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Book Details
Abstract
The use of tomosynthesis in breast imaging is growing rapidly due to its superior ability to identify and characterize normal findings, benign lesions, and breast cancer, as well as its optimal performance with dense breast tissue. Providing unparalleled coverage of this breakthrough breast imaging modality, Breast Tomosynthesis explains how this new modality can lead to enhanced interpretation and better patient outcomes. This new reference is an indispensable guide for today's practitioner looking to keep abreast of the latest developments with correlative findings, practical interpretation tips, physics, and information on how tomosynthesis differs from conventional 2D FFDM mammography. Over 900 high-quality images offer visual guidance to effectively reading and interpreting this key imaging modality.
- Includes over 900 high-quality tomosynthesis and mammography images representing the spectrum of breast imaging.
- Features the latest Breast Imaging Reporting and Data System (or BI-RADS) standards updated in February 2014.
- Highlights practical tips to interpreting this new modality and how it differs from 2D mammography.
- Details how integration of tomosynthesis drastically changes lesion work-up and overall workflow in the department.
- "Tomo Tips" boxes offer tips and pitfalls for expert clinical guidance.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| BREAST TOMOSYNTHESIS | i | ||
| BREAST TOMOSYNTHESIS | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Foreword | vii | ||
| Preface | x | ||
| Contents | xi | ||
| 1 - Introduction | 1 | ||
| 2 - Physics and Development of Breast Tomosynthesis | 5 | ||
| Development of Tomosynthesis | 5 | ||
| System Design | 7 | ||
| Acquisition Angle | 7 | ||
| Number of Projection Images | 7 | ||
| X-Ray Source Motion | 8 | ||
| Acquisition Time | 8 | ||
| Radiation Dose | 8 | ||
| Breast Compression | 8 | ||
| Imaging Views | 8 | ||
| Synthetic Mammograms | 8 | ||
| Summary | 8 | ||
| 3 - The Technologist’s Perspective | 9 | ||
| Training | 9 | ||
| Radiation Exposure | 9 | ||
| Performing the Tomosynthesis Mammogram | 10 | ||
| Additional Views | 10 | ||
| Artifacts | 12 | ||
| Skin and Positioning Related Artifacts | 12 | ||
| Slinky Artifact | 13 | ||
| Motion Artifact | 14 | ||
| Additional Tomosynthesis Artifacts | 15 | ||
| Tomosynthesis Quality Control | 16 | ||
| Conclusion | 17 | ||
| 4 - Implementation of Digital Breast Tomosynthesis Into Clinical Practice | 18 | ||
| Introduction | 18 | ||
| Tomosynthesis Equipment | 18 | ||
| Early Research With Tomosynthesis | 18 | ||
| Implementation Considerations | 18 | ||
| Preparation | 18 | ||
| Information Technology, Picture Archiving, and Communication System and Workstation Requirements | 19 | ||
| Hanging Protocols | 19 | ||
| Radiologist and Technologist Considerations | 19 | ||
| Tomosynthesis Biopsy Capabilities | 20 | ||
| Dose Considerations | 21 | ||
| Community Outreach | 22 | ||
| Hybrid Conversion: Things to Consider | 22 | ||
| Summary | 25 | ||
| 5 - Tomosynthesis in Screening Mammography | 26 | ||
| How to Read Screening Mammograms With Tomosynthesis | 26 | ||
| How Is Tomosynthesis Reducing Recall Rates? | 26 | ||
| Technical Issues | 27 | ||
| Asymmetry | 27 | ||
| Calcifications | 28 | ||
| Mass | 31 | ||
| How Is Tomosynthesis Increasing Cancer Detection? | 31 | ||
| Architectural Distortion | 31 | ||
| Masses | 34 | ||
| Calcifications | 34 | ||
| Asymmetries | 34 | ||
| Using Synthesized (Two-Dimensional) Mammograms | 36 | ||
| Challenges to Tomosynthesis Screening | 36 | ||
| Computer-Aided Detection: To Use or Not To Use? | 38 | ||
| Downstream Effects of Tomosynthesis in Screening Mammography | 38 | ||
| Tomosynthesis Screening in Women With Dense Tissue | 38 | ||
| Summary | 38 | ||
| 6 - Tomosynthesis in Diagnostic Mammography | 39 | ||
| Changes in Diagnostic Environment and Outcomes | 39 | ||
| Abbreviated Diagnostic Work-Up | 39 | ||
| Improved Accuracy and Shift in Use of BI-RADS Assessment Categories | 39 | ||
| Single-View–Only Lesions | 44 | ||
| Two-Dimensional Screening Recall: Should the Study Be Repeated With Tomosynthesis? | 44 | ||
