the patient was born in 1965; she presented with significant palpable laterocranial mastopathy on... more the patient was born in 1965; she presented with significant palpable laterocranial mastopathy on both sides.
Two-dimensionlal (2D) mammography screening programs reduce breast cancer mortality substantially... more Two-dimensionlal (2D) mammography screening programs reduce breast cancer mortality substantially, but they do not depict all cancers early enough to result in a cure. Thus, to detect cancers earlier, the aim has to be to increase the sensitivity and specificity of the diagnostic methods used (Coldman et al. 2007, 2014; Heywang-Kobrunner et al. 2011; The Swedish Organized Screening Evaluation Group 2006; Jonsson et al. 2007; Allgood et al. 2008; Parvinen et al. 2006; Schopper and deWolf 2009; Gabe et al. 2007; Roder et al. 2008; Kopans 2014b). Tomosynthesis (3D) fulfills these criteria and will, in the end, replace standard 2D digital mammography for breast cancer screening (Kopans 2014a). Many of the arguments against 2D mammography screening raised through recent years are based on faulty science (Heywang-Kobrunner et al. 2011; Kopans 2014b). Indeed, there are true disadvantages of 2D mammography screening, such as radiation risks, the risk of a false alarm, interval cancers, and—to a certain point—overdiagnosis (Heywang-Kobrunner et al. 2011). Many of these disadvantages will be markedly reduced due to the emerging widespread use of tomosynthesis. 2D mammography is associated with a small amount of radiation. But the average glandular dose is low, calculated as 4 mGy per breast. The individual dose may differ depending on breast size and compression (Heywang-Kobrunner et al. 2011). According to the literature, tomosynthesis with synthetic 2D views reduces the breast dose by approximately half, which has substantial implications for the future of population screening programs (Svahn et al. 2015). Like every medical test, screening 2D mammography may detect abnormalities that require further evaluation, but will eventually turn out to be benign. Psychologically, such a false-positive alarm causes distress. Meanwhile, many studies have shown that the recall rate of tomosynthesis (2D + 3D) is significantly lower than that in the 2D mammography-alone group, even if the combination 2D + 3D group has additional risk factors (recall rate for 2D, 11.5 %; in the combination 2D + 3D group, 4.2 %) (Destounis et al. 2014). Interval cancers represent a limitation of screening and not a side effect. Screening does not allow us to recognize these cancers at a preclinical stage. They exist, but are 2D mammographically occult and become clinically detectable during the screening interval (Heywang-Kobrunner et al. 2011). Meanwhile, many studies have shown that the use of 2D + 3D in a screening environment results in a significantly higher cancer detection rate and enables the detection of more invasive cancers (Skaane et al. 2013, 2014; Ciatto et al. 2013). It can be accepted that these cancers were occult on the regular 2D mammography screening and later found at a more advanced stage. Improved possibilities of treatment are an important advantage of early detection. It is well known that early detection leads to a reduced number of mastectomies, better cosmetic results in cases of breast conservation, reduced adjuvant chemotherapy, and increased replacement of axillary dissection by sentinel node biopsy (Heywang-Kobrunner et al. 2011). Overdiagnosis of breast cancer in a screening program describes the fact that, in a screened population, more breast cancers are detected than in a comparable unscreened population of the same age and composition. Some of the additional cancers that are detected in the screening group would never have become apparent without screening, and their detection does not contribute to mortality reduction (Heywang-Kobrunner et al. 2011). A quite realistic and very sophisticated calculation was presented by Duffy et al. in 2010 (Duffy et al. 2010). They concluded that the lifesaving effects of mammography screening exceeded the potential harm of overdiagnosis by a factor of 2–2.5. Since some ductal carcinoma in situ (DCIS; even though being a precursor) may not develop into invasive breast cancer during the remaining lifespan of a woman, DCIS must be considered a potential and real source of overdiagnosis or, rather, overtreatment and thus requires special attention. Someone could suggest that the use of 3D would lead to more overdiagnosis/overtreatment and thus in the end to more and more costs. But the contrary is demonstrated by Bonafede et al., who have shown clinical and economic favorability of 3D for breast cancer screening among commercially insured women in the United States (US) (Bonafede et al. 2015).
