Mammography

In this volume, the topics are constructed from a variety of contents: the bases of mammography systems, optimization of screening mammography with reference to evidence-based research, new technologies of image acquisition and its surrounding systems, and case reports with reference to up-to-date multimodality images of breast cancer. Mammography has been lagged in the transition to digital imaging systems because of the necessity of high resolution for diagnosis. However, in the past ten years, technical improvement has resolved the difficulties and boosted new diagnostic systems. We hope that the reader will learn the essentials of mammography and will be forward-looking for the new technologies. We want to express our sincere gratitude and appreciation?to all the co-authors who have contributed their work to this volume

Imaging of the Breast

Early detection of breast cancer combined with targeted therapy offers the best outcome for breast cancer patients. This volume deal with a wide range of new technical innovations for improving breast cancer detection, diagnosis and therapy. There is a special focus on improvements in mammographic image quality, image analysis, magnetic resonance imaging of the breast and molecular imaging. A chapter on targeted therapy explores the option of less radical postoperative therapy for women with early, screen-detected breast cancers

Diagnostic Reference Levels for digital mammography in Australia

Aims: In 3 phases, this thesis explores: radiation doses delivered to women during mammography, methods to estimate mean glandular dose (MGD), and the use of mammographic breast density (MBD) in MGD calculations. Firstly, it examines Diagnostic reference levels (DRLs) for digital mammography in Australia, with novel focus on the use of compressed breast thickness (CBT) and detector technologies as a guide when determining patient derived DRLs. Secondly, it analyses the agreement between Organ Dose estimated by different digital mammography units and calculated MGD for clinical data. Thirdly, it explores the novel use of MBD in MGD calculations, suggesting a new dose estimation called the actual glandular dose (AGD), and compares MGD to AGD. Methods: DICOM headers were extracted from 52405 anonymised mammograms using 3rd party software. Exposure and QA information were utilised to calculate MGD using 3 methods. LIBRA software was used to estimate MBD for 31097 mammograms. Median, 75th and 95th percentiles were calculated across MGDs obtained for all included data and according to 9 CBT ranges, average population CBT, and for 3 detector technologies. The significance of the differences, correlations, and agreement between MGDs for different CBT ranges, calculation methods, and different density estimation methods were analysed. Conclusions: This thesis have recommended DRLs for mammography in Australia, it shows that MGD is dependent upon CBT and detector technology, hence DRLs were presented as a table for different CBTs and detectors. The work also shows that Organ Doses reported by vendors vary from that calculated using established methodologies. Data produced also show that the use of MGD calculated using standardised glandularities underestimates dose at lower CBTs compared to AGD by up to 10%, hence, underestimating radiation risk. Finally, AGD was proposed; it considers differences in breast composition for individualised radiation-induced risk assessment

Focal Spot, Spring 1997

https://digitalcommons.wustl.edu/focal_spot_archives/1075/thumbnail.jp

Near-Field Radar Microwave Imaging as an Add-on Modality to Mammography

According to global statistics, there is a high incidence of cancer in western countries; and, due to the limited resources available in most health care systems, it seems like one of the most feasible options to fight against cancer might be strict prevention policies—such as eliminating carcinogens in people’s daily lives. Nevertheless, early cancer detection and effective treatment are still necessary, and understanding their efficacy and limitations are important issues that need to be addressed in order to ultimately enhance patients’ survival rate. In the case of breast cancer, some of the problems faced by conventional mammography have been addressed in the literature; they include high rate of false-positive and false-negative results, as well as the possibility of overdiagnosis. New technologies, such as digital breast tomosynthesis (DBT), have been able to improve the sensitivity and specificity by using 3D imaging. However, the low contrast (1%) existing between tumors and healthy fibroglandular tissue at X-ray frequencies has been identified as one of the main causes of misdiagnosis in both conventional 2D mammography and DBT. Near-field radar imaging (NRI) provides a unique opportunity to overcome this problem, since the contrast existing between the aforementioned tissues is intrinsically higher (10%) at microwave frequencies. Moreover, the low resolution and highly complex scattering patterns of microwave systems can be enhanced by using prior information from other modalities, such as the DBT. Therefore, a multimodal DBT/NRI imaging system is proposed to exploit their individual strengths while minimizing their weaknesses. In this work, the foundation of this idea is reviewed, and a preliminary design and experimental validation of the NRI system, used as a DBT complement, is introduced

Elemental and phase composition of breast calcifications

Despite the importance of calcifications in early detection of breast cancer, and their proposed association with tumour growth, remarkably little detail is known about their chemical composition, or how this relates to pathology. One reason for this gap is the difficulty of systematically and precisely locating calcifications for analysis, particularly in sections taken from diagnostic archives. Two simple methods were developed which can achieve this in sections cut from wax embedded breast tissue. These are based on micro-CT and x-ray fluoroscopy mapping, and were used to locate calcifications for further study. The elemental composition of calcifications in histological sections was measured using energy-dispersive x-ray spectroscopy in an environmental scanning electron microscope. Variations in Ca:P ratio could in principle be detected non-invasively by dual energy absorptiometry, as demonstrated in a proof of principle experiment. However, the Ca:P ratio was found to lie in a narrow range similar to bone, with no significant difference between benign and malignant. In contrast, a substantial and significant difference in Na:Ca ratio was found between benign and malignant specimens. This has potential for revealing malignant changes in the vicinity of a core needle biopsy. The phase composition and crystallographic parameters within calcifications was measured using synchrotron x-ray diffraction. This is the first time crystallite size and lattice parameters have been measured in breast calcifications, and it was found that these both parallel closely the changes in these parameters with age observed in foetal bone. It was also discovered that these calcifications contain a small proportion of magnesium whitlockite, and that this proportion increases from benign, to carcinoma in-situ, to invasive cancer. When combined with other recent evidence on the effect of magnesium on hydroxyapatite precipitation, this suggests a mechanism explaining observations that carbonate levels within breast calcifications are lower in malignant specimens

