Digital Mammography: A Holistic Approach

Foreword
Preface
Terminology
Acknowledgements
Contents
Editors and Contributors
About the Editors
Contributors
Abbreviations
Part I
1: Optimising Breast Screen Reading Efficacy
Introduction
Impact of Screening on Survival and Mortality Rates
Diagnostic Efficacy
Conclusion
Appendix
References
2: Screening Programmes for Breast Cancer
Introduction
Mammography Screening
Other Imaging Modalities That May Have Value in Screening for Breast Cancer
Magnetic Resonance Imaging (MRI) Screening
Ultrasound Screening
Appendix
References
3: Breast Anatomy
Introduction
Embryology and Development
Macroscopic and Microscopic Anatomy
Macroscopic Anatomy
Microscopic Anatomy
Arterial Supply
Venous Drainage
Innervation
Lymphatic Drainage
Pregnancy and Lactation
Involution
Appendix
References
4: Breast Density and Influencing Factors
Breast Structure
Breast Density Classification
Drawbacks of Categorisations
The Significance of Sensitivity
Factors Influencing Breast Density
Age
Pregnancy and Lactation
Hormonal Status
Body Mass Index
Lifestyle Factors
Physical Activity
Alcohol
Malignant and Benign Breast Change
Summary
Appendix
References
5: Mammographic Density
Introduction
Measuring Mammographic Density
Subjective Classification
Semi-Automated Methods
Automated Methods
Area-Based Measures
Volumetric Measures
Appendix
References
6: Aetiology and Epidemiology of Breast Cancer
Introduction
How Common Is Breast Cancer?
Lifetime Risk (Females)
Risk Factors for Breast Cancer
Biological Risk
Gender
Age
Endogenous Factors
Breast Density
Reproductive Factors
Hereditary Factors
Family History
Genetic Factors
Personal History of Breast Cancer
Previous Benign Breast Disease
Breast Carcinoma In Situ
Obesity
Post-Menopausal
Pre-Menopausal
Vitamin D
Medical Conditions
Behavioural Risk
Parity
Having Children
Maternal Age
Breastfeeding
Hormonal Contraceptives
Hormone Replacement Therapy (HRT)
Alcohol Consumption
Coffee Consumption
Diet
Physical Activity
Smoking
Medications
Social Risk
Socio-Economic Factors
Night Work and Sleep Duration
Physical Risk
Medical Radiation Exposure
Radiotherapy
Hodgkins Lymphoma
Prior Radiotherapy for Breast Cancer
Diagnostic Radiology
Passive Smoking
Endocrine-Disrupting Chemicals (EDCs)
Appendix
References
7: Breast Diseases
Introduction
Cysts
Fibroadenoma
Phyllodes Tumours
Haemangioma
Gynaecomastia
Schwannoma
Hamartoma
Lipoma
Pseudoangiomatous Stromal Hyperplasia (PASH)
Galactocele
Haematoma
Papilloma
Amyloid Tumour
Mastitis/Abscess
Puerperal
Non-puerperal
Breast Metastases
Breast Lymphoma
Breast Sarcoma
Duct Ectasia
Radial Scar/Complex Sclerosing Lesion
Fat Necrosis
Surgical Scar
Calcifications
Benign Calcification
Benign Breast Changes
Atypia
LCIS
DCIS
Paget’s
Appendix
References
8: Signs and Symptoms of Breast Cancer with Management Pathways
Summary
Clinical Signs and Symptoms
Locations and Types of Cancers Within the Breast
Breast Density
The Axilla
Referrals
Triple Assessment
Further Imaging
The Multi-Disciplinary Team
Overview
Appendix
References
9: Disease Progression
Introduction
The Influence of Genes
The Mutated Cell
Hallmarks of Cancer
Establishing the Tumour
Local Invasion
Metastasizing
Breast Cancer
Atypia and In Situ Disease
Invasive Tumour
Regional Nodes
Metastatic Spread
Appendix
References
10: Interval Cancers
Why and How Are Interval Cancers Reviewed?
How Common Are Interval Cancers?
