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Schäfgen B, Juskic M, Radicke M, Hertel M, Barr R, Pfob A, Togawa R, Nees J, von Au A, Fastner S, Harcos A, Gomez C, Stieber A, Riedel F, Hennigs A, Sohn C, Heil J, Golatta M. Evaluation of the FUSION-X-US-II prototype to combine automated breast ultrasound and tomosynthesis. Eur Radiol 2021; 31:3712-3720. [PMID: 33313983 PMCID: PMC8128739 DOI: 10.1007/s00330-020-07573-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/17/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The FUSION-X-US-II prototype was developed to combine 3D automated breast ultrasound (ABUS) and digital breast tomosynthesis in a single device. We evaluated the performance of ABUS and tomosynthesis in a single examination in a clinical setting. METHODS In this prospective feasibility study, digital breast tomosynthesis and ABUS were performed using the FUSION-X-US-II prototype without any change of the breast position in patients referred for clarification of breast lesions with an indication for tomosynthesis. The tomosynthesis and ABUS images of the prototype were interpreted independently from the clinical standard by a breast diagnostics specialist. Any detected lesion was classified using BI-RADS® scores, and results of the standard clinical routine workup (gold standard) were compared to the result of the separate evaluation of the prototype images. Image quality was rated subjectively and coverage of the breast was measured. RESULTS One hundred one patients received both ABUS and tomosynthesis using the prototype. The duration of the additional ABUS acquisition was 40 to 60 s. Breast coverage by ABUS was approximately 80.0%. ABUS image quality was rated as diagnostically useful in 86 of 101 cases (85.1%). Thirty-three of 34 malignant breast lesions (97.1%) were identified using the prototype. CONCLUSION The FUSION-X-US-II prototype allows a fast ABUS scan in combination with digital breast tomosynthesis in a single device integrated in the clinical workflow. Malignant breast lesions can be localized accurately with direct correlation of ABUS and tomosynthesis images. The FUSION system shows the potential to improve breast cancer screening in the future after further technical improvements. KEY POINTS • The FUSION-X-US-II prototype allows the combination of automated breast ultrasound and digital breast tomosynthesis in a single device without decompression of the breast. • Image quality and coverage of ABUS are sufficient to accurately detect malignant breast lesions. • If tomosynthesis and ABUS should become part of breast cancer screening, the combination of both techniques in one device could offer practical and logistic advantages. To evaluate a potential benefit of a combination of ABUS and tomosynthesis in screening-like settings, further studies are needed.
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Affiliation(s)
- Benedikt Schäfgen
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Marija Juskic
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | | | | | - Richard Barr
- Northeastern Ohio Medical University and Southwoods Imaging, Youngstown, OH, USA
| | - André Pfob
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Riku Togawa
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Juliane Nees
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Alexandra von Au
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Sarah Fastner
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Aba Harcos
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Christina Gomez
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Anne Stieber
- Department of Radiology, University Breast Unit, Heidelberg, Germany
| | - Fabian Riedel
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - André Hennigs
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Christof Sohn
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Joerg Heil
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany
| | - Michael Golatta
- Department of Gynecology and Obstetrics, University Breast Unit, Heidelberg, Germany.
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Huang CH, Lo YJ, Kuo KM, Lu IC, Wu H, Hsieh MT, Liu IT, Lin YC, Lai YC, Huang RY, Hung WC, Lin CW. Health literacy and cancer screening behaviors among community-dwelling female adults in Taiwan. Women Health 2021; 61:408-419. [PMID: 33902386 DOI: 10.1080/03630242.2021.1917477] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study was designed to explore the association among health literacy and cancer screening behaviors in Taiwanese females. A total of 353 community-dwelling females were recruited in this cross-sectional study from February to October 2015. Demographic, socioeconomic and personal behavior variables including physical activity, community activity, smoking, alcohol consumption, and betel nut chewing were recorded. Health literacy was evaluated using the Mandarin version of the European Health Literacy Survey Questionnaire. Data on screening behaviors for cervical, breast and colorectal cancers were confirmed by the Taiwanese National eHealth Database. Most respondents with inadequate or problematic general health literacy had no or irregular screening behaviors for cervical, breast and colorectal cancers. In multivariable regression analysis, women with inadequate health literacy were at a greater risk (Odds ratio = 5.71; 95% CI: 1.40-23.26) of having no previous Pap smear screening or >3 years screening interval regardless of education level. However, this association was not detected for breast or colorectal cancer. Women with inadequate health literacy were more likely to have irregular cervical cancer screening, however no associations among health literacy and breast or colorectal cancer were detected. The impact of health literacy on cancer screening behavior warrants further attention and research.
