Rosa Lin

CHICAGO - Women in their 40s without a family history of the disease face the same risk for breast cancer and should be screened, according to a study released at RNSA Tuesday

“Family history does not seem to impact the rate of invasive disease in our patient cohort,” said Stamatia Destounis, MD, radiologist and managing partner of the Elizabeth Wende Breast Care Center, whose 

 found women between the ages of 40 and 49 showed the same rates of cancer regardless of history.

Destounis and colleagues conducted a retrospective study on patients diagnosed with breast cancer at their center from 2000 to 2010. Three hundred seventy-three patients obtained their diagnosis through mammography screening out of 1,071 total patients diagnosed with breast cancer. Of those 373, 144 patients, or 39 percent, had a family history of breast cancer, with seven of them having a personal history of breast cancer. There were 228 patients, or 61 percent, with no family history, 16 of whom had a personal history. There was one with an unknown family history.

Of the 144 patients with a family history of breast cancer, 46 patients, or 31.9 percent, had a premenopausal history among first degree relatives. This meant that they had a young family member with breast cancer. Another 54 patients, or 37.5 percent, had a postmenopausal history. Lastly, 44 patients, or 30.6 percent, had pre- or postmenopausal history in a second or third degree relative.

In the non-history group, there were 86 masses, 97 microcalcifications, 18 masses with calcium, 18 architectural distortions, and nine asymmetries. In the group with family history, there were 42 masses, 69 microcalcifications, 21 masses with calcium, 11 architectural distortions, and one asymmetry. Types of lesions between the two groups were statistically different.

Analysis showed that in the non-history group, 146 patients, or 64 percent, had invasive disease, and 36 percent had noninvasive disease. In the group with family history, 91 patients, or 63.2 percent, had invasive disease, and 36.8 percent had noninvasive disease. In the non-history group, a total of 71 patients, 31.1 percent, had a mastectomy. In the group with family history, 54 patients, or 37.5 percent, had a mastectomy.

The study also looked at lymph node metastatic rates, and found the rates to be 29 percent for non-history and 31 percent for family history groups. The research group also collected data on breast density and demographics of the patients, and are in the process of collecting recurrence and survival rates.

Breast cancer is the most common cancer diagnosis among women in the U.S., comprising 30 percent of all diagnoses, according to the American Cancer Society. It is the second leading cause of death in women.

This study supports the American Cancer Society's recommendation for all women 40 and over to get an annual mammography screening. This is in contrast to the guidelines issued by the U.S. Preventive Services Task Force, 

which recommend an individualized choice.

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CHICAGO - Women in their 40s without a family history of the disease face the same risk for breast cancer and should be screened, according to a study released at RNSA Tuesday.

Study Supports Breast Cancer Screening for Women in 40s

CHICAGO - Great strides have been made in the past century in ensuring women's safety during childbirth. Now, new imaging software presented Tuesday at RSNA furthers this by simulating childbirth to predict difficult deliveries.

Because of the upright position of humans and the large head size of a fetus, the movement of a fetus through the birth canal of a woman is more complicated than that of other animals, leading to a higher risk of dystocia, or difficult labor. Olivier Ami, MD, of Antoine Béclères Hospital at Université Paris Sud, France, and colleagues used software called Predibirth in conjunction with MR images to study 24 pregnant women and their delivery outcomes.

They produced 3-D reconstructions of the fetus and each woman's pelvic measurements, with which they simulated 72 possible trajectories of the fetal head through the birth canal. Animation of the fetus was obtained by the adjunction of a skeleton to the 3-D reconstruction of the fetus.

“The computer simulates what we call collision detection,” Ami said. The software tries to find a trajectory of the given fetal head through the pelvis, and a collision is detected if it is not possible. Based on these results, each mother was scored on her likelihood to have a favorable childbirth.

In a highly favorable birth, there is no potential collision detected. In a mildly favorable birth, there is less than 3 percent of fetal head volume reduction, as the head may be slightly molded during childbirth. If the fetal head volume reduction is over 3 percent, there is an unfavorable birth, which corresponds to potential brain damage or inability to deliver vaginally.

The Predibirth scores in the study were computed retrospectively and compared with actual delivery outcomes. Of the 24 pregnant women, the 13 who delivered vaginally were all scored as highly favorable by the simulator. Three women who had elective cesarean sections (C-section) also had scores for high dystocia risk.

Emergency C-section for obstructed labor occurred in three patients, who were estimated to have high risk for dystocia. Three instrumental extractions, meaning use of a vacuum to aid in delivery, were scored as mildly favorable.

“We could've targeted the emergency C-section for obstructed labor, and the instrumental extractions, for planned Cesarean sections,” Ami said.

The imaging tests were performed during the last month of pregnancy. “The more you are performing it close to the delivery, the more it is accurate,” Ami said. Extrapolation curves for the growth of the head are also available when a test is performed earlier in the pregnancy.

Approximately a third of all births in the U.S. are delivered through C-sections. An emergency C-section has significantly higher risk for mortality as compared to a planned C-section.

