Digital Mammography Pioneer Looks to a Future with Tomosynthesis

Breast Imaging Department, Magee-Womens Hospital of UPMC, Pittsburgh, Penn.

 

April 13, 2011

The Breast Imaging Department of Magee-Womens Hospital of UPMC (University of Pittsburgh Medical Center) operates eight breast centers, providing far-reaching access to screening and diagnostic services for women in Western Pennsylvania. “Patients come here because we specialize in women’s health. Within radiology we have 18 radiologists dedicated to women’s imaging, and we perform 175,000 breast procedures annually,” states Shireen Braner, Magee’s Director of Breast Imaging.

Magee pioneered the use of digital mammography in 2000 when it became one of the first hospitals in the United States to install a clinical digital system. In 2006, Magee became one of the country’s largest digital mammography centers when it converted its remaining analog systems to digital. The hospital has chosen to use Hologic technology in its breast imaging centers, including Hologic’s Selenia digital mammography system, MultiCare Platinum stereotactic breast biopsy guidance system, ImageChecker computer-aided detection, ATEC MRI-guided breast biopsy and excision system, and Hologic’s Discovery bone densitometry system.

“We like the performance and stability of Hologic equipment,” states Braner. “The systems are easy to use, and the images are crisp. We were so impressed with image quality, we established Hologic’s breast imaging systems as the standard in all 12 UPMC adult medical care hospitals in Western Pennsylvania.”

And notes Dr. Jules Sumkin, Chief of Radiology, Magee-Womens Hospital, “Hologic was also one of the early developers of tomosynthesis. We were looking to partner with a company with an interest in tomosynthesis.”

Tomosynthesis – the Next Advance in Digital Imaging

In 2005, Magee installed a Hologic prototype digital tomosynthesis system as part of a research initiative to evaluate the technology. In 2009, the hospital installed a second tomosynthesis unit, Hologic’s Selenia Dimensions system, expanding its research capabilities.

Since then, Magee-Womens Hospital has performed 1,500 breast exams using tomosynthesis. Dr. Sumkin believes tomosynthesis is the next great advancement in digital technology. “There’s no question tomosynthesis will be most helpful in women with dense breast tissue. I think tomosynthesis will have a considerable impact as it becomes a standard screening tool. If we can diminish recall rates by 30 percent or so, it will have a tremendous effect on our practice’s operation.”

Dr. Margarita Zuley, Medical Director of Breast Imaging for Magee-Womens Hospital, points out the two potential advantages of tomosynthesis over 2D mammography: improved sensitivity and the ability to characterize findings. “With standard mammography, we call back many patients because of overlapped normal tissue. In addition, we perform biopsies on many lesions, which are not cancerous. Tomosynthesis offers the potential of marked improvement on both those fronts.”

As Dr. Zuley explains, “The real advantage of tomosynthesis is actually looking inside the breast through thin slices. Two-dimensional mammography provides two standard images that show the whole breast in a flat representation. Our minds have to convert these images into a 3D breast. Because there’s so much overlapping tissue or structural noise, we can miss lesions hiding in the breast. Tomosynthesis eliminates the overlapping tissue and has already been shown in research studies to offer the benefit of lower recall rates. Because we can see mass borders better as well, we are hopeful that tomosynthesis will help reduce biopsy rates of benign lesions.”

In the diagnostic area, Dr. Sumkin notes that tomosynthesis may make a significant difference in how physicians work up patients. “When a standard mammogram raises a question, instead of doing multiple views as we do today, we will do a tomosynthesis, which will hopefully diminish the number of views and increase the efficiency of the workup.”

Hologic’s Selenia Dimensions system enables radiologists to take 2D and 3D images in the same compression. Says Dr. Zuley: “The combo-mode is very helpful because the patient’s position is identical to that of the 2D image. We can use that information to help in our understanding of the thin slices of tomosynthesis.”

“Tomosynthesis gives me more confidence in understanding what’s going on with the patient,” continues Dr. Zuley. “I’ve found several cancers with tomosynthesis that we didn’t see with 2D images, which is exciting.”

“Hologic’s dedication to women’s healthcare is exemplary,” concludes Braner. “They look at the whole woman and provide comprehensive solutions for women’s imaging, which complements Magee’s focus on women’s healthcare. And I can’t sing the praises of Hologic’s service engineers enough. They are accommodating, prompt and maintain our equipment, and have the same passion as we do for ensuring our patients get the exams they need.”

This case study was supplied by Hologic Inc. The comments included in this article are the opinions and personal stories of the individuals quoted and not necessarily those of Hologic.

Hologic, ATEC, Dimensions, Discovery, Image-Checker, MultiCare and Selenia are trademarks and/or registered trademarks of Hologic Inc. and/or its subsidiaries in the United States and/or other countries.

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