Breast Imaging Section Research and Training Activities

Northwestern University, Feinberg School of Medicine, Department of

Automated Whole Opto-acoustic Imaging - Dr. Neuschler (PI) Breast MRI Screening Dr. Mendelson (PI) • ACRIN 6702: A Multi-Center Study Evaluating the Utility Team Building for Organizing and Offering Co-Investigators: Drs. Neuschler, Rao, Solari, Wolfman Co-Investigator: Dr. Gupta of Diffusion Weighted Imaging for Detection and Supplemental US Screening for Women with The transducer makes contact with the breast through a mesh screen. A • Functional imaging coupling agent called ‘lotion’ is used. There are 3 basic views: AP, lateral, and Diagnosis of Mammographically Dense , a New Service medial. The acquisition is a linear but wide transverse image, knitted into a • Combination of light and sound at Lynn Sage volume to allow reformatting in sagittal and whole-breast coronal images as Drs. Wang (PI) and Neuschler seen in the figures below. As of now, these supine systems cannot supply • High-resolution, high-contrast images to demonstrate vascular or tissue stiffness information, and for axillary evaluation and presence of angiogenesis guidance of interventions, handheld, high-resolution transducers are • With hospital and departmental support, a one-day necessary. • Short laser pulse creates thermoelastic expansion • High Risk Lesions and MRI – Are there significant MR training program with faculty of 5 breast imaging • Acoustic waves propagate to surface of tissue and are imaging or histological features of these lesions which physicians and 2 technologists, all experienced in breast detected by wideband ultrasonic receivers can be used to predict upgrade to malignancy and ultrasound will offer a one-day training session that • Image contrast related to hemoglobin concentration avoid unnecessary surgical excisions? includes formal presentations as well as hands-on and oxygen saturation workshops with models for handheld and automated Drs. Goldberg, Gupta and Hui • Designed to concurrently collect images in conjunction whole breast ultrasound with diagnostic ultrasound (co-registered OA and B- An arrow is placed on center mode imaging). of breast, usually the nipple, • Invitees are Northwestern’s breast sonographers and the transducer moves to the • Efficacy of Specimen in MRI Guided Core dual -ultrasound technologists, breast inframammary fold and Needle Biopsies – presented at ARRS 2014 sweeps upward, with 60 – 72 imaging physicians, and Breast and Women’s Imaging seconds for a complete sweep. Drs. Gupta, Goldberg, Su, Verma, Neuschler, Floerke, and fellows Image Display Mendelson (PI) • A pretest distributed the week before the meeting will Results show that high risk and malignant lesions are more be turned in at the start of the meeting, the posttest likely to have calcifications on specimen radiography taken at the conclusion of the meeting with scoring and compared to benign lesions. review prior to adjournment as a means of documenting There is a strong correlation between specimen radiograph educational benefit of the session PIONEER-01 Trial calcifications and the presence of calcifications on the pathology report. • The program will afford 6.5 hours of ASRT CE credit for • A Pivotal Study of Imaging with Opto-acoustics to technologists at no cost to attendees. Northwestern diagnose breast masses detected by mammography and / Biopsies performed for extent of disease are more likely to or clinical findings: A new Evaluation Tool for Category 1 CME credit for physicians was not sought Radiologists have calcifications than those for screening MRI. because of prohibitive cost, which would have exceeded the low budget restrictions. Physician faculty time for • Multi-site FDA trial, IRB-approved, HIPAA-compliant There is no correlation between non-mass enhancement and presence of calcifications on specimen radiography. lecture preparation and presentation is donated; • Funded by a grant from Seno Medical technologist faculty members are compensated RSNA 2014 Abstract • 200 women enrolled at Northwestern (2107 total from 16 according to their NMH agreements. 72 year-old with invasive mammary carcinoma Breast Lesion Detection Using the Acuson S2000 ABVS™ (Automated Breast Volume sites nationwide) in the left breast. MRI for extent of disease. Scanner, Siemens Health Systems) Compared with Handheld Physician-performed Ultrasound Examinations • The educational and organizational benefit of the • Women with BI-RADS 4 or BI- RADS 5 lesions underwent 9-mm mass in lower central right breast with Mendelson EB1, Bohm-Velez M, 2 Neuschler E1, Rao S1, Solari M1, Wolfman J1, Kalata M1, rapid uptake and plateau delayed cooperative technologist-physician team will be Karst I1 an opto-acoustic (OA) study prior to biopsy. Women with enhancement. analyzed for continuation of such model programs, for 1Northwestern University, Feinberg School of Medicine, Department of Radiology; 2Weinstein Imaging, BI-RADS 3 lesions underwent an initial OA study and are Pittsburgh, PA Specimen radiograph: grouped calcifications returning for a one year follow-up OA exam. with pathology of intraductal papilloma with section planning based on evidence of efficacy, and for BACKGROUND microcalcifications possible recommendation to other departments or to • The sensitivity of mammography may decrease by 50% or more when breast tissue is extremely or • Endpoints: heterogeneously dense, with breast density determined on mammograms. Although x-ray mammography is radiological organizations such as the American College the only imaging modality that has been shown in randomized trials to decrease mortality, due to breast • Cancer Yield for MRI biopsy of foci on screening breast cancer, breast density advocacy groups have brought the density issue into the foreground with a two- 1. Does Imagio (OA device) have clinically acceptable PPV MRI of Radiology. pronged approach proposed: direct communication to women of their breast density in the lay letters and NPV for breast cancer? required by the federal Mammography Quality Standards Act (MQSA )and identification of low risk, affordable, accessible methods of supplemental screening. Handheld physician-performed US Drs. Gupta (PI), Goldberg, Floerke, Neuschler, Mendelson supplementation of mammography improved the rate of cancer detection compared with mammography 2. Does it achieve high degree of concordance with biopsy Program Chair: Ellen B. Mendelson, MD, FACR, FSBI, FSRU alone by 4.2 cancers/1000 women screened in the first year results of ACRIN 6666 (Berg et al, JAMA, outcome? Physician Faculty: Erin Neuschler, MD, Sandra Rao, MD, 2008). Severe workflow issues as well as practice patterns in the U.S. make physician performed supplemental whole breast real-time US screening unlikely. Technologist-performed US may be one option, 3. Does it improve classification accuracy for masses Mariana Solari, MD, Judith A. Wolfman, MD, FACR but the perceived operator dependence of US and dissociation of performance from interpretation with technologist performing and physician interpreting, has raised questions of appropriateness and liability of classified as BI-RADS 4A and 4B? Screening Technologist Faculty: Linda Arnold, BS, RTR (M), (US); Erika reading static images representing a real-time small FOV exam. While this study’s investigators believe that technologist-performed supplemental screening will be one option, automated breast ultrasound which Dimitrijevic, ARDMS (Breast). provides a global view of the breast may be the other. Automated ultrasound is considered a new Screening mammography recall rates and breast cancer technology, and our study has been undertaken to confirm the hypothesis that the encouraging results from Breast Ultrasound Screening: Rationale, Methods, Techniques, and Tips Saturday, November 1, 2014 handheld physician-performed ultrasound can be obtained from an automated scanner which does not Prentice Women's Hospital, 4th floor - Breast Imaging Conference Room require physician performance detection: finding the sweet spot 7:25 AM Registration, Welcome, Hand in Pre-Test OBJECTIVES Fibroadenoma 7:30 AM Dr. Mendelson Ultrasound Breast Anatomy and Physiology 0.5 30 min 8:00 AM Dr. Rao 0.5 30 min

