Characterization of the imaging settings in screening mammography using a tracking and reporting system: A multi-center and multi-vendor analysis

A tracking and reporting system was developed to monitor radiation dose in X-ray breast imaging. We used our tracking system to characterize and compare the mammographic practices of five breast imaging centers located in the United States and Brazil. Clinical data were acquired using eight mammography systems comprising three modalities: computed radiography (CR), full-field digital mammography (FFDM), and digital breast tomosynthesis (DBT). Our database consists of metadata extracted from 334,234 images. We analyzed distributions and correlations of compressed breast thickness (CBT), compression force, target-filter combinations, X-ray tube voltage, and average glandular dose (AGD). AGD reference curves were calculated based on AGD distributions as a function of CBT. These curves represent an AGD reference for a particular population and system. Differences in AGD and imaging settings were attributed to a combination of factors, such as improvements in technology, imaging protocol, and patient demographics. The tracking system allows the comparison of various imaging settings used in screening mammography, as well as the tracking of patient- and population-specific breast data collected from different populations.     

Mammographic measurements before and after augmentation mammaplasty

Thirty-five augmented women underwent mammography using both the standard implant-compression technique and, when possible, the implant-displacement technique; all had preaugmentation film-screen mammography available for evaluation. The area of mammographically visualized breast tissue before and after augmentation mammaplasty was measured using a transparent grid. Patients with subglandular implants had a mean decrease of 49 percent of measurable tissue area with compression mammography and a 39 percent decrease with displacement mammography. Patients with submuscular implants had a 28 percent decrease in measurable tissue area with compression mammography and a 9 percent decrease with displacement mammography. Anterior breast tissue was seen better with displacement mammography; posterior breast tissue, with compression mammography. Most patients had some degree of parenchymal scarring and lower image quality after augmentation. State-of-the-art mammography was not possible in most patients augmented with silicone-gel-filled implants.     

Mammography: a surgeon's experience.

Most reports advocating mammography have been written by radiologists rather than by clinicians who are frequently confronted by women with breast complaints. The value of mammography in managing patients with breast problems was studied by reviewing its role in 1026 breast consultations; there were 129 patients with cancer. Mammography was performed in 95 patients. The procedure hastened the diagnosis of one comedocarcinoma, and in another patient was suspicious 3 years before she presented with a locally advanced lesion. It missed six cancers. In seven patients it recognized clinically obvious cancers, though in one of these it had given negative results 10 months before the patient presented with a lesion 15 cm in diameter. It also falsely suggested the possibility of cancer in 28 women. In the other 52 patients the clinical diagnosis of a benign condition was usually fairly evident. The morbidity caused by mammography does not seem to have been widely appreciated, no doubt because of the hope that clinically unrecognized cancers would be found by it. Most breast problems can be diagnosed without mammography.     

钼靶X线摄片联合肿瘤相关标志物检测对乳腺癌的诊断价值

目的:探讨乳腺钼靶X射线摄片与血清糖类抗原15-3(CA15-3)、癌胚抗原(CEA)和骨桥蛋白(OPN)联合检测对乳腺癌的临床诊断价值。方法:选择在我院经手术和病理证实为乳腺癌的患者60例作为研究组,另选取60例健康体检者作为对照组。分别检测两组的血清CA15-3、CEA和OPN水平,并采用乳腺钼靶X射线检查。比较X射与血清学检测单独检测及联合检测的阳性率。结果:研究组患者血清CA15-3、CEA及OPN水平均显著高于对照组,差异具有统计学意义(P0.05);血清CA15-3、CEA、OPN和钼靶X射线摄片联合检测的敏感性显著高于单独检测,差异具有统计学意义(P0.05)。结论:对乳腺癌患者进行钼靶X射线摄片及肿瘤相关标志物检测可提高阳性检出率,有利于乳腺癌的早期诊断及治疗。     

Cancer: improving early detection and prevention. A community practice randomised trial.

OBJECTIVE--To test the impact of physician education and facilitator assisted office system interventions on cancer early detection and preventive services. DESIGN--A randomised trial of two interventions alone and in combination. SETTING AND SUBJECTS--Physicians in 98 ambulatory care practices in the United States. INTERVENTIONS--The education intervention consisted of a day long physician meeting directed at improving knowledge, attitudes, and skills relevant to cancer prevention and early detection. The office system intervention consisted of assistance from a project facilitator in establishing routines for providing needed services. These routines included division of responsibilities for providing services among physicians and their staff and the use of medical record flow sheets. MAIN OUTCOME MEASURES--The proportions of patients provided the cancer prevention and early detection services indicated annually according to the US National Cancer Institute. RESULTS--Based on cross sectional patient surveys, the office system intervention was associated with an increase in mammography, the recommendation to do breast self examination, clinical breast examination, faecal occult blood testing, advice to quit smoking, and the recommendation to decrease dietary fat. Education was associated only with an increase in mammography. Record review for a patient cohort confirmed cross sectional survey findings regarding the office system for mammography and faecal occult blood testing. CONCLUSION--Community practices assisted by a facilitator in the development and implementation of an office system can substantially improve provision of cancer early detection and preventive services.     