Mammographic Review and Classification of Interval Cancers
Feedback to Women with Interval Cancers and Duty of Candour
Factors Associated with Higher Rates of Interval Cancers
Mammographic Features of Interval Cancers
Biology and Prognosis of Interval Cancers
Appendix
References
Part II
11: Patient Diary
Background: Professional and Family Context
Finding a Lump
How Do I Feel?
Support for Breast Cancer
Appendix
12: Psychological Considerations When Attending for Mammography Screening
Recent Context
What Can Psychology Offer?
Perceptions of Risk and Pain
From the Health Beliefs Model to COM-B
The Role of Negative Psychological Factors and Practical Barriers
Conclusions
Appendix
References
13: Managing Anxiety in Mammography: The Client and the Practitioner
Introduction
Client Anxiety
What Is Anxiety?
Precursors for Anxiety
Staff Interactions
Pain and Discomfort
Waiting
Fear
Physical Environment
How Practitioners Can Decrease Client Anxiety
Staff Interactions
Pain and Discomfort
Waiting and Fear
Physical Environment
Practitioner Anxiety
The Role of Anxiety
Burnout
Errors
Challenging Situations
Result Disclosure
How to Decrease Anxiety in Mammographers?
Burnout
Mindfulness Techniques
Step 1
Next Steps
How to Do This
Stress Management Techniques
Errors
Challenging Situations
Result Disclosure
Future Considerations
Appendix
References
14: Client-Practitioner Interactions Within Breast Care Services
Introduction
The Breast Screening Experience
Practitioner Strategies
Compression Techniques
Client Anxieties
Client Engagement
The Breast Clinic Experience
Client Interventions
Interventional Procedures
Difficult Client Conversations
Improving Re-attendance
Delivering Results
Appendix
References
15: Digital Health Technologies
The Concept of Digital Health for Promoting Health
Using Social Media for Health Promotion
Using Social Media in Breast Screening and Symptomatic Contexts
Using Social Media to Communicate with Clients
Using Social Media for Continuing Professional Development
What’s Next? Blue Sky Thinking
Pre-examination
Appointment
During the Examination
Post examination
The UK NHS App
Summary
Appendix
References
16: Pain and Discomfort in Mammography
Introduction
Defining, Describing, and Measuring Pain
The Extent and Importance of the Problem of Pain in Mammography
Factors Associated with Pain in Mammography
Interventions to Minimise Pain in Mammography
Summary
Appendix
References
17: Tissue Viability and Skin Tearing in Mammography
Introduction
Recording Information
Case Studies
Case Study 1 (Fig. 17.1)
Case Study 2 (Fig. 17.2)
Case Study 3
Risks of Mammography to the Skin
Anatomy and Physiology of the Skin
Defining Skin Tears and Pressure Ulcers
Where Do They Occur?
Predisposing Risk Factors
Prevention of Tearing and Ulceration from Mammography
Pressure Ulcer and Skin Tear Classification Systems
Skin Tears
Intertrigo
Management and Other Considerations
Appendix
References
Part III
18: Mammography Equipment
Introduction
The Mammographic X-Ray Unit
The Mammographic X-Ray Spectrum
Compression Paddle Design
Magnification Compression Paddle
Biopsy Compression Paddle
Digital Mammographic Image Receptors
General Features of Digital Mammographic Images
The Direct Digital Detector: Amorphous Selenium
The Indirect Digital Detector: Scintillator and Amorphous Silicon
Legacy Devices
The Automatic Exposure Control System
Optimisation of Digital Mammography
Display Devices
The DICOM Greyscale Standard Display Function
Display Tools
Windowing
Spatial Frequency Filtering
Quality Control of Display Devices
Digital Breast Tomosynthesis
Image Acquisition
Reconstruction
Image Interpretation
Radiation Dose for Tomosynthesis
Synthetic Mammograms
Dedicated Breast CT
Contrast-Enhanced Spectral Mammography
Appendix
References
19: Artificial intelligence (AI) in Mammography
Introduction
Background