Mammography is X-ray imaging of the breast. The technique works because different components of t... more Mammography is X-ray imaging of the breast. The technique works because different components of the breast absorb X-rays in different amounts, generating an image in which fat, fibrous, and glandular tissue; soft tissue lesions; and calcifications can be identified. Fibroglandular tissue and soft tissue lesions have almost identical X-ray absorption properties, which can make identifying small cancers challenging when using mammography. Unless a lesion is located in a region that is surrounded by fat, its visibility is reduced because of the shadows of fibroglandular structures overlying the cancer. These interfering structures are sometimes referred to as structure noise or anatomical noise. In denser breasts, there are more structures that interfere with seeing a cancer, and the clinical performance of mammography decreases with increasing breast density (Pisano et al. 2005). The sensitivity, or ability to detect cancer, is lower in extremely dense breasts compared with breasts co...
Tienda online donde Comprar Atlas Of Breast Tomosynthesis. Imaging Findings And Image-Guided Inte... more Tienda online donde Comprar Atlas Of Breast Tomosynthesis. Imaging Findings And Image-Guided Interventions al precio 218,45 € de Christian Waldherr | Martin Sonnenschein, tienda de Libros de Medicina, Libros de Ginecologia y Obstetricia - Ginecologia general
The patient was a 56-year-old female. Previous bilateral breast reduction. Routine screening mamm... more The patient was a 56-year-old female. Previous bilateral breast reduction. Routine screening mammography and tomosynthesis (3D), 17.6.2013. Tomosynthesis-guided vacuum-assisted biopsy (T-VAB) (27.06.2013).
Evaluation of feasibility and clinical performance of a tomosynthesis-guided vacuum-assisted brea... more Evaluation of feasibility and clinical performance of a tomosynthesis-guided vacuum-assisted breast biopsy (TVAB) system compared to Stereotaxy (SVAB). All biopsies were performed on consecutive patients: 148 TVAB biopsies and 86 biopsies on different patients using SVAB. Evaluation criteria for each biopsy were technical feasibility, histopathology, procedure time, and complications. All 148 TVAB biopsies were technically successful, and gained the targeted groups of microcalcifications (100 %). In 1 of 86 SVAB procedures, it was not possible to gain the targeted microcalcifications (1 %), in 3 of 86 the needle had to be adjusted (4 %). All TVAB biopsies were performed without clinically relevant complications. Distortions were biopsied exclusively by TVAB, mean size 0.9 cm, p < 0.0001. Of the 24 distortions, 13 were cancer, 11 Radial Scars/ CSL. The mean procedure time for TVAB was 15.4 minutes (range 7-28 min), for SVAB 23 minutes (range 11-46 min), p < 0.0001. TVAB is able to biopsy small architectural distortions with high accuracy. TVAB is easily feasible and appears to have the same degree of clinical performance for diagnosing microcalcifications. The increased number of biopsied distortions by TVAB is presumably due to increased use of tomosynthesis and its diagnostic potential. • TVAB is easily feasible. • TVAB is able to target architectural distortions with high accuracy. • TVAB diagnoses microcalcifications with the same clinical performance as SVAB.
PURPOSE Injury analysis in forensic medicine is progressing towards the utilisation of scientific... more PURPOSE Injury analysis in forensic medicine is progressing towards the utilisation of scientific, 3D high-tech methods. Our trans-disciplinary forensic-radiological group has used combined CT and MRI in over 100 cases for postmortem examination. The goal of this paper is to demonstrate the advantages of merging 3D body surface scanning data with CT and MRI data for combined forensic surface and internal body documentation. METHOD AND MATERIALS The bodies were marked with radiological multi-modality markers, which served later for body surface scanning and radiological data merging. Body surfaces with relevant forensic injuries were scanned by an optical 3D surface scanner. After this CT and MRI scans of the whole body were performed, and optical and CT data were fused. In an additional step the MRI information was merged with the model.In addition to the 3D body documentation, the suspected injury-causing instruments (vehicles, tires, shoes etc.) were documented by the 3D optical s...