High-resolution gamma-camera for molecular breast imaging: First clinical results

Scintimair mography is a molecular breast imaging technique using tumour-seeking radiopharmaceuticals; with standard gamma-cameras, is proved of value especially when mammography is indeterminate and in women with dense breasts; nevertheless, this technique shows a high sensitivity only for cancers >1 cm. The issue of detecting small cancers is critical for the future development and clinical usefulness of breast imaging with radiopharmaceuticals, because other modalities are increasingly employed for early identification of small abnormalities. The use of high-resolution dedicated cameras for breast imaging is the best option to improve small cancers' detection: they allow greater flexibility in patient positioning, and the availability of projections similar to those of mammography. Moreover, the detector can be placed directly against the breast, and a mild compression is possible, with the results of reducing breast thickness, increasing the target-to-background ratio and the sensitivity. Our first clinical findings using the dedicased camera Lumagem 3200S (Gamma Medica, Inc., Northridge, USA) are very satisfactory. Till now, 29 patients with BI-RADS category III and IV lesions ≤1 cm were prospectively evaluated using a conventional gamma-camera and the dedicated device. Four out nine (44%) of the malignant lesions were detected with the standard gamma-camera, whereas the high-resolution camera visualized all the breast cancers. The standard gamma-camera and the dedicated one showed the same specificity: 19 out of 20 (95%) benign lesions were negative. Our results indicate that molecular breast imaging with this dedicated camera is able to detect small cancers in patients with probably benign or low-suspicion to indeterminate mammographic findings.     

Development of a pressure-measuring device to optimize compression treatment of lymphedema and evaluation of change in garment pressure with simulated wear and tear

The use of compression garments in treating lymphedema following treatment of genital (penis, testes, uterus, cervical) and breast cancer treatment is a well-established practice. Although compression garments are classified in compression classes, little is known about the actual subgarment pressure exerted along the extremity. The aims of this study were to establish an in vitro method for measuring subgarment pressure along the extremity and to analyze initial and over time subgarment pressure of compression garments from three manufacturers. The measurements were performed with I-scan(?) (Tekscan Inc.) pressure measuring equipment once a week during a period of 4 weeks. Wear and tear was simulated by washing and putting on the garments on plastic legs every day. There was a statistically significant difference between the garments of some of manufacturers. There was no difference between garments from the same manufacturer. No significant decrease of subgarment pressure was observed during the trial period. The study demonstrated that Tekscan pressure-measuring equipment could measure subgarment pressure in vitro. The results may indicate that there was a difference in subgarment pressure exerted by garments from different manufacturers and that there was no clear decrease in subgarment pressure during the first four weeks of usage.     

乳腺X 线摄影癌周透亮带的影像特征及其病理基础与价值

目的:研究乳腺X线摄影癌周透亮带影像学特征,分析其病理基础及临床意义。方法:回顾性分析2010年6月-2011年10月期间我院经手术病理证实为乳腺癌患者196例,筛选出术前进行过乳腺X线摄影检查并且图像上癌周出现透亮带征象的患者共47例51个病灶,测量肿块直径、癌周透亮带宽度等,与病理大体标本切面和镜下切片进行对比研究分析。结果:双乳病灶多分布于外上象限(19/51),临床触诊病灶大小平均值约35.45±1.25 mm。乳腺X摄影观察病灶均为肿块样,影像测量病灶大小平均值约20.49±1.18 mm,与临床触诊大小之间的差别具有统计学意义(t=2.85,P<0.01);肿块周围可观察到宽窄不均透亮带,平均宽度约15.07±0.86 mm,乳腺癌癌周透亮带宽度与肿块大小之间没有显著相关性(r=0.188,P=0.186)。病理大体标本观察病灶周围包绕一圈连续的黄色脂肪组织;HE染色镜下切片观察瘤灶周围为一圈成熟脂肪细胞,局部被瘤灶边缘增生的致密结缔组织为主的毛刺分割,脂肪组织中散在分布炎性细胞,部分区域见灶状癌细胞团浸润。结论:乳腺X线摄影癌周透亮带病理基础为伴随瘤周间质反应的富含脂肪的组织层,此征象对乳腺癌的诊断、以及临床评估肿瘤浸润范围具有一定意义。     