Imaging Software Simulates Childbirth

CHICAGO - Passing compact discs full of diagnostic images from institutions to patients and back will soon seem as archaic as “sneakernet” file transfer by floppy disk.

That, at least, is the hope of the people behind 

, a $4.7 million initiative funded through the National Institute of Biomedical Imaging and Bioengineering (NIBIB). Three hospitals of the five pilot sites, which include the Mayo Clinic, the University of Chicago, University of California San Francisco, Mount Sinai and Washington University in St. Louis, are already live.

The technology is built to mimic the banking model. Medical images taken at radiology departments are uploaded to a secure clearinghouse, where patients can control access from their personal health record, much like accessing funds from an ATM. An eight-digit code, plus a password known only to the patient, ensures the privacy of the patient. After a patient accesses their images, they may select those they wish to share with others.

“This mechanism of distribution eliminates an entire layer of security and consent [issues] that you have to consider when you're trying to share enterprise-to-enterprise,” said the project's principal investigator, David Mendelson, MD, of The Mount Sinai Medical Center, who presented the initiative at RSNA 2011 Tuesday.

The NIBIB funds allow for 300,000 patients to be enrolled in the image-sharing network, and though only five institutions have implemented the technology so far, the funds cover 28 different sites.

The technology behind the image-sharing network is not new. “It's basically an image router sitting in the cloud,” Mendelson said. However, the implications for the project are far-reaching. With an image-sharing network, it is no longer necessary to FedEx a CD of images during a time-sensitive situation, nor fear that somebody will walk out of a hospital with a CD that is not theirs.

The image-sharing network provides a way to reduce redundancy of tests, thereby lowering a patient's exposure to radiation and freeing up key resources. “What's really inappropriate is to redo a scan on a patient that's just been done a few hours ago, and make the same diagnoses,” just because of poor image-sharing capabilities, said Keith Hentel, MD, of New York Presbyterian Hospital.

The project also worked on bringing together existing vendors doing “image sharing with proprietary solutions to adopt a common set of standards,” which would make image sharing more efficient and convenient for everybody, Mendelson said.

Several aspects of the RSNA Image Share project is powered by lifeIMAGE, an image-sharing vendor. According to Hamid Tabatabaie, CEO of lifeIMAGE, there are vendors who facilitate image sharing among two parties, but currently he has no competitors in the broadcasting system the Image Share project employs. His company processes 14 million radiology exams per year, less than 5 percent of all radiology exams. However, he predicts this technology will become the dominant method of image sharing within the next few years.
 

CHICAGO - Passing compact discs full of diagnostic images from institutions to patients and back will soon seem as archaic as “sneakernet” file transfer by floppy disk. That, at least, is the hope of the people behind RSNA Image Share, a $4.7 million initiative funded through the National Institute of Biomedical Imaging and Bioengineering (NIBIB) that was presented at RSNA Tuesday.

RSNA Image Share Gives Patient Access to Images

CHICAGO - Heading a soccer ball may cause serious brain injury visible through an advanced magnetic resonance technique, according to a new study presented Tuesday at RSNA.

A study from the Albert Einstein College of Medicine on amateur soccer players revealed that those who practiced heading - a common maneuver where the player drives the ball with a forceful blow from his head - the most often had brain abnormalities on par with traumatic brain injury patients.

Michael Lipton, MD, and colleagues used diffusion tensor imaging (DTI), an advanced magnetic resonance technique, to study changes in the brain's white matter of 32 amateur soccer players (average age 30.8 years). DTI measures the direction of water movement along axons, called fractional anisotropy (FA).

In normal white matter, water follows “a very unidirectional, uniform diffusion,” indicating high anisotropy, said Lipton at the RSNA meeting. “Everybody here, hopefully, has very high levels of anisotropy,” he added to the audience.

However, random water movement, or low FA, is associated with cognitive impairment in traumatic brain injury patients. Lipton and colleagues found that the players with the highest frequency headings had significantly lower FA than players with lower frequency of headings.

The players' frequency of heading ranged from zero to 5,000 headings per year. Further analysis revealed a threshold level – players who practiced a frequency above 1,000 to 1,500 headings per year showed significant decrease in FA, while players below that level did not.

“The implications of this finding is that the lower FA indicates that there is something missing or wrong with the white matter in that location, which is consistent with what we've seen in people with concussions or minor brain injuries,” Lipton said. These minor injuries can escalate over time.

“We have to realize that even very small scale injury can have major functional repercussions because you disrupt not just that one small spot in the brain, but a large, interconnected network,” of neurons in the brain, Lipton said.

The study authors warned against the repetitive heading common during soccer practice sessions. As Lipton explained, small injuries occurring rapidly within a short period of time were more likely to lead to serious damage to the brain then the same amount spread over a longer period of time.

Lipton emphasized that the study is not calling for a ban on heading. The bulk of heading occurs in practice, and Lipton suggested reducing the amount of heading in practice safely below the threshold level.

Author | Rosa Lin

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