Department of Radiology-Annual Report-July 1, 1990 to June 30, 1991

Department of Radiology Annual Report, July 1, 1990 to June 30, 1991. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States. 84 pages

Microcalcifications Detection Using Image And Signal Processing Techniques For Early Detection Of Breast Cancer

Breast cancer has transformed into a severe health problem around the world. Early diagnosis is an important factor to survive this disease. The earliest detection signs of potential breast cancer that is distinguishable by current screening techniques are the presence of microcalcifications (MCs). MCs are small crystals of calcium apatite and their normal size ranges from 0.1mm to 0.5mm single crystals to groups up to a few centimeters in diameter. They are the first indication of breast cancer in more than 40% of all breast cancer cases, making their diagnosis critical. This dissertation proposes several segmentation techniques for detecting and isolating point microcalcifications: Otsu’s Method, Balanced Histogram Thresholding, Iterative Method, Maximum Entropy, Moment Preserving, and Genetic Algorithm. These methods were applied to medical images to detect microcalcifications. In this dissertation, results from the application of these techniques are presented and their efficiency for early detection of breast cancer is explained. This dissertation also explains theories and algorithms related to these techniques that can be used for breast cancer detection

Deep learning algorithms for tumor detection in screening mammography

Population-wide mammography screening was fully implemented in Sweden in 1997. The implementation has helped to identify breast cancer at earlier stages and thereby lowered mortality by 30-40%. However, it still has its limitations, many studies have shown a discrepancy between radiologist when assessing mammographic examinations. Additionally, women with very dense breasts have a lower mammographic sensitivity and cancers are easily missed. There is also a shortage on breast radiologists and the workload is increasing due to more women being screened. These challenges could be addressed with the help of artificial intelligence systems. The artificial intelligence system can serve both as an assistant to replace one radiologist in a double-reading setting and as a tool to triage women with a high risk of breast cancer for additional screening using other modalities. In this thesis we used data from two cohorts: the cohort of screen aged women (CSAW) and the ScreenTrust MRI cohort. The primary objectives were to establish performance benchmarks based on radiologists recorded assessments (study I), compare the diagnostic performance of various AI CAD systems (study II), investigate differences and similarities in false assessments between AI CAD and radiologists (study III), and evaluate the potential of artificial intelligence in triaging women for complementary MRI screening (study IV). The data for studies I-III were obtained from CSAW, while the data for study IV were obtained from the MRI ScreenTrust cohort. CSAW is a collection of data from Stockholm County between the years of 2008 and 2015. Study I was a retrospective multicenter cohort study that examined radiologist performance benchmarks in screening mammography. Operating performance was assessed in terms of abnormal interpretation rate, false negative rate, sensitivity, and specificity. Measures were determined for each quartile of radiologists classified according to performance, and performance was evaluated overall and by different tumor characteristics. The study included a total of 418,041 women and 1,186,045 digital mammograms, and involved 110 radiologists, of which 24 were defined as high-volume readers. Our analysis revealed significant differences in performance between highvolume readers, as well as a variability in sensitivity based on tumor characteristics. This study was presented during the 2019 annual meeting of the Radiological Society of North America, and was awarded the Trainee research prize that same year. Study II was a retrospective case-control study that evaluated the performance of three commercial algorithms. We performed an external evaluation of these algorithms and compared the retrospective mammography assessments of radiologists with those of the algorithms. Operating performance was determined in terms of abnormal interpretation rate, false negative rate, sensitivity, specificity and the AUC. The study included 8,805 women, of whom 740 women had cancer, and a random sample of 8,066 healthy controls. There were 25 radiologists involved. For a binary decision, the cutpoint was defined by the mean specificity of the original first-reader radiologists (96.6%). Our findings showed that one AI algorithm outperformed the other AI algorithm and the original first-reader radiologists. This study was presented during the 2020 annual meeting of the European Society of Radiology. Study III was a retrospective case-control study that evaluated the differences and similarities in false assessments between an artificial intelligence system and a human reader in screening mammography. In this study we included 714 screening examinations for women diagnosed with breast cancer and 8,003 randomly selected healthy controls. The abnormality threshold was predefined from study II. We examined how false positive and false negative assessments by AI CAD and the first radiologist, were associated with breast density, age and tumor characteristics. Our findings showed that AI makes fewer false negative assessments than radiologists. Combining AI with a radiologist resulted in the most pronounced decrease in false negative assessments for high-density women and women over the age of 55. This study was presented at the 2021 annual meeting of the Radiological Society of North America. Study IV is a randomized clinical trial that aims to investigate the effect of applying deep learning methods to select women for MRI-based breast cancer screening. The study examines how effectively AI can identify women who should be offered a complementary MRI screening based on their likelihood of having cancer that is not visible on regular mammography. The results reported in this thesis are preliminary and based on examinations from April 1, 2021 to December 31, 2022. During the indicated time period, 481 MRI examinations have been completed, and 28 cancers have been detected, yielding a cancer detection rate of 58.2 per 1,000 examinations. Although, the trial is still ongoing, the inter-rim results suggest that using AI-based selection for supplemental MRI screening can lead to a higher rate of cancer detection than that reported for density-based selection methods. In conclusion, we have shown that the use of AI for breast cancer detection can increase precision and efficiency in mammography screening