As Breast Cancer Awareness month unfolds in October, patients and
clinicians alike have cause to celebrate. Recent advances in screening
for breast cancer—the leading cancer killer in women—and osteoporosis
are increasing the odds of detecting and diagnosing these diseases at
earlier stages, when they are most treatable.1
Osteoporosis and bone densitometry
Two in one testing
Some 52 million people in the United States (U.S.) are estimated to
suffer from osteoporosis, with 2 million fractures related to the
disease occurring each year. Osteoporosis is overwhelmingly a women’s
condition, affecting 1 in every 3 women, but only 1 in every 5 men, over
Standard operating procedure has been, and
still is, for women at risk for the disease to undergo bone densitometry
(DXA), a standalone X-ray examination of the wrist, back and/or hip
that is then analyzed to measure the degree of bone loss.
could soon be changing, thanks to OneScreen, a new screening system
developed by Sectra (Linkoping, Sweden). With OneScreen, an x-ray of the
hand provides the basis for an osteoporosis diagnosis. In what is
essentially a “two in one” exam, the image is taken at the same time as
the breast images during a mammogram, and on the same digital radiology
equipment. The extra examination takes <30 sec, according to Sectra.
image is then electronically sent for analysis with Sectra’s patented
technology, Digital X-ray Radiogrammetry (DXR). With the help of DXR,
women in the osteoporosis risk group can be identified and offered
further examination and treatment. Sectra’s online service is ideal for
identifying and prioritizing those women who should be referred for the
DXA measurement, a more expensive and considerably more time-consuming
technique for analyzing bone mass.
According to a Sectra statement
issued earlier this year, some 1,000 women in Europe at very high risk
of contracting osteoporosis have been identified as a result of
the Sectra OneScreen online service.
Introduced at the 2011
meeting of the Radiological Society of North America, OneScreen could
soon make its clinical debut in the U.S. Elin Kindberg, Senior Medical
Advisor at Sectra, said the company is negotiating with several U.S.
mammography providers, and that the service could be operating stateside
in the near future.
“We are talking to leading mammography
providers in the country and once the service is implemented at one
account, we think that many others will follow, considering the
simplicity and efficacy of this product, as well as the fact that there
is no need for investment in new hardware or software,” Kindberg said.
In the meantime, OneScreen is getting good reviews from European
clinicians, such as Dr. Björn Löndalen, a consultant radiologist and
chief marketing officer at Unilabs Teleradiology Norway, Unilabs Röntgen
“The OneScreen system provides us with an easy and
flexible way of identifying the women at risk [for osteoporosis],” Dr.
Londalen said. “As osteoporosis is a ‘silent’ disease, this method
allows them to be treated before any fractures occur. The method is
rather effective and takes up little time—a complete examination is done
in about 30 sec. This allows us to do the exam without having to
reschedule, which obviously is a huge benefit in terms of patient
“The fact that OneScreen is coupled with mammography
is also a benefit in the sense that the women coming for a mammogram are
already concerned about their health, and doing a check-up on another
female-specific area—bone density and osteoporosis—is an easy choice to
make when you don’t have to make another appointment. The responses have
been almost exclusively positive,” Dr. Londalen added.
With respect to clinicians, Dr. Londalen said, one of OneScreen’s greatest benefits is its ease of use.
takes only about 1 or 2 exams for a radiographer to learn the
technique,” he said. “There is no need to interpret images. The report
sent back by email, or as a DICOM/HL7 in the PACS, gives any clinician
or radiologist a full status report at a glance.”
medical imaging industry, meanwhile, continues to build its already
impressive arsenal of breast screening tools with an array of recent
developments in mammography and emerging breast imaging options, such as
low-dose mammography and tomosynthesis.
Low dose mammography:
Addressing a growing concern
One of the leading
concerns in medical imaging among clinicians and patients is exposure to
radiation during imaging exams; and with women 40-years and older
receiving an annual mammogram, the call for low-dose mammography is
being met by industry leaders.
A study of breast radiation
exposure was recently published by the Irish Breast Screening Program.
The purpose of the study was to compare radiation dose to the breast per
exposure and per exam among the digital mammography systems of 3
leading vendors. The study concluded that Philips Healthcare’s MicroDose
low-dose mammography system had the lowest mean glandular dose per
image and per exam among the 3 vendors.3
Europe and Canada for several years, the MicroDose full field digital
mammography (FFDM) system, which Philips acquired from Sectra, made its
debut in the U.S. last April. MicroDose provides all the benefits of
existing digital mammography with greater resolution and up to a 40%
lower dose than that of competing technology, according to the company.
