Advances in breast imaging technologies have enabled the integration of novel imaging modalities, beyond conventional planar mammography, into the clinical practice. For example, the use of volumetric imaging techniques is now commonplace and digital breast tomosynthesis is widespread for both screening and diagnostic tasks. Other emerging three-dimensional imaging technologies including breast CT and abbreviated breast MRI are increasingly used, usually in combination with conventional mammography for further evaluation in patients presenting a significant fraction of dense fibroglandular tissue or for assessment of inconclusive results.
Beyond the introduction of volumetric imaging modalities, recent developments combine digital breast tomosynthesis with the use of an intravenous iodinated contrast, with common approaches using dual energy subtraction to allow the depiction of contrast-enhanced malignant lesions that would otherwise be non-conspicuous in standard tomosynthesis.
Despite adoption of advanced imaging, current approaches to volumetric imaging and contrast enhanced imaging still show challenges to image quality associated with limitations of the imaging chain, the need for mechanical motion, and the moderately long acquisition time. Beside the limitations posed by image quality, further improvement of screening and diagnosis can be achieved by combining conventional imaging with the extraction of advanced imaging (radiomic) and pathology biomarkers.
This symposium will illustrate novel developments for enhancement of image quality in volumetric breast imaging via novel detector designs for dual-energy contrast enhanced breast imaging and novel multi-source arrangements allowing acquisition of volumetric imaging with stationary configurations. The combination of imaging with biological markers for earlier detection and therapy optimization of breast cancer will also be explored. Finally, the symposium will cover translation of novel imaging approaches to clinical environments.
Novel Detectors for Dual-Energy Contrast Enhanced Breast Imaging:
Dual-energy contrast enhanced breast imaging has been developed as both 2D (contrast enhanced digital mammography CEDM) and 3D (contrast enhanced digital breast tomosynthesis CEDBT) techniques to detect iodinated contrast agent uptake in breast lesions. In CEDM, two separate images are acquired using two different x-ray energy spectra, one below (low energy LE) and the other above (high energy HE) the k-edge of iodine. Weighted subtraction is then applied to cancel breast tissue background structure and highlight the areas with iodine uptake. When LE and HE images are taken with two different exposures (i.e. dual-shot), patient motion could result in misregistration and imperfect breast tissue cancelation. Photon-counting detectors and dual-layer energy integration detectors are being investigated for CEDM to obtain LE and HE images simultaneously with a single x-ray exposure, thereby eliminating the effect of patient motion. Different detector designs and their performance for CEDM will be discussed.
X-ray multi-source configurations for stationary tomosynthesis or limited-angle cone-beam breast CT:
Current breast tomosynthesis systems are based on mechanical translation of a single x-ray source along an arc above the patient breast. Such translation motion poses limits to the size and weight of the system, its mechanical stability, and its acquisition speed, with current systems featuring 4-25 second scan times, making them susceptible to patient motion and instability-induced image blurring. Recent advances in x-ray source technology enabled the development of sources combined into a single vacuum tube, resulting in compact linear or matrix arrangements of individually controllable x-ray focal spots that serve as basis for stationary configurations in which several x-ray poses are acquired by sequential activation of the focal spots. Such stationary, multi-source, designs enable the acquisition of tomosynthesis and limited angle volumetric imaging with sub-second scan times and no source motion, minimizing the effects of mechanical instability and patient motion.
Hybrid Imaging / Biology Approaches to Earlier Detection and Therapy Optimization of Breast Cancer:
A paradigm will be described in which a precision medicine approach is applied to breast cancer screening employing a range of techniques combining imaging and biology-based methods. Our research utilizes image feature analysis and microsimulation modeling to optimize the use of multiple and possibly hybrid modalities for screening women of different age, risk and breast characteristics. Future approaches may combine non-imaging “prescreens” to improve accessibility to underserved groups and increase efficiency. The potential of using imaging (radiomic) and pathology biomarkers to avoid under- or overtreatment of cancer will also be discussed.
Clinical Perspectives on Emerging Breast Imaging Technologies:
Mammography has been the most effective tool for early detection and is at the heart of breast cancer screening programs in the US and Europe. Today, digital mammography (DM) together with targeted ultrasound (US) and dynamic contrast enhanced magnetic resonance imaging (MRI) are standard-of-care breast imaging modalities used routinely to detect and diagnose breast cancer. To date, mammography remains the only imaging modality demonstrated to reduce mortality due to breast cancer. Continuous efforts to overcome the limitations of 2-D mammography have fostered the development of newer breast imaging techniques. In the past decade MRI has evolved into an established modality with specific indications for use in breast imaging. Newer techniques including mammography extensions such as tomosynthesis and contrast enhanced mammography as well as whole breast ultrasound and molecular imaging have emerged in recent years. Dedicated breast computed tomography is a three-dimensional imaging modality developed to overcome the limitations of mammography due to both false negative and false positive examinations. Breast CT has the potential to improve clinical diagnostic workups in the clinic and reduce the number of false positive examinations and interventions. It is being investigated as a screening and diagnostic tool that may offer similar advantages of MRI as compared to mammography.
1 – Learn about challenges to image quality in state-of-the art volumetric breast imaging.
2 – Understand approaches for image quality improvement via novel detector designs for dual energy contrast-enhanced breast imaging and multi-source stationary systems.
3 – Learn the potential of hybrid imaging / biology approaches for early detection of breast cancer and for optimization of therapeutic approaches.
4 – Learn the potential for clinical application of novel approaches to breast imaging.
Funding Support, Disclosures, and Conflict of Interest: Wei Zhao has research support from Siemens Medical Solutions USA. Martin Yaffe holds shares in Volpara Health, has research support from GE Healthcare, and is a principal of Mammographic Physics Inc. Alex Sisniega is partially funded by industry-academy research agreements with Izotropic Corp, Micro-X Ltd., and Siemens Healthineers.
Not Applicable / None Entered.
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