Computing Architecture and Patient Data Are Both Vital for AI Development
Process of Training a Model
Datasets used in AI Development
Analysis of System Performance
Definitions of Cancer Cases
Current Performance
Possible Use Cases
Reader Assist
Independent Reader
Stratified Screening
Triage and Workflow
Problem of Interpretability
Quality Assurance and Monitoring
Conclusion
Appendix
References
20: Radiation Dose in Mammography
Introduction
Biological Effects of Radiation
Radiation Protection in Mammography
Mammography Dosimetry
Mean Glandular Dose (MGD)
Target/Filter Combination
X-ray Tube Output
Breast Density (Glandularity)
Breast Size (Compressed Breast Thickness)
MGD Estimation
MGD Estimation for Digital Breast Tomosynthesis (DBT)
Mammography: Dose to Organs Other than the Examined Breast
Appendix
References
21: Image Quality, System Optimisation and Quality Control
Introduction
Image Quality Parameters
Contrast Resolution
Inherent Contrast
Image Contrast
Spatial Resolution
Unsharpness
Noise
Quality Control and Implications for Justification and Optimisation
Processes for Quality Assurance and Quality Control
Acceptance Testing and Commissioning
Baseline Measurements and Acceptable Ranges
Regular Quality Control
Quality Control Tests
Tests for Acquisition Systems
X-Ray Tube and Generator
Tests for Detection Systems
Alignment of X-Ray Field to Optical Field
Compression Force and Thickness Accuracy
Signal Transfer Function
Automatic Exposure Control System (AEC)
Detector Uniformity and Artefacts
Procedures and Materials
Frequency
Expected Results
Test to Evaluate Image Retention (Ghosting)
Image Quality Assessment Using Phantoms
TORMAM (Assessment of Low Contrast Detail)
Appendix
References
22: Automated Assessment of Breast Positioning in Mammography Screening
Introduction
Assessment of Breast Positioning in Current Clinical Practice
Automated Breast Positioning
Integration of Automated Breast Positioning into Clinical Practice
Summary
Appendix
References
23: Radiographic Service Quality
Introduction
Why Do Practitioners Require Service Quality Standards?
How Do Practitioners Ensure They Are Working to the Required Standards?
Technical Repeats (TP) and Technical Recall (TC)
Reasons for Repeat Images
Peer Review
QA Role and Visits
Auditing Clinical Practice
Continuous Professional Development (CPD)
Appendix
References
Part IV
24: Recording Clinical and Client Information
Initial Client Contact
Previous Imaging
History Taking
Appendix
References
25: Infection Control
Introduction
Principles of Prevention and Control
Pandemic
Responsibilities
National policy
Organisation
Healthcare Professional
Practicalities of Prevention and Control
Preventative Tasks
Hand Hygiene
Personal Protective Equipment
Safe Management of Equipment
Safe Management of Care Environment
Safe Management of Linen
Safe Management of Blood and Body Fluid Spillages
Safe Disposal of Waste (Including Sharps)
Compliance and Governance Monitoring and Audit
Infection Control Issues Specific to Mammography
Routes of Infection
Under Breast Soreness: Intertrigo
Appendix
References
26: Repetitive Strain Injury
Introduction
The Risks of Musculoskeletal Disorder
Equipment Considerations
The Column/Gantry
Easy Height Adjustment of Equipment
Motorised Compression
Acquisition Workstation
Room Design
Staff Rotation and Working Patterns
Positioning Considerations
Conclusion
Appendix
References
27: Practical Mammography
Contextual Use
Effective Compression Force Application
Compression Force and Pressure
Achieving Compression Balance
Cranio-Caudal (CC) View: A Step by Step Guide
Medio-Lateral (MLO) View: A Step by Step Guide
Checklists
Appendix
References
28: Mammographic Compression: A Need for Mechanical Standardisation
Introduction
The Mechanics of Compression
Mammographic Monitoring Software
Methods
Results
Discussion
Conclusion
Implementation of Mechanical Standardisation; Pressure-Assisted Compression
