Mammography

Prospective buyers of digital mammography equipment got a warning at the 2005 RSNA meeting: Watch out when comparing images from equipment made by different vendors.

All year long, we at Diagnostic Imaging write about important radiology issues. You might think that by the time the RSNA meeting rolls around, we would have covered just about everything. Well, in a sense, we have. But the reality is that the "big show" never ceases to amaze us. Each year, forecasted trends don't materialize, surprise trends sneak up, and the usual number of boom and bust predictions either boom... or bust.

The merits of screening mammography have again become a subject of debate following new research suggesting that breast cancer surgery speeds up disease progression in young women. The study's authors recommend that breast screening consent forms include the risk of accelerated tumor growth and early relapse.

The clinical trial numbers may be small, but the ambitions of one new technology-breast tomosynthesis-were nevertheless larger than life at the RSNA meeting. While many of the breast imaging papers showcased refinements to relatively new techniques, breast tomosynthesis stood out by promising a revolution.

Interest in digital mammography was strong on the 2005 RSNA exhibit floor, driven at least in part by positive results from the Digital Mammographic Imaging Screening Trial, whose results were announced 10 weeks prior to the start of the meeting. A few doors down from the prospective buyers crowding exhibitor booths, however, early adopters of the equipment were sounding an alarm.

As computer-aided detection continues to make inroads into virtual colonoscopy territory, studies presented at the 2005 RSNA meeting highlighted its potential for spotting polyps.

R2 Technology is leveraging knowledge gained in developing computer-aided detection to make products easier and more efficient to use.

Digital breast tomosynthesis promises to dramatically reduce the rate of false-positive mammograms, potentially sparing women from unnecessary follow-up tests and biopsies, according to a study presented at the RSNA meeting.

R2 Technology is making machines smarter and, in the process, easing the transition to digital mammography.

Digital mammography cleared a substantial hurdle earlier this year, when researchers established its clinical advantages in women under 50 and in those with dense breasts. Now, with demand for digital already on the rise, the technology faces another obstacle: image integration and workstation interoperability.

The volume of breast biopsies performed on Medicare beneficiaries has soared in recent years, and radiologists have taken the lion’s share of the utilization growth, according to a study presented at the RSNA meeting on Wednesday.

Digital mammography images acquired in a 64-foot van serving Washington residents are as good as mobile film-based images, according to a study from a Seattle breast center.

An upgrade to the computer-aided detection product line from R2 Technology gives users a choice of operating points to set different sensitivity/false marker rates for microcalcifications and masses in the breast. The enhanced system allows users to set sensitivity to their own comfort levels, providing unprecedented flexibility, according to the company.

Digital breast tomosynthesis (DBT) promises to dramatically reduce the rate of false-positive mammograms, potentially sparing women from unnecessary follow-up tests and biopsies, according to a study presented Tuesday.

As computer-aided detection continues to make inroads into virtual colonoscopy territory, studies presented Tuesday at the RSNA meeting highlighted its potential for spotting polyps.

A new phase-contrast CR mammography system that magnifies edge effects from x-ray refraction is sharpening contrast at the edges of the breast. The system, unveiled today at the RSNA meeting, also enhances the visualization of microcalcifications and fibrils within the breast, according to representatives from Konica Minolta.

Hot on the heels of favorable findings from the Digital Mammographic Imaging Screening Trial, digital mammography systems are in high demand on the RSNA exhibition floor. But buyers may have a rude awakening when they encounter problems with interoperability of systems from different vendors, according to a mammography task force.

OpView image processing software reconstructs breast images obtained from full-field digital mammography, as well as ultrasound and MRI, to bring clarity to challenging breast scans. The software, unveiled Sunday at the RSNA meeting by Siemens Medical Solutions, will assist interpretation of lesions in dense breasts and microcalcifications, according to the company.

Computer-aided detection is evolving from an interesting technological trapping to a standard of care. Part of that process involves the ongoing iterative advancement expected to be on display at the RSNA meeting.

Computer-aided detection is scoring new points for lung cancer diagnosis, according to European researchers. Despite ongoing controversy, investigators also showed advances in CAD for lung cancer screening.

Kodak readies FDA pitch for CR mammographyThe next step in Kodak’s push to expand its market for computed radiography in mammography to the U.S. is under way. The company has begun the submission process to the FDA to approve its CR system for the detection of breast cancer. It plans to submit a series of “modules” for agency review. The first ones will contain manufacturing and nonclinical information regarding the DirectView CR 850, CR 950, and CR 975 systems. Kodak, which is selling CR mammography products outside the U.S., is currently conducting clinical trials of its digital mammography system at sites in the U.S. and Canada.If and when these systems appear in the U.S., they will not be the first such products (DI SCAN 10/10/05). Fuji began marketing CR technology for mammography in 1983 but voluntarily removed those products in the mid-1990s, when the FDA changed its position on digital mammography and required PMA review. Fuji turned in the final module of its premarket approval submission in March. Fuji executives believe approval of their CR mammography product is imminent.

Ablating the safety margins of tumors following lumpectomy could reduce the need for another resection. The combined treatment approach could also reduce breast disfigurement, according to a study presented at the American College of Surgeons annual meeting in October.

Dynamic Imaging prepares enhanced RIS/PACSVisitors to the Dynamic Imaging exhibit booth at the RSNA meeting will see the company’s version of its IntegradWeb RIS/PACS. The system builds on the Web-based architecture of its predecessors to address ambulatory settings. Included in the IT package are RIS, PACS, billing, document management, and digital dictation.

CONTEXT: Cerebral tissue damage due to stroke occurs in two stages: Lack of blood causes initial damage, and delayed cell death, presumably by apoptosis, follows in neighboring regions. Dr. Francis Blankenberg, an associate professor of radiology and pediatric medicine at Stanford University, used technetium-99m-rh-Hynic-Annexin V, an imaging marker that binds to cells at an early stage of apoptosis, to identify at-risk tissue surrounding the initial damage caused by stroke. Tc-99m-rh-Hynic-Annexin V attaches to phosphatidylserine, a phospholipid that is expressed on the membranes of neuronal cells undergoing apoptosis and is viewed using SPECT.

Digital mammography's superiority over film in cancer detection in select patients took industry watchers and researchers by surprise. While proponents hoped for a best-case scenario of a clinical draw between the two techniques, few expected digital to excel.

Digital mammography is maturing. Full-field digital systems are becoming more flexible, endowed with screening and diagnostic capabilities, while physicians are experimenting with 3D capabilities that promise to eliminate poor visualization and clutter on 2D mammograms. Workstations designed to display digital mammograms are becoming more cosmopolitan. Like workstations built for CT and MR, they can exchange and display imaging data from multiple sources and modalities.

Computer-aided detection is evolving from an interesting technological trapping to a standard of care. Part of that process involves the ongoing iterative advancement expected to be on display at the RSNA meeting.

Computer-aided detection is scoring new points for lung cancer diagnosis, according to European researchers. Despite ongoing controversy, investigators also showed advances in CAD for lung cancer screening.

The last of the four FDA-approved full-field digital scanners, Siemens Mammomat Novation DR, has gained American College of Radiology accreditation. The FDA granted the ACR the right in 2003 to accredit the other three digital mammography machines approved for sale in the U.S.: GE Senographe 2000D, Fischer SenoScan, and Lorad Selenia. The ACR accredits about 95% of mammography equipment in the U.S., while the state handles the accreditation process in Texas, Arkansas, and Iowa.