Breast Ultrasound Past, Present, and Future

This chapter will review the utilization of breast ultrasound for screening and diagnostic purposes. Currently, ultrasound is primarily used to investigate palpable lesions in women less than 30 years old, to provide further characterization of abnormal mammographic findings, and to guide invasive breast interventions. Innovations in ultrasound technology have improved the detection and diagnosis of breast cancer. Computer-aided detection (CAD), elastography, quantitative breast ultrasound technology, and ultrasound contrast agents (microbubbles) were developed to improve diagnostic accuracy. These advancements have the potential to impact overall survival by detecting cancers that are smaller and less aggressive

Development and Evaluation of a Web-based Chest and Abdominal Radiology Game for Fourth Year Medical Students

Background: The educational potential of non-traditional computer-assisted models to enhance knowledge acquisition and retention, has been recognized across many disciplines, including medicine. In particular computer-based games allow for the incorporation of multimedia, provide access to learning material in a time and place convenient for the student, and give interactive feedback critical for active self-assessment. Studies of these interactive games, which appear to engage the student in an informal way, have demonstrated the ability to stimulate greater individual learning with improved retention of the material and a desire for self-improvement. Most studies conducted, however, have assessed the effectiveness of the game systems using subjective student feedback. More empirical data is needed to confirm their efficacy in knowledge acquisition and retention. Further, computer-based instruction is particularly well suited to image-based disciplines such as radiology. Radiology is integral to clinical management as a physician, and its role continues to expand as fast as new technologies grow. Studies have shown, however, that long-term retention of specific structures on chest radiographs between the second year and fourth year of medical school was poor despite evidence documenting good short-term retention of tested information. A need for more effective teaching methods to improve chest and abdominal radiology knowledge retention has been identified. This project proposes to study knowledge acquisition and retention of abdominal and chest imaging in fourth year medical students enrolled in a diagnostic radiology elective courses at George Washington University School of Medicine and Health Science. Methods: Fourth year medical students who enroll in a four week clinical diagnostic radiology elective course from July 2016 to November 2016 will be recruited for the study, and randomly assigned to complete either the online-game or the traditional lecture course. Students assigned to complete the online-game will progress through three levels of increasing complexity: beginning with basic structure identification and orientation, then diagnosis of common pathologies, finally introduction to more complex and rare cases. After completion of each level of the game, students must correctly answer five questions before progressing to the next level, which will assess knowledge acquisition in real time. One month after completion of the module, students in the control and experimental groups will complete a 10 question quiz on the material to assess knowledge retention. Significance: We hypothesize that compared to traditional didactic teaching, students who participate in the gaming format lesson will demonstrate greater knowledge acquisition and long-term knowledge retention

Clinical utility of CAD systems for breast cancer

© 2015 by Taylor & Francis Group, LLC. Breast cancer is a leading cause of mortality among North American women regardless of race or ethnicity. Screening and therapy advancements lead the charge in the breast cancer mortality decline since 1990. Several recent reports document screening mammography’s impact on breast cancer survival. Smith et al. evaluated the clinical presentation and outcome of 6000 Michigan women diagnosed with breast cancer. In this study, mammography detected 65% of breast cancers. The parameters of patient age and cancer stage at the time of diagnosis stratify the patients. In women less than 50 years of age, mammography detected less than half of the breast cancers. The authors note that the screen-detected cancers had favorable prognostic indicators including (1) earlier stage, (2) lower tumor grade, (3) fewer mastectomies (27% with screen-detected cancers vs. 46% with cancers presenting with palpable findings), and (4) less chemotherapy requirements. In fact, the authors conclude that when patients or physicians find cancer on physical examination, it is more often due to advanced cancers that may require mastectomies. Further, in one of largest randomized controlled breast screening trials, Tabar et al. report a 30% decline in mortality when women undergo regular screening mammography

Ductal lavage: A novel approach for breast cancer risk assessment: Why, how, and when

