**8. Conclusion**

110 Imaging of the Breast – Technical Aspects and Clinical Implication

diagnostic mammographic acquisition times with processing were 13.02 min/case for SFM (Phase 1), 8.16 min/case for digital (Phase 2), and 10.66 min/case for digital (Phase 3). All phases also included the measured time for additional imaging that was requested by the interpreting study radiologists. Compared to SFM, acquisition time for Phase 2 and 3 digital were significantly less (P < .001 and P < .0001, respectively). For Phase 2 & 3 digital, there was a 4.86 min/case (37.3%) and 2.36 min/case (18.1%) time savings compared to SFM

Regardless of reason for the mammogram, the main reason for the time savings is the elimination of processing time with DR mammography. The technologist no longer has to leave the exam room with SF cassettes to develop. With SFM, each film takes approximately 90 seconds to develop. This time is now saved. The technologist now can review the images on a 1-megapixal monitor after exposure while the patient is still in the room. After initial review by the technologist for positioning and technique, the images are sent to PACS with

As part of the clinical workflow, there has been the concern of radiologist interpretation time with digital mammography. Berns et al. published average interpretation times, interpreted by seven radiologists, for their screening study of 1.2 minutes for SFM and 2.0 minutes for DR FFDM (Berns et al., 2006). Study results by Haygood et al. showed similar results in longer interpretation times with digital (Haygood et al., 2009). Haygood's study included 4 radiologists who were timed in clinical interpretation of 457 screening mammograms consisting of 189 SFM and 268 digital mammograms. They reported increased interpretation times for digital ranging from 1.27 to 3.37 minutes. The average interpretation time for all readers for SFM was 2.12 minutes and 4.0 minutes for digital

In contrast to the above screening studies, Kuzmiak et al. found the radiologist interpretation time for digital mammography on softcopy display was not significantly different from that for film mammography in a diagnostic mammography setting (*P* = .2853 and *P* = .2893, respectively) (Kuzmiak et al., 2010). The mean interpretation times were 3.75 min/case for screen film (Phase 1), 2.14 min/case for digital (Phase 2), and 2.26 min/case for digital (Phase 3). The results provide support to radiologists for conversion to direct radiographic digital mammography for clinical use and that radiologists planning on using softcopy display systems must have appropriate training to optimize throughput. In addition, softcopy display manufacturers should continue to improve the functionality and ergonomics of their products to make softcopy interpretation more

With softcopy display systems an electronically generated reporting system can be integrated with it. Numerous vendors are available and each has different functions depending on radiologist preference. With these systems, mammograms and other imaging reports can be dictated (generated) and electronically signed off. Thus, it decreases the time from the initiation of the patient's exam to the exchange of information to the patient's

(Kuzmiak et al., 2010).

(Haygood et al., 2009).

efficient.

referring physician.

a push of a button or touch of a screen.

**7.2 Electronically generated report** 

Digital mammography decouples the process of image acquisition, processing and display so that each component can be optimized. The digital format has allowed the development of additional software to aid the radiologist in lesion detection – computed aided detection. We are now able to view mammography images and interpret them from other clinical sites in different parts of the city, state, or country through televideo. Other emerging technologies such as three dimensional tomosynthesis are now entering clinical use. Digital technology has changed mammography over the last decade, and it will continue to change it for decades to come. It will be interesting to see what the future holds for our patients and us.

#### **9. Acknowledgement**

Dr. Kuzmiak is grateful for the inspiration and guidance provided over the years by her friend and colleague, Etta Pisano, MD. She would like to express her gratitude to Martin Yaffe, PhD, and Elodia Cole, MS, for their clinical insights and outstanding work. Finally, she would also like to thank Shiela Kuzmiak for the many hours of support during this project.

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**5** 

*1Spain 2Chile 3,4Brazil* 

**Image Quality Requirements** 

**in Breast Cancer Screening** 

*3Centro de Desenvolvimento da Tecnologia Nuclear* 

Margarita Chevalier1, Fernando Leyton2,3, Maria Nogueira Tavares3, Marcio Oliveira3, Teogenes A. da Silva3 and João Emilio Peixoto4

Mammography is currently considered to be the best tool for early detection of breast cancer. The target groups of most of the population-based screening programmes are women aged between 50 and 65 years. A recent study has also shown mortality benefit in the age group 40-49 (Hellquist, et al, 2010). Screen-film mammography has been to date the traditional test for breast screening having been shown its efficacy in reducing breast cancer mortality in large randomised trials (Duffy, et al, 2006). The potential advantages of digital mammography over screen-film techniques have been the subject of several investigations which provides an improved diagnosis in dense breasts and an increase in breast cancer

Breast screening using X-ray mammography only confers a benefit on the screened population if it is able to detect breast cancer at an early stage, whereby the prognosis is improved. This can only be achieved by having high quality breast images to assure as much as possible the detection of small and subtle lesions in the breast (Muller, 1997;Karellas, 2004; Lewin, 2004; ICRU, 2009). High quality mammography must be achieved and maintained by applying rigorous and comprehensive quality assurance and

The quality of the breast images depends critically on the design and performance of the radiographic unit, the image receptor, and on how that equipment is used to acquire and process the mammogram. The type of display and the conditions under which the image is viewed have an important effect on the ability of the radiologist to extract the information recorded in the mammogram. The diagnostic information is integrally related to the quality of the image and higher image quality will result in more accurate diagnosis (Nishikawa, 2004). The systematic monitoring of both image quality and radiation dose is needed to

detection rate (Pisano et al, 2006; Hendrick et al, 2010).

**1. Introduction** 

control programmes.

**for Digital Mammography** 

*1Complutense University of Madrid* 

*2Diego Portales University* 

*4Instituto Nacional do Cáncer* 