MicroDose system is the first to use photon-counting technology, a
patented technological revolution in x-ray detector development. The
individual x-ray photon is counted by a 50-micrometer detector element,
creating very low noise and eliminating analog to digital conversion.2
using a multi-slit pre-collimator and a matching multi-slit
post-collimator, only those x-rays perfectly aligned with the detector
are allowed to pass through the breast. All other x-rays are blocked;
and scatter radiation, which adds to patient dose and degrades image
quality, is minimized.
Raymond Tu, MD, chair of the radiology
Department at United Medical Center, Washington, DC, is an early adopter
of the system. The MicroDose system was installed at Dr. Tu’s facility
in August, providing his facility with the final component needed for
accreditation by the American College of Radiology (ACR), according to
“I chose Philips because they provided me with a turnkey
solution to completely overhaul my existing analog mammography program,”
said Dr. Tu, whose facility images an average of 10 breast screening
patients per day. “The MicroDose installation was very easy and the
engineers were lock step with me to guide our construction team through
Dr. Tu said the biggest advantage to MicroDose is
its low radiation dose. “Patient safety and ‘first do no harm’ are not
idle words,” he said. “I want to detect and cure breast cancer. But I
don’t want to cause cancer, either. All mammography machines have higher
dose than MicroDose. Low dose makes sense.”
Tomosynthesis adds another dimension
FFDM is the gold standard for screening for breast cancer, it may not
always be the imaging solution for women with dense breast tissue. With
conventional 2-dimensional (2D) mammography systems, overlapping breast
tissue can hide small cancers or cause normal areas to look suspicious.4
With this in mind, Connecticut pioneered a law in 2009 requiring
doctors to provide women with a breast density score after their
The introduction of 3-dimensional (3D) mammography,
or tomosynthesis, has played a key role in screening women with dense
breasts. Hologic’s Selenia Dimensions 3D mammography system is indicated
for diagnostic performance, with a one-touch control for seamless,
instantaneous transition between imaging modes: FFDM (2D imaging),
tomosynthesis (3D imaging), or “combo-mode” imaging (2D+3D imaging). The
latter feature quickly acquires a digital mammogram and a tomosynthesis
scan in the same compression (a screening exam consists of a digital
mammogram and breast tomosynthesis image set).
A study led by
Liane Philpotts, MD, Chief of Breast Imaging at the Yale University
School of Medicine, New Haven, CT, concluded that adding 3D to a
screening exam reduced recall rates by 40%.4
Hologic’s 3D technology, we can see the entire breast more clearly in
one millimeter slices,” said Dr. Philpotts. “This allows us to find
additional cancers earlier and also dismiss ambiguous spots that are
actually normal breast tissue.”
Good things come in small packages
standalone breast imaging centers are being challenged to upgrade their
systems and transition from analog to digital imaging on a limited
budget. FUJFILM Medical Systems (Stamford, CT) in March unveiled the
Aspire CRm FFDM system as a solution for smaller facilities.
the Aspire CRm, Fujifilm women’s health offering continues to expand to
provide options to facilities of all sizes,” David Hotchkiss, Director
of Modality Solutions Marketing at Fujifilm, explained in a statement
announcing the introduction. “Gone are the days of small facilities
having to sacrifice image quality or ease-of-use because a digital
solution was out of their price range. With the introduction of our
Aspire CRm, these facilities can now offer their patients the benefits
of digital mammography instead of losing these patients to neighboring
facilities who offer this technology. We provide both CR-and DR-based
FFDM systems in the U.S.”
The Aspire CRm eliminates film to
improve overall workflow while increasing daily productivity and offers
optimal image quality and improved dose efficiencies over analog
systems. Like the other systems in Fujifilm’s women’s imaging
technologies, the Aspire CRm provides radiologists with 50-micron
resolution. Additionally, it delivers Fujifilm’s legacy capture
technology that improves clarity, contrast, and exposure latitude as
compared to screen-film mammography.
- American Cancer Society: Cancer Facts and Figures 2012. Atlanta,
Ga: American Cancer Society, 2012. Last accessed January 6, 2012.
- Sectra OneScreen promotional brochure. Facts about Osteoporosis.
- Baldelli P, McCullagh J, Phelan, N, Flanagan F. Comprehensive dose survey of breast screening in Ireland. Radiation Protection Dosimetry. 2012;145:52-60.
- Philpotts L, Raghu M, Durand M, Hooley R, Vashi R, Horvath L, Geisel J, Butler R. Yale University School of Medicine. Initial Experience With Digital Breast Tomosynthesis in Screening Mammography. Presented May 3, 2012 at American Roentgen Ray Society Annual Meeting.