· Breast Cancer Detection: Roundup
· How to Act, What to Use

Breast Cancer Detection: Roundup

The American College of Radiology Imaging Network (ACRIN), Philadelphia, recently released the latest in a series of analyses of the original findings from the Digital Versus Standard Film Mammography Trial. Its principal investigator, Etta Pisano, MD, and colleagues compared the accuracy results of digital and film in 10 subgroups of women, looking at combinations of menopausal status, age, and breast density. The findings were reported in the February issue of Radiology.

Pisano says the new analysis "pretty much confirms what we found in the original study. Women under the age of 50 with dense breasts who are premenopausal or perimenopausal get more accurate results with digital mammograms." The researchers also noted a trend toward improved accuracy of film mammography for women over age 65 with fatty breasts, though the finding is not statistically significant.

The additional results highlight how far breast cancer detection technology has progressed in 2 years. Clinical validation continues for CAD for breast ultrasound, while new technologies like mobile full-field digital mammography (FFDM) gain ground. A 2007 Radiology study even introduced the possibility that proton MRI spectroscopy could eliminate close to 70% of biopsies for benign nonmass breast lesions.

Siemens Medical Solutions, Malvern, Pa, recently released a comprehensive preview of its works-in-progress technologies for breast cancer detection. The Mammomat Inspiration is a full-field digital mammography platform offering time-saving workflow functions and integration with breast tomosynthesis. And Siemens' "eSie Touch Elasticity Imaging" utilizes ultrasound, a common adjunctive modality for women with dense breast tissue, to measure compression characteristics of breast tissue.

Meanwhile, Techniscan Medical Systems, Salt Lake City, recently announced that it would begin its next set of clinical trials for its proprietary breast scanning system in May. The UltraSound CT Imaging System, which TechniScan hopes to introduce by the close of 2008, will be tested at both the Mayo Clinic, Rochester, Minn, and the University of California San Diego, La Jolla.

On February 21, Fujifilm Medical Systems USA Inc, Stamford, Conn, announced that its Computed Radiography for Mammography (FCRm) system is now available for use in mobile mammography environments. More than 400 mobile mammography units are currently in use in the United States, but only 10% to 15% are digital; the FCRm system is intended to ease the transition to digital by making it both simpler and more affordable.

On Feb 12, Medipattern Corp, Toronto, announced the publication of a study confirming an increase in diagnostic accuracy when using the company's B-CAD v2 for breast ultrasound on lesions less than 1 cm in size. The study was conducted in Beijing—B-CAD v2 is currently only available outside the United States—and was based on 100 confirmed biopsied cases, comparing the diagnostic accuracy of three reading scenarios: one physician, double reading with two physicians, and a single physician reading with B-CAD.

"Finding small cancers is a particularly important part of our overall goal to find cancer in its earlier stage while it is still treatable," notes the paper. "Yet small cancers present doctors with their greatest challenge as it is one of the main reasons for misdiagnosis. B-CAD can assist doctors in focusing on these easily overlooked important details and increase the detection rate of small cancers . . . A single doctor with B-CAD is far more efficient and economical than using [China's] limited skilled resources for double reading."

A similar study, released by Hologic Inc, Bedford, Mass, on February 13, confirms that CAD for digital mammography creates a statistically significant increase in sensitivity for a single reader, around 11%. The report, which will appear in the April issue of the Journal of the American Roengtgen Ray Society, also shows that a single reading with CAD review yields a significantly lower recall rate than independent double reading. "CAD appears to be an effective alternative that provides similar, and potentially greater, benefits [over double reading]," concluded the study's lead author.

—Cat Vasko

How to Act, What to Use

It could be a tornado that sweeps through a rural county or a hurricane that hits an urban community—disasters can happen at any time, anywhere. And when they do occur, physicians must be prepared to adjust to the situation, whether they are responding to victims on-site or reviewing images and completing reports from home.

That's the perspective of two new offerings in the field of emergency ultrasound.

One is a 2-day introductory course that will discuss the primary applications of emergency ultrasound, aptly called the Emergency Ultrasound Course. Taking place in the Hapuna Beach Prince Hotel in the Big Island, Hawaii, on March 26 and 27, the course is a mix of lectures and lab experience, with live models available for realistic training. Moreover, attendees will be given discounted access to a full set of online learning tools, online image-review capabilities, and 16 hours of Category I CME.

The 5500 SmartProbe Ultrasound is part of a Deployable Emergency Kit designed for exams at trauma scenes.

Called "a very enjoyable course" and an "overall, superior CME" using "quality instructors, slides, [and] real-time images," by its former participants who shared their opinions on the Web site, the Emergency Ultrasound Course boasts a faculty of more than 20 under course directors Patrick Hunt, MD, MBA, FACEP, and Tom Cook, MD, FACEP. Since it first launched in 1998, the course has relayed its knowledge to more than 4,500 physicians.

The other development is part of a Deployable Emergency Kit recently released by AMD Telemedicine, whose 5500 SmartProbe Ultrasound is a solution not only for remote clinics, but also for examinations on the scene and in the field. The laptop-based ultrasound was developed to offer big system applications in a small package, as well as at an economical price.

"Hospital ultrasound equipment typically is large, stationary, and cumbersome to use," said Deborah A. Jeffries, MD, director of sales at AMD Telemedicine, based in North Chelmsford, Mass. "Many portable ultrasounds are closed, proprietary systems that produce poor-quality images. This is not the case with AMD's ultrasound."

Rather, Jeffries continued, the portable SmartProbe Ultrasound has very high resolution and possesses an open platform, which makes the offering available for connection with other applications. Developed more than 5 years ago, the ultrasound is small, portable, and designed to be user-friendly and multifunctional. Specifically, with its Window-based program, users can access e-mail and create documents, among other tasks. Customers seek these qualities in a mobile ultrasound, Jeffries said.

"The most important thing in the AMD SmartProbe Ultrasound is that it's an easy-to-use system that produces excellent images for all kinds of medical disciplines," she said, adding that is can be applied to cardiology, gastroenterology, obstetrics and gynecology, ophthalmology, and urology, among other disciplines.

Specifically, the ultrasound provides true 128-channel resolution in a laptop PC, with robust software that supports a wide range of functions, such as signal gain, TGC, brightness, contract, color palette, freeze frame, frame scrolling, cine loop capture, and DICOM 3.0 transmission. Simultaneous 2D and M-Mode imaging is valuable for the efficient assessment of moving structures, and its Power Doppler has been expanded to differentiate flow directions.

Jeffries said the SmartProbe Ultrasound is especially relevant in the current health care environment, which can be targeted by outside threats. "With today's challenges of terrorism and bioterrorism, it is very important to be able to quickly bring medical help to patients in the field and to isolate any threat of bioterrorism from spreading," Jeffries said. "The AMD SmartProbe Ultrasound can help in this area."

Furthermore, it can combat and minimize the damage that Mother Nature inflicts, Jeffries pointed out. "In situations such as Katrina, the widespread fires in California, and the tornados in the Midwest, it is very helpful to have such a device close to where the patients are because it lessens the chance of doing more damage or spreading infection," Jeffries said.

Those interested in attending the upcoming Emergency Ultrasound Course taking place in Hawaii can log onto www.emergencyultrasound.com or call (803) 917-2495.

—Elaine Sanchez