| Second Look After Magnetic Resonance Imaging | 46 | ||
| Tomosynthesis-Detected Lesions With No Ultrasound Correlate | 46 | ||
| Architectural Distortion | 47 | ||
| Focal Asymmetry | 49 | ||
| Microcalcifications | 49 | ||
| Nipple Discharge | 54 | ||
| Breast Pain | 54 | ||
| Summary | 55 | ||
| 7 - Tomosynthesis Interpretation Tips and Pitfalls | 56 | ||
| Interpretation Tips | 56 | ||
| Tomosynthesis Case Review | 56 | ||
| Localization Tips | 62 | ||
| Assessing Focal Findings | 63 | ||
| Pitfalls | 64 | ||
| Pseudolesions | 64 | ||
| Fat-Containing Lesions | 69 | ||
| Tomo-Occult Cancers | 69 | ||
| Summary | 73 | ||
| 8 - Benign Findings | 74 | ||
| Introduction | 74 | ||
| What Constitutes a Benign Appearance? | 74 | ||
| Asymmetries | 75 | ||
| Masses | 76 | ||
| Cysts | 77 | ||
| Fibroadenomas | 77 | ||
| Phyllodes Tumor | 77 | ||
| Fat-Containing Lesions | 81 | ||
| Lymph Nodes | 81 | ||
| Lipomas and Hamartomas | 82 | ||
| Galactocele and Lactational Changes | 82 | ||
| Abscess | 84 | ||
| Seromas and Hematomas | 84 | ||
| Architectural Distortion | 86 | ||
| Calcifications | 86 | ||
| Characterizing Benign Findings by Multimodality Work-Up | 86 | ||
| Summary | 87 | ||
| 9 - Malignant Findings | 88 | ||
| Multifocal and Multicentric Cancer | 96 | ||
| Advanced Breast Cancer | 99 | ||
| Metastases | 99 | ||
| Summary | 99 | ||
| 10 - Architectural Distortion | 100 | ||
| Tomosynthesis Features of Architectural Distortion | 100 | ||
| Architectural Distortion | 100 | ||
| Pathology of Architectural Distortion | 101 | ||
| Diagnostic Work-up of Architectural Distortion | 104 | ||
| The Role of Ultrasound | 109 | ||
| The Role of Magnetic Resonance Imaging | 110 | ||
| Management of Architectural Distortion | 111 | ||
| Potential Pitfalls/Complications | 112 | ||
| Conclusion | 114 | ||
| 11 - Integrating Tomosynthesis With Multimodality Imaging | 115 | ||
| Assessment of Tomosynthesis Findings | 115 | ||
| Targeted Ultrasound to Assess Tomosynthesis Findings | 115 | ||
| Tomosynthesis and Evaluation of Extent of Disease | 120 | ||
| Contrast-Enhanced Breast Magnetic Resonance Imaging to Assess Tomosynthesis Findings | 120 | ||
| Second-Look Tomosynthesis for Ultrasound or Magnetic Resonance Imaging Findings | 121 | ||
| Correlating Ultrasound Findings With Tomosynthesis | 122 | ||
| Correlating Magnetic Resonance Findings With Tomosynthesis | 125 | ||
| Evaluation of Incidental Breast Lesions Seen on Chest Computed Tomography | 128 | ||
| Patients Presenting With Metastatic Disease: How Tomosynthesis and Other Modalities Can Help | 129 | ||
| Summary | 132 | ||
| 12 - The Postoperative Breast | 133 | ||
| General Postoperative Assessment Tips | 133 | ||
| Needle Biopsy | 141 | ||
| Surgical Biopsy | 142 | ||
| Reduction Mammoplasty | 143 | ||
| Augmentation | 144 | ||
| Lumpectomy | 145 | ||
| Radiation Therapy | 146 | ||
| Post-Mastectomy Reconstruction | 148 | ||
| Recurrence | 148 | ||
| Specimen Radiography | 148 | ||
| Summary | 151 | ||
| 13 - Tomosynthesis in the Male Breast | 152 | ||
| Imaging the Male Patient | 152 | ||
| Gynecomastia | 152 | ||
| Breast Cancer | 157 | ||
| Other Findings on Tomosynthesis | 162 | ||
| Summary | 166 | ||
| 14 - Interventional Procedures | 167 | ||
| Advantages of Tomosynthesis-Guided Biopsy | 167 | ||
| Calcifications | 167 | ||
| Cost Effectiveness | 167 | ||
| Patient Access | 173 | ||
| Workflow | 176 | ||
| Limitations of Tomosynthesis-Guided Biopsy | 176 | ||
| Procedure | 176 | ||
| Tomosynthesis-Guided Wire and Seed Localizations | 176 | ||
| Conclusion | 180 | ||
| Video Case Studies | 181 | ||
| Chapter 1 | 181 | ||
| Chapter 3 | 183 | ||
| Chapter 5 | 185 | ||
| Chapter 6 | 191 | ||
| Chapter 7 | 201 | ||
| Chapter 8 | 208 | ||
| Chapter 9 | 213 | ||
| Chapter 10 | 219 | ||
| Chapter 11 | 228 | ||
| Chapter 12 | 234 | ||
| Chapter 13 | 239 | ||
| Selected Readings | 243 | ||
| Index | 247 | ||
| A | 247 | ||
| B | 247 | ||
| C | 248 | ||
| D | 248 | ||
| E | 248 | ||
| F | 248 | ||
| G | 249 | ||
| H | 249 | ||
| I | 249 | ||
| L | 249 | ||
| M | 249 | ||
| N | 249 | ||
| O | 250 | ||
| P | 250 | ||
| Q | 250 | ||
| R | 250 | ||
| S | 250 | ||
| T | 250 | ||
| U | 251 | ||
| V | 251 | ||
| W | 251 | ||
| X | 251 |