Lara A. Hardesty

Recall and detection rates in screening mammography: A review of clinical experience: Implications for practice guidelines

The authors investigated the correlation between recall and detection rates in a group of 10 radiologists who had read a high volume of screening mammograms in an academic institution.

Digital Breast Tomosynthesis Utilization in the United States: A Survey of Physician Members of the Society of Breast Imaging

PURPOSE To assess utilization of digital breast tomosynthesis (DBT) and examine criteria for offering DBT to patients. METHODS We created an online survey for physician members of the Society of Breast Imaging to assess their use of DBT. The questions covered availability of DBT at the participants practice, whether DBT was used for clinical care or research, clinical decision rules guiding patient selection for DBT, costs associated with DBT, plans to obtain DBT, and breast imaging practice characteristics. Fishers exact tests and logistic regression were used to compare DBT users and nonusers. RESULTS In all, 670 members responded (response rate = 37%). Of these, 200 (30.0%) respondents reported using DBT, with 89% of these using DBT clinically. Participants were more likely to report DBT use if they worked at an academic practice (odds ratio [OR], 2.07; 95% confidence interval [CI], 1.41 to 3.03; P < .001), a practice with more than 3 breast imagers (OR, 2.36; 95% CI, 1.62 to 3.43; P < .001), or a practice with 7 or more mammography units (OR, 3.05; 95% CI, 2.11 to 4.39; P < .001). Criteria used to select patients to undergo DBT varied, with 107 (68.2%) using exam type (screening versus diagnostic), 25 (15.9%) using mammographic density, and 25 (15.9%) using breast cancer risk. Fees for DBT ranged from

A method to test the reproducibility and to improve performance of computer‐aided detection schemes for digitized mammograms

25 to

Different Search Patterns and Similar Decision Outcomes: How Can Experts Agree in the Decisions They Make When Reading Digital Mammograms?

250. In addition, 62.3% of nonusers planned to obtain DBT. CONCLUSION DBT is becoming more common but remains a limited resource. Clinical guidelines would assist practices in deciding whether to adopt DBT and in standardizing which patients should receive DBT.

Implications of CISNET Modeling on Number Needed to Screen and Mortality Reduction With Digital Mammography in Women 40–49 Years Old

The purpose of this study is to develop a new method for assessment of the reproducibility of computer-aided detection (CAD) schemes for digitized mammograms and to evaluate the possibility of using the implemented approach for improving CAD performance. Two thousand digitized mammograms (representing 500 cases) with 300 depicted verified masses were selected in the study. Series of images were generated for each digitized image by resampling after a series of slight image rotations. A CAD scheme developed in our laboratory was applied to all images to detect suspicious mass regions. We evaluated the reproducibility of the scheme using the detection sensitivity and false-positive rates for the original and resampled images. We also explored the possibility of improving CAD performance using three methods of combining results from the original and resampled images, including simple grouping, averaging output scores, and averaging output scores after grouping. The CAD scheme generated a detection score (from 0 to 1) for each identified suspicious region. A region with a detection score >0.5 was considered as positive. The CAD scheme detected 238 masses (79.3% case-based sensitivity) and identified 1093 false-positive regions (average 0.55 per image) in the original image dataset. In eleven repeated tests using original and ten sets of rotated and resampled images, the scheme detected a maximum of 271 masses and identified as many as 2359 false-positive regions. Two hundred and eighteen masses (80.4%) and 618 false-positive regions (26.2%) were detected in all 11 sets of images. Combining detection results improved reproducibility and the overall CAD performance. In the range of an average false-positive detection rate between 0.5 and 1 per image, the sensitivity of the scheme could be increased approximately 5% after averaging the scores of the regions detected in at least four images. At low false-positive rate (e.g., < or =average 0.3 per image), the grouping method alone could increase CAD sensitivity by 7%. The study demonstrated that reproducibility of a CAD scheme can be tested using a set of slightly rotated and resampled images. Because the reproducibility of true-positive detections is generally higher than that of false-positive detections, combining detection results generated from subsets of rotated and resampled images could improve both reproducibility and overall performance of CAD schemes.

Renal medullary cystic disease: assessment by MRI

Experts may agree in most decisions that they make when they read a case set of digital mammograms, but eye-position tracking studies suggest that they use very different visual search strategies to make such decisions. If indeed each expert uses a unique strategy, it may be very difficult to teach radiology trainees effective ways to search the background parenchyma. In this study, we examined how much agreement exists in the actual locations used by the experts in their decision making process when reading digital mammograms.

Breast Cancers Found with Digital Breast Tomosynthesis: A Comparison of Pathology and Histologic Grade

OBJECTIVE In this article, we evaluate the implications of recent Cancer Intervention and Surveillance Modeling Network (CISNET) modeling of benefits and harms of screening to women 40-49 years old using annual digital mammography. CONCLUSION We show that adding annual digital mammography of women 40-49 years old to biennial screening of women 50-74 years old increases lives saved by 27% and life-years gained by 47%. Annual digital mammography in women 40-49 years old saves 42% more lives and life-years than biennial digital mammography. The number needed to screen to save one life (NNS) with annual digital mammography in women 40-49 years old is 588.

Issues to Consider Before Implementing Digital Breast Tomosynthesis Into a Breast Imaging Practice

Abstract. Medullary cystic disease is an important cause of renal failure in adolescent patients. Imaging plays a primary role in the diagnosis of this entity as cysts are characteristically seen in the renal medulla and corticomedullary junction with normal to small sized kidneys. Imaging studies that do not use intravenous contrast or ionizing radiation are particularly useful given the young age of these patients and presence of renal failure. In this case, we demonstrate the imaging findings of medullary cystic disease by MRI.

Subjective assessment of high-level image compression of digitized mammograms

To compare the pathology and histologic grading of breast cancers detected with digital breast tomosynthesis to those found with conventional digital mammography. The institutional review board approved this study. A database search for all breast cancers diagnosed from June 2012 through December 2013 was performed. Imaging records for these cancers were reviewed and patients who had screening mammography with tomosynthesis as their initial examination were selected. Five dedicated breast imaging radiologists reviewed each of these screening mammograms to determine whether the cancer was visible on conventional digital mammography or whether tomosynthesis was needed to identify the cancer. A cancer was considered mammographically occult if all five radiologists agreed that the cancer could not be seen on conventional digital mammography. The size, pathology and histologic grading for all diagnosed breast cancers were then reviewed. The Mann–Whitney U and Fisher exact tests were utilized to determine any association between imaging findings and cancer size, pathologic type and histologic grade. Sixty‐five cancers in 63 patients were identified. Ten of these cancers were considered occult on conventional digital mammography and detected with the addition of tomosynthesis. These mammographically occult cancers were significantly associated with Nottingham grade 1 histologic pathology (p = 0.02), were smaller (median size: 6 mm versus 10 mm, p = 0.07) and none demonstrated axillary nodal metastases. Breast cancers identified through the addition of tomosynthesis are associated with Nottingham grade 1 histologic pathology and prognostically more favorable than cancers identified with conventional digital mammography alone.

Incorporation of negative regions in a knowledge-based computer-aided detection scheme

OBJECTIVE. The purpose of this article is to discuss issues surrounding the implementation of digital breast tomosynthesis (DBT) into a clinical breast imaging practice and assist radiologists, technologists, and administrators who are considering the addition of this new technology to their practices. CONCLUSION. When appropriate attention is given to image acquisition, interpretation, storage, technologist and radiologist training, patient selection, billing, radiation dose, and marketing, implementation of DBT into a breast imaging practice can be successful.