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Affiliation(s)
- Chi-Hsien Huang
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Yen-Ju Lo
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Kuang-Ming Kuo
- Department of Business Management, National United University, Miaoli County, Taiwan
| | - I-Cheng Lu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Hsing Wu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,Department of Information Management, National Yunlin University of Science and Technology, Yunlin County, Taiwan
| | - Ming-Ta Hsieh
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - I-Ting Liu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Yu-Ching Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Yu-Cheng Lai
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan
| | - Ru-Yi Huang
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan.,Center for International Medical Education, E-Da Hospital, Kaohsiung City, Taiwan
| | - Wei-Chieh Hung
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan.,Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Chi-Wei Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
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Ahmad HM, Khan MJ, Yousaf A, Ghuffar S, Khurshid K. Deep Learning: A Breakthrough in Medical Imaging. Curr Med Imaging 2020; 16:946-956. [PMID: 33081657 DOI: 10.2174/1573405615666191219100824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/25/2019] [Accepted: 12/06/2019] [Indexed: 02/08/2023]
Abstract
Deep learning has attracted great attention in the medical imaging community as a promising solution for automated, fast and accurate medical image analysis, which is mandatory for quality healthcare. Convolutional neural networks and its variants have become the most preferred and widely used deep learning models in medical image analysis. In this paper, concise overviews of the modern deep learning models applied in medical image analysis are provided and the key tasks performed by deep learning models, i.e. classification, segmentation, retrieval, detection, and registration are reviewed in detail. Some recent researches have shown that deep learning models can outperform medical experts in certain tasks. With the significant breakthroughs made by deep learning methods, it is expected that patients will soon be able to safely and conveniently interact with AI-based medical systems and such intelligent systems will actually improve patient healthcare. There are various complexities and challenges involved in deep learning-based medical image analysis, such as limited datasets. But researchers are actively working in this area to mitigate these challenges and further improve health care with AI.
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Affiliation(s)
- Hafiz Mughees Ahmad
- Artificial Intelligence and Computer Vision (iVision) Lab, Department of Electrical Engineering, Institute of Space
Technology, Islamabad, Pakistan
| | - Muhammad Jaleed Khan
- Artificial Intelligence and Computer Vision (iVision) Lab, Department of Electrical Engineering, Institute of Space
Technology, Islamabad, Pakistan
| | - Adeel Yousaf
- Artificial Intelligence and Computer Vision (iVision) Lab, Department of Electrical Engineering, Institute of Space
Technology, Islamabad, Pakistan,Department of Avionics Engineering, Institute of Space Technology, Islamabad, Pakistan
| | - Sajid Ghuffar
- Artificial Intelligence and Computer Vision (iVision) Lab, Department of Electrical Engineering, Institute of Space
Technology, Islamabad, Pakistan,Department of Space Science, Institute of Space Technology, Islamabad, Pakistan
| | - Khurram Khurshid
- Artificial Intelligence and Computer Vision (iVision) Lab, Department of Electrical Engineering, Institute of Space
Technology, Islamabad, Pakistan
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Wang J, Phi XA, Greuter MJW, Daszczuk AM, Feenstra TL, Pijnappel RM, Vermeulen KM, Buls N, Houssami N, Lu W, de Bock GH. The cost-effectiveness of digital breast tomosynthesis in a population breast cancer screening program. Eur Radiol 2020; 30:5437-5445. [PMID: 32382844 PMCID: PMC7476964 DOI: 10.1007/s00330-020-06812-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/17/2020] [Accepted: 03/13/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate at which sensitivity digital breast tomosynthesis (DBT) would become cost-effective compared to digital mammography (DM) in a population breast cancer screening program, given a constant estimate of specificity. METHODS In a microsimulation model, the cost-effectiveness of biennial screening for women aged 50-75 was simulated for three scenarios: DBT for women with dense breasts and DM for women with fatty breasts (scenario 1), DBT for the whole population (scenario 2) or maintaining DM screening (reference). For DM, sensitivity was varied depending on breast density from 65 to 87%, and for DBT from 65 to 100%. The specificity was set at 96.5% for both DM and DBT. Direct medical costs were considered, including screening, biopsy and treatment costs. Scenarios were considered to be cost-effective if the incremental cost-effectiveness ratio (ICER) was below €20,000 per life year gain (LYG). RESULTS For both scenarios, the ICER was more favourable at increasing DBT sensitivity. Compared with DM screening, 0.8-10.2% more LYGs were found when DBT sensitivity was at least 75% for scenario 1, and 4.7-18.7% when DBT sensitivity was at least 80% for scenario 2. At €96 per DBT, scenario 1 was cost-effective at a DBT sensitivity of at least 90%, and at least 95% for scenario 2. At €80 per DBT, these values decreased to 80% and 90%, respectively. CONCLUSION DBT is more likely to be a cost-effective alternative to mammography in women with dense breasts. Whether DBT could be cost-effective in a general population highly depends on DBT costs. KEY POINTS • DBT could be a cost-effective screening modality for women with dense breasts when its sensitivity is at least 90% at a maximum cost per screen of €96. • DBT has the potential to be cost-effective for screening all women when sensitivity is at least 90% at a maximum cost per screen of €80. • Whether DBT could be used as an alternative to mammography for screening all women is highly dependent on the cost of DBT per screen.