PURPOSE We prospectively evaluated postmortem MSCT and MRI in correlation with autopsy. Excellent... more PURPOSE We prospectively evaluated postmortem MSCT and MRI in correlation with autopsy. Excellent visualization of skeletal (MSCT) and soft tissue (MRI) injuries and pathologies has been demonstrated whereas postmortem unenhanced cross sectional imaging has so far not been sufficient in visualizing the vascular system. We hypothesized that postmortem angiography technique can be implemented and enhance the potential of minimally invasive virtual autopsy by imaging. Therefore, techniques for postmortem MSCT and MRI angiography were investigated. METHOD AND MATERIALS An ex vivo porcine model and a modified Seldinger guide-wire technique for vascular contrast injection in corpses via peripheral arteries were developed. Using MSCT (16 row scanner; iodinated contrast agent) and MRI (1.5 Tesla; gadolinium) coronary arteriography of the porcine model and both coronary and peripheral arteriography of the human model were performed. RESULTS The entire arterial system could be visualized post...
PURPOSE In forensic medicine determination of fatal hemorrhage as cause of death is often difficu... more PURPOSE In forensic medicine determination of fatal hemorrhage as cause of death is often difficult at autopsy, and the means by which a prosector makes his estimation of blood volume are nothing more than common sense and the power of observation. Based on the recent application of postmortem radiology to forensic medicine we hypothesized that multi-detector row computed tomography (MSCT) and magnetic resonance imaging (MRI) might be valuable in the objective diagnosis of fatal hemorrhage. METHOD AND MATERIALS By the end of October 2003, 90 forensic cases were studied by CT and MRI and correlated with autopsy. 25 of these cases were excluded because tissue was destroyed, putrefaction present, or the trunk of the body only partially scanned. Out of the 65 remaining cases, 19 had fatal hemorrhage (fh) at autopsy whereas 46 died of other causes (nh). Cross sectional areas of 12 large body vessels and the volumes of the 4 heart chambers were determined on cross sectional images; quanti...
the patient was born in 1965; she presented with significant palpable laterocranial mastopathy on... more the patient was born in 1965; she presented with significant palpable laterocranial mastopathy on both sides.
Two-dimensionlal (2D) mammography screening programs reduce breast cancer mortality substantially... more Two-dimensionlal (2D) mammography screening programs reduce breast cancer mortality substantially, but they do not depict all cancers early enough to result in a cure. Thus, to detect cancers earlier, the aim has to be to increase the sensitivity and specificity of the diagnostic methods used (Coldman et al. 2007, 2014; Heywang-Kobrunner et al. 2011; The Swedish Organized Screening Evaluation Group 2006; Jonsson et al. 2007; Allgood et al. 2008; Parvinen et al. 2006; Schopper and deWolf 2009; Gabe et al. 2007; Roder et al. 2008; Kopans 2014b). Tomosynthesis (3D) fulfills these criteria and will, in the end, replace standard 2D digital mammography for breast cancer screening (Kopans 2014a). Many of the arguments against 2D mammography screening raised through recent years are based on faulty science (Heywang-Kobrunner et al. 2011; Kopans 2014b). Indeed, there are true disadvantages of 2D mammography screening, such as radiation risks, the risk of a false alarm, interval cancers, and—to a certain point—overdiagnosis (Heywang-Kobrunner et al. 2011). Many of these disadvantages will be markedly reduced due to the emerging widespread use of tomosynthesis. 2D mammography is associated with a small amount of radiation. But the average glandular dose is low, calculated as 4 mGy per breast. The individual dose may differ depending on breast size and compression (Heywang-Kobrunner et al. 2011). According to the literature, tomosynthesis with synthetic 2D views reduces the breast dose by approximately half, which has substantial implications for the future of population screening programs (Svahn et al. 2015). Like every medical test, screening 2D mammography may detect abnormalities that require further evaluation, but will eventually turn out to be benign. Psychologically, such a false-positive alarm causes distress. Meanwhile, many studies have shown