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In the Beginning

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In the Beginning 2/9/2015 IN THE BEGINNING Mammography technology has come a long way since the first machine specifically designed for producing mammograms was introduced in 1966. The first mammography system was essentially a tripod supporting a special X-ray camera EARLY MILESTONES IN MAMMOGRAPHY 1913 - Albert Solomon, a surgeon in Berlin, uses a conventional X-ray machine to visualize breast cancers in 3,000 mastectomy specimens. 1949 - Uruguayan Raul Leborgne emphasizes the need for breast compression to identify calcifications. 1956 - Robert Egan, a radiologist in Houston, introduces dedicated film for mammography to produce simple and reproducible images with improved detail. 1966 – The first dedicated mammography system is introduced. 1971 – Commercial introduction of xeromammography 1980 – Introduction of single emulsion film; 2x faster at significantly lower dose REMEMBER THIS? 1953 Uruguay If you do, you’ve been working way too hardand too long! 1 2/9/2015 EARLY POSITIONING AND COMPRESSION MANY VENDORS SAW THE POTENTIAL PHILIPS(LORAD) CGR-500T GE800T BENNETT INSTRMENTARIUM CONTINENTAL GENRAD LORAD TRANSPO Cone PLANMED MLO view done in reclining position SIEMENS Compression Pad How long do you think this exam took? CC in standing position WHAT ABOUT THIS? FDA Approval Approvable Letter Usually done when a patient had a very large 510K—manufacturer “claims” product is palpable mass substantially equivalent----used for Limited productivity; 4-5 proven technology-Today patients imaged per day Limited to CC and MLO PMA---manufacturer “proves” product is views; no ability to do substantially equivalent----used for new extra diagnostic views If you remember this, I technology know your age! DEDICATED MAMMOGRAPHY SYSTEMS OTHER BENEFITS The first systems developed specifically for mammograms More comfortable procedure for the were released in 1966. patient Rotating C-arm allowed both Dedicated work areas for CC and MLO views to be taken with patient in standing Radiologists and Technologists, for or sitting position, for better improved productivity efficiency Additional diagnostic views Birth of the “ team approach ” in enabled mammography Image quality was limited due to limitations in film capabilities 2 2/9/2015 THE NEXT ADVANCE XEROMAMMOGRAPHY First introduced in 1971 Provided better image quality than systems using industrial film packs Allowed excellent visualization of chest wall The Grandpappy of Selenium digital technology Xeroradiographs (blue and white prints), as Key Inventor – Lothar shown above, gave adequate image quality; however, the radiation dose to the breast was Jeromin (“Mr. Xerox”) much higher than current imaging methods. Holds 23 patents XEROMAMMOGRAPHY Is This Your Past DIFFERENT PERSPECTIVES LOVE Radiologists and Surgeons loved the image quality and ability to see chest wall and ribs DREAD Technologists were uncomfortable with length of exam and lack of training in positioning (all on the job, at that time) FEAR Patients were very uneasy, as the exam was not expected to bring good results (done primarily for symptomatic patients at that time) AND IT APPEALED TO THE Is This Your Past PUBLIC Advertisement in Life and Glamour magazine promoting the new technology, xeromammography Your Mother’s Mammogram Model demonstrates the latest in mammography technology and fashion. Check out the hosiery 3 2/9/2015 BUT WHAT A MESS! A GLIMPSE OF THE FUTURE LOTHAR’S STORY Technologists were the original Smurfs! As a testimonial of faith in their xeromammography system, Xerox offered Lots of blue, on your free mammograms to female employees in shoes, uniforms, the breast cancer at-risk age group. ONE non-symptomatic woman was indeed hands,hair etc. diagnosed with breast cancer And so the seeds of a screening program were sown IMPROVEMENTS IN XEROMAMMOGRAPHY 80s AND 90s PROFICIENCY In 1985, xeromammography changed from blue DEVELOPMENT powder toner to black liquid toner Worldwide acceptance of mammography as the first This resulted in substantial dose reductions (and line of defense cure of Smurf-syndrome in technologists) Radiologists became MAMMOGRAPHERS and in many facilities multitasked Technologists began to seek out specialized training courses Administrators & Technologists worked together on Lothar Jeromin with low-dose creating “The Breast Center” xeromammography system at RSNA 1985 MQSA enacted to ensure consistently high quality in all mammography facilities 1983 prototype of low-dose xeromammography system MILESTONES IN MODERN AT THE SAME TIME. MAMMOGRAPHY 1985 – Declaration of Breast Cancer Awareness Week, which Single emulsion film for use in mammography was led to Nation Breast Cancer Awareness Month being introduced, with the