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Breast imaging use of tomo in kwh e fung
1. Use
of
Breast
Tomosynthesis
Experience
in
Kwong
Wah
Hospital
Dr
Fung
Po
Yan
Eliza
Specialist
in
Radiology
Associate
Consultant,
Well
Women
Clinic,
Honorary
Associate
Consultant,
Department
of
Radiology
Kwong
Wah
Hospital
2. Disclosure
• Neither
I
nor
my
immediate
family
members
have
a
financial
relaAonship
with
a
commercial
organizaAon
that
may
have
a
direct
or
indirect
interest
in
the
content.
4.
Workflow
of
Screening
mammography
Screening
Mammogram
(
Double
Reading
)
Abnormal
(
Cat
3
or
above
)
Refer
MulDdisciplinary
MeeDng
Normal
/benign
(
Cat
1
and
2
)
Early
Follow
up
(
Phone
consultaDon
)
Follow
up
in
2
years
(
ConDnuous
care
)
9. Hologic-‐Dimensions
• Tube head moves in a continuous motion 15°(± 7.5°)
around the breast
• A total of 15 low-dose projection images are acquired at 1
projection/degree
• Tomo scan in 4 seconds
• Combo mode ( 3D + 2D ) in 13 secs
• Reconstruction images are displayed in 1mm slices at 90µm
resolution
11. PotenAal
Benefits
of
DBT
• MicrocalcificaAons:
-‐
DM
slightly
more
sensiDve
in
detecDon
(
Spangler
ML
:
AJR
2011;
196(2):320-‐4
)
-‐
DBT
equal
or
greater
clarity
(
Kopans
D
:
Breast
J
2011;
17:638
)
• Non-‐calcified
lesions
evaluaAon:
-‐
Superior
cancer
visibility
and
conspicuity
(
Andersson
I
:
Eur
Radiol
2008;
18:
2817
)
-‐
DBT
superior
to
DM
(Margarita
L
:
Radiology
Jan
2013
,
266,
89-‐95
)
13. Oslo
Tomosynthesis
Screening
Trial
Radiology:
Volume
267:
Number
1—April
2013
•
•
•
•
•
•
•
ProspecDve
Study
Nov
2010-‐Dec
2011
Oslo
University
,
8
radiologists
Independent
Double
Reading
with
consensus
12621
screening
MMG
50-‐69
year
old
Screen
biennially
14. Oslo
Tomosynthesis
Screening
Trial
Screening
DM(2D)+DBT(3D)
DM
Independent
double
reading
DM+DBT
Independent
double
reading
Arm
A
DM
Arm
B
DM
+
CAD
Arm
C
DM
+
DBT
Arm
D
SyntheDc
DM
+
DBT
Single
reading
Single
reading
Single
Reading
Single
reading
15. Methods
• 5
point
raDng
system
(1=normal/benign,
2-‐5=>posiDve
)
• For
all
cases
>2
in
at
least
one
arm
=>
ArbitraDon
meeDng
• Published
data
in
Arm
A
(
DM
)
and
Arm
C
(
DM
+
DBT
)
• Among
12621
cases,
121
malignancy
found
20. Invasive
Cancer
(
no
of
Ca
)
2D
vs
Combo
(
2D
+
3D
)
2D+3D
2D
Difference
101
Total
number
77
+24
Invasive
Cancer
56
81
+25
Grade
I
<15mm
17
37
32
59
+15
+22
LN
negaDve
44
63
+19
21. Invasive
Cancer
(
no
of
Ca
)
Tumour
Grade
2D
2D+3D
Difference
Total
number
Invasive
Cancer
77
56
101
81
+24
+25
Grade
I
Grade
II
17
29
32
35
+15
+6
Grade
III
9
13
+4
22. <10mm
11-‐15mm
16-‐19mm
>20mm
Invasive
Cancer
(
no
of
Ca
)
Lesion
Size
2D+3D
2D
Difference
36
27
+9
37
59
+22
6
12
5
15
-‐1
3
23. Invasive
Cancer
(
no
of
Ca
)
Lymph
nodes
status
2D
2D+3D
Difference
LN
negaDve
LN
posiDve
Unknown
44
9
3
63
13
5
+19
4
2
24. Invasive
Cancer
(
no
of
Ca
)
Radiological
finding
2D+3D
2D
Difference
Circumscribed
mass
7
9
+2
Spiculated
mass
28
37
+9
Architectural
distorDon
8
16
+8
Asymmetric
density
4
4
+0
CalcificaDons
Mass
with
calcificaDons
6
9
+0
+6
6
3
25. In
situ
Cancers
(
DCIS
)
2D
vs
Combo
(
2D
+
3D
)
2D
2D+3D
Difference
Total
number
21
20
-‐1
CalcificaDons
20
19
-‐1
Mass
+calcificaDons
1
1
0
26. Oslo
Tomosynthesis
Screening
Trial
• Significant
increase
in
cancer
detecDon
rates
• ParDcularly
useful
for
invasive
cancers
• Simultaneous
decrease
in
false
posiDve
rates
27. Experience
of
Kwong
Wah
Hospital
• Hologic
Dimensions
installaDon
in
Oct
2011
• Study
Period
:
February
to
May
2012
• Call
back
for
compression
view
(
CC
or
MLO
view
)
=>
Tomosynthesis
• Not
used
for
calcificaDon
workups
• No
preselecDon
of
paDents
• 261
sets
performed
28. Experience
of
Kwong
Wah
Hospital
• Compression
Pressure
• RadiaDon
dose
• Reason
for
call
back
(
Focal
asymmetry/Mass/
Architectural
distorDon/Others
)
• Radiologists
grade
the
Tomo
vs
FFDM
(Superior/Equal/Inferior)
• Need
to
call
back
if
Tomo
is
available
29. Results
•
•
•
•
•
Reduce
recall
rate
by
61.3%
Especially
useful
in
evaluaDng-‐focal
