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Gold LS, Klein G, Carr L, Kessler L, Sullivan SD. The emergence of diagnostic imaging technologies in breast cancer: discovery, regulatory approval, reimbursement, and adoption in clinical guidelines. Cancer Imaging 2012; 12:13-24. [PMID: 22275726 PMCID: PMC3266577 DOI: 10.1102/1470-7330.2012.0003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2011] [Indexed: 12/02/2022] Open
Abstract
In this article, we trace the chronology of developments in breast imaging technologies that are used for diagnosis and staging of breast cancer, including mammography, ultrasonography, magnetic resonance imaging, computed tomography, and positron emission tomography. We explore factors that affected clinical acceptance and utilization of these technologies from discovery to clinical use, including milestones in peer-reviewed publication, US Food and Drug Administration approval, reimbursement by payers, and adoption into clinical guidelines. The factors driving utilization of new imaging technologies are mainly driven by regulatory approval and reimbursement by payers rather than evidence that they provide benefits to patients. Comparative effectiveness research can serve as a useful tool to investigate whether these imaging modalities provide information that improves patient outcomes in real-world settings.
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Affiliation(s)
- Laura S Gold
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA 98195-9455, USA.
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2
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Feasibility Study for the Improvement of Microcalcification Visualization in Different Breast Thicknesses and Tissue Components Using a Dual-Energy Approach in Digital Mammography. J Comput Assist Tomogr 2012; 36:488-94. [DOI: 10.1097/rct.0b013e31825c83c4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Recent advances in digital detector technology have paved the way to full-field digital mammography (FFDM) systems. The performance of these systems has evolved to the point where replacement of screen-film mammography (SFM) systems is becoming realistic. Despite some commonality between the two techniques, there are fundamental differences in how images are recorded, displayed, and stored. These differences necessitate an understanding of the principles of detection and the characteristics of digital images. Several approaches have been taken in the development of FFDM systems: (a) slot scanning with a scintillator and a charge-coupled device (CCD) array, (b) a flat-panel scintillator and an amorphous silicon diode array, (c) a flat-panel amorphous selenium array, (d) a tiled scintillator with fiberoptic tapers and a CCD array, and (e) photostimulable phosphor plates (computed radiography). Although the initial cost of an FFDM system is high compared with that of an SFM system, digital mammography has inherent advantages, such as wide dynamic range, reduction in recall rates, potential for reduction in radiation dose, increased patient throughput, postprocessing capability, and digital acquisition. These advantages and the rapidly occurring technologic developments will help establish FFDM as a mainstay of breast evaluation.
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Affiliation(s)
- Mahadevappa Mahesh
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC Suite 4235, 601 N Caroline St, Baltimore, MD 21287-0856, USA.
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Shah AJ, Wang J, Yamada T, Fajardo LL. Digital mammography: a review of technical development and clinical applications. Clin Breast Cancer 2003; 4:63-70. [PMID: 12744760 DOI: 10.3816/cbc.2003.n.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
For detecting and diagnosing breast cancer at its earliest stage, mammography is the most sensitive technique currently available and is therefore the method of choice. Screen-film mammography has been used successfully as a screening test for breast cancer for > 2 decades. However, conventional mammography has substantial limitations and, therefore, digital mammography systems have been developed to improve image quality and overcome the limitations of screen-film technique limitations. Herein we discuss the differences between screen-film and digital mammography systems and the processes related to digital mammography that differ from conventional mammography, including detector technology, digital image formation, image processing, image display, and image archival. Finally, we review the results from currently available clinical trials regarding the performance of digital mammography and discuss clinical implications such as cost-effectiveness.