Breast Cancer in the U.S. -- Epidemiology, Screening Recommendations, and Mammography Benchmarks • A primary goal is to determine equivalence in lesion detection of the ABVS automated examination and the 8:30 AM Dr. Wolfman 0.5 30 min

The Dense Breast -- Inherent Risk, Masking Effect, or Both; Supplemental Screening with MRI and US: Single Site and handheld physician-performed ultrasound examination. Lesion is the unit of analysis, and equivalence will Drs. Wang and Grabler Multicenter Trials 9:00 AM Coffee Break 15 min be defined as the detection rate of the two methods being within an absolute difference of 5%. 9:15 AM Dr. Mendelson BI-RADS for Ultrasound -- Case Based 0.75 45 min 10:00 AM Dr. Mendelson Ultrasound Image Quality 0.5 30 min • An additional objective is to define a specific workflow for optimal ABVS performance in clinical routine Rita Mahadevia (medical student) 10:30 AM US Technique Demonstrations with Model: 0.5 30 min Arnold A. ABVS Technique Demonstration with Model (A-M) Dimitrijevic METHODS B. Handheld Whole Breast US Technique Demonstration with Model (N-Z) 11:00 AM US Technique Demonstrations with Model: 0.5 30 min • This IRB-approved, HIPAA-compliant study, supported by a Siemens grant to Northwestern, is currently Arnold A. ABVS Technique Demonstration with Model (N-Z) Dimitrijevic closed to accrual with 250 Northwestern patients having participated and 250 at Weinstein Imaging in B. Handheld Whole Breast US Technique Demonstration with Model (A-M) Breast cancer in young women: imaging features, 11:30 AM Break 15 min 11:45 AM Lunch/Dr. Rao 0.5 30 min Pittsburgh, PA. Statistical evaluation is underway. Image Annotation, Measuring Masses, and Correlating Mammography and Ultrasound 12:15 PM Breast Ultrasound Technique, Hands-On with Model: 1 60 min Dimitrijevic • Each participant received a protocol-defined handheld bilateral US performed by a physician-investigator as histopathology, and patient characteristics A. Screening Whole Breast Ultrasound Technique, Hands-On (A-M) Arnold well as an automated US performed by a trained breast sonographer and interpreted by a second physician- B. Automated Whole Breast Ultrasound Technique, Hands-On (N-Z) Invasive Ductal 1:15 PM Breast Ultrasound Technique, Hands-On with Model: 1 60 min investigator without knowledge of findings in the other type of exam. Each lesion found in the handheld or Arnold A. Screening Whole Breast Ultrasound Technique, Hands-On (N-Z) automated study was analyzed by the investigator using a BI-RADS-based feature analysis and a BI-RADS Dimitrijevic B. Automated Whole Breast Ultrasound Technique, Carcinoma Hands-On (A-M) assessment was given for each lesion. Data analysis by Alfred Rademaker, PhD and Angela Fought, MS at Drs. Wang and Deitch 2:15 PM Coffee Break 15 min 2:30 PM Dr. Neuschler Controversies Managing Benign Masses 0.5 30 min Northwestern’s Department of Biostatistics is underway. 3:00 PM Dr. Solari Imaging of the Postsurgical Breast 0.5 30 min 3:30 PM Post-Test 0.5 30 min 4:00 PM Dr. Mendelson Review of Post-Test 0.5 15 min RESULTS AND CONCLUSIONS 4:15 PM Adjourn • We expect to validate supine automated US (ABVS) as equivalent to handheld US in lesion detection as well as to define a method for efficient integration of automated US in the current busy, complicated breast center workflow. Images from Pilot Study, courtesy of Seno Medical