Sonography school strives to enhance imaging of breast disease

After mammography, breast ultrasound is the key imaging modality for investigating symptoms in the breast, particularly in younger women, and for follow-up testing of palpable and nonpalpable abnormalities found on screening mammography in any woman. It is also the first choice for guiding percutaneous biopsies in the breast and axilla.

Keeping up with advancements in ultrasound equipment for imaging the breast has been difficult in the last few years, however, as equipment has expanded to include simple and compound scanners, mechanical and electronic transducers, automated and handheld probes, and water bath and direct contact coupling. When Doppler signals were found to originate in the vicinity of breast tumors in the 1970s, ultrasound began to provide functional as well as structural information about breast pathology.

Ultrasound imaging of the breast is also one of the most challenging imaging techniques to master because its use and the interpretation of ultrasound scans are highly operator-dependent. In addition, the examination of the breast is extremely interactive, requiring the examiner to manipulate the transducer systematically to make sure the area of interest is fully explored.

The International Breast Ultrasound School (IBUS) was formed in 1991 with three goals:
? to provide international multidisciplinary educational programs in breast imaging and to improve the standards of ultrasound imaging in the assessment of the breast and its pathology;
? to place ultrasound imaging within the context of conventional and cutting-edge breast imaging techniques; and
? to create an international forum for exchanging scientific information.

Since its first seminar in Rhodes, Greece in 1992, the IBUS has conducted four to six seminars a year in Europe, the U.S., Asia, and South America, each drawing 100 to 500 participants for lectures, demonstrations, and hands-on workshops.

Each seminar is geared to the host country and taps the skills of local experts. During a recent seminar in Moscow that attracted 450 attendees, speakers presented the principles of high-resolution ultrasound and the techniques of ultrasound-guided biopsies. In China, an IBUS seminar reviewed developments in contrast agent technology and clinical experience with the use of contrast. Every seminar also covers the same ground: differential diagnosis with breast ultrasound, ultrasound staging of breast cancer, and assessment of the vascularity of breast tumors.

The IBUS has also established a set of guidelines for assuring the quality of ultrasound imaging in the breast. They cover the spatial, contrast, temporal, and vascular resolution of equipment; placement and movement of the transducer; interpretation of sonographic features in the lesion and adjacent structures; performance of ultrasound-guided interventional procedures; and the number of examinations and procedures that should be performed by examiners to assure accurate and confident imaging.

"Ultrasound is a bit of a poor sister when it comes to guidelines and accreditation compared to x-ray mammography," said Dr. Jack Jellins, a New South Wales, Australia, researcher in breast ultrasound and founding president of the IBUS. "The guidelines show how to look for features in lesions, differentiate normal from abnormal breast tissue, and help clinicians learn how to read ultrasound images."