Breast imaging tomosynthesis l rotenberg

7 t h t o 1 0 t h N o v 2 0 1 3

K O W L O O N S H A N G R I - L A 6 4 M o d y R o a d , T s i m S h a T s u i E a s t , K o w l o o n , H o n g K o n g

D r L i l i a n L . Y . L E O N G - H o n g K o n g P r e s i d e n t P r G i l b e r t F E R R E T T I - P r é s i d e n t F r a n ç a i s P r J e a n M i c h e l T U B I A N A - P r é s i d e n t d ’ H o n n e u r

H o n g K o n g 1 2 t h e d i t i o n

DIGITAL BREAST TOMOSYNTHESIS

(DBT) Luc Rotenberg, Jean Guigui, Gregory Lenczner ISHH – RPO Clinique Hartmann – Ambroise Paré

Neuilly Sur Seine - France #drrotenberg

dr.rotenberg@radiologieparisouest.com

H o n g K o n g 1 2 t h e d i t i o n

WHY TOMOSYNTHESIS? FFDM WAS NOT ENOUGH?

After more than 10 years from its introduction, FFDM has almost totally replaced the analogue mammography (SFM). Its superior diagnostic performances have been demonstrated by a large scale multi-center study: the DMIST

GE SIEMENS SECTRA FISCHER

HOLOGIC IMS GIOTTO

THE SUPERIORITY OF FFDM VS. SFM HAS BEEN PROVEN!

•  Clinical trial made in2004 – 2006 in North America •  50.000 women enrolled made both exams (FFDM/SFM) •  Preliminary results published starting from 2006 RESULTS •  For women ≤ 50 years old and/or dense breast

•  Sensitivity goes from 51% (SFM) to 70 - 78% (FFDM) •  Visualized almost 28% more breast cancers •  More than 1 over 4 cancers were not recognized:

false negatives • 

DMIST Results : Technologic or Observer Variability? Daniel B. Kopans Radiology 2008, Vol.248: 703-704 Diagnostic Accuracy of Digital versus Film Mammography: Exploratory Analysis of Selected Population Subgroups in DMIST Etta D. Pisano & coll, Radiology, 2008, Vol.246: 376-383

As a matter of fact we know:

•  Breast screening target is EARLY DIAGNOSIS OF BREAST CANCER

•  In most of the cases Screening reaches the

•  almost 10 – 15% of the found late cancers is originated in regularly screened women

•  FFDM is “blind” under some particular

circumstances : •  dense breasts •  dense tissues overlapping lesions

FFDM: SUPERIOR TECHNIQUE, BUT NOT PERFECT

Pooled BI-RADS–based ROC curves for diagnostic assessment of conventional diagnostic views and tomosynthesis views

Zuley M L et al. Radiology 2013;266:89-95, Pittsburgh

ROC curves for average probability of malignancy as assessed by using conventional supplemental diagnostic views and tomosynthesis views.

Zuley M L et al. Radiology 2013;266:89-95

Pooled ROC curves for reader studies 1 and 2 using probability of malignancy scores; curves represent average ROC performance

for 12 readers in study 1 and 15 in study 2.

Rafferty E A et al. Radiology 2013;266:104-113

Assessing Radiologist Performance Using Combined Digital Mammography and Breast Tomosynthesis Compared with Digital Mammography Alone: Results of a Multicenter, Multireader Trial

Diagnostic Sensitivity, Specificity, and Positive and Negative Predictive Values

Rafferty E A et al. Radiology 2013;266:104-113, Boston

The challenge of tomosynthesis

An efficient DBT system should accomplish some basic requirements:

•  The total released dose should be lower than the one released during an FFDM exam and the closest possible to a 2-D FFDM projection •  The image quality should be same as the 2-D, but it has to provide much more clinical information. •  The exam has to be the shortest possible (fast scan). •  The scan angle should be large enough to provide an adequate depth (3-D) resolution.

