ECR_2016

TOTALLY FLEXIBLE R/F ROOM EXPO X1 BOOTH 501 Excellent image quality Outstanding ergonomics Improved workflow C M J CM MJ CJ CMJ N Platinum.pdf 1 16/02/2016 12:55:08 EUROPEAN HOSPITAL  Vol 25 Issue 1/16 20 EH @ ECR Digital breast tomosynthesis Tomosynthesis on D2RS redefines the remote controlled table stan Ready to take over? Mammo enhance Contrast enhanced 2-D an Launching a new field of investigation Interview: Bettina Döbereiner The technology in itself is not new. The principle of tomosynthesis was already invented in the early 1930s. The basic idea: several low dose X-ray projections are made in a lim- ited rotation angle around an object. Afterwards, these projections are reconstructed into three-dimensional images. Even though tomosynthesis has a lower radiation exposure than computed tomography (CT) it was put in the shade for a while and often only named ‘limited angle computed tomography’. DBT solves overlapping tissue problem In the late 1990s, tomosynthesis was reborn and continuously improved – above all in breast imaging, then called digital breast tomosynthesis (DBT). The big advantage of 3-D DBT is that it reduces the effect of overlapping breast tissue that may hide or simulate a tumour in standard mammography projection imaging. ‘In the 3-D image where you get 1 mm thin slices, suddenly you can see the tumour very clearly,’ explains Sophia Zackrisson, radiologist at Skåne University Hospital in Malmö, Sweden. It is not a real 3-D image, DBT does expose in a 15° to 60° angle and not in a 360° angle around the breast as in a CT scan. Tomosynthesis is an advanced appli- cation that allows a multi-slice acquisition and provides a recon- struction of a volume. Several acquisitions at low dose are acquired with a single sweep of the X-Ray tube around the region of interest. Also known as 3-D mammogra- phy, tomosynthesis has many clin- ical applications including chest, orthopaedic exams, extremities, kid- neys and sinuses; tomosynthesis is the simplest application to add the third dimension on your digital remote controlled system. The firm Stephanix has integrat- ed this very exciting feature on the D2RS remote controlled table, which allows a high level of diagno- sis at very low dose,’ the company reports ‘The wide range of movements and the column angulation of the Stephanix table enables exploration different anatomical structures eas- ily, due to the following features: •Column angulation: 10 to 70° • Number of projections: 10 to 80 projections The Malmö Trial: One view DBT detects 40% more breast cancers Two recent large-scale and population based trials compared two view digi- tal mammography (DM) and two view DBT in the so-called combo mode with two view DBT. The STORM-trial (Screening with Tomosynthesis OR standard Mammography) and the first results of the Oslo-Trial showed a significantly increased detection rate of breast cancers in screening by using the combination of DM and DBT. The Malmö Trial (Malmö Breast Tomosynthesis Screening Trial) from Lund University, Sweden, now proved, for the first time, that even one view DTB as an exclusive method is supe- rior in cancer detection than digi- tal mammography. B background: Typically, a screening mammogram contains two projections from differ- ent angles - the mediolateral oblique (mlo) and the craniocaudal (cc) view. However, even with one view DBT (mlo) 40 percent more breast cancers can be detected compared to the two view digital mammography, as the findings of the Malmö-Trial now showed. The characteristics of the additionally found cancers using DBT appear to be the same as with con- ventional mammography screening. Up to now, no statistically relevant differences could be proven - we have to wait for the final publications of the Oslo and Malmö trial in the next two years. Could DBT replace 2-D mammo screening already? All these promising results from the recent trials could suggest that DBT is ready to become the future gold standard of mammography screen- ing – for this device not only detects more cancers in women, accord- ing to Sophia Zackrisson DBT also makes it easier to stage a cancer and its size-estimation is more accurate. Additionally, another positive effect must be mentioned: if DBT is used in the same way as in the Malmö trial it is more women-friendly than mammog- raphy because it reduces procedural discomfort. Zackrisson estimates that, in the trial, the compression force on the breasts in DBT-screening was halved. In 2-D mammography com- pression is needed to reduce