Breast Cancer Awareness Month: Current and Future Technologies for Diagnosis

Developments in breast imaging can help steal time from cancer.

One of the primary goals of Breast Cancer Awareness Month is to increase awareness for screening and the fact that early detection can help save lives.

Fortunately, advances are being made in the technologies that can help breast imagers make their  diagnoses more efficiently and confidently. These include digital breast tomosynthesis and emerging screening technologies like whole-breast ultrasound, and AI-powered applications. Mammography is no longer the one-size-fits-all approach to breast cancer screening.

Supporting the fight against breast cancer with the power of one

Carestream is a partner in the fight against breast cancer by supporting new modalities and their associated functions in one unified diagnostic desktop. Reducing the need to open external applications or switch workstations to perform the reporting helps improve efficiency. Also, having everything accessible in one workspace contributes to a patient-centered overview, further enhancing breast imaging workflow and productivity.

radiograph of a breast and pink ribbon  for breast cancer awareness month

Increasing awareness about early detection, through events like Breast Cancer Awareness Month, helps fuel new technology developments.

Providing breast imaging physicians with a diagnostic viewer that allows for high-volume mammography screening and advanced diagnostic evaluation – often including ultrasound and MRI with potential guided biopsy additions – is fundamental to the one workstation philosophy of the Clinical Collaboration Platform.

Digital breast tomosynthesis

3D tomosynthesis is one of the fastest-expanding, breast-imaging technologies used by the majority of Carestream customers worldwide. We continue to improve the overall user experience for these breast imagers. Recent releases of our mammography software improved the loading performance of the traditionally large tomosynthesis volumes. Radiologists have reported improvements up to 70 percent.

In our latest software release, we added support for the newest 3D tomosynthesis offerings in the market including Siemens Healthineers Mammomat Inspiration; General Electric Senographe Pristina Mammography System; and Hologic 3Dimensions system. The image sets generated by these modalities reveal an extraordinary level of detail; however, that comes at a price of large file sizes.

Numerous  usability improvements have been incorporated into the user preferences. These allow for a personal touch to the user experience for tomo scrolling, graphical annotations, and more.

Whole breast ultrasound

Whole breast ultrasound is commonly referred to as “ABUS” or “ABVS” by vendors like GE and Siemens. It is a breast scanning technique that uses high-frequency sound waves to produce a 3D volumetric image of the entire breast. The 3D image allows radiologists to check the breast from multiple angles. The capability might reveal lesions that were invisible or difficult to find in 2D mammography. Whole breast ultrasound also has been shown to find small, invasive, node-negative cancers that were missed by mammography.

PACS workstation with a breast image on it

Carestream supports new modalities in one unified diagnostic desktop.

Additional benefits of whole breast ultrasound are significantly faster acquisition time and less operator variability – as opposed to the traditional ultrasound that is reliant on a handheld transducer. Whole-breast ultrasound as adjunct to a screening mammography is becoming an integral part of many practices, especially in women with dense breast parenchyma.

Proliferation of whole-breast ultrasound is very noticeable in nearly all regions; particularly in countries that have mature population-based screening programs.

Differences in image with whole breast ultrasound

The appearance of a whole breast ultrasound image is a bit different since it typically includes the coronal view, traditionally not used in breast imaging. The benefits of this are:

  1. Coronal view from skin line to chest wall (adjustable in increments using MPR parameters).
  2. Breast body marker in each quadrant displays the three coordinates of the current region of interest position (clock, distance from nipple, and depth from the skin). This provides a very precise location of the lesion. This body marker information helps in targeting the area very quickly when performing a follow up handheld ultrasound.
  3. Nipple marker in each coronal image remains in view to provide constant orientation.

Keeping true to our one workstation philosophy, we added native support for whole breast ultrasound (GE Invenia and Siemens S2000) in the most recent release of our Diagnostic Viewer. We are among the first vendors to do this. This alleviates the need for breast imaging physicians to switch back and forth between workstations when the screening workflow includes whole breast ultrasound.

