| 1. |
- Andersson, Ingvar, et al.
(författare)
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Breast tomosynthesis and digital mammography: a comparison of breast cancer visibility and BIRADS classification in a population of cancers with subtle mammographic findings.
- 2008
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Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 18, s. 2817-2825
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Tidskriftsartikel (refereegranskat)abstract
- The main purpose was to compare breast cancer visibility in one-view breast tomosynthesis (BT) to cancer visibility in one- or two-view digital mammography (DM). Thirty-six patients were selected on the basis of subtle signs of breast cancer on DM. One-view BT was performed with the same compression angle as the DM image in which the finding was least/not visible. On BT, 25 projections images were acquired over an angular range of 50 degrees, with double the dose of one-view DM. Two expert breast imagers classified one- and two-view DM, and BT findings for cancer visibility and BIRADS cancer probability in a non-blinded consensus study. Forty breast cancers were found in 37 breasts. The cancers were rated more visible on BT compared to one-view and two-view DM in 22 and 11 cases, respectively, (p < 0.01 for both comparisons). Comparing one-view DM to one-view BT, 21 patients were upgraded on BIRADS classification (p < 0.01). Comparing two-view DM to one-view BT, 12 patients were upgraded on BIRADS classification (p < 0.01). The results indicate that the cancer visibility on BT is superior to DM, which suggests that BT may have a higher sensitivity for breast cancer detection.
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| 2. |
- Boita, Joana, et al.
(författare)
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Development and content validity evaluation of a candidate instrument to assess image quality in digital mammography : A mixed-method study
- 2021
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Ingår i: European Journal of Radiology. - : Elsevier BV. - 0720-048X. ; 134
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To develop a candidate instrument to assess image quality in digital mammography, by identifying clinically relevant features in images that are affected by lower image quality. Methods: Interviews with fifteen expert breast radiologists from five countries were conducted and analysed by using adapted directed content analysis. During these interviews, 45 mammographic cases, containing 44 lesions (30 cancers, 14 benign findings), and 5 normal cases, were shown with varying image quality. The interviews were performed to identify the structures from breast tissue and lesions relevant for image interpretation, and to investigate how image quality affected the visibility of those structures. The interview findings were used to develop tentative items, which were evaluated in terms of wording, understandability, and ambiguity with expert breast radiologists. The relevance of the tentative items was evaluated using the content validity index (CVI) and modified kappa index (k*). Results: Twelve content areas, representing the content of image quality in digital mammography, emerged from the interviews and were converted into 29 tentative items. Fourteen of these items demonstrated excellent CVI ≥ 0.78 (k* > 0.74), one showed good CVI < 0.78 (0.60 ≤ k* ≤ 0.74), while fourteen were of fair or poor CVI < 0.78 (k* ≤ 0.59). In total, nine items were deleted and five were revised or combined resulting in 18 items. Conclusions: By following a mixed-method methodology, a candidate instrument was developed that may be used to characterise the clinically-relevant impact that image quality variations can have on digital mammography.
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| 3. |
- Boita, Joana, et al.
(författare)
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How does image quality affect radiologists’ perceived ability for image interpretation and lesion detection in digital mammography?
- 2021
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Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 31:7, s. 5335-5343
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To study how radiologists’ perceived ability to interpret digital mammography (DM) images is affected by decreases in image quality. Methods: One view from 45 DM cases (including 30 cancers) was degraded to six levels each of two acquisition-related issues (lower spatial resolution and increased quantum noise) and three post-processing-related issues (lower and higher contrast and increased correlated noise) seen during clinical evaluation of DM systems. The images were shown to fifteen breast screening radiologists from five countries. Aware of lesion location, the radiologists selected the most-degraded mammogram (indexed from 1 (reference) to 7 (most degraded)) they still felt was acceptable for interpretation. The median selected index, per degradation type, was calculated separately for calcification and soft tissue (including normal) cases. Using the two-sided, non-parametric Mann-Whitney test, the median indices for each case and degradation type were compared. Results: Radiologists were not tolerant to increases (medians: 1.5 (calcifications) and 2 (soft tissue)) or decreases (median: 2, for both types) in contrast, but were more tolerant to correlated noise (median: 3, for both types). Increases in quantum noise were tolerated more for calcifications than for soft tissue cases (medians: 3 vs. 4, p = 0.02). Spatial resolution losses were considered less acceptable for calcification detection than for soft tissue cases (medians: 3.5 vs. 5, p = 0.001). Conclusions: Perceived ability of radiologists for image interpretation in DM was affected not only by image acquisition-related issues but also by image post-processing issues, and some of those issues affected calcification cases more than soft tissue cases. Key Points: • Lower spatial resolution and increased quantum noise affected the radiologists’ perceived ability to interpret calcification cases more than soft tissue lesion or normal cases. • Post-acquisition image processing-related effects, not only image acquisition-related effects, also impact the perceived ability of radiologists to interpret images and detect lesions. • In addition to current practices, post-acquisition image processing-related effects need to also be considered during the testing and evaluation of digital mammography systems.
