Mammography

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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.

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.

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.

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.

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.

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.

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.

Combining computer-aided detection with screening mammography increases marginal costs per year of life saved by 19%. This is well within the cost-effectiveness range of other medical procedures, according to a study presented Monday.

An investigational device shown as a work-in-progress at the RSNA meeting promises to improve the detection of breast cancer by keying off the process of angiogenesis, which can transform an innocuous tumor into a lethal one by triggering the growth of new blood vessels to feed the cancer.