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

Complexity Reduction in Image-Based Breast Cancer Care

The diversity of malignancies of the breast requires personalized diagnostic and therapeutic decision making in a complex situation. This thesis contributes in three clinical areas: (1) For clinical diagnostic image evaluation, computer-aided detection and diagnosis of mass and non-mass lesions in breast MRI is developed. 4D texture features characterize mass lesions. For non-mass lesions, a combined detection/characterisation method utilizes the bilateral symmetry of the breast s contrast agent uptake. (2) To improve clinical workflows, a breast MRI reading paradigm is proposed, exemplified by a breast MRI reading workstation prototype. Instead of mouse and keyboard, it is operated using multi-touch gestures. The concept is extended to mammography screening, introducing efficient navigation aids. (3) Contributions to finite element modeling of breast tissue deformations tackle two clinical problems: surgery planning and the prediction of the breast deformation in a MRI biopsy device

Creating Anthropomorphic Models with Mesh Phantoms in MCNP to Simulate Mammography

Breast cancer is the most common cancer among women as it accounts for about 25% of all female cancer cases. Studies have shown that early detection of breast cancer increases the chances of a positive prognosis amongst patients therefore it is crucial to provide accurate diagnosis tools in routine exams. Experimenting with new techniques and tools that can provide increased accuracy requires time-consuming and costly studies, therefore, simulating outcomes that have high potential can provide guidance for increased accuracy without requiring expensive tests. This project outlines the possibility of developing an advanced anthropomorphic mesh phantom of the breast to experiment different contrast agents with. The phantom would contain all the components of a real breast and it would be able to simulate the physiological and metabolic components that play a role in the outcome of a real tomosynthesis-mammography scan. This project focuses on creating a basic model of a breast and a tomosynthesis system that provides an indication on whether a simulation system can be produced. The materials used for this project include Abaqus/CAE software, Python, MCNP6.2, and scripting tools as well as resources on tomosynthesis equipment. The results demonstrated a positive outcome thus indicating that the model can be further developed to incorporate the multiple components of a real breast scan to increase the simulation’s realism. Further work on this project will focus on increasing the model’s complexity and incorporating contrast agents so that the efficacy of each can be explored

Utility Of Shear Wave Elastography In Breast Cancer Diagnosis: A Systematic Review And Meta-Analysis

In the United States, breast cancer is one of the most diagnosed cancers in women. Early detection, often via mammography, and intervention have been shown to reduce mortality. However, not all cancers are mammographically evident in early stages, if at all. As a result, ultrasound has been increasingly used to supplement mammography for breast cancer detection and assessment, particularly in dense breasts. Recent advancements in ultrasonography include the ability to characterize the stiffness of biological tissues. Shear Wave Elastography (SWE) is one such development used to quantify tissue stiffness within a region of interest. The resistance of soft tissue to deformation depends on the molecular makeup of the tissue components as well as elements of tissue structure, such as stromal and connective tissue. As tumor growth often involves architectural changes that cause increased stiffness compared to normal neighboring tissue, SWE has the potential to compliment mammography and B-mode ultrasound for breast lesion characterization. Studies establishing the clinical value of SWE may aid in its incorporation into diagnostic guidelines. This study aimed to quantify the performance of 2D SWE for differentiating benign and malignant breast lesions in women with abnormal mammography via a systematic review of the literature and meta-analysis. A systematic search of PubMed, Scopus, Embase, Ovid-Medline, Cochrane Library and Web of Science was performed. Studies of diagnostic accuracy published prior to June 2021 using SWE to evaluate abnormal breast tissue with at least 50 lesions that reported quantitative shear wave speed (SWS) parameters (the mean (SWSmean), maximum (SWSmax), minimum (SWSmin), or standard deviation (SWSSD) of the SWS) and thresholds and included a reference standard of either biopsy or 2-year stability were included in the analysis. The QUADAS- 2 tool was used to assess possible bias within studies as well as their applicability. 87 studies of diagnostic accuracy were included, encompassing 17,810 women (47) with 19,043 lesions (7,623 malignant). A hierarchical summary receiver operating characteristic model produced the following summary sensitivities and specificities: 0.86 [0.83, 0.88] / 0.87 [0.84, 0.88] for SWSmean, 0.83 [0.80, 0.85]/ 0.88 [0.86, 0.90] for SWSmax, 0.86 [0.74, 0.93]/ 0.81 [0.69, 0.89] for SWSmin, and 0.82 [0.77, 0.86] / 0.88 [0.85, 0.91] for SWSSD, respectively. By calculating and utilizing the resulting likelihood ratios, SWE was shown capable of downgrading BI-RADS 4a and upgrading BI-RADS 3 lesions. Thus, SWE has the potential to provide increased discriminative power in the diagnosis of breast cancer if used synergistically with mammography and B-mode ultrasound. Current society guidelines do not provide definitive recommendations about the role of SWE in screening and diagnosis, nor its counterpart strain elastography (SE). The literature suggests that a combination of SE and SWE may provide better discriminatory power than SWE alone and serve as an adjunct to current diagnostic techniques, opening an avenue for future study

