X-ray Vision: Diagnostic X-rays and CT Scans
Suzanne Amador Kane, Boris A. Gelman in Introduction to Physics in Modern Medicine, 2020
To see if digital mammography is more effective than film for detecting breast cancer and reducing mortality, the NIH performed a large clinical trial, the Digital Mammography Imaging Screening Trial, featuring 49,500 women. (Mortality is defined in terms of death rate: for example, the number of deaths due to breast cancer each year per 100,000 women.) Participants received a digital and film mammogram at the same visit in 2001, then were followed up over several years. Results of this study revealed that certain subsets of women benefited from digital mammography, which proved significantly better in screening the 65% of the women enrolled who were under age 50, who had very dense breasts, or who were pre- or perimenopausal (defined in terms of having had a recent menstrual period). However, no benefit was seen for women who did not fit into these categories.* Subsequently, the use of digital mammography has rapidly increased. A recent technological development in digital mammography has been the introduction of digital breast tomosynthesis (the use of mammograms taken at multiple angles to reconstruct a three-dimensional view of the breast, using techniques described in the next section). In addition, as we mentioned in Section 5.6, current research is focused on the development of new contrast agents to heighten the appearance of tumors.
Breast Cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2020
Bilateral mammography is undertaken in all women over the age of 40 (with a concerning breast symptom) and in those between 35 and 40 with a clinical score of or above 3 (BIRADS), followed by ultrasound and core needle biopsy. Digital breast tomosynthesis (further detailed in the screening section) is established as an integral assessment tool with many centers offering DBT as the mammographic standard in symptomatic breast imaging. Mammographic abnormalities that are not visible on ultrasound undergo stereotactic biopsy. Stereotactic biopsy may also be undertaken using tomosynthesis. Clinically concerning findings that are occult on imaging undergo clinical biopsy. The axilla is assessed with ultrasound in all cases and any suspicious nodes are biopsied. Magnetic resonance imaging (MRI) of the breasts is reserved for those with occult disease on conventional imaging, lobular cancer, multi-focal disease, or prior to neo-adjuvant therapy. Radiological marker clip insertion should be considered in small or very subtle abnormalities.
Preoperative radiological assessment
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava in Oncoplastic and Reconstructive Management of the Breast, 2020
Digital breast tomosynthesis is a new technique which produces a three dimensional derivative of full-field digital mammography using reconstructions of the breast from multiple low-dose digital images, acquired along a 15–50 degree arc. This process reduces the effect of tissue superimposition and results in enhanced visibility, detection, and evaluation of non-calcified mammographic lesions.8,9 Digital breast tomosynthesis also assists in lesion localization and determining mammographic extent of non-calcified disease in women with suspected or known breast cancer.
Systematic review of agreement between tomosynthesis and pathologic tumor size for newly diagnosed breast cancer and comparison with other imaging tests
Published in Expert Review of Medical Devices, 2018
M. Luke Marinovich, Petra Macaskill, Daniela Bernardi, Nehmat Houssami
Digital breast tomosynthesis (DBT) is a recent evolution of full-field digital mammography involving quasi-three-dimensional transformation of breast images. By acquiring projection images that are reconstructed as a series of slices through the breast, tomosynthesis has the potential to improve visualization of breast cancer due to a reduction in the effect of tissue superimposition on standard mammography [1]. Tomosynthesis in the screening setting has been evaluated in prospective studies that show detection of additional cancers when tomosynthesis is added to mammography [2–4] or synthetic 2D images reconstructed from 3D acquisitions [4] versus 2D mammography alone. Furthermore, tomosynthesis has been demonstrated to improve cancer detection in women with dense breasts [5], for whom cancer may be ‘masked’ by tissue superimposition on conventional mammography. Given such improvements in breast cancer detection, the application of tomosynthesis to the pretreatment assessment of cancer extent is an important area for further study, particularly given the increasing adoption of tomosynthesis into population screening practice and the availability of those screening images for breast cancer staging. More accurate measurement of tumor size at initial staging may better inform surgical management, including informing decisions about eligibility for breast conservation, and planning resection to achieve clear margins.
Digital breast tomosynthesis (3D mammography) for breast cancer screening and for assessment of screen-recalled findings: review of the evidence
Published in Expert Review of Anticancer Therapy, 2018
Tong Li, Michael Luke Marinovich, Nehmat Houssami
The development of digital breast tomosynthesis (DBT, also referred to as 3D-mammography) was intended to address the limitations of digital mammography (DM, also known as 2D-mammography), namely the overlap of tissue inherent in projection of a three-dimensional structure (the breast) on two-dimensional images. Overlapping breast tissue can reduce cancer visibility and creates ‘false’ lesions leading to unnecessary (false-positive) recalls from screening. By reducing the effect of tissue overlap, DBT is expected to improve the visualization of breast cancer (BC) and likely to enhance the interpretation of mammography in various clinical applications [1,2]. To date, DBT has shown promise as a primary screening modality, generally as an integrated modality with DM (acquired 2D, or synthesized 2D mammograms reconstructed from DBT acquisitions) where rapidly emerging data have shown improved detection measures using DBT compared to DM [1–3].
The role of artificial intelligence in breast cancer screening: how can it improve detection?
Published in Expert Review of Molecular Diagnostics, 2020
Axel Gräwingholt
The European commission initiative on breast cancer issued a recommendation for screening (strong recommendation for screening versus non-screening in 50–69 years, conditional recommendation for screening in age group 45–49 and 70–74 years.) Also recommendations are issued that identify the 2 year interval as the most appropriate screening interval, double reading of mammograms is recommended over single reading of mammograms. Also a neutral recommendation was formulated about the use of tomosynthesis (3D)-mammography as a primary means of screening versus the commonly used 2D Full Field Digital Mammography. The reason for a neutral recommendation was that there is still a lack of studies and a controversial discussion about the effect of the proven additional detection rates 3D-mammography provides in contrast to the lack of decrease of interval cancers shown in studies and the possible amount of overdiagnosis (meaning detection of cancers that would not have threatened the womens life, even if not had been detected) [4]. This also applies to the additional use of AI algorithms in screening programs. The aim is to find the clinical relevant cancers in a stage where treatment can be more effective and less harmful and to reduce the rate of overdiagnosis and overtreatment.
Related Knowledge Centers
- Breast Cancer Screening
- Digital Radiography
- Ionizing Radiation
- Tomography
- Projectional Radiography
- CT Scan
- Radon Transform
- Depth of Field
- Mammography
- Spectral Imaging