Mammography

There’s no doubt that computer-aided detection increases the ability to pick up breast cancers. But questions remain about which users benefit most from CAD, as cancer detection rates vary widely with breast imaging experience.

Plans to digitize radiology departments often exclude mammography. But advances in digital acquisition, viewing, and network technologies may change this, according to a study presented at the 2004 EuroPACS and Management in Radiology conference.

Five years have passed since the first full-field digital mammography unit was released, yet mammographers are only beginning to embrace the electronic capture of images. Still unrealized, but progressing faster than immediately obvious, is contrast media mammography (CMM), the use of contrast agents and FFDM to visualize the bed of blood vessels that typically accompanies the growth of cancer.

Digital mammography has so much to offer that it might, almost, overcome the fact that it has yet to prove clinical superiority over screen-film mammography. Many users have, in fact, already decided that digital is worth its higher cost-about 40% of all mammography systems sold in the first half of 2004 were digital.

Digital mammography integrated with PACS has numerous advantages over screen-film mammography when it comes to image storage, transmission, archiving, and consultation, according to a study conducted at Cottage Health System in Santa Barbara, CA. But those benefits come at a cost in time and productivity.

Critics of population-based mammography screening regularly pick holes in studies claiming to show its value. Now researchers from Denmark have produced a watertight case, showing that mass screening really can cut breast cancer deaths.

Enter Ripley’s Odditorium on the Web, and you are greeted by the man who smokes through his eye, the human plank, Fire Eater, and Rubber Man. These are not the sort of folks most people meet in their daily lives. They establish Ripley’s Believe It Or Not as the world’s authority on unbelievable, odd, weird, and unusual things.

Digital mammography integrated with PACS has numerous advantages over screen-film mammography when it comes to image storage, transmission, archiving, and consultation, according to a study conducted at Cottage Health System in Santa Barbara, CA. But those benefits come at a cost in time and productivity.

About 90 digital mammography systems were shipped to U.S. customers in the first half of 2004, compared with 130 film-based units, according to industry executive estimates. Full-field digital mammography systems thus accounted for almost 40% of the units delivered in the first half of last year. The percentage of revenue tips the scales in FFDM's favor, as each digital system sells for more than a half-million dollars, about six times more than the cost of a film system.

Digital mammography has so much to offer that it might, almost, overcome the fact that it has yet to prove clinical superiority over screen-film mammography. Many users have, in fact, already decided that digital is worth its higher cost-about 40% of all mammography systems sold in the first half of 2004 were digital.

The industry ended the calendar year with a flurry of FDA clearances, easily topping last year’s total and establishing a new high for the decade.

No other company has done what GE has done: The merger of its medical systems unit with British pharmaceutical giant Amersham combined a multimodality maker of imaging equipment with the manufacturer of contrast media.

Full-field digital mammography (FFDM) captured the lion’s share of attention during the 2004 RSNA meeting. As expected, Siemens Medical Solutions showed its Mammomat Novation as a marketable product, while several other manufacturers reappeared with upgraded products or works-in-progress.

Full-field digital mammography is comparable to screen-film in detecting breast cancer, according to results of a randomized trial in Norway involving nearly 25,000 women.

Hologic, which in recent years has made women’s health its principal focus, is showing its full-field digital breast tomosynthesis system as a work-in-progress for the second consecutive RSNA meeting. Despite growing interest in this technology, the company expects to present it as a work-in-progress again next year.

Siemens’ fortunes in women’s health have taken a turn for the better since the company released its full-field digital mammography (FFDM) system. Only a few months after the FDA approved its Novation FFDM, Siemens executives were animated about the product.

Adding a clinical breast exam to routine mammography screenings can pick up additional cancers, but at a cost. At Memorial Sloan-Kettering Cancer Center, adding CBE to screening helped identify an additional eight cancers at a cost of $106,280 each, said Dr. Kimberly Feigin, a radiologist at the New York medical center.

Preliminary findings from a national trial of ultrasound as a screening tool in patients at high risk for breast cancer shed light on key variables that influence radiologist interpretive performance.

Hormone replacement therapy, previous breast surgery, and a low body mass index may interfere with the accuracy of screening mammography, according to a study in the October British Medical Journal.

Strong evidence suggests that MR imaging is the most sensitive of all breast imaging techniques, including state-of-the-art mammography and high-frequency breast ultrasound. In contrast to mammography, the sensitivity and specificity of MR are not impaired by dense breast tissue, fibrocystic disease, or therapeutic interventions such as postsurgical scars or radiotherapy-induced fibrosis.

Hormone replacement therapy, previous breast surgery, and a low body mass index may reduce the accuracy of screening mammography, according to a study in the 28 August edition of the British Medical Journal (2004;329:477). Age, family history, physical activity levels, smoking, and alcohol consumption did not significantly affect the sensitivity or specificity.

Planmed, which markets a variety of advanced mammography products, is showing its Nuance full-field digital mammography system during RSNA 2004. A work-in-progress, the Nuance is being displayed with a tomosynthesis capability.

Digital mammography’s latest vendor, Siemens Medical Solutions, is showing its new Mammomat Novation system on the 2004 RSNA exhibit floor. The product meets all the demands of modern mammography practices, providing digital screening, diagnosis, and stereotactic biopsy capabilities. Since receiving FDA approval in August, Novation has been installed at 10 sites, and the company expects to install another 20 by year-end.

Plans to digitize radiology departments often exclude mammography. But advances in digital acquisition, viewing, and network technologies mean that this should no longer be the case, according to a group of Spanish researchers.

Adding a clinical breast exam to routine mammography screenings can pick up additional cancers, but at a cost. At Memorial Sloan-Kettering Cancer Center, adding CBE to screening helped identify an additional eight cancers at a cost of $106,280 each, said Dr. Kimberly Feigin, a radiologist at the New York medical center.

Cedara Software is developing a computer-assisted detection system for breast ultrasound. The software, announced as a work-in-progress at the RSNA meeting, is intended to identify the sonographic characteristics of benign as well as malignant breast masses and to classify the extent of malignancy for specific nodules.

The SenoScan2 slot scanning digital mammography (SSDM) system from Fischer Imaging is being introduced at the RSNA meeting. Fischer designs, manufactures, and markets medical imaging systems for screening and diagnosis.

Breast tomosynthesis may be a work-in-progress in the RSNA exhibit halls, but researchers are already considering ways to incorporate computer-assisted detection algorithms to improve its efficacy.