DOSE 3-D circa = DOSE 2-D

DBT : PARAMETERS AFFECTING THE IMAGE QUALITY

The quality of the DBT images depends on several parameters, often in contrast each other

•  Scan Angle: a wide angle causes high depth resolution (the ideal angle is 360°!). •  Dose released to the patient: it must be the lowest possible. •  Number of projections: the smallest possible to decrease the time of exam. • Pixel dimension/ Binning: smaller the pixel higher the spatial resolution and visibility of details •  Tube movement: shooting while tube moves or stop at each exposure (Step & Shoot) • 3-D Reconstruction Algorithm: Better if dedicated to the specific DBT geometry.

SCAN ANGLE– PROS & CONS

Wide angle:

+ It provides superior depth resolution: ideal 360° (CT) - It causes mechanical movement complexities - It causes longer scan time

Small angle:

+ More simple design / construction mechanics + Shorter scan time - Lower Depth resolution. Loss of details perception

15° (±7,5°)

(Hologic Dimensions)

40° 50°

(GE Essential-Siemens Inspiration)

GIOTTO: 40°

NUMBER OF PROJECTIONS PROS & CONS

Large Number:

+ Better reconstruction because more data to the 3-D algorithm

- Lower S/N per projection because the total dose is unchanged = Low Image Quality

- Longer scan time

Small Number: - Less data for the 3-D algorithm

+ Higher S/N per projection = Improved I.Q.

+ Faster scan

•  Hologic Dimensions: 15 exp. •  GE Essential: 9 exp (or 15?) •  Siemens Inspiration: 25 exp. •  Giotto Tomo: 13 exp with variable

angles

-20° +20°

Compression plate

Breast

Digital detector

�  The tube moves rapidly along an arc stopping at each exposure for a fraction of a second

�  The images are

shown as 1mm “slices” or more (slab)

Giotto:13 Projections

STEP & SHOOT

CONTINUOUS AND STEPPING MOVEMENT: PROS & CONS

Continuous + It is faster = Faster scan time + Much simpler mechanics to design and to build

- The exposures during the tube’s movement create anyway a “blurring” effect so causing the loss of “crispy” contours of the details, especially of the tiny microcalcifications

Step & Shoot:

- More complex mechanics to avoid vibrations due to variations of speed + The images made in “frozen” conditions are clear and “crispy”. No detail is lost.

PIXEL DIMENSION/ BINNING

Binning: Virtual combination of two or more pixels of the detector matrix. Usually 4.

+ The total number of pixel decreases 75% shortening the detector reading, decreasing the weight of the file and the 3-D recon time

- The spatial resolution decreases dramatically with loss of details that, if simultaneously the tube movement is continuous, causes an important decrease of micro calcifications visibility.

3-D RECONSTRUCTION ALGORITHM

•  The classic 3-D Algorithms are those created in the last 30 years for CT scanners or forMRI (FBP o SART) •  They have the advantage to be well known and tested, but also the defect to be designed for a different geometry: source and detectors rotating 360° around the object. •  The DBT geometry is by far different: it can go from a minimum of 15° (Hologic) to a maximum of 50° (Siemens) •  Adapting these algorithms to the DBT geometry causes streaking artifacts and worsensthe image quality. •  The Iterative algorithm is much more fit for DBT, but it is heavier and causes longer reconstruction time (to a maximum of 4 min).

•  Non CT style, but DBT dedicated

•  Low number of artifacts

•  Better micro calcifications visualization •  Better visualization of the skin line

•  Better S/N ratio

•  It requires less projections

•  The projections can be further apart

ADVANCED 3-D ITERATIVE ALGORITHM

ALL PARAMETERS OPTIMIZED •  Wide scan angle, 40° •  Only 13 exposures •  Step & Shoot •  3-D Iterative Algorithm RESULTS: •  Increased S/N ratio •  Visibility of tiny microcalcs •  Visibility of the skin line •  Contrast and contours of the tissues

are clear and crispy

GIOTTO TOMO: ADVANCED 3-D ITERATIVE ALGORITHM

S  Angiomammography (CEDM) based on the Dual Energy principle.

S  Automatic calculation of the breast density

S  Biopsy

NEW ADVANCED APPLICATIONS

Applications

1.  Detection « screening » 2.  Caracterisation 3.  localisation

Applications

! 24/11/2013

Detection

! 24/11/2013

Applications

! 24/11/2013

Mme P.