Artificial intelligence

Dare we say “Radiology Image Software Analyzers” or “computer-aided detection (CAD) devices”? Artificial intelligence (AI) is changing the world of radiology. Needless to say – AI won’t replace radiologists or specifically breast imagers. Rather, it will augment their ability to find the key data they need to care for their patients and present it in a concise, usable format.

A new generation of CAD-like solutions that are machine learning based are entering the realm of breast imaging. Here are a few notable ones:

  • Zebra Medical Vision – Mammo Lesion (1) is part of the Imaging Analytics App inside the Clinical Collaboration Platform. Zebra uses a proprietary database of millions of imaging scans, along with machine and deep learning tools, to create software that analyzes data in real time with human level accuracy. This provides radiologists with the assistance they need to manage their ever-growing workloads, without sacrificing quality. The algorithm has been trained on a dataset of biopsy proven malignancies and runs on 2D FFDM. Findings are presented to the breast imager using a region of interest (non-contoured). Productivity and quality can be amplified significantly when Imaging Analytics is combined with Workflow Orchestration and studies are automatically prioritized and triaged for reading – when positive findings are AI-detected. These is especially useful in high-volume screening programs. Customers are encouraged to take advantage of the CARESTREAM Workflow Orchestrator and Imaging Analytics App today.
  • Screenpoint – Transpara (2) automatically identifies soft-tissue and calcification lesions, using image analysis and deep learning technology, and combines the findings of all available views into a single cancer suspiciousness score. While calcifications are marked similar to traditional CAD systems, only a small number of soft-tissue lesion marks are shown, and are proven to have low false positive rates. However, readers can probe any suspicious image region for decision support to help determine whether further investigation is needed.
  • iCAD – PowerLook Tomo Detection (3) scans each plane in the tomosynthesis volume, identifying suspicious soft tissue densities (masses, architectural distortions, and asymmetries) using deep learning-based algorithms. The soft tissue densities are extracted from the planes and naturally blended onto a synthetic 2D image. The detected regions on the enhanced synthetic 2D image are linked to the appropriate tomosynthesis planes. This creates a navigation tool for radiologists to decrease reading time and improve reader experience. The app is designed to be used concurrently throughout study interpretation.

To support these new technologies, Carestream added integration and support for the Transpara and PowerLook Tomo Detection Apps into our Vue Mammo module.

What’s next in breast imaging?

The U.S. Food and Drug Administration (FDA) is issuing a proposed order to reclassify certain radiological medical image analyzers from class III to class II devices. This includes CAD devices for mammography breast cancer and ultrasound breast lesions. If finalized, this will reduce the regulatory burden on the medical device industry, streamline review for these types of devices, and provide more timely access to these devices for patient care.

Breast imaging is an ever-evolving subspecialty that thrives on new scientific insights and technology development. The increasing awareness about early detection, through events like Breast Cancer Awareness Month, help fuel new developments. Carestream is gratified to be a partner in the fight to steal time from breast cancer.

[1] CE marked; NOT AVAILABLE FOR COMMERCIAL SALE IN THE US

[2] CE marked; NOT AVAILABLE FOR COMMERCIAL SALE IN THE US

[3] CE marked, FDA approved for use with GE Healthcare digital breast tomosynthesis

#weloveinnovation #breastcancerawareness

Thierry Verstraete is Carestream’s Product Line Manager for Clinical Solutions and Analytics. He has more than 20 years of experience in healthcare IT.

COMMENTS

  • October 20, 2018
    reply

    Sherri

    Hello and thankyou for all you do to help us understand imaging in a better way. I am writing to you because I have a project that I am working on about “constructing a technique chart using fixed Kvp”. I was kindly asking for your help to come up with the procedure on how to arrive to the chart. I have various body parts phantoms that i need to xray so as to come up with the chart as well as the DI value. I will be using the FPD system as well. Kindly your help is needed. Thankyou.

    • October 22, 2018
      reply

      Hello, thank you for your nice comment. The best resource to help you with this is a qualified medical physicist. I hope this is helpful.

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