BY JANE LOWERS, SUPPLEMENTS EDITOR

For sheer creativity, it is hard to beat breast imaging. Breast cancer's subtleties stretch the abilities of every established modality and encourage the development of new technologies. The high stakes of mammography reading helped spur advances in computer-aided detection. A steady stream of new research on secondary imaging and biopsy techniques is decreasing the rate of false positives and sparing women unnecessary and expensive procedures.

Behind all of these innovations lies urgency and financial necessity. Mammography's effectiveness at reducing the number of breast cancer deaths has been proven, most recently in a longitudinal population study by Dr. Lázló Tabár in Sweden, but many U.S. imaging centers lose money with every screening mammogram they perform. Squeezing the most accurate and cost-effective abilities out of technology is a matter of survival.

Those combined pressures have given breast imaging a strong diagnostic armamentarium that improves yearly. The challenge now is to find the financial resources to support that technology and keep and attract skilled breast imagers.

Ultimately, imaging technology is only as good as the radiologist who uses it. Single reads, double reads and CAD all rely on a well-trained eye, but fewer and fewer radiologists are finding mammography attractive, given its high stress factor and low financial gain.

Mammography as a field has stretched its resources, both technological and human, to the maximum to provide a necessary screening service. It's time for reimbursement to catch up and allow the field to reach its full potential.