Deep Learning in Medical Image Analysis

The accelerating power of deep learning in diagnosing diseases will empower physicians and speed up decision making in clinical environments. Applications of modern medical instruments and digitalization of medical care have generated enormous amounts of medical images in recent years. In this big data arena, new deep learning methods and computational models for efficient data processing, analysis, and modeling of the generated data are crucially important for clinical applications and understanding the underlying biological process. This book presents and highlights novel algorithms, architectures, techniques, and applications of deep learning for medical image analysis

Characterization of alar ligament on 3.0T MRI: a cross-sectional study in IIUM Medical Centre, Kuantan

INTRODUCTION: The main purpose of the study is to compare the normal anatomy of alar ligament on MRI between male and female. The specific objectives are to assess the prevalence of alar ligament visualized on MRI, to describe its characteristics in term of its course, shape and signal homogeneity and to find differences in alar ligament signal intensity between male and female. This study also aims to determine the association between the heights of respondents with alar ligament signal intensity and dimensions. MATERIALS & METHODS: 50 healthy volunteers were studied on 3.0T MR scanner Siemens Magnetom Spectra using 2-mm proton density, T2 and fat-suppression sequences. Alar ligament is depicted in 3 planes and the visualization and variability of the ligament courses, shapes and signal intensity characteristics were determined. The alar ligament dimensions were also measured. RESULTS: Alar ligament was best depicted in coronal plane, followed by sagittal and axial planes. The orientations were laterally ascending in most of the subjects (60%), predominantly oval in shaped (54%) and 67% showed inhomogenous signal. No significant difference of alar ligament signal intensity between male and female respondents. No significant association was found between the heights of the respondents with alar ligament signal intensity and dimensions. CONCLUSION: Employing a 3.0T MR scanner, the alar ligament is best portrayed on coronal plane, followed by sagittal and axial planes. However, tremendous variability of alar ligament as depicted in our data shows that caution needs to be exercised when evaluating alar ligament, especially during circumstances of injury

Proceedings of the International Workshop on Medical Ultrasound Tomography: 1.- 3. Nov. 2017, Speyer, Germany

Ultrasound Tomography is an emerging technology for medical imaging that is quickly approaching its clinical utility. Research groups around the globe are engaged in research spanning from theory to practical applications. The International Workshop on Medical Ultrasound Tomography (1.-3. November 2017, Speyer, Germany) brought together scientists to exchange their knowledge and discuss new ideas and results in order to boost the research in Ultrasound Tomography

Case series of breast fillers and how things may go wrong: radiology point of view

INTRODUCTION: Breast augmentation is a procedure opted by women to overcome sagging breast due to breastfeeding or aging as well as small breast size. Recent years have shown the emergence of a variety of injectable materials on market as breast fillers. These injectable breast fillers have swiftly gained popularity among women, considering the minimal invasiveness of the procedure, nullifying the need for terrifying surgery. Little do they know that the procedure may pose detrimental complications, while visualization of breast parenchyma infiltrated by these fillers is also deemed substandard; posing diagnostic challenges. We present a case series of three patients with prior history of hyaluronic acid and collagen breast injections. REPORT: The first patient is a 37-year-old lady who presented to casualty with worsening shortness of breath, non-productive cough, central chest pain; associated with fever and chills for 2-weeks duration. The second patient is a 34-year-old lady who complained of cough, fever and haemoptysis; associated with shortness of breath for 1-week duration. CT in these cases revealed non thrombotic wedge-shaped peripheral air-space densities. The third patient is a 37‐year‐old female with right breast pain, swelling and redness for 2- weeks duration. Previous collagen breast injection performed 1 year ago had impeded sonographic visualization of the breast parenchyma. MRI breasts showed multiple non- enhancing round and oval shaped lesions exhibiting fat intensity. CONCLUSION: Radiologists should be familiar with the potential risks and hazards as well as limitations of imaging posed by breast fillers such that MRI is required as problem-solving tool