promise of providing faster processing, improved image quality, and 1988 – Congress passes legislation to provide annual screening significantly decreased dose mammography benefit for Medicare recipients 1990 – Breast and Cervical Cancer Mortality Prevention Act By 1986, screen-film mammography was being implemented to provide free or low cost mammograms and pap used by more than half of all radiologists smears to low-income women Production of xeromammography was halted in 1998 – First Computer Aided Detection (CAD) system for 1989, due to declining sales mammography approved by FDA Screen-film mammography became the gold 1999 – National Mammography Quality Standards Act standard in the late 1980’s – early 1990’s implemented 2000 – First Full Field Digital Mammography system approved by FDA 4 2/9/2015 THE 80’S and 90’s The Image Interpreter’s Challenge: Find Waldo Find DECADES OF AWARENESS Waldo: Significant increase in incidence of breast cancer diagnoses between 1980 - 1987 attributed to implementation of screening programs, enabling earlier detection of smaller breast cancers Earlier detection has led to decreases in mortality Breast cancer mortality rates have decreased approximately 2% annually since 1990! The “WAR” on Breast Cancer has been the biggest American accelerator for development of better detection technologies and improved treatment options in the last two decades Are there ANY? Are there MANY? Your time’s up! Where? Are you sure? The Image Interpreter’s Challenge: (In USA), If radiologist screening interprets 40 Mammograph patient y exam is two studies/hour, views per = 1 study breast, = 4 every 90 images/study seconds FIND “WALDO” Typically, the previous 4 Reviewing 8 images are images every compared with 90 seconds = the latest 4 11 seconds images, = 8 per image! images viewed 5 2/9/2015 Breast Tomosynthesis A 3D screening modality that preserves the very high resolution of 2D FFDM Multiple images of the breast are acquired at different angles during a sweep of The “Star Wars” fantasy of beaming digital the x-ray tube mammograms via satellite to doctors in remote locations around the world has Allows radiologists to see around become a reality. overlapping structures In 2D FFDM: Tissue superimposition hides pathologies in 2D Tissue superimposition mimics pathologies in 2D l Tomosynthesis is a three-dimensional mammographic examination that can minimize the effects of structure overlap within the breast Hologic, Dimensions, Selenia, and other associated logos are trademarks and/or registered trademarks of Hologic, Inc. and/or its subsidiaries in the United States and /or other countries. PRE-00023 6 2/9/2015 The 2D Mammography Image next to one slice of a 3D Image Set Tube moves in a 15 o arc 15 low dose images are acquired 1 image at each degree Four second sweep Images are reconstructed into 1 mm slices In combo-mode imaging, the 2D and 3D are taken in the same compression, with no additional positioning for the patient. 2D 3D Compressed Breast Detector Housing LCC A 2D Mammography Image with RMLO a suspicious area identified and blown up A 2D Mammography Image 2D 2D Hologic – Proprietary and Confidential l LCC The 2D Mammography Image next to one slice of a 3D Image Set A suspicious area in a 2D Mammography Image 2D 3D 2D Hologic – Proprietary and Confidential 7 2/9/2015 Recall Reduction Superimposed Tissue Examples A 2D Mammography Image with a suspiciousRCC area identified next to a 3D image set RCC • 2D reconstruction algorithm • Eliminates the need for a 2D mammogram • Creates synthesized images from single tomosynthesis scan • Reduces dose • Additional cost 2D 3D Hologic – Proprietary and Confidential Slice 14 18 22 26 30 As you go thru the image set, you see that the suspicious area is nothing more than normal breast structures overlapping Hologic – Proprietary and Confidential 8 2/9/2015 2 D MLO 3 D MLO • Routine for GE tomosynthesis-FDA A 2 D image generated Approval-Screening from the raw DBT projection data that • 2 D CC helps the user get a overview of the entire • 3 D MLO stack of images before reading individual • Diagnostic Exam tomosynthesis images • 3 D CC • 3D MLO V-View • Step and shoot mode preserves microcalcification sharpness and avoids image blur, since the tube makes a complete stop for each of nine exposures • Anti scatter solution designed for tomosynthesis, the SenoClaire grid in 3 D reduces scattered radiation while preserving dose ABUS-Automated Breast Ultrasound and performance Breast Density Elastography • SenoClaire uses ASIR ®-A calcification correction reconstruction algorithim 9 2/9/2015 • Began in the 1950’s • 21 sites • Incorporated the use of A mode technology • 2809 women (at least heterogeneously • Immersion, compression, and contact transducers dense in one quadrant)
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