DIGITAL MAMMOGRAPHY

Krista DavenportJuly 31, 2008

A Brief History- 1913 Albert Salomon, German surgeon

- 1950’s - Jacob Gershon-Cohen began to advocate widespread use of X-rays for screening

- December 2005 – RSNA brings digital mammography to US

Instant Upgrade Improved signal-to-noise ratio Ability to magnify, change contrast, or alter

the brightness. Near instantaneous image acquisition

Courtesy: Magee-Women’s Hospital of UPMC

Digital versus Conventional

Digital Mammographic Imaging Screening Trial

(DMIST)

Retrospective study of 49,500 asymptomatic women Assessed accuracy of digital vs film mammograms

RESULTS: Digital mammography significantly more accurate in pre-

and perimenopausal women under 50 with dense breasts

Nonsignificant trend toward improved accuracy with film mammograms in women over 65 with fatty breasts

Courtesy: MIAS digital mammogram database

Computer-Aided Detection

Software program that highlights areas of concern on digital mammograms

Uses image processing algorithms and decision threshold parameters to detect features in an image likely to be of clinical significance

Very sensitive – detects 90% of all cancers However, has a high rate of false positives (2-4 per study)

http://www.imagingeconomics.com/issues/articles/2005-12_04.asp

cost issues Digital mammography is expensive!

Using digital technology in all women would cost >$300,000 per QALY gained

Targeted use of digital mammography on basis of age/breast density costs ~$50,000 per QALY gained

References• Pisano E, Gatsonis C, Hendrick E, Yaffe M, Baum J, Acharyya S, Conant E, Fajardo L, Bassett L, D'Orsi C, Jong

R, and Rebner M. Diagnostic Performance of Digital versus Film Mammography for Breast Cancer Screening - The Results of the American College of Radiology Imaging Network (ACRIN) Digital Mammographic Imaging Screening Trial (DMIST). NEJM, published online September 16, 2005 and in print on October 27, 2005.

• Full Field Digital Mammography: A New Breast Cancer Screening Tool. Dr. Mark Helvie, Dept of Radiology, Univ of Michigan

• Tosteson ANA, Stout NK, Friback DG, Acharyya S, Herman BA, Hannah LG, Pisano ED. Cost-Effectiveness of Digital Mammography Breast Cancer Screening. Ann Intern Med. 2008;148:1-10.

• Grainger & Allison's Diagnostic Radiology, 5th ed.• http://www.ucdmc.ucdavis.edu/welcome/features/20070502_cancer_Fenton_cad/index.html