Mammography Past & Present Similar equipments were & are still being used, these can be called as old fashioned equipments cone Tube Breast Stand

Mammography In digital mammography screen-film system has been replaced by Detectors to give the digital images

Mammography Present & future CCD camera Work station Equipments look like this

Mammogram These digital mammograms are surely better in resolution & details

Standard views: 45* Medio lateral Oblique (MLO view)/ Lundgren’s view Craniocaudal view (CC view) RCC RMLO LCC LMLO Left Craniocaudal Right Craniocaudal Right Mediolateral Oblique Left Mediolateral Oblique

LAT Left Axillary Tail LCV Left Cleavage LFB Left From Below LLMO Left Lateromedial Oblique LML Let Mediolateral LRL Left Roll Lateral LRM Left Roll Medial LLM Left Lateromedial

Extended CC view / Cleopatra’s view Extended CC view- medial or lateral rotation True Lateral view Axillary view Cleavage view Paddle compression view Magnification view Eklund view (for breast implants)

Extended CC view medially rotated Extended CC view laterally rotated

Magnification view

CONVENTIONAL CC VIEW EKLUND CC VIEW

cost issues Digital mammography is expensive! Using digital technology in all women would cost >$300,000 per QALY gained Targeted use of digital mammography on basis of age/breast density costs ~$50,000 per QALY gained

Computer-Aided Detection Software program that highlights areas of concern on digital mammograms Uses image processing algorithms and decision threshold parameters to detect features in an image likely to be of clinical significance Very sensitive – detects 90% of all cancers However, has a high rate of false positives (2-4 per study)

Courtesy: MIAS digital mammogram database

Instant Upgrade Improved signal-to-noise ratio Ability to magnify, change contrast, or alter the brightness. Near instantaneous image acquisition

Courtesy: Magee-Women’s Hospital of UPMC Digital versus Conventional

Digital Mammographic Imaging Screening Trial (DMIST) Retrospective study of 49,500 asymptomatic women Assessed accuracy of digital vs film mammograms RESULTS: Digital mammography significantly more accurate in pre- and perimenopausal women under 50 with dense breasts Nonsignificant trend toward improved accuracy with film mammograms in women over 65 with fatty breasts

A Brief History Albert Salomon, German surgeon -1950’s - Jacob Gershon-Cohen began to advocate widespread use of X-rays for screening -December 2005 – RSNA brings digital mammography to US

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