that the recall rate of tomosynthesis (2D + 3D) is significantly lower than that in the 2D mammography-alone group, even if the combination 2D + 3D group has additional risk factors (recall rate for 2D, 11.5 %; in the combination 2D + 3D group, 4.2 %) (Destounis et al. 2014). Interval cancers represent a limitation of screening and not a side effect. Screening does not allow us to recognize these cancers at a preclinical stage. They exist, but are 2D mammographically occult and become clinically detectable during the screening interval (Heywang-Kobrunner et al. 2011). Meanwhile, many studies have shown that the use of 2D + 3D in a screening environment results in a significantly higher cancer detection rate and enables the detection of more invasive cancers (Skaane et al. 2013, 2014; Ciatto et al. 2013). It can be accepted that these cancers were occult on the regular 2D mammography screening and later found at a more advanced stage. Improved possibilities of treatment are an important advantage of early detection. It is well known that early detection leads to a reduced number of mastectomies, better cosmetic results in cases of breast conservation, reduced adjuvant chemotherapy, and increased replacement of axillary dissection by sentinel node biopsy (Heywang-Kobrunner et al. 2011). Overdiagnosis of breast cancer in a screening program describes the fact that, in a screened population, more breast cancers are detected than in a comparable unscreened population of the same age and composition. Some of the additional cancers that are detected in the screening group would never have become apparent without screening, and their detection does not contribute to mortality reduction (Heywang-Kobrunner et al. 2011). A quite realistic and very sophisticated calculation was presented by Duffy et al. in 2010 (Duffy et al. 2010). They concluded that the lifesaving effects of mammography screening exceeded the potential harm of overdiagnosis by a factor of 2–2.5. Since some ductal carcinoma in situ (DCIS; even though being a precursor) may not develop into invasive breast cancer during the remaining lifespan of a woman, DCIS must be considered a potential and real source of overdiagnosis or, rather, overtreatment and thus requires special attention. Someone could suggest that the use of 3D would lead to more overdiagnosis/overtreatment and thus in the end to more and more costs. But the contrary is demonstrated by Bonafede et al., who have shown clinical and economic favorability of 3D for breast cancer screening among commercially insured women in the United States (US) (Bonafede et al. 2015).
Mammography is X-ray imaging of the breast. The technique works because different components of t... more Mammography is X-ray imaging of the breast. The technique works because different components of the breast absorb X-rays in different amounts, generating an image in which fat, fibrous, and glandular tissue; soft tissue lesions; and calcifications can be identified. Fibroglandular tissue and soft tissue lesions have almost identical X-ray absorption properties, which can make identifying small cancers challenging when using mammography. Unless a lesion is located in a region that is surrounded by fat, its visibility is reduced because of the shadows of fibroglandular structures overlying the cancer. These interfering structures are sometimes referred to as structure noise or anatomical noise. In denser breasts, there are more structures that interfere with seeing a cancer, and the clinical performance of mammography decreases with increasing breast density (Pisano et al. 2005). The sensitivity, or ability to detect cancer, is lower in extremely dense breasts compared with breasts co...
Tienda online donde Comprar Atlas Of Breast Tomosynthesis. Imaging Findings And Image-Guided Inte... more Tienda online donde Comprar Atlas Of Breast Tomosynthesis. Imaging Findings And Image-Guided Interventions al precio 218,45 € de Christian Waldherr | Martin Sonnenschein, tienda de Libros de Medicina, Libros de Ginecologia y Obstetricia - Ginecologia general
The patient was a 56-year-old female. Previous bilateral breast reduction. Routine screening mamm... more The patient was a 56-year-old female. Previous bilateral breast reduction. Routine screening mammography and tomosynthesis (3D), 17.6.2013. Tomosynthesis-guided vacuum-assisted biopsy (T-VAB) (27.06.2013).