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Affiliation(s)
- Amisha J Shah
- Department of Radiology, University of Iowa Carver School of Medicine, Iowa City, Iowa, USA
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Rong XJ, Shaw CC, Johnston DA, Lemacks MR, Liu X, Whitman GJ, Dryden MJ, Stephens TW, Thompson SK, Krugh KT, Lai CJ. Microcalcification detectability for four mammographic detectors: flat-panel, CCD, CR, and screen/film). Med Phys 2002; 29:2052-61. [PMID: 12349926 DOI: 10.1118/1.1500768] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amorphous silicon/cesium iodide (a-Si:H/CsI:Tl) flat-panel (FP)-based full-field digital mammography systems have recently become commercially available for clinical use. Some investigations on physical properties and imaging characteristics of these types of detectors have been conducted and reported. In this perception study, a phantom containing simulated microcalcifications (microCs) of various sizes was imaged with four detector systems: a FP system, a small field-of-view charge coupled device (CCD) system, a high resolution computed radiography (CR) system, and a conventional mammography screen/film (SF) system. The images were reviewed by mammographers as well as nonradiologist participants. Scores reflecting confidence ratings were given and recorded for each detection task. The results were used to determine the average confidence-rating scores for the four imaging systems. Receiver operating characteristics (ROC) analysis was also performed to evaluate and compare the overall detection accuracy for the four detector systems. For calcifications of 125-140 microm in size, the FP system was found to have the best performance with the highest confidence-rating scores and the greatest detection accuracy (Az = 0.9) in the ROC analysis. The SF system was ranked second while the CCD system outperformed the CR system. The p values obtained by applying a Student t-test to the results of the ROC analysis indicate that the differences between any two systems are statistically significant (p<0.005). Differences in microC detectability for the large (150-160 microm) and small (112-125 microm) size microC groups showed a wider range of p values (not all p values are smaller than 0.005, ranging from 0.6 to <0.001) compared to the p values obtained for the medium (125-140 microm) size microC group. Using the p values to assess the statistical significance, the use of the average confidence-rating scores was not as significant as the use of the ROC analysis p value for p value.
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Affiliation(s)
- Xiujiang J Rong
- Department of Imaging Physics, University of Texas M. D. Anderson Cancer Center, Houston 77030-4009, USA.
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Mesurolle B, Ariche-Cohen M, Mignon F, Goumot PA. Clustering of breast microcalcifications on digital mammography: which parameters? Clin Radiol 2002; 57:75-6. [PMID: 11798209 DOI: 10.1053/crad.2001.0694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Suryanarayanan S, Karellas A, Vedantham S, Baker SP, Glick SJ, D'Orsi CJ, Webber RL. Evaluation of linear and nonlinear tomosynthetic reconstruction methods in digital mammography. Acad Radiol 2001; 8:219-24. [PMID: 11249085 DOI: 10.1016/s1076-6332(03)80530-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to comparatively evaluate digital planar mammography and both linear and nonlinear tomosynthetic reconstruction methods. MATERIALS AND METHODS A "disk" (ie, target) identification study was conducted to compare planar and reconstruction methods. Projective data using a composite phantom with circular disks were acquired in both planar and tomographic modes by using a full-field, digital mammographic system. Two-dimensional projections were reconstructed with both linear (ie, backprojection) and nonlinear (ie, maximization and minimization) tuned-aperture computed tomographic (TACT) methods to produce three-dimensional data sets. Four board-certified radiologists and one 4th-year radiology resident participated as observers. All images were compared by these observers in terms of the number of disks identified. RESULTS Significant differences (P < .05, Bonferroni adjusted) were observed between all reconstruction and planar methods. No significant difference, however, was observed between the planar methods, and only a marginally significant difference (P < .054, Bonferroni adjusted) was observed between TACT-backprojection and TACT-minimization. CONCLUSION A combination of linear and nonlinear reconstruction schemes may have potential implications in terms of enhancing image visualization to provide radiologists with valuable diagnostic information.
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Affiliation(s)
- S Suryanarayanan
- Department of Radiology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester 01655, USA
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Abstract
Breast cancer is the most common female malignancy in the USA and second only to lung malignancy in cancer mortality. The only screening modality that effectively detects early breast cancer and decreases mortality is mammography. Because many females turn to obstetrician gynecologists for breast cancer screening, an understanding of the benefits and limitations of mammography and the breast imaging reporting and data system is imperative. Mammography remains the most cost effective and sensitive tool for early detection.
