Mammography

Vendors struggling to keep up with orders look for ways to boost production and beat backlogs

Israeli and U.S. researchers have found that computer aided-detection systems can boost the accuracy of chest radiography for lung cancer, especially when the procedures are performed by inexperienced readers.

Digital tomosynthesis detects more breast masses, better categorizes those masses, and produces lower callback rates than conventional mammography. In a study of symptomatic patients, tomosynthesis was not superior to mammography, but a combination of the two techniques detected more carcinomas than either alone.

Emory University trial results showed that a new technique called stereoscopic digital mammography reduces false positives by 49% and false negatives by 40% in women with an elevated risk of breast cancer. But the technique may have difficulty catching on, as it requires double the images and double the radiation dose compared with conventional digital mammography.

While demand for MR and CT equipment languishes, digital mammography is enjoying a heyday with no end in sight. When the final numbers are tallied, vendors expect to have shipped twice as many full-field digital mammography units in 2007 to customers in the U.S. as in the previous year. And 2009 could be more of the same.

A large prospective screening trial from the University of Pennsylvania compared screen-film mammography, digital mammography, whole-breast ultrasound, and contrast-enhanced MRI in a population of 569 asymptomatic women. In this single-center trial, funded by the National Cancer Institute, the definition of high risk included women with a 25% lifetime risk based on genetic testing or Gail or Claus models and those with a history of cancer in the contralateral breast.

Philips Medical Systems plans to be on the U.S. market with a computed radiography system for mammography in the second half of 2008 and with a flat panel mammography system in the first half of 2009. When approved by the FDA, they will be available as part of a digital platform that can support CR and DR, the first such hybrid ever.

Not since the height of the CT slice wars have vendors said so much about products that were so far from market. They have been talking up breast tomosynthesis for years, adding details with each passing RSNA meeting, whetting the appetite of a marketplace enamored of digital imaging. Looming larger, year after year, until it can no longer be ignored is the question-spoken or unspoken-that begins with the word "when."

Breast tomosynthesis used in the screening setting detects more breast masses, better categorizes those masses, and produces lower callback rates than conventional mammography, according to research presented at the RSNA meeting. Tomosynthesis was not superior to mammography in one study of symptomatic patients, but a combination of the two techniques detected more carcinomas than either alone.

Immune to the effects of the Deficit Reduction Act and impervious to concerns of obsolescence, digital mammography this year will achieve nearly triple-digit growth in the U.S. In the first half of 2007, demand for digital mammography almost doubled with about 770 units sold to U.S. customers compared with 400 in the first half of 2006.

RSNA newcomer Parascript takes aim this week at false positives in computer-aided detection, hoping to convince other vendors that its proprietary image analysis software, proven in fields outside radiology, can do a better job than other mammography CAD systems.

Philips frames R&D at RSNA 2007Toshiba showcases interventional systemVisage, Medicsight partner on CT colonographySiemens launches digital mammo screening unit

A 1996 National Aeronautics and Space Administration report speculated that telemammography could be used to connect neglected rural patients with timely, critical medical expertise-if only an adequate communications infrastructure in these areas could support such an undertaking. NASA went on to predict that global satellite networks then evolving could bring low-cost telecommunications infrastructure connectivity to virtually any location.

Digital mammography is penetrating the marketplace at a rapid rate, with approximately 26% of facilities now having at least one full-field digital mammography system, according to the Mammography Quality Standards Act scorecard.

Every mammogram is different, and every patient is her own control. Mammographers are watching for changes over time. But the digital age has brought with it some challenges. Because each digital mammography vendor uses proprietary processing algorithms, it may be hard to distinguish pathology from actual differences in image quality that can occur when images are scaled up. Everything scales differently.

Radiologists must become more alert to the extensive range of health problems faced by patients who swallow fish bones, according to a thought-provoking poster from Spain that was one of eight international exhibits to scoop a prestigious Magna Cum Laude award in the vast RSNA 2007 poster hall on Wednesday afternoon.

Digital tomosynthesis detects more breast masses, better categorizes those masses, and produces lower callback rates than conventional mammography, according to research presented at the RSNA meeting. In a study of symptomatic patients, tomosynthesis was not superior to mammography, but a combination of the two techniques detected more carcinomas than either alone.

Vendors geared up for their biggest week of the year, jockeying for position with news about offerings, and hinting at what is yet to come. Digital mammography market to nearly double this year in U.S. Flat panels deliver more dose than image intensifiers R&D seeks stroke therapy with ultrasound microbubbles Commentary: The bumpy road to molecular imaging

Week in review:Heart disease and cancer news dominated.Feature stories: Acusphere preps novel ultrasound agent for FDA submission Cardiac IT morphs to handle images and patient data PET scans may clear path for noninvasive lung cancer treatment Contrast agent illuminates breast cancer with near-infrared light Commentary: Truth versus the frontal parietal network

An FDA advisory panel has voted to support a plan for mandatory accreditation for stereotactic breast biopsy under the Mammography Quality Standards Act program.

Siemens’ mammography system rolls through Vegas Infrared breast scanner appears on television talk showEuropeans apply special catheterMindray revenues boom in 3QMindray appoints new director

In the wake of the RSNA meeting, DI SCAN takes a closer look at the news underlying the announcements along with other noteworthy items.Siemens unveils interventional robotHitachi hopes to jumpstart demand for open MRiCAD sets course to build CAD salesCommentary: Implementing technology in stages

The deepening crisis, then sudden resolution of a medical isotope shortage brought drama, as a cryptic message from Agfa’s board of directors added mystery to the holiday season.Canadian reactor ramps up to renew supply of technetiumPhilips prepares to move into digital mammography“Care areas” characterize GE approach to ultrasound Siemens introduces new premium-class ultrasound scannerCommentary: Trouble-prone Chalk River haunts medical community: When will we learn?

Of the 6000 scientific abstracts submitted to the RSNA this year, four major areas dominate, according to Dr. Gerald Dodd III, chair of the RSNA's scientific program committee.

Information management for digital mammography is unlike that of any other imaging modality. It generates huge files and enormous amounts of imaging data, which must then be stored, transmitted, and displayed.

Digital mammography and general radiography developed from the same x-ray root, but mammography has veered off, driven by a need to meet clinical demands for low radiation exposure and high image quality.

A 10-year study of imaging volume demands on a PACS at the Medical University of South Carolina shows how significant a factor multislice CT has become in image data storage.

The live audience for Diagnostic Imaging’s Netseminar “Emerging Trends in Breast Ultrasound” had a number of questions for the faculty. Below, Dr. William Svensson responds to their queries:

Imaging threats-some averted, others coming or at hand-punctuated the week.Features: CT took it on the chin during the first half of 2000, creating what one exec called the “toughest period in the industry for a decade.” It’s not looking good for Slovakia-or the rest of Europe, for that matter-as the Old World braces for fallout from a European directive that threatens to bring MR imaging to a standstill. The U.S. imaging community dodged a bullet, as Congress reauthorized the State Children’s Health Insurance Program. A pending “Medicare Severity DRG” could give CT vendors a shot in the arm, as hospital administrators look for ways to ensure that staff diagnose patients within the first 24 hours of admittance.

Small-field-of-view positron imaging, optimized for breast cancer detection, is jockeying for position among several adjuncts to x-ray mammography. A proponent of the technology, Dr. Kathy Schilling, believes it has an edge over MRI.