The ability to assess women for breast cancer risk is limited. The currently available approaches, such as the commonly used Gail Model, have significant limitations. The risk assessed is population-based and not based on specific cytology of the individual woman. Therefore, improved individualized methods for risk assessment are needed, particularly with the increasing use of prophylactic approaches to breast cancer, such as with the prophylactic use of tamoxifen. Ductal lavage is a recently developed technique for evaluating a woman\u27s intraductal cytology based on rinsing the ducts with aliquots of saline and evaluating the resultant fluid cytopathologically. This manuscript describes the ductal lavage procedure, the data supporting cytologic evaluation of intraductal cells, and the clinical indications for ductal lavage as well as possible future uses

Clinical utility of CAD systems for breast cancer

© 2015 by Taylor & Francis Group, LLC. Breast cancer is a leading cause of mortality among North American women regardless of race or ethnicity. Screening and therapy advancements lead the charge in the breast cancer mortality decline since 1990. Several recent reports document screening mammography’s impact on breast cancer survival. Smith et al. evaluated the clinical presentation and outcome of 6000 Michigan women diagnosed with breast cancer. In this study, mammography detected 65% of breast cancers. The parameters of patient age and cancer stage at the time of diagnosis stratify the patients. In women less than 50 years of age, mammography detected less than half of the breast cancers. The authors note that the screen-detected cancers had favorable prognostic indicators including (1) earlier stage, (2) lower tumor grade, (3) fewer mastectomies (27% with screen-detected cancers vs. 46% with cancers presenting with palpable findings), and (4) less chemotherapy requirements. In fact, the authors conclude that when patients or physicians find cancer on physical examination, it is more often due to advanced cancers that may require mastectomies. Further, in one of largest randomized controlled breast screening trials, Tabar et al. report a 30% decline in mortality when women undergo regular screening mammography

Detection of Ductal Carcinoma in Situ with Mammography, Breast Specific Gamma Imaging, and Magnetic Resonance Imaging: A Comparative Study

Rationale and Objectives: To evaluate the sensitivity of high-resolution breast-specific gamma imaging (BSGI) for the detection of ductal carcinoma in situ (DCIS) based on histopathology and to compare the sensitivity of BSGI with mammography and magnetic resonance imaging (MRI) for the detection of DCIS. Materials and Methods: Twenty women, mean 55 years (range 34-76 years), with 22 biopsy-proven DCIS were retrospectively reviewed. After injection of 25-30 mCi (925-1,110 MBq) technetium 99m-sestamibi, patients had BSGI with a high-resolution, small-field-of-view gamma camera in craniocaudal and mediolateral oblique projections. BSGI studies were prospectively classified according to focal radiotracer uptake using a 1 to 5 scale, as normal 1), with no focal or diffuse uptake; benign 2), with minimal patchy uptake; probably benign 3), with scattered patchy uptake; probably abnormal 4), with mild focal radiotracer uptake; and abnormal 5), with marked focal radiotracer uptake. Imaging findings were compared to findings at biopsy or surgical excision. The sensitivity of BSGI, mammography, and when performed, MRI were determined for the detection of DCIS. Breast MRI was performed on seven patients with eight biopsy-proven foci. The sensitivities were compared using a two-tailed t-test and confidence intervals were determined. Results: Pathologic tumor size of the DCIS ranged from 2 to 21 mm (mean 9.9 mm). Of 22 cases of biopsy-proven DCIS in 20 women, 91% were detected with BSGI, 82% were detected with mammography, and 88% were detected with magnetic resonance imaging. BSGI had the highest sensitivity for the detection of DCIS, although this small sample size did not demonstrate a statistically significant difference. Two cases of DCIS (9%) were diagnosed only after BSGI demonstrated an occult focus of radiotracer uptake in the contralateral breast, previously undetected by mammography. There were two false-negative BSGI studies. Conclusions: BSGI has higher sensitivity for the detection of DCIS than mammography or MRI and can reliably detect small, subcentimeter lesions. © 2007 AUR