Evaluation of feasibility and clinical performance of a tomosynthesis-guided vacuum-assisted brea... more Evaluation of feasibility and clinical performance of a tomosynthesis-guided vacuum-assisted breast biopsy (TVAB) system compared to Stereotaxy (SVAB). All biopsies were performed on consecutive patients: 148 TVAB biopsies and 86 biopsies on different patients using SVAB. Evaluation criteria for each biopsy were technical feasibility, histopathology, procedure time, and complications. All 148 TVAB biopsies were technically successful, and gained the targeted groups of microcalcifications (100 %). In 1 of 86 SVAB procedures, it was not possible to gain the targeted microcalcifications (1 %), in 3 of 86 the needle had to be adjusted (4 %). All TVAB biopsies were performed without clinically relevant complications. Distortions were biopsied exclusively by TVAB, mean size 0.9 cm, p < 0.0001. Of the 24 distortions, 13 were cancer, 11 Radial Scars/ CSL. The mean procedure time for TVAB was 15.4 minutes (range 7-28 min), for SVAB 23 minutes (range 11-46 min), p < 0.0001. TVAB is able to biopsy small architectural distortions with high accuracy. TVAB is easily feasible and appears to have the same degree of clinical performance for diagnosing microcalcifications. The increased number of biopsied distortions by TVAB is presumably due to increased use of tomosynthesis and its diagnostic potential. • TVAB is easily feasible. • TVAB is able to target architectural distortions with high accuracy. • TVAB diagnoses microcalcifications with the same clinical performance as SVAB.
PURPOSE Injury analysis in forensic medicine is progressing towards the utilisation of scientific... more PURPOSE Injury analysis in forensic medicine is progressing towards the utilisation of scientific, 3D high-tech methods. Our trans-disciplinary forensic-radiological group has used combined CT and MRI in over 100 cases for postmortem examination. The goal of this paper is to demonstrate the advantages of merging 3D body surface scanning data with CT and MRI data for combined forensic surface and internal body documentation. METHOD AND MATERIALS The bodies were marked with radiological multi-modality markers, which served later for body surface scanning and radiological data merging. Body surfaces with relevant forensic injuries were scanned by an optical 3D surface scanner. After this CT and MRI scans of the whole body were performed, and optical and CT data were fused. In an additional step the MRI information was merged with the model.In addition to the 3D body documentation, the suspected injury-causing instruments (vehicles, tires, shoes etc.) were documented by the 3D optical s...
PURPOSE We prospectively evaluated postmortem MSCT and MRI in correlation with autopsy. Excellent... more PURPOSE We prospectively evaluated postmortem MSCT and MRI in correlation with autopsy. Excellent visualization of skeletal (MSCT) and soft tissue (MRI) injuries and pathologies has been demonstrated whereas postmortem unenhanced cross sectional imaging has so far not been sufficient in visualizing the vascular system. We hypothesized that postmortem angiography technique can be implemented and enhance the potential of minimally invasive virtual autopsy by imaging. Therefore, techniques for postmortem MSCT and MRI angiography were investigated. METHOD AND MATERIALS An ex vivo porcine model and a modified Seldinger guide-wire technique for vascular contrast injection in corpses via peripheral arteries were developed. Using MSCT (16 row scanner; iodinated contrast agent) and MRI (1.5 Tesla; gadolinium) coronary arteriography of the porcine model and both coronary and peripheral arteriography of the human model were performed. RESULTS The entire arterial system could be visualized post...
PURPOSE In forensic medicine determination of fatal hemorrhage as cause of death is often difficu... more PURPOSE In forensic medicine determination of fatal hemorrhage as cause of death is often difficult at autopsy, and the means by which a prosector makes his estimation of blood volume are nothing more than common sense and the power of observation. Based on the recent application of postmortem radiology to forensic medicine we hypothesized that multi-detector row computed tomography (MSCT) and magnetic resonance imaging (MRI) might be valuable in the objective diagnosis of fatal hemorrhage. METHOD AND MATERIALS By the end of October 2003, 90 forensic cases were studied by CT and MRI and correlated with autopsy. 25 of these cases were excluded because tissue was destroyed, putrefaction present, or the trunk of the body only partially scanned. Out of the 65 remaining cases, 19 had fatal hemorrhage (fh) at autopsy whereas 46 died of other causes (nh). Cross sectional areas of 12 large body vessels and the volumes of the 4 heart chambers were determined on cross sectional images; quanti...
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