Studies Presented at RSNA 2014 Focus on Mammography

Mammograms have been one of the main topics of conversation in diagnostic radiology throughout the year, as radiologists look for new ways to conduct exams that are minimally invasive. With the annual meeting of the Radiological Society of North America being held in Chicago, researchers have offered new solutions to this common issue.

Making the procedure more comfortable
While undergoing mammograms, it is necessary for the breast to be compressed during the scan. This makes the experience uncomfortable and can deter many women from participating in screening exams. But a study from the Academic Medical Center in Amsterdam focused on how a new device that measures pressure could provide relief for patients.

According to HealthImaging, a team led by Woutjan Branderhorst, Ph.D., from the Department of Biomedical Engineering and Physics, was comparing the differences between force-based and pressure-based compression protocols. The researchers felt that the latter setting might limit pain and variability that can be experienced during the procedure.

"Standardizing the applied pressure would reduce both over- and under-compression and lead to a more reproducible imaging procedure with less pain," explained Branderhorst, quoted by the source.

To measure their hypothesis, Branderhorst and colleagues created a device that reports the average pressure during compression and assessed its effects on patient comfort and image clarity. They implemented a randomized trial with 433 asymptomatic patients and compressions standardized to various levels of pressure, including three at 14 dekanewtons and one at 10 kilopascals.

On average, the participants reported that the 10 kPa compressions were less painful than the other three scans. In addition, three experienced radiologists ensured that the pressure-based exams did not affect radiation dose or image quality.

Specific screenings might miss more cancers
Many physicians will review a woman's family history and determine that she might be at a higher risk for developing breast cancer. As a result, medical imaging specialists will conduct thorough exams to detect any presence of lesions.

However, a risk-based approach to screening mammography might miss more than 75 percent of breast cancers, according to research from the University of California, San Francisco, presented at RSNA 2014. Elissa Price, M.D., and her colleagues analyzed all cancers detected by these procedures between January 1997 and November 2012. Subjects were asymptomatic women ages 40 to 49, and the researchers documented their family histories, breast densities, malignancy types and tumor node statuses, AuntMinnie.com reported.

The total number of women screened during the time frame was 39,715, with 136 cancers being identified among the group. Half of the malignancies were invasive, while the remainder were ductal carcinoma in situ. Price and her team found that the two biggest risk factors, which included strong family history of disease and extremely dense breast tissue, were missing in large percentages of the diagnosed patients.

The dangers of poor protocols
Family histories were absent in 88 percent of the study's cases, while tissue density was not a factor in 86 percent. The UCSF researchers explained that using these categories as screening protocols would have missed 76 percent of the cancers.

"Risk-based screening would not have captured invasive, node-positive cancers," said Price, quoted by AuntMinnie.com. "And in our opinion, that makes it an unacceptable strategy."

While risk-factors might still serve as potential indicators of breast cancer development, the study from Price and her team underscores the need for improved digital imaging protocols for screenings. Without them, patients are continually at risk of missed diagnoses that put their lives in danger.

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