography only; p = 0.03 for biopsy). Substantial variability in diagnostic pathway frequency was seen across facilities. For instance, the frequency of evaluation with diagnostic mammography alone ranged from 23 to 55 % across facilities. Differences in evaluation of positive digital and screen-film screening mammograms were minor, and appeared to be largely attributable to substantial variation between radiology facilities. To guide health systems in their efforts to eliminate practices that do not contribute to effective care, we need further research to identify the causes of this variation and the best evidence-based approach for follow-up.
Topics: Adult; Aged; Aged, 80 and over; Biopsy; Breast Neoplasms; Female; Humans; Logistic Models; Magnetic Resonance Imaging; Mammography; Middle Aged; Radiographic Image Enhancement; Time Factors; Ultrasonography; United States
PubMed: 23471650
DOI: 10.1007/s10549-013-2466-5 -
Swiss Medical Weekly May 2004In Switzerland controversy exists on how to summarise the evidence on the efficacy and effectiveness, as well as adverse effects, of mammography screening, and breast... (Review)
Review
QUESTIONS UNDER STUDY
In Switzerland controversy exists on how to summarise the evidence on the efficacy and effectiveness, as well as adverse effects, of mammography screening, and breast cancer mortality trends are often discussed in the context of the impact of mammography. PRINCIPLES/METHODS: Single-study publications, meta-analyses, and reports by international expert groups on mammography screening are reviewed. Breast cancer mortality trends from 1970-2000 are reported and discussed in the context of the Swiss screening situation.
RESULTS
In Switzerland breast cancer mortality rates for female Swiss nationals aged 50-79 years fell between 1990 and 2000 by some 25% in all language regions. The data from randomised studies in large populations in several countries with well organised mammography programmes prompt the conclusion that participation in organised screening programmes with rigorous quality standards reduces breast cancer mortality. The achievable long-term reduction in breast cancer mortality ranges from 5-20% in the target population provided that appropriate diagnostic investigation and treatment are available. To achieve this in Switzerland 830 to 3300 women need to be invited to screening for ten years to prevent one death from breast cancer. The risk-benefit profile of mammography screening is likely to be less favourable if mammographies are performed outside the context of organised screening programmes. In Switzerland we are now confronted with growing regional disparities in access to screening mammography which is under systematic quality control.
CONCLUSIONS
The decrease in breast cancer mortality in Switzerland is most probably due to treatment developments and changes in cause-of-death coding. Public health measures in Switzerland should aim at regulating quality control for screening mammography, monitoring mammography use and improving the information on mammography available to women. For an evidence-based decision regarding health insurance coverage of screening mammography in 2007, large gaps need to be filled. The current coexistence of systematic screening programmes and opportunistic screening, with distinct regional differences, provides a unique opportunity for research into the merits and drawbacks of the two approaches.
Topics: Aged; Breast Neoplasms; Female; Health Services Accessibility; Humans; Mammography; Mass Screening; Middle Aged; Population Surveillance; Switzerland; Treatment Outcome
PubMed: 15243841
DOI: 10.4414/smw.2004.10507 -
AJR. American Journal of Roentgenology Nov 2017The objective of this study was to investigate the impact of decreasing breast compression during digital mammography and breast tomosynthesis (DBT) on perceived pain...
OBJECTIVE
The objective of this study was to investigate the impact of decreasing breast compression during digital mammography and breast tomosynthesis (DBT) on perceived pain and image quality.
MATERIALS AND METHODS
In this two-part study, two groups of women with prior mammograms were recruited. In part 1, subjects were positioned for craniocaudal (CC) and mediolateral oblique (MLO) views, and four levels of compression force were applied to evaluate changes in breast thickness, perceived pain, and relative tissue coverage. No imaging was performed. In part 2, two MLO DBT images of one breast of each patient were acquired at standard and reduced compression. Blurring artifacts and tissue coverage were judged by three breast imaging radiologists, and compression force, breast thickness, relative tissue coverage, and perceived pain were recorded.
RESULTS
Only the first reduction in force was feasible because further reduction resulted in inadequate breast immobilization. Mean force reductions of 48% and 47% for the CC and MLO views, respectively, resulted in a significantly reduced perceived pain level, whereas the thickness of the compressed breast increased by 0.02 cm (CC view) and 0.09 (MLO view, part 1 of the study) and 0.38 cm (MLO view, part 2 of the study), respectively, with no change in tissue coverage or increase in motion blurring.
CONCLUSION
Mammography and DBT acquisitions may be possible using half of the compression force used currently, with a significant and substantial reduction in perceived pain with no clinically significant change in breast thickness and tissue coverage.
Topics: Adult; Aged; Breast Neoplasms; Feasibility Studies; Female; Humans; Mammography; Middle Aged; Observer Variation; Pain; Pressure; Stress, Mechanical
PubMed: 28929809
DOI: 10.2214/AJR.16.17615 -
AJR. American Journal of Roentgenology Jun 2012Interpreting screening mammography accurately is challenging and requires ongoing education to maintain and improve interpretative skills. Recognizing this, many...
OBJECTIVE
Interpreting screening mammography accurately is challenging and requires ongoing education to maintain and improve interpretative skills. Recognizing this, many countries with organized breast screening programs have developed audit and feedback systems using national performance data to help radiologists assess and improve their skills. We developed and tested an interactive Website to provide screening and diagnostic mammography audit feedback with comparisons to national and regional benchmarks.
MATERIALS AND METHODS
Radiologists who participate in three Breast Cancer Surveillance Consortium registries in the United States were invited during 2009 and 2010 to use a Website that provides tabular and graphical displays of mammography audit reports with comparisons to national and regional performance measures. We collected data about the use and perceptions of the Website.
RESULTS
Thirty-five of 111 invited radiologists used the Website from one to five times in a year. The most popular measure was sensitivity for both screening and diagnostic mammography, whereas a table with all measures was the most visited page. Of the 13 radiologists who completed the postuse survey, all found the Website easy to use and navigate, 11 found the benchmarks useful, and nine reported that they intended to improve a specific outcome measure that year.
CONCLUSION
An interactive Website to provide customized mammography audit feedback reports to radiologists has the potential to be a powerful tool in improving interpretive performance. The conceptual framework of customized audit feedback reports can also be generalized to other imaging tests.
Topics: Benchmarking; Breast Neoplasms; Clinical Audit; Feedback; Female; Humans; Internet; Mammography; Practice Patterns, Physicians'; Professional Competence; Radiology; United States
PubMed: 22623571
DOI: 10.2214/AJR.11.7971 -
The British Journal of Radiology Feb 2020In this article, we explore the evidence around the relative benefits and harms of breast cancer screening using a single radiologist to examine each female's mammograms... (Review)
Review
In this article, we explore the evidence around the relative benefits and harms of breast cancer screening using a single radiologist to examine each female's mammograms for signs of cancer (single reading), or two radiologists (double reading). First, we briefly explore the historical evidence using film-screen mammography, before providing an in-depth description of evidence using digital mammography. We classify studies according to which exact version of double reading they use, because the evidence suggests that effectiveness of double reading is contingent on whether the two radiologists are blinded to one another's decisions, and how the decisions of the two radiologists are integrated. Finally, we explore the implications for future mammography, including using artificial intelligence as the second reader, and applications to more complex three-dimensional imaging techniques such as tomosynthesis.
Topics: Aged; Aged, 80 and over; Breast Neoplasms; Early Detection of Cancer; Female; Forecasting; Humans; Mammography; Middle Aged
PubMed: 31617741
DOI: 10.1259/bjr.20190610