the radiation dose and to separate over- lapping tissue; but in DBT the sepa- ration effect is already solved by the multi-angle-technique that reduces the overlapping tissue effect per se. Also, if only one view DBT is used, as in the Malmö trial, the radiation exposure is lower. Altogether - what stops us subsequently to introduce this new method of screening – bear- ing in mind that DBT is widely used in the USA already? DBT screening: possibly in five to seven years Sophia Zackrisson believes there are several reasons that should stop us going fast forward. First: we must wait for the final publications of the Oslo and the Malmö trial. Next comes the important and not yet answered question: Does DBT-screening also affect breast cancer mortality in the population? For ethical and economi- cal reasons, Zackrisson does not rec- ommend randomised mortality stud- ies to evaluate whether DBT reduces breast cancer deaths in the long run. Instead, she suggests waiting for the follow-up analyses of the tri- als to see whether DBT screening has an effect on the interval cancer rates – a term for cancers that are detected within the period up to the following screening. In general the rate of interval cancers is used to assess the efficacy of breast imaging. ‘I’d like to see at least some trend of decreasing interval cancer rates in the trials before we translate tomosynthe- sis into screening,’ Zackrisson says. According to her this is important to know, because otherwise it could indicate that DBT is over detecting and its additional findings represent just very small, indolent, non-aggres- sive tumours that never would have appeared clinically later. However, Zackrisson seems to be confident that DBT will replace 2-D mam- mography in the long run. Not yet, but approximately in the next five to seven years. Using an iodinated contrast agent, I-View software on the Hologic tomosynthesis system enables the user to image the functional 2-D contrast uptake and the morpho- logical mammography images in rapid sequence and combine these Results from recent trials are promising: an almost 40% increased breast cancer detection rate from digital breast tomosynthesis (DBT screening compared to conventional mammography. Therefore, is an introduction of DBT to screening already a realistic scenario? The pros and cons will be discussed at this year’s ECR by radiologist and DBT specialist Sophia Zackrisson Sophia Zackrisson is Associate Professor at the Department of Translational Medicine, Lund University, and radiologist at Skåne University Hospital in Malmö. © Sophia Zackrisson. Photographer: Kim Lindkvist ECR 2016 Digital Breast Tomosynthesis 2-6 March: several sessions focus on DBT Sophia Zackrisson will speak during the following dates: • 2 March. 12:15-13:45, Studio 2016. ‘Is digital breast tomosynthesis ready for mamm-screening?’ • 5 March. 16:00-17:30 Room F2. ‘Should we abandon 2D mamography?’ • The prof. is also moderator for the Satellite Symposium ‘Digital breast tomosynthesis out of the daily routine.’ 2 March. 14:00-15:30, Studio 2016. DM v. DBT imaging Breast cancer is the most common type of female cancer and continues to be one of the main causes of cancer death in women. Despite the advances made in modern medicine and contemporary targeted thera- pies, the stage of breast cancer at the time of diagnosis is still the most important driver of patient survival. This means that there is an obvious and persisting need for an improved early diagnosis of this disease. The project Digital Hybrid Breast PET/MRI for Enhanced Diagnosis of Breast Cancer, HYPMED for short, will develop a hybrid system of two medical imaging modalities (MRI and PET) for improved diagnosis of breast cancer and personalised therapy control. A European consor- tium made up of nine partners from leading universities, research organ- isations and industry has recently started their ambitious research ini- tiative. „The HYPMED project com- bines visionary clinical expertise with excellence in physical and engineering sciences and the devel- oped technology will greatly help us to choose an appropriate treat- ment that is exactly right for a given cancer in a given woman“, states, Prof. Christiane Kuhl from University Hospital Aachen and Scientific Coordinator of the project. PET/MRI imp breast cancer A new EU-funded project HYPMED is develo method for more accurate detection of breas understanding of its response to therapy. Platinum.pdf 116/02/201612:55:08

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