S  National Screening program

S  68 y

S  No history

S  Clin examination normal

S  P2,G2

S  Menauposal, No hormonal traitment

2D Digital Mammography

Right CC Left CC

Right AXIL Left AXIL

2D Digital Mammography

Question 1

Bi-Rads Classification?

S  1

S  2

S  3

S  4

S  5

S  0

Question 1

Bi-Rads Classification?

S  1

S  2

S  3

S  4

S  5

S  0

Localized incidences

! 24/11/2013

Question 2

Final Birads classification ?

S  1

S  2

S  3

S  4

S  5

S  0

Question 2

Final Birads classification ?

S  1

S  2

S  3

S  4

S  5

S  0

! 24/11/2013

Wire Marker

Applications

1.  Detection « screening » 2.  Caracterisation 3.  Localisation

! 24/11/2013

Breast US diagnostic & balistic

IDC grade 2, RH+, Her2 -

US Biopsy & Wire Marking

IDC grade 2, RH+, Her2 -

Large core 16g Biopsy Wire marker

! 24/11/2013

Conclusion Take Home Messages

S  Best detection

S  Best caracterisation

S  Best localisation

S  Dose

S  Time

S  Pricing

S  National Screening Program ?

Breast imaging tomosynthesis l rotenberg

Health & Medicine

Digital Breast Tomosynthesis, Microcalcifications

Clinical Implementation of Digital Breast Tomosynthesis · Clinical Implementation of Digital Breast Tomosynthesis Emily F. Conant, MD INTRODUCTION Despite continuedcontroversy overhowoftenand

Radiation Dosimetry in Digital Breast Tomosynthesis/media/downloads/uk/services/dose management... · Dosimetry in Digital Breast Tomosynthesis • Similar to the example in mammography

Oh no, it’s not!!! Dose with Breast Tomosynthesis IT IS ...€¦ · Dimensions 3D digital breast tomosynthesis (DBT) system from Hologicthat creates synthesized 2D images from 3D

Understanding Digital Breast Tomosynthesis - sbi … Imaging Symposium 2016...Understanding Digital Breast Tomosynthesis ... Siemens’ approach: CC and MLO DBT + 2D CC and MLO. Differences

ProFound AI for Digital Breast Tomosynthesis Rev D

Issue 32 - Updated Claim Process for Digital Breast Tomosynthesis€¦ · Issue 32 - Updated Claim Process for Digital Breast Tomosynthesis Author: Registered to: HELTHNOW Subject:

Digital Breast Tomosynthesis & the Informatics Infra ...• Breast Tomosynthesis images are huge – large matrix & high resolution (2 – 2.5 MP) – many slices, typically 50 –

Study of role of digital breast tomosynthesis over digital

Case-Based Review & Advanced Breast Imaging Course: Digital Breast Tomosynthesis

3D Breast Tomosynthesis - Advanced Radiology Consultants · What is 3D Breast Tomosynthesis? Breast tomosynthesis, also known as three-dimensional (3-D) mammography and digital breast

Measuring Spatial Resolution in Digital Breast Tomosynthesis

Tomosynthesis in Breast Cancer Imaging - CBC · 2018-03-02 · Breast cancer Digital mammography Digital breast tomosynthesis Breast imaging Diagnostic breast imaging Mammography

Open Access Protocol Digital breast tomosynthesis plus ... · plus tomosynthesis (cancer detection rate 8.5/1000 women screened) and synthetic mammography plus tomosynthesis (8.8/1000)

owerook Breast Tomosynthesis · PowerLook® Tomo Detection Designed to optimize breast tomosynthesis reading efficiency, streamline workflow, and support cancer detection without

Digital breast tomosynthesis: a concise overview · Digital breast tomosynthesis has the potential to reduce false positives and provide equal or better sensitivity compared with

Luc Rotenberg : Digital Breast Tomosynthesis

Principles of Breast Tomosynthesis Acquisition …...1 Principles of Breast Tomosynthesis Acquisition and Reconstruction Andrew Maidment, PhD, FAAPM Associate Professor of Radiology

Luc rotenberg, breast mri, multiple lesion

Digital Breast Tomosynthesis (3D) · Digital breast tomosynthesis (3D) is covered (subject to Limitations and Administrative Guidelines) for screening mammograms of breast cancer