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| 4. |
- Boita, Joana, et al.
(författare)
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Validation of a candidate instrument to assess image quality in digital mammography using ROC analysis
- 2021
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Ingår i: European Journal of Radiology. - : Elsevier BV. - 1872-7727 .- 0720-048X. ; 139
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTo validate a candidate instrument, to be used by different professionals to assess image quality in digital mammography (DM), against detection performance results.MethodsA receiver operating characteristics (ROC) study was conducted to assess the detection performance in DM images with four different image quality levels due to different quality issues. Fourteen expert breast radiologists from five countries assessed a set of 80 DM cases, containing 60 lesions (40 cancers, 20 benign findings) and 20 normal cases. A visual grading analysis (VGA) study using a previously-described candidate instrument was conducted to evaluate a subset of 25 of the images used in the ROC study. Eight radiologists that had participated in the ROC study, and seven expert breast-imaging physicists, evaluated this subset. The VGA score (VGAS) and the ROC and visual grading characteristics (VGC) areas under the curve (AUCROC and AUCVGC) were compared.ResultsNo large differences in image quality among the four levels were detected by either ROC or VGA studies. However, the ranking of the four levels was consistent: level 1 (partial AUCROC: 0.070, VGAS: 6.77) performed better than levels 2 (0.066, 6.15), 3 (0.061, 5.82), and 4 (0.062, 5.37). Similarity between radiologists’ and physicists’ assessments was found (average VGAS difference of 10 %).ConclusionsThe results from the candidate instrument were found to correlate with those from ROC analysis, when used by either observer group. Therefore, it may be used by different professionals, such as radiologists, radiographers, and physicists, to assess clinically-relevant image quality variations in DM.
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| 5. |
- Dustler, Magnus, et al.
(författare)
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Realism of mammography tissue patches simulated using perlin noise : A forced choice reading study
- 2021
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Ingår i: Medical Imaging 2021 : Physics of Medical Imaging - Physics of Medical Imaging. - : SPIE. - 1605-7422. - 9781510640191 ; 11595
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Konferensbidrag (refereegranskat)abstract
- Software breast phantoms are central to the optimization of breast imaging, where in many cases the use of real images would be inefficient - or impossible. Establishing the realism of such phantoms is critical. For this study, patches of simulated breast tissue with different composition - fatty, scattered, heterogenous and dense tissue - were generated using a method based on Perlin noise. The composition of the patches is controlled by numerical parameters derived from input by radiologists and medical physicists with experience of breast imaging. Separate Perlin noise-based methods were used to simulate skin pores, high-frequency noise (representing quantum and electronic noise) and ligaments and vascular structures. In a forced choice reading study, the realism of the simulated tissue patches compared to patches from real mammograms was determined. Patches of 200-500 pixels were extracted from radiolucent, linear, nodular or homogenous (10 per category) mammograms randomly selected from a previously acquired dataset. Eighteen simulated patches in the same size range were added. Four readers, two radiologists and two medical physicists were shown the images in random order and asked to rate them as real or simulated. All readers accepted a substantial fraction of simulated images as real, ranging from 22% to 72%. Only two readers showed a significant difference in the number of images rated real in the real and simulated groups, 22% vs 73% (P=.0003) and 33% vs 63% (P=.04), respectively. These results suggest that the method employed can create images that are almost indistinguishable from patches of real mammograms.
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| 6. |
- Hibar, Derrek P., et al.