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Affiliation(s)
- Jing Wang
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Xuan-Anh Phi
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcel J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alicja M Daszczuk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Talitha L Feenstra
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Lee JS, Oh M. Breast Density of Mammography is Correlated with Reproductive Risk Factors Regardless of Menopausal Status: A Cross-Sectional Study of the Korean National Screening Program. Asian Pac J Cancer Prev 2020; 21:1011-1018. [PMID: 32334463 PMCID: PMC7445990 DOI: 10.31557/apjcp.2020.21.4.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To clarify the limitations of mammography screening for women with dense breasts, we examined breast density and its effects on screening results. PATIENTS AND METHODS We performed a cross-sectional, observational study on women who underwent mammography. Data from the National Cancer Screening Program(NCSP) from 2009 to 2013 were used. The study population consisted of participants with high breast density. We used a logistic regression analysis to evaluate the relationships between breast density and reproductive factors and screening results according to menopause status. RESULTS High breast density was reported for 57.5% of all participants (3,417,319 participants). Screening results indicated breast density of <25%, 25-50%, 51-75%, and ≥76% for 16.4%, 26.3%, 37.8%, and 19.5%, respectively, of participants. According to the screening results, high breast density was correlated with high deferment and recall rates. Reproductive factors, especially parity, breastfeeding, and use of oral contraceptives, had consistent effects on screening results of premenopausal and postmenopausal women. Regardless of menopausal status, age, early onset of menarche (15 years or younger), fewer live births (≤1 birth), and previous benign breast disease were correlated with increased breast density. In postmenopausal women, early-onset menopause and longer-term hormone replacement therapy (≥2 years) also independently increased breast density. CONCLUSION Breast density influenced screening results, which could increase the rate of recall. Breast density was also influenced by reproductive factors, with patterns similar to those of breast cancer risk, regardless of menopausal status. We need to identify high-risk women with high density who would probably benefit from supplemental breast cancer screening.
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Affiliation(s)
- Jung Sun Lee
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Minkyung Oh
- Department of Pharmacology, Inje University College of Medicine, Clinical Trial Center, Inje University Busan Paik Hospital, Busan, Korea
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Advanced approaches to imaging primary breast cancer: an update. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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8
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An overview of mammographic density and its association with breast cancer. Breast Cancer 2018; 25:259-267. [PMID: 29651637 PMCID: PMC5906528 DOI: 10.1007/s12282-018-0857-5] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/30/2018] [Indexed: 12/24/2022]
Abstract
In 2017, breast cancer became the most commonly diagnosed cancer among women in the US. After lung cancer, breast cancer is the leading cause of cancer-related mortality in women. The breast consists of several components, including milk storage glands, milk ducts made of epithelial cells, adipose tissue, and stromal tissue. Mammographic density (MD) is based on the proportion of stromal, epithelial, and adipose tissue. Women with high MD have more stromal and epithelial cells and less fatty adipose tissue, and are more likely to develop breast cancer in their lifetime compared to women with low MD. Because of this correlation, high MD is an independent risk factor for breast cancer. Further, mammographic screening is less effective in detecting suspicious lesions in dense breast tissue, which can lead to late-stage diagnosis. Molecular differences between dense and non-dense breast tissues explain the underlying biological reasons for why women with dense breasts are at a higher risk for developing breast cancer. The goal of this review is to highlight the current molecular understanding of MD, its association with breast cancer risk, the demographics pertaining to MD, and the environmental factors that modulate MD. Finally, we will review the current legislation regarding the disclosure of MD on a traditional screening mammogram and the supplemental screening options available to women with dense breast tissue.
