What Music and Mammography Have in Common

February 1, 2016

Advancements in music and mammography follow similar paths.

Remember those 78 vinyl records that had amazing sound. It was true that you could hear some noise, but, it was not really a problem. Actually, the sound quality was such that a well-informed listener would "hear through the noise."

What we may not have realized at the time was that the bandwidth was wide enough to impact our senses through both the music and the “feeling” of sound. With the right speakers, we got it all. Having worked at RCA Labs, in the early 1960s, I had the opportunity to buy a pair of LC1As - the professional recording studio speakers. High compliant outer surround on axis tweeter and woofer; all that good stuff. It was truly amazing when coupled with 78 vinyl records.

Then came digital music in the form of CDs. The convenience, such as portability, changed the game and the CD craze significantly impacted the sales of 78 vinyl records. Interestingly, today, we have two simultaneous shifts taking place. Streaming is now the latest craze and, therefore, CD sales are down. However, sales of vinyl are up as people are realizing that they have been missing the excellent performance associated with the quality of vinyl records – despite some noise.[[{"type":"media","view_mode":"media_crop","fid":"45426","attributes":{"alt":"Ronald B. Schilling, PhD","class":"media-image media-image-right","id":"media_crop_660559034193","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5206","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 144px; width: 180px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Ronald B. Schilling, PhD","typeof":"foaf:Image"}}]]

Remember those X-ray mammo images that came from systems that could visualize all 16 artifacts in the ACR-NEMA phantom. What we may not have fully realized at the time was that the very high spatial resolution, responsible for seeing the phantom artifacts linked to visualization of calcifications, was a very significant element in the overall patient results that were obtained.

Then came digital mammography, which soon started to dominate the market. There wasn't much attention placed on the fact that all 16 artifacts on the ACR-NEMA could no longer be seen. The ones missing dealt with spatial resolution - the ability to see fine calcifications. 

Interestingly, there were attempts at systems that could see all 16 artifacts on the ACR-NEMA phantom. However, they required the use of line scanning and could not compete with the convenience of area scans, even if the performance was being compromised.

During the last several years, tomosynthesis has come into play in mammography. In some ways it parallels the music case outlined above - the desire to get back to the performance of old using new technology. At a recent panel discussion of experts in the field, tomosynthesis was predicted to become the gold standard for X-ray-related imaging in mammography.

There are a few messages that we can glean from music and mammo. One is that performance will eventually be "rediscovered" as new generations come into the game. The amazing thing is that it can take such a long time to go through a complete cycle. This is especially true in the medical case in which gaining adequate evidence for new technology takes much time and a catalyst of a new technology (eg, tomosynthesis) is required to get the market "back to the future."