A biomechanical model of mammographic compressions

A number of biomechanical models have been proposed to improve nonrigid registration techniques for multimodal breast image alignment. A deformable breast model may also be useful for overcoming difficulties in interpreting 2D X-ray projections (mammograms) of 3D volumes (breast tissues). If a deformable model could accurately predict the shape changes that breasts undergo during mammography, then the model could serve to localize suspicious masses (visible in mammograms) in the unloaded state, or in any other deformed state required for further investigations (such as biopsy or other medical imaging modalities). In this paper, we present a validation study that was conducted in order to develop a biomechanical model based on the well-established theory of continuum mechanics (finite elasticity theory with contact mechanics) and demonstrate its use for this application. Experimental studies using gel phantoms were conducted to test the accuracy in predicting mammographic-like deformations. The material properties of the gel phantom were estimated using a nonlinear optimization process, which minimized the errors between the experimental and the model-predicted surface data by adjusting the parameter associated with the neo-Hookean constitutive relation. Two compressions (the equivalent of cranio-caudal and medio-lateral mammograms) were performed on the phantom, and the corresponding deformations were recorded using a MRI scanner. Finite element simulations were performed to mimic the experiments using the estimated material properties with appropriate boundary conditions. The simulation results matched the experimental recordings of the deformed phantom, with a sub-millimeter root-mean-square error for each compression state. Having now validated our finite element model of breast compression, the next stage is to apply the model to clinical images.     

GEANT4 Monte Carlo simulations for virtual clinical trials in breast X-ray imaging: Proof of concept

Virtual clinical trials (VCT) are in-silico reproductions of medical examinations, which adopt digital models of patients and simulated devices. They are intended to produce clinically equivalent outcome data avoiding long execution times, ethical issues related to radiation induced risks and huge costs related to real clinical trials with a patient population. In this work, we present a platform for VCT in 2D and 3D X-ray breast imaging. The VCT platform uses Monte Carlo simulations based on the Geant4 toolkit and patient breast models derived from a cohort of high resolution dedicated breast CT (BCT) volume data sets. Projection images of the breast and three-dimensional glandular dose maps are generated for a given breast model, by simulating both 2D full-field digital mammography (DM) and 3D BCT examinations. Uncompressed voxelized breast models were derived from segmented patient images. Compressed versions of the digital breast phantoms for DM were generated using a previously published digital compression algorithm. The Monte Carlo simulation framework has the capability of generating and tracking ~10⁵ photons/s using a server equipped with 16-cores and 3.0 GHz clock speed. The VCT platform will provide a framework for scanner design optimization, comparison between different scanner designs and between different modalities or protocols on computational breast models, without the need for scanning actual patients as in conventional clinical trials.     

乳腺分型及乳腺厚度与全数字化乳腺X线摄影曝光条件及平均腺体剂量的关系

目的：探讨不同乳腺分型（Ⅰ型（脂肪型）、Ⅱ型（致密型）、Ⅲ型（中间型）、Ⅳ型（导管型））、不同乳腺厚度与全数字化乳腺X射线摄影曝光条件（kV、mms）、平均腺体剂量（mGy）之间的关系。方法：回顾性分析2009年9月-2010年6月间采用德国Siemens公司MAMMOMAT Novation DR全数字化乳腺摄影系统、自动曝光控制模式下摄影所获得的2000例头尾位和内外侧斜位乳腺片,分析7840幅Ⅰ级乳腺照片中不同乳腺分型、不同乳腺厚度的曝光条件、平均腺体剂量,以研究乳腺分型及乳腺厚度与全数字化乳腺X线摄影曝光条件及平均腺体剂量的关系。结果：当乳腺厚度相同时,Ⅱ型（致密型）乳腺的曝光条件及平均腺体剂量最大,Ⅳ型（导管型）次之,Ⅲ型（中间型）再次之,Ⅰ型（脂肪型）乳腺的曝光条件及平均腺体剂量最小。无论何种乳腺分型,随着乳腺厚度的增加,全数字化乳腺X射线摄影曝光条件及平均腺体剂量随之增加。结论：乳腺分型及乳腺厚度与全数字化乳腺X射线摄影曝光条件及平均腺体剂量关系密切,乳腺腺体组织越致密、厚度越厚,其曝光条件及平均腺体剂量就越大。     

