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Emerging Technologies: Breast Density Software and CEM

M Yaffe1*, S Fahrenholtz2*, B Patel2*, (1) Sunnybrook Research Institute, Toronto, ON, CA, (2) Mayo Clinic Arizona, Phoenix, AZ


MO-C-Diagnostic Room-0 (Monday, 4/19/2021) 3:00 PM - 5:00 PM [Eastern Time (GMT-4)]

Martin J. Yaffe, Ph.D.
Applications of Automated Volumetric Density Software for Optimized Breast Cancer Screening

Most breast imaging in North America is performed through digital acquisition. This makes possible the use of image processing and quantitative analysis methods that can enhance the information value of images and improve the detection and therapy of breast cancer. For example, breast density, the prevalence of fibroglandular tissue in the breast can be automatically quantified volumetrically from mammograms, tomosynthesis or MRI. Density has been well established as an independent risk factor for breast cancer, but can also reduce the sensitivity of mammography by “masking” cancers through superposition of normal tissue structures over the signal from a lesion. Masking is dependent on both the amount of dense tissue and its spatial arrangements. In this presentation, after a brief review of mammographic density, an approach to the use of measured density and other biomarkers in predicting the probability of cancer masking and potentially stratifying women to an optimal screening regimen will be discussed including consideration as to the requirements for such optimization to be practical.

Radiomic information extracted from breast images as well as data from the image headers on acquisition parameters and patient-related variables can also be useful in assessing many factors (human and/or technology related) that affect the quality of breast imaging. Such knowledge can be applied in a quality improvement (QI) program.

Samuel Fahrenholtz, PhD
Contrast Enhanced Mammography: Principles and Practice

Contrast enhanced mammography (CEM) is a growing option for breast imaging practices, principally used for dense breasts. This presentation is an introduction for physicists serving practices that are beginning or considering the use of CEM. The physical principles, cancer biology concepts, and practice of CEM will be explained from a perspective familiar with full field digital mammography (FFDM). Juxtaposed with FFDM, CEM leverages similar radiographic techniques – namely the careful selection of kVp to k-edges of materials – but commercial CEM adds a second higher voltage exposure, another filter material, and intravenous iodinated contrast media which is retained by malignant tissues. Retained media is elucidated by a subtraction image between paired high- and low-energy exposures. From a practice perspective, CEM most significantly adds intravenous contrast logistics. Finally, there are a few additional vendor-provided QC procedures for the QC technologist and medical physicist.

Bhavika Patel, MD
The Emerging Role of Contrast Enhanced Mammography

This session will discuss how to implement contrast enhanced mammography (CEM) in a breast imaging practices. Topics will include establishing workflow, considerations when starting a program, and discussing examples of clinical diagnostic and screening CEM cases.

Learning Objectives:
1. Describe implementation of a Contrast-enhanced mammography (CEM) program
2. Recognize the diagnostic uses of Contrast-enhanced mammography (CEM) in breast imaging practices
3. Recognize the screening uses of Contrast-enhanced mammography (CEM) in breast imaging practices


Mammography, Contrast, Densitometry


IM- Breast X-Ray Imaging: Contrast imaging

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