asymmetry
Superior
(
64%
),
Equal
(
34
%
)
,
Inferior
(
2%
)
Comparable
breast
compression
(
111%
)
Slight
increased
entrance
radiaDon
dose
(
129%
)
30. Experience
of
Kwong
Wah
Hospital
• PaDent
(
lible
to
no
d
ifference
)
• Physician
(
posiDve
)
• Radiographer
(
fast
adopDon
)
• Radiologist
(
learning
curve,
extra-‐Dme
,
performance
affected
by
the
network
,
dedicated
mammo
viewer,
memory
space)
• Two-‐
views
DM
vs
DBT
(
100MB
vs
250
MB
)
57. SyntheDc
mammogram
• Generates
from
the
Tomo
data
• No
addiDonal
radiaDon
dose
• Emulates
2D
image:
– Facilitates
comparison
to
old
films
• Maintains
important
details
from
tomosynthesis
slices
– Interpreted
in
combinaDon
with
tomosynthesis
images
58. Acad Radiol. Author manuscript; available in PMC 2013 February 1.
Published in final edited form as:
Acad Radiol. 2012 February ; 19(2): 166–171. doi:10.1016/j.acra.2011.10.003.
Dose reduction in digital breast tomosynthesis (DBT) screening
using synthetically reconstructed projection images: an
observer performance study
David Gur, ScD1, Margarita L. Zuley, MD2, Maria I. Anello, DO2, Grace Y. Rathfon, MD2,
Denise M. Chough, M.D.2, Marie A. Ganott, M.D.2, Christiane M. Hakim, M.D.2, Luisa
Wallace, MD2, Amy Lu, MD2, and Andriy I. Bandos, PhD3
1University of Pittsburgh, Department of Radiology, Radiology Imaging Research, 3362 Fifth
Avenue, Pittsburgh, PA 15213
114
MMG
SyntheDc
view+DBT
vs
DM+DBT
Lower
sensiDvity
Comparable
specificity
Missed
clustered
microcal
2Department
of Radiology, Magee-Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213
3University
of Pittsburgh, Graduate School of Public Health, Department of Biostatistics, 130
DeSoto Street, Pittsburgh, PA 15261
Abstract
Rationale and Objectives—Retrospectively compare interpretive performance of synthetically
reconstructed two-dimensional images in combination with DBT versus FFDM plus DBT.
Materials and Methods—Ten radiologists trained in reading tomosynthesis examinations
interpreted retrospectively, under two modes, 114 mammograms. One mode included the directly
acquired FFDM combined with DBT and the other, synthetically reconstructed projection images
combined with DBT. The reconstructed images do not require additional radiation exposure. We
compared the two modes with respect to “sensitivity”, namely recommendation to recall a breast
with either a pathology proven cancer (n=48) or a high risk lesion (n=6); and “specificity”, namely
no recommendation to recall a breast not depicting an abnormality (n=144) or depicting only
benign abnormalities (n=30).
Results—The average sensitivity for FFDM with DBT was 0.826 versus 0.772 for synthetic
FFDM with DBT (difference=0.054, p=0.017 and p=0.053 for fixed and random reader effect,
respectively). The fraction of breasts with no, or benign, abnormalities recommended to be
recalled were virtually the same: 0.298 and 0.297 for the two modalities, respectively (95%
confidence intervals for the difference CI= −0.028, 0.036 and CI = −0.070, 0.066 for fixed and
random reader effects, correspondingly). Sixteen additional clusters of micro-calcifications
(“positive” breasts) were missed by all readers combined when interpreting the mode with
synthesized images versus FFDM.
Conclusion—Lower sensitivity with comparable specificity was observed with the tested
64. Future
DirecDon
•
•
•
•
In
place
of
the
convenDonal
FDDM
FDA
Approval
(
May
2013
)
Less
radiaDon
and
paDent
discomfort
DiagnosDc
Quality
?
• Oslo
Tomosynthesis
Screening
Trial
• DM+CAD
vs
SyntheDc
view+DBT
• RSNA
2013
?
66. The End
Acknowledgment
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Department
of
Radiology,
KWH
Dr
Chun
Ying
LUI
Dr
Kimmy
KWOK
Dr
William
WONG
Dr
Julian
FONG
Dr
Kevin
LAU
Ms
Daisy
SIU
Mammography
Team,
KWH
Breast
Centre,
KWH
Dr
Miranda
CHAN
Dr
Marcus
YING
Dr
Yolanda
CHAN
Well
Women
Clinic
Dr
Tung
Yeung
LEUNG
Dr
Rebecca
CHUNG
Dr
Wai
Ka
HUNG
Dr
Hang
Yi
So
Dr
Hiu
Wing
Hong
Pathology
Department
Dr
Kong
Ling
MAK