乳腺MRI 与乳腺X线在导管原位癌临床诊断中应用的比较研究

目的:探讨乳腺MRI与乳腺X线检查在导管原位癌(DCIS)诊断中的应用价值。方法:选择2012年5月至2014年9月在我院接受诊治的乳腺DCIS患者52例(58个病灶)为研究对象,对所有患者进行乳腺MRI及X线检查,以病理检查结果作为金标准,比较乳腺MRI及X线检查在导管原位癌(DCIS)诊断中的应用价值。结果:58个病灶中,乳腺MRI共检查出阳性54例,阴性4例,其中误诊或漏诊4例;乳腺X线共检查出阳性49例,阴性9例,其中误诊或漏诊11例。乳腺MRI检查的灵敏度和准确度均显著高于乳腺X线,差异有统计学意义(P0.05)。此外,乳腺MRI检查的特异度、阳性预测值及阴性预测值均分别高于乳腺X线,但差异无统计学意义(P0.05)。结论:乳腺MRI检查对DCIS的诊断价值较高,具有广泛的应用前景,但亦存在少数误诊或漏诊。     

The role of various modalities in breast imaging

Background: Breast cancer is the most common type of cancer in women worldwide. Mammography is considered the "gold standard" in the evaluation of the breast from an imaging perspective. Apart from mammography, ultrasound examination and magnetic resonance imaging are being offered as adjuncts to the preoperative workup. Recently, other new modalities like positron emission tomography, 99mTc-sestamibi scintimammography, and electrical impedance tomography (EIT) are also being offered. However, there is still controversy over the most appropriate use of these new modalities. Based on the literature, this review evaluates the role of various modalities used in the screening and diagnosis of breast cancer. Methods and Results: Based on relevant literatures this article gives an overview of the old and new modalities used in the field of breast imaging. A narrative literature review of all the relevant papers known to the authors was conducted. The search of literatures was done using pubmed and ovid search engines. Additional references were found through bibliography reviews of relevant articles. It was clear that though various new technics and methods have emerged, none have substituted mammography and it is still the only proven screening method for the breast as of date. Conclusion: From the literature it is clear that apropos modern radiology's impact on diagnosis, staging and patient follow-up, only one imaging technique has had a significant impact on screening asymptomatic individuals for cancer i.e.; low-dose mammography. Mammography is the only screening test proven in breast imaging. Positron emission tomography (PET) also plays an important role in staging breast cancer and monitoring treatment response. As imaging techniques improve, the role of imaging will continue to evolve with the goal remaining a decrease in breast cancer morbidity and mortality. Progress in the development and commercialisation of EIT breast imaging system will definitely help to promote other systems and applications based on the EIT and similar visualization methods. Breast ultrasound and breast magnetic resonance imaging (MRI) are frequently used adjuncts to mammography in today's clinical practice and these techniques enhance the radiologist's ability to detect cancer and assess disease extent, which is crucial in treatment planning and staging.     

Use of a capacitive measuring mat for recording inter-fragment pressures and pressure distribution in ventral inter-corporal spondylodesis

With respect to ventral interbody fusion, rates of pseudarthrosis of up to 30% are reported. With the aim of reducing this figure, the use of dorsal fixation systems to stabilise the fused spinal units is recommended by a number of authors. The aim of these osteosynthetic procedures is to elevate the interfragmentary compression between the ventral bone block and the adjacent vertebrae. In order to measure the pressure achievable, and its local distribution, an experimental investigation involving the use of a capacitive measuring mat has been designed. The system of capacitive measurement and its application to the spine is described. The simple mode of measurement and mechanical stability, combined with high accuracy, are the specific advantages of capacitive systems of measurement. Especially in the documentation of interfragmentary pressure and pressure distribution, capacitive measuring mats are superior to comparable systems.     

全数字化乳腺X线摄影诊断临床隐匿型乳腺癌的价值

目的：探讨全数字化乳腺X线摄影对临床隐匿性乳癌的诊断价值。方法：回顾性分析临床扪诊阴性,手术病理证实乳腺癌12例。全部病例均使用全数字化乳腺X线摄影。结果：12例病例发现病灶12个,其中单纯钙化7例,微结节或结构紊乱伴微钙化3例,微结节伴毛刺11例。局部结构紊乱1例。结论：全数字化乳腺X线摄影能清晰显示乳房各个层次结构,尤其发现恶性钙化敏感性高,对发现临床隐匿型乳腺癌具有重大价值。     

Application of Breast Ultrasound in a Mammography-Based Chinese Breast Screening Study

