Health Imaging & IT - June 2008 - (Page 26)

MoDAliTy ReVieW By Lisa Fratt MaMMogRaPHy’S nEXt StEP The Dawning of Breast Tomosynthesis For decades, breast imaging has pivoted around one gold-standard technology—mammography. Although it is the standard in breast cancer detection, mammography is far from perfect. “Mammography is saving lives. The breast cancer mortality rate is down 25 percent since 1990, primarily because of early detection,” says Daniel Kopans, MD, director of breast imaging at Massachusetts General Hospital (MGH) in Boston. But the downsides to mammography are signiﬁcant. The falsenegative rate hovers in the 20 percent range; false-positives sit at 12 percent, and a radiologist cannot distinguish malignant and benign breast tissue by viewing a mammogram. Consequently, researchers are pursuing a number of avenues to improve the breast cancer detection process via mammography. One technology close to the verge of reality is expected to address mammography’s shortcomings: breast tomosynthesis. GE Healthcare, Siemens Medical Solutions and Hologic, Inc. are developing breast tomosynthesis systems, and it’s likely that at least one vendor will receive Food and Drug Administration (FDA) approval in the next year, Kopans notes. As researchers demonstrate the promise of breast tomosynthesis, Health Imaging & IT offers a primer on the technology to help sites prep for the next wave of breast imaging technology. A new view Digital tomosynthesis acquires multiple projections of a compressed breast from different angles. Images are reconstructed and can be viewed individually or dynamically. The new and improved images address many of the problems associated with conventional mammography. “Part of the problem with mammographic images is that the breast gets in the way,” says Kopans. That is, breast tissue can obscure malignancies. In some mammographic images, normal tissue can appear suspicious, setting off a chain of additional imaging and patient anxiety. False-positives cost money, impact workflow and frustrate patients and physicians. “Tomosynthesis eliminates problems caused by the superimposition of normal structures,” Kopans says. Tissue isn’t sandwiched; it can be viewed layer by layer, much like the slices of a multidetector CT or MRI study. The ability to view tissue layer by layer translates into important benefits, says Liane Philpotts, MD, chief of breast imaging at Yale New Haven Hospital in New Haven, Conn. Most importantly, the ability to view individual layers is expected to reduce the callback rate because the radiologist’s view of any suspicious area is not obscured by breast tissue. In addition, radiologists should be able to detect more cancers, specifically those obscured (and missed) by overlapping tissue. Earlier detection is another strong possibility. “It is likely that radiologists will find more smaller cancers HealthImaging.com [ Siemens’ digital prototype breast tomosynthesis system is being investigated in preliminary clinical trials for the detection of subtle mass lesions often undetectable by conventional mammography. On a 56-year-old woman undergoing routine screening mammography, an area of possible distortion is visible in the left breast. The subject was recalled for magniﬁcation compression view, which still showed a persistent area of distortion. No suspicious lesions were seen by sonography.The tomo scan reveals a spiculated mass. The subject was referred to stereotactic core biopsy, which revealed invasive ductal carcinoma with lobular features. ] 26 Health Imaging & IT | June 2008 http://HealthImaging.com

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Health Imaging & IT - June 2008 Contents On The Web The Enterprise News Update Cover Story: Pushing Productivity: How Imaging is Building Efficiency and Cutting Costs Technology Outlook: Imaging Procedures Poised for Growth Great Expectations: PET/CT Delivers SPECT/CT Proving it's Potential MR/PET Holds Promise Good Image Management: Infiltrating Molecular Imaging SNM Preview Modality Review: Mammography’s Next Step: The Dawning of Breast Tomosynthesis Managing Technology: Radiation Oncology: Opening the Doors to IT Reader's Resource Stat Sheet

Health Imaging & IT - June 2008

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