Health Imaging & IT - June 2008 - (Page 28)

Mammography’s Next Step: The Dawning of Breast Tomosynthesis than they would with conventional mammograms,” says Philpotts. Over the last few years, Kopans and his colleagues at MGH have imaged 3,500 women with breast tomosynthesis and compared the findings to 2D mammography. The callback rate is reduced by 30 to 40 percent with tomosynthesis, mainly because tomosynthesis eliminates superimposition of the breast. Breast tomosynthesis also delivers image quality improvements. “Radiologists can see the margins of abnormalities with greater clarity,” says Kopans. Because cancers tend to be ill-defined masses and may have spiculations, clearer margins can help radiologists differentiate benign and malignant findings. Finally, tomosynthesis’ slices allows radiologists to see the exact location of an abnormality. “Breast tomosynthesis will be a great improvement over 2D mammography,” sums Kopans. Breast tomosynthesis in practice It’s fair to say that many radiologists’ heads are still swimming after adjusting (or considering the shift) from analog to digital mammography. Is tomosynthesis another major paradigm shift? Is it affordable? What does it mean for workflow? It appears likely that tomosynthesis will be an easier—and could Innovation Confidence Life f Powerful Tools at Your Fingertips At EDDA, we build advanced clinical applications to bring a new generation of interactive decision aid solutions for your needs in early detection, diagnosis and treatment. • • • • • Intuitive & efficient Lesion specific enhancement & analysis Advanced 3D/4D visualization Volumetric segmentation, editing & quantification Enterprise-wide solution for seamless workflow in PACS IQQA®-Chest CAD for DR/CR IQQA®-Liver for multi-phase contrast CT www.edda-tech.com • 609-919-9889 VISIT US AT AHRA 2008 • Booth #737 28 Health Imaging & IT | June 2008 be a relatively affordable—transition. “Tomosynthesis images look like mammograms, but allow radiologists to scroll through the breast tissue. It’s similar to breast MRI,” says Philpotts. Because most radiologists have grown accustomed to 3D views in other modalities, the learning curve should be relatively short. The workflow impact of breast tomosynthesis remains unclear. It takes Kopans about 40 seconds to review a breast tomosynthesis study, about the same amount of time as a mammogram. Philpotts provides a longer rough estimate, placing her digital mammography review time at one minute and tomosynthesis review time at two minutes. “It does depend on the patient. It takes longer to read a study if the patient has calcifications or masses,” adds Philpotts. In addition, the two radiologists prefer different protocols, which could partially explain the variability in review time. Kopans believes it may be possible to provide an accurate interpretation of breast tomosynthesis studies based on medio lateral oblique (MLO) views of each breast. Philpotts disagrees. “It’s most likely that radiologists will need two views of each breast: the MLO and craniocaudal (CC),” she says. Although the MLO view generally includes more tissue than the CC view, breast compression tends to be better during the MLO view. In fact, research conducted at MGH and presented at the Radiological Society of North America (RSNA) 2006 annual meeting indicated that subtle cancers may be missed in the MLO view. The study concluded that obtaining both views optimizes visualization of lesions. Ultimately, the workflow impact should be minimal with any increased review time cancelled out by a reduced callback rate. The financial front remains a bit murky as well. Breast tomosynthesis systems are based on digital mammography detectors, which can cost two to four times as much as an analog system. But the additional cost of a breast tomosynthesis system should be marginal. That’s because most digital mammography vendors expect to offer digital mammography buyers an upgrade path to the tomosynthesis platform. “Administrators should insist on an upgrade path to tomosynthesis if they are in the digital acquisition process,” advises Kopans, who estimates that tomosynthesis will add 20 percent to the cost of a digital mammography system. But note that for sites going from analog to tomosynthesis, once available, will need to plan for a cost about four times that of an analog system. Kopans adds another key cost point. “The initial equipment cost is a small component of the total cost of breast imaging.” Other factors such as radiologist and technologist time are larger elements of the cost equation. Plus, if preliminary data hold up, fewer women will require diagnostic mammograms, resulting in an overall cost-savings. What’s more, tomosynthesis could provide a competitive advantage. “Tomosynthesis will be tremendous once it hits the market. Women will demand access,” predicts Philpotts. On the other hand, cost hurdles do exist. The FDA process is lengthy, and securing reimbursement for tomosynthesis, a prerequisite for return on investment, could take some time. Initially, tomosynthesis may be limited to academic or research sites, but as research demHealthImaging.com http://www.edda-tech.com http://www.edda-tech.com http://HealthImaging.com

Table of Contents Feed for the Digital Edition of Health Imaging & IT - June 2008

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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