We evaluated the clinical significance of the combined use of mammography + ultrasound as a new breast screening strategy. The inclusion criteria were: (1) females aged >40yrs; (2) breast cancer diagnosis by the breast image screening personnel at FUSCC; (3) screening by both ultrasound and mammography; (4) mammographic/sonographic images analyzed independently by different radiologists; and (5) follow-up for at least 1 year. Fifty-four women were enrolled. The analysis included diagnostic sensitivity of mammography, ultrasound, and mammography + ultrasound. The sensitivities of mammography and mammography + ultrasound were compared overall as well as among different age groups/breast densities. The screening sensitivity of mammography, ultrasound, and mammography + ultrasound was 79.6, 57.4, and 92.6 %, respectively. The difference between mammography and mammography + ultrasound was significant (P < 0.05). The benefit of including ultrasound with mammography as a new breast image screening strategy was found statistically significant in patients with dense breast on mammogram while it was non-significant in younger (<50 years) women. We, therefore, concluded that mammography + ultrasound increased the diagnostic sensitivity of breast screening; hence it was more desirable for women with dense breast on mammography.     

Methodological features of magnetic resonance imaging mammography

By studying 211 females by currently available radiation techniques, such as X-ray study, ultrasonography, and magnetic resonance imaging mammography (MRIM), the authors consider that the specificity of contrast-enhanced MRIM (CE MRIM) is greater than that of MRIM without administering magnetic resonance contrast agents (MRCA). CE MRIM reveals clinically suspicious early-stage breast lesions and defines the stage of a tumorous process, the patients being unexposed to ionizing irradiation. CE MRIM as an auxiliary technique becomes one of the most informative ones, particularly in girls, early reproductive-age females with developed glandular tissue, and pregnant females. In the authors' opinion, the total algorithm of a breast study in this group of patients in specialized medical centers where trained physicians work should differ from the generally accepted algorithm: instead of applying X-ray mammography (XRM) as a basic method of primary diagnosis, ultrasound mammography using Doppler color mapping, followed by MRIM or XRM should be employed.     

乳腺肿块X线检查常见漏、误诊原因的病例分析

目的:分析乳腺X线检查的误漏诊原因,提高诊断准确性。方法:选择2011年3月至2013年12月来我院就诊的135例经乳腺X线摄影和病理检查证实的乳腺肿瘤患者为研究对象,将X线摄影结果与病理检查结果对比,进行回顾性的分析。结果:病理诊断72例良性肿瘤而X线误诊为恶性7例(误诊率9.72%);63例恶性肿瘤而X线误诊为良性5例(漏诊率7.93%)。结论:乳腺X线误诊与乳腺致密程度、患者年龄以及肿瘤形态相关。掌握拍片技术减少技术性误差,提高影像质量,诊断时仔细阅片并熟知各类型乳腺疾病的特征性X影像表象,并与临床相结合,增强责任心,可减少乳腺X线检查的误漏诊。     

ClearPEM,un TEP dédié au sein

Conventional breast imaging (mammography, ultrasound, MRI) relies on the analysis of anatomical characteristics. Whole-body positron emission tomography (PET) allows for the acquisition of a metabolic image, yet is limited by its poor spatial resolution. The Crystal Clear Collaboration developed a PET dedicated for breast imaging, the ClearPEM, in order to offer a high-resolution nuclear imaging technique. The patient is installed in the prone position on the exam bed, with two detector plates rotating around to breast to acquire a 3-dimensional image. Two prototypes were built and installed in hospitals. We summarize the technical solutions necessary for the development of this system and present a summary of its performances as well as an outlook on preclinical and clinical tests.     

乳腺错构瘤X线及病理特征分析

目的：探讨乳腺错构瘤的病理及影像学特征。方法：对11例乳腺错构瘤患者的临床特征、X线征象及病理表现进行回顾性分析。结果：患者平均年龄为46岁（26-58岁）,10例可触及肿块（9例患者自己发现,1例体检摄片时发现）,还有1例未能触及肿块。左乳7例,右乳4例,5／11（45．5％）肿块位于外上象限。11例钼靶X线平片均发现乳腺肿块,多数肿块呈卵圆形,边界清楚。肿块平均最大直径为6．Ocm（2．5-13．0cm）,6／11（54．5％）肿块呈混合密度影。4／11例（36．4％）术前X线确诊。镜下：肿瘤由数量不等、杂乱无章的乳腺导管、小叶和成熟的脂肪细胞及纤维纽织混杂组成。结论：混合密度影是其特异性X线表现,不同个体肿瘤各成分比例的不同导致X线表现差异较大。