In the United States, breast cancer is the most commonly
diagnosed noncutaneous cancer among women, with approximately
213,000 new cases expected to be diagnosed this year alone.
Of these new cases, the American Cancer Society estimates that only
63% will be diagnosed at the localized stage when the survival rate
They further note that nearly 41,000 women will die of breast
cancer this year, making it second only to lung cancer in the
number of cancer deaths among women.
It is clear that early detection is the key to improving
survival rates and mammography remains the gold standard for the
detection of breast cancer. Until recently, all mammography was
film-based, but with the advent of digital mammography, clinicians
now have a choice of mammography systems.
This year, there has been a great deal of discussion about the
relative efficacy of the two types of mammography systems and, in
particular, on the findings of the American College of Radiology
Imaging Network (ACRIN) Digital Mammographic Imaging Screening
This 2-year study, involving more than 42,000 women, compared the
sensitivity and specificity of analog and digital mammography.
Overall, the authors reported no significant differences in the
accuracy of the two methods for detecting cancer. They did,
however, report that digital mammography has some advantages over
film-based mammography for certain subsets of women, particularly
younger women, those with heterogeneously dense or extremely dense
breasts, and women who are pre- or perimenopausal.
Some experts believe that these findings will spur more
widespread use of digital mammography, and many healthcare
facilities have begun to make the migration to digital technology
for their breast cancer screening and diagnosis. For these
facilities, the transition requires careful planning and
coordination between many shareholders, stretching well beyond the
borders of the radiology department to include PACS administrators,
information technology staff, facilities managers, clerical
supervisors, and others. Switching to or adding digital mammography
can have a significant impact on workflow, and healthcare
facilities must plan carefully before implementing such
Despite an increase in the use of digital mammography, in
clinical practice today, most mammograms are still performed on
analog systems-it is currently estimated that <10% of all
facilities have digital systems-and new technology is also
improving the quality of film-screen mammography.
One such development in analog mammography is a non-rotating
compression paddle that curves slightly, providing a downward slope
from the chest wall to the nipple, resulting in a more effective
spreading of the fibroglandular tissue. Another improvement is the
introduction of double-emulsion film and an improved intensifying
screen with smaller, more densely packed phosphor particles that is
designed to increase contrast and image sharpness in film-screen
Mammographic findings can be inconclusive at times, however, and
additional imaging methods are often used in the diagnostic workup.
One such adjunct method is breast-specific gamma imaging (BSGI), a
functional imaging technique designed to assess changes in tissue
function rather than in anatomic structure. BSGI, which is now part
of the standard clinical practice at some breast centers, allows
clinicians to detect functional changes in breast tissue, often
before the structural changes are visible on anatomic imaging.
As BSGI, breast magnetic resonance imaging, ultrasound, and
other techniques become more common in clinical breast imaging, the
workstations used to view these images must change as well. New
multimodality, vendor-neutral workstations allow clinicians to view
images from all acquisition modalities at a single workstation,
thereby increasing productivity and enhancing workflow.
Such innovations in technology are helping clinicians detect and
diagnose breast cancer at its earliest stage, thereby saving the
lives of countless women every year.