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Affiliation(s)
- J J Bomalaski
- Department of Obstetrics and Gynecology, Keesler Air Force Base, Biloxi, Mississippi, USA
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Vedantham S, Karellas A, Suryanarayanan S, Levis I, Sayag M, Kleehammer R, Heidsieck R, D’Orsi CJ. Mammographic imaging with a small format CCD-based digital cassette: physical characteristics of a clinical system. Med Phys 2000; 27:1832-40. [PMID: 10984230 PMCID: PMC4280185 DOI: 10.1118/1.1286720] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The physical characteristics of a clinical charge coupled device (CCD)-based imager (Senovision, GE Medical Systems, Milwaukee, WI) for small-field digital mammography have been investigated. The imager employs a MinR 2000 (Eastman Kodak Company, Rochester, NY) scintillator coupled by a 1:1 optical fiber to a front-illuminated 61 x 61 mm CCD operating at a pixel pitch of 30 microns. Objective criteria such as modulation transfer function (MTF), noise power spectrum (NPS), detective quantum efficiency (DQE), and noise equivalent quanta (NEQ) were employed for this evaluation. The results demonstrated a limiting spatial resolution (10% MTF) of 10 cy/mm. The measured DQE of the current prototype utilizing a 28 kVp, Mo-Mo spectrum beam hardened with 4.5 cm Lucite is approximately 40% at close to zero spatial frequency at an exposure of 8.2 mR, and decreases to approximately 28% at a low exposure of 1.1 mR. Detector element nonuniformity and electronic gain variations were not significant after appropriate calibration and software corrections. The response of the imager was linear and did not exhibit signal saturation under tested exposure conditions.
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Affiliation(s)
- Srinivasan Vedantham
- Department of Radiology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Andrew Karellas
- Author to whom correspondence should be addressed. Electronic mail:
| | - Sankararaman Suryanarayanan
- Department of Radiology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Ilias Levis
- Department of Radiology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | - Michel Sayag
- Lockheed Martin Fairchild Systems, Milpitas, California 95035
| | | | | | - Carl J. D’Orsi
- Department of Radiology, UMass Memorial Health Care, University of Massachusetts Medical School, Worcester, Massachusetts 01655
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Vedantham S, Karellas A, Suryanarayanan S. Full breast digital mammography with an amorphous silicon-based flat panel detector: physical characteristics of a clinical prototype. Med Phys 2000; 27:558-67. [PMID: 10757607 PMCID: PMC4280189 DOI: 10.1118/1.598895] [Citation(s) in RCA: 207] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The physical characteristics of a clinical prototype amorphous silicon-based flat panel imager for full-breast digital mammography have been investigated. The imager employs a thin thallium doped CsI scintillator on an amorphous silicon matrix of detector elements with a pixel pitch of 100 microm. Objective criteria such as modulation transfer function (MTF), noise power spectrum, detective quantum efficiency (DQE), and noise equivalent quanta were employed for this evaluation. The presampling MTF was found to be 0.73, 0.42, and 0.28 at 2, 4, and 5 cycles/mm, respectively. The measured DQE of the current prototype utilizing a 28 kVp, Mo-Mo spectrum beam hardened with 4.5 cm Lucite is approximately 55% at close to zero spatial frequency at an exposure of 32.8 mR, and decreases to approximately 40% at a low exposure of 1.3 mR. Detector element nonuniformity and electronic gain variations were not significant after appropriate calibration and software corrections. The response of the imager was linear and did not exhibit signal saturation under tested exposure conditions.
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Affiliation(s)
| | - Andrew Karellas
- Author to whom correspondence should be addressed; electronic mail:
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11
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Abstract
Many exciting developments are occurring in breast imaging. Digital mammography holds the promise of telemammography and computer-aided diagnosis. Mammoscintigraphy may be helpful in identifying drug-resistant tumors before therapy. There is renewed interest in evaluating ultrasound as a potential adjunctive screening tool in women with radiographically dense breasts. Finally, contrast-enhanced magnetic resonance imaging may be used more extensively in the monitoring of tumor response to primary chemotherapy and in the preoperative workup of patients being considered for breast conservation therapy.