Appendix
References
29: Supplementary Projections
Introduction
Lateral Images: Mediolateral Approach
Contextual Use
Positioning Technique
Lateral Images: Lateromedial Approach
Contextual Use
Positioning Technique
Laterally Extended Cranio Caudal Projection
Contextual Use
Region Demonstrated
Positioning Technique
Medially Extended Craniocaudal Projection
Contextual Use
Region Demonstrated
Positioning Technique
Mediolateral Axillary Tail Projection
Contextual Use
Region Demonstrated
Positioning Technique
Extended Craniocaudal (Cleopatra) Projection
Contextual Use
Region Demonstrated
Positioning Technique
Digital Breast Tomosynthesis
Contextual Use
Region Demonstrated
Equipment
Positioning Technique
Cleavage Projection
Contextual Use
Region Demonstrated
Positioning Technique
Nipple in Profile Projection
Contextual Use
Region Demonstrated
Positioning Technique
Inverted Craniocaudal Projection
Contextual Use
Region Demonstrated
Positioning Technique
Projections Using Skin Markers to Localise Skin Lesions/Tangential View
Contextual Use
Region Demonstrated
Positioning Technique
Rolled Projection
Contextual Use
Region Demonstrated
Positioning Technique
Appendix
References
30: Magnification and Compression Views
Introduction
Magnification Views
Coned Compression Views
Mammographic Technique
Case Studies
Case A: Paddle Views
Case B: Magnification Views
Appendix
References
31: Specimen Imaging
Introduction
Types of Specimen Imaging and Reporting
Biopsy Specimen Imaging
Surgical Excision Specimen Imaging
Fixed Pathology Specimen Imaging
Appendix
References
32: Imaging the Augmented Breast
Introduction
Consideration for Practitioners
Visual Observation of the Breasts
Mammographic Imaging
Breast Implant Placement
Subglandular Placement
Subpectoral Placement
Implant Displacement: Eklund Views
Implant Complications
Realistic Client Expectations
Injectable Enhancements
Breast Awareness
Training and Education
Conclusion
Appendix
References
33: Imaging the Male Breast
Overview
Mammography
Gynaecomastia
Ductal Carcinoma In Situ (DCIS)
Invasive Carcinoma
International Male Breast Cancer Program
Appendix
References
34: Imaging Bariatric, Post-Surgical and Limited Mobility
Introduction
Bariatric Imaging
Imaging Bariatric Clients with Larger Breasts
Imaging Bariatric Clients with Smaller Breasts
Post-surgical Imaging
Imaging Clients with Limited Mobility
Seated Imaging
Appendix
References
35: Imaging Persons Living with Dementia
Introduction
Dementia: Statistics and Symptoms
Environment
Communication Adaptations
Carer and Care Partner Integration
Justification and Consent
Pre-appointment Adaptations
Contextual Barriers and Training
Summary
Useful Resources and Websites for Further Information
Appendix
References
36: Stereotactic Image Guided and Tomosynthesis Guided Interventional Techniques
Introduction
3D Perception
Digital Breast Tomosynthesis (DBT) Guided Biopsy
Procedure
Stereotactic Core Biopsy
Explanation of the Procedure
Client and Breast Positioning
Technique
Vacuum Assisted Biopsy (VAB)
Pre-Operative Needle Localisation
Radio-Guided Occult Lesion Localisation (ROLL)
Magnetic Seed Localisation
LOCalizer™: Tag Applicator System (Hologic©)
Appendix
References
37: Digital Breast Tomosynthesis
Introduction
Equipment
Image Acquisition
Image Processing
Screening
Diagnostic Evaluation
Compression
Quality Control (QC) Performed by the Practitioner
DBT Procedures
Appendix
References
38: Contrast Enhanced Investigations
Introduction
Basic Principle of Contrast Mammography Technique
Temporal Subtraction Technique
Bilateral Dual-Energy Technique
Contrast Agent Administration
Contrast Agent Side Effects
Contrast Medium Nephrotoxicity
Interaction with the Thyroid Gland
Allergic Reactions
Extravasation
Common Side Effects and Reactions
Clinical Applications
Conclusion
Appendix
References
Index