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Newburgh Hospital Event 2015

Deborah Thames R.T. (R)(M)(QM)

Diagnostic Radiology /MammographyAll courses offered by AHEC are approved by a Recognized Continuing Education Evaluation

Mechanism (RCEEM), AHRA (The Association for Medical Imaging Management) or ASRT

(American Society of Radiologic Technologists). Courses are approved in states with

independent approval requirements if the course is being presented in that state.

Disclosure of Relevant Financial Interest for Individuals in Control of Content. AHEC

Financial interest includes but is not limited to relationships with commercial companies,

manufacturers, or corporations, whose products or services are related to the subject matter of the

presentation within the prior 12 months.Please turn off all cell phones and pagersAnd be kind to your neighbor and not talk

out Loud in class-Thank You

You can get up and use the restroom anytime, but be discreet please

About me

Work full time at a cancer hospital in Houston, Texas, born in South Dakota

Done X-rays/Mammography for 20 years Taught classes for AHEC for 12 yearsGoing to college finish what I started Have two sons, daughter-in-law and one year

old grandson and the only other estrogen in my life are my two female dogs

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Objectives

Use of C-View images in clinical practice

Comparison of C-View images to traditional 2D images

Advantages of using C-View and Case studies

Tomosynthesis Upright Stereotactic Biopsies

New Codes for DBT

What holds the future for DBT

Staging a Patient with different imaging modalities

Knowing the choices with BI-RADS and the lexicon

Treatment options and managing patient care

Identifying Breast Pathology and physiology

Study Design —Image Acquisition

• Cases were accrued from 22 sites in the United States under IRB approval with written informed consent

• Subjects presented for either screening or biopsy

• Subjects underwent investigational 2D and 3D imaging (in a single compression) of both breasts in the MLO and CC views

• Screening subjects also underwent standard of care 2D FFDM imaging (SOC) on the same day

• Biopsy subjects were eligible for the study if their SOC imaging had been performed within the past 60 days.

• SOC imaging and investigational imaging were interpreted by different radiologists at the accruing sites

Enrollment Exclusion Criteria

• Women with a prior excisional biopsy

• Women with an internal breast marker

• Women with breast implants

• Breasts too large to be imaged in a single compression 

Study Design – Reader Case Review

302 cases 2D FFDM and 3Ds

Data Analysis

Session 22D FFDM (151)

Session 23Ds  (151)

Session 13Ds  (151)

Session 12D FFDM (151) 

1 month washout

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2D FFDM C‐View 3D Slices 2D FFDM C‐View Tomosynthesis

3D SliceC‐View

15/15 readers recalled

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The C-View software was introduced for sale throughout the European Economic Area and in other countries recognizing the CE Mark.

This approach would provide the advantage of reducing

the number of exposures, leading to slightly shorter exam times and reduced patient dose.

The dose would be approximately half the dose of a 2D plus tomo exam, and approximately the same as a 2D exam alone. This could be an important evolution of this technology, especially in dose-sensitive regions.

The algorithms to create such a synthesized image that approximate the necessary components of the true 2D

involve smart summing of the individual slices that make up

the tomosynthesis image set.

In clinical use, the synthesized 2D image will be reviewed together with the tomosynthesis image set.

There are technical challenges to creating a synthesized

2D image that is close in quality to that of a true 2D image,

however much progress has been made in this area.

Gur has studied the performance of an early version of synthesized 2D in a pilot study. He concluded that a minor

improvement in the quality of a synthesized 2D image

could lead to an acceptable diagnostic quality and eliminate

the need for acquiring both a 2D and tomo dataset during

tomosynthesis based screening.

This is certainly promising and offers the possibility of providing the improved performance gain of two-view breast tomosynthesis with doses comparable to current 2D mammography levels.

It can look different and look to have too much contrast. Some radiologist have a hard time adjusting to the likeness of this new software. There are radiologist that still do a combo mode and have the C-View software.

Tomosynthesis Computer-Aided Detection (CAD)Just as in conventional 2D digital mammography,

CAD may help find suspicious objects in a tomosynthesis

dataset.

However, there are differences in the use for CAD in tomosynthesis.

Conventional 2D CAD helps find both masses and microcalcifications.

In tomosynthesis, there may be less of a need for a mass-detection algorithm, because often the masses and distortions are found very quickly and easily by the human observer.

The situation is different in the case of microcalcifications.

It can be time consuming to have to carefully search a large number of slices, and there is the potential for the reviewer to overlook some subtle microcalcifications.

An efficient and sensitive calcification CAD algorithm could help speed up the search.

For example, CAD could identify suspicious calcification clusters on a scout image and rapidly navigate to the appropriate slices of interest.

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An example of a CAD algorithm marking potentially suspicious microcalcifications on a single slice from a tomo study.

Hologic has developed an extension to its

Image Checker® CAD product line for identification

of potential calcifications in tomosynthesis slices.

ImageChecker 3D Calc CAD is available in Canada and throughout the European Economic Area and in other countries recognizing the CE Mark.

R2 Image Checker for 2D

R2 Image metrics

Number of calcifications

Size (Long Axis)

Distance to nipple

Distance to chest wall

Measure of density

Degree of spiculations

Contrast

CAD Operating Point