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Affiliation(s)
- H E Reynolds
- Department of Radiology, Indiana University School of Medicine, Indianapolis, USA
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12
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Chakraborty DP. The effect of the antiscatter grid on full-field digital mammography phantom images. J Digit Imaging 1999; 12:12-22. [PMID: 10036663 PMCID: PMC3452430 DOI: 10.1007/bf03168622] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Computer Analysis of Mammography Phantom Images (CAMPI) is a method for making quantitative measurements of image quality. This article reports on a recent application of this method to a prototype full-field digital mammography (FFDM) machine. Images of a modified ACR phantom were acquired on the General Electric Diagnostic Molybdenum Rhodium (GE-DMR) FFDM machine at a number of x-ray techniques, both with and without the scatter reduction grid. The techniques were chosen so that one had sets of grid and non-grid images with matched doses (200 mrads) and matched gray-scale values (1500). A third set was acquired at constant 26 kVp and varying mAs for both grid conditions. Analyses of the images yielded signal-to-noise-ratio (SNR), contrast and noise corresponding to each target object, and a non-uniformity measure. The results showed that under conditions of equal gray-scale value the grid images were markedly superior, albeit at higher doses than the non-grid images. Under constant dose conditions, the non-grid images were slightly superior in SNR (7%) but markedly less uniform (60%). Overall, the grid images had substantially greater contrast and superior image uniformity. These conclusions applied to the whole kVp range studied for the Mo-Mo target filter combination and 4 cm of breast equivalent material of average composition. These results suggest that use of the non-grid technique in digital mammography with the GE-DMR-FFDM unit, is presently not warranted. With improved uniformity correction procedure, this conclusion would change and one should be able to realize a 14% reduction in patient dose at the same SNR by using a non-grid technique.
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Affiliation(s)
- D P Chakraborty
- Department of Radiology, University of Pennsylvania, Philadelphia 19104, USA
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13
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Affiliation(s)
- M Kallergi
- Digital Medical and Analysis Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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Arfelli F, Bonvicini V, Bravin A, Cantatore G, Castelli E, Palma LD, Michiel MD, Longo R, Olivo A, Pani S, Pontoni D, Poropat P, Prest M, Rashevsky A, Tromba G, Vacchi A. A linear array silicon pixel detector: images of a mammographic test object and evaluation of delivered doses. Phys Med Biol 1997; 42:1565-73. [PMID: 9279906 DOI: 10.1088/0031-9155/42/8/007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present images of a mammographic test object obtained using a linear array silicon pixel detector capable of single-photon counting. The detector pixel size was 200 x 300 microns2 and images were acquired by scanning the test object between the laminar detector and the x-ray source with a scanning step of 100 microns. A molybdenum anode tube was used with two different filtrations: 2 mm aluminium and 25 microns molybdenum. Conventional film-screen images were also obtained in order to compare spatial and contrast resolution. In our digital images it is possible to recognize low-contrast details having dimensions smaller than or equal to the dimensions of details visible by means of a clinical mammographic unit. The detection of microcalcifications smaller than 150 microns was possible only when using the Mo filtration. However a copper wire of 50 microns diameter was detectable when embedded in a simulated tissue. We discuss in detail the mean glandular doses (MGDs) delivered during the image acquisition. The MGDs necessary to obtain good-quality images are always smaller than at a conventional mammographic unit. Since MGDs depend on the x-ray spectrum, the dose reduction becomes larger when the applied spectrum is harder than in film-screen acquisition (Al filtration and 35 kVp).
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Affiliation(s)
- F Arfelli
- Istituto Nazionale di Fisica Nucleare, Sezione di Trieste, Italy
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Abstract
Digital mammography using storage phosphor CR is still in the investigational stage. It is the only digital mammography system that has been tested in preliminary clinical trials with promising early results. Further clinical studies are needed to assess the impact of the limited spatial resolution of storage phosphor technology on its application as a digital screening mammography system. Further studies also are needed to determine the optimum image processing parameters needed in digital mammography.
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Affiliation(s)
- J P Hogge
- Department of Radiology, Georgetown University Medical Center, Washington, DC, USA
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