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Initial results of the FUSION-X-US prototype combining 3D automated breast ultrasound and digital breast tomosynthesis. Eur Radiol 2018; 28:2499-2506. [DOI: 10.1007/s00330-017-5235-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 11/08/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
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10
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Gossner J. Digital Mammography in Young Women: Is a Single View Sufficient? J Clin Diagn Res 2016; 10:TC10-2. [PMID: 27134963 DOI: 10.7860/jcdr/2016/17342.7502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Single view mammography may be a less time consuming, more comfortable and radiation reduced alternative for young women, but there are no studies examining this approach after the implementation of digital mammography into clinical practice. MATERIALS AND METHODS Retrospective analysis of all mammographies performed in women younger than 40 years during a 24 month period. The sample consisted of 109 women with 212 examined breasts. All patients initially received standard two- view mammography. In the study setting the MLO- views were read by a single viewer and compared to a composite reference standard. RESULTS In this sample 7 malignant findings were present and the review of the MLO-view detected 6 of them (85%). In patients with dense breasts 4 out of 5 malignant findings were found on the single-view (sensitivity 80%) and all 2 malignant findings were detected in patients with low breast density (sensitivity 100%). There were 7 false positive findings (3.3%). i.e. in total 8 out of 212 examined breasts were therefore misinterpreted (3.8%). CONCLUSION Single view digital mammography detects the vast majority of malignant findings, especially in low density breast tissue and the rate of false-positive findings is within acceptable limits. Therefore this approach may be used in different scenarios (for example in increasing patient throughout in resource poor settings, reducing radiation burden in the young or in combination with ultrasound to use the strengths of both methods). More research on this topic is needed to establish its potential role in breast imaging.
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Affiliation(s)
- Johannes Gossner
- Faculty, Department of Clinical Radiology, Evangelisches Krankenhaus Göttingen- Weende , An der Lutter 24, 37024 Göttingen, Germany
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Olsson L, Nilsson M, Svenson B, Hellén-Halme K. The effect of anatomical noise on perception of low contrast in intra-oral radiographs: an in vitro study. Dentomaxillofac Radiol 2016; 45:20150402. [PMID: 26891747 DOI: 10.1259/dmfr.20150402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Radiographic images suffer from varying amounts of noise. The most studied and discussed of these is random noise. However, recent research has shown that the projected anatomy contributes substantially to noise, especially when detecting low-contrast objects in the images. Our aim, therefore, was to evaluate the extent to which overprojected anatomical noise affects the detection of low-contrast objects in intra-oral images. METHODS Our study used four common sensor models. With each sensor, we took four series of images, three series with and one series without an anatomical phantom present. In each series, we exposed a low-contrast phantom at 18 different exposure times using a standardized method. 4 observers evaluated all 288 images. RESULTS The low-contrast characteristics differed substantially when imaging low contrast on a homogeneous background compared with imaging low contrast when an anatomical phantom was present. For three of the sensors, optimal exposure times for low-contrast imaging were found, while the fourth sensor displayed a completely different behaviour. CONCLUSIONS Calibrating the low-contrast properties of an imaging system using low-contrast objects on a homogeneous background is not recommended. On an anatomical background, low-contrast properties are completely different, and these will mimic the clinical situation much more closely, directing the operator how to best use the system. There is a clear demand for further research on this subject.
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Affiliation(s)
- Lars Olsson
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden.,2 Department of Oral Radiology, Postgraduate Dental Education Center, Örebro, Sweden
| | - Mats Nilsson
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden.,3 Department of Radiation Physics, Skåne University Hospital, Malmö, Sweden
| | - Björn Svenson
- 4 Postgraduate Dental Education Center, Faculty of Medicine and Health, School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Kristina Hellén-Halme
- 1 Department of Oral and Maxillofacial Radiology, Faculty of Odontology, Malmö University, Malmö, Sweden
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