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Digital advancement in mammography creating crisper images, speedier treatment

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GINA R. HEINE
July 27, 2012

— Health providers compare upgrading from film mammography to digital to the switch from analog TV to high-definition.

The switch gives crisper, more detailed images that allow providers to see small problems, sometimes much sooner than they would have in the past.

“It’s a little bit more sensitive so that we’re able to pick up abnormalities a little bit sooner, rather than what we may have with just the plain film,” said Dr. Noreen King, an obstetrician/gynecologist at Dean.

When the new Dean Clinic-Janesville East opened in January, it unveiled its new Hologic Selenia Dimensions 2D Full Field Digital Mammography machine. The state-of-the-art technology uses a direct conversion detector, meaning it eliminates the need to convert X-rays to light.

Using film in the past, the X-ray beam captured the breast image, hit a filter, a plate and the film, which had to be developed in a processor.

“We lost a lot of detail by doing that,” said Mary Klund, a mammography compliance technologist at Dean.

With the direct capture method, the radiation beam hits a plate and goes directly into the computer system.

“We’re not losing any detail or any quality,” she said.

Patients who benefit most from digital mammography are under age 50, have dense breast tissue or are premenopausal or have been in menopause less than a year, she said.

The American Cancer Society recommends women get mammograms annually starting at age 40.

The type of digital mammography offered at Mercy Health System does not include direct capture, but Jere Johnson, director of radiology at Mercy, said they are planning for the advancement.

Mercy has been using a method called computed radiography, which puts the image on a cassette before being transferred to a computer monitor.

The pricing for direct capture continues to decline, he said, and Mercy is following the life cycle of its current equipment as it evaluates the need to upgrade because of the image quality.

During a mammogram, Klund is able to compare the new images to digitized images of a woman’s previous film mammograms and look for changes in the breasts.

“That way we can compare our old films that we digitized to the films we took today, so it’s easier for comparison,” she said.

Radiologists at Dean use a reading room with high-resolution screens that allow them to magnify and reverse the images.

Computer aid detection provides a backup to human review.

The system puts markers on images, pointing out calcifications or masses, in effect saying to the radiologist, “Did you see that?” “Did you see that?” Klund said.

“It could be something that’s been there for 20 years, but they just want them to look at that and pay close attention to that, so it’s kind of like a second read for the radiologist,” she said.

She compares it to spell check on a computer—you don’t always agree with it.

A drawback to the detailed images, however, is a greater chance of false positives, or detection of something that’s a benign issue, King said.

“On the other hand, if there is something there, we’re able to pick (it) up a little sooner or little easier than with the old technology,” she said. “If it does turn out that it’s a malignancy that’s picked up, we’re able to diagnose when it’s a smaller mass or tumor, so it’s less likely to have spread beyond the breast.”

When such cases are detected sooner, the problem is more likely to be curable, and less-aggressive treatment typically is needed, she said.

Dr. Michael Rainiero, a general surgeon at Dean, thinks the digital images will decrease the number of patients called back for additional imaging. In the past, a patient might have been called back after six months for more images.

On the horizon for local providers is tomosynthesis, or 3-D imaging, which gives physicians an even more thorough view of breast tissue. Mercy and Dean officials say they are looking into the technology, which requires costly software and hardware upgrades.



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