(författare)
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Novel genetic loci associated with hippocampal volume
- 2017
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- The hippocampal formation is a brain structure integrally involved in episodic memory, spatial navigation, cognition and stress responsiveness. Structural abnormalities in hippocampal volume and shape are found in several common neuropsychiatric disorders. To identify the genetic underpinnings of hippocampal structure here we perform a genome-wide association study (GWAS) of 33,536 individuals and discover six independent loci significantly associated with hippocampal volume, four of them novel. Of the novel loci, three lie within genes (ASTN2, DPP4 and MAST4) and one is found 200 kb upstream of SHH. A hippocampal subfield analysis shows that a locus within the MSRB3 gene shows evidence of a localized effect along the dentate gyrus, subiculum, CA1 and fissure. Further, we show that genetic variants associated with decreased hippocampal volume are also associated with increased risk for Alzheimer's disease (r(g) = -0.155). Our findings suggest novel biological pathways through which human genetic variation influences hippocampal volume and risk for neuropsychiatric illness.
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| 7. |
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| 8. |
- Johnson, Kristin, et al.
(författare)
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Interval breast cancer rates and tumor characteristics in the prospective population-based Malmö breast tomosynthesis screening trial
- 2021
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Ingår i: Radiology. - : Radiological Society of North America (RSNA). - 0033-8419 .- 1527-1315. ; 299:3, s. 559-567
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Tidskriftsartikel (refereegranskat)abstract
- Background: Interval cancer rates can be used to evaluate whether screening with digital breast tomosynthesis (DBT) contributes to a screening benefit. Purpose: To compare interval cancer rates and tumor characteristics in DBT screening to those in a contemporary population screened with digital mammography (DM). Materials and Methods: The prospective population-based Malmö Breast Tomosynthesis Screening Trial (MBTST) was designed to compare one-view DBT to two-view DM in breast cancer detection. The interval cancer rates and cancer characteristics in the MBTST were compared with an age-matched contemporary control group, screened with two-view DM at the same center. Conditional logistic regression was used for data analysis. Results: There were 14 848 women who were screened with DBT and DM in the MBTST between January 2010 and February 2015. The trial women were matched with two women of the same age and screening occasion at DM screening during the same period. Matches for 13 369 trial women (mean age, 56 years ± 10 [standard deviation]) were found with 26 738 women in the control group (mean age, 56 years ± 10). The interval cancer rate in the MBTST was 1.6 per 1000 screened women (21 of 13 369; 95% CI: 1.0, 2.4) compared with 2.8 per 1000 screened women in the control group (76 of 26 738 [95% CI: 2.2, 3.6]; conditional odds ratio, 0.6 [95% CI: 0.3, 0.9]; P = .02). The invasive interval cancers in the MBTST and in the control group showed in general high Ki-67 (63% [12 of 19] and 75% [54 of 72]), and low proportions of luminal A–like subtype (26% [five of 19] and 17% [12 of 72]), respectively. Conclusion: The reduced interval cancer rate after screening with digital breast tomosynthesis compared with a contemporary age-matched control group screened with digital mammography might translate into screening benefits. Interval cancers in the trial generally had nonfavorable characteristics.
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| 9. |
- Johnson, Kristin, et al.
(författare)
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Interval Cancers in a Large, Prospective Breast Tomosynthesis Screening Trial
- 2018
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Konferensbidrag (refereegranskat)abstract
- PURPOSETo assess interval cancer rate in a large, prospective digital breast tomosynthesis (DBT) screening trial in comparison with a concurrent screening population and to assess tumor characteristics of interval cancers in DBT-screening.METHOD AND MATERIALSThe prospective ****Trial, comparing digital breast tomosynthesis (DBT) with digital mammography (DM) in 14,848 women has shown a significantly increased sensitivity with DBT. Interval cancer rate in the trial was compared with a concurrent screening population; i.e. women participating in DM screening at the same screening site during the same time period (2010-15, n=100,273 screens). Interval cancers and concurrent screens were identified through linkage with the Radiology Information System, the **Cancer Registry and the National Quality Register Breast Cancer. Confidence intervals (CI) 95 % were calculated for rates and difference between rates. Tumor characteristics were retrieved from pathology reports and invasive cancers classified according to St Gallen subtypes.RESULTSIn total, there were 22 interval cancers in the ****Trial. The interval cancer rate was 1.5 per 1000 screens [22/14,848] (95% CI 0.9-2.2) in the ****Trial and 1.8 per 1000 screens [179/100,273] (95% CI 1.5-2.1) in the concurrent population. Although the interval cancer rate was lower in the trial, the difference of 0.3 was not statistically significant (95 % CI -0.5-0.9). Among the interval cancers in the ****Trial, the mean cancer size was 17 mm (range 2-37 mm), 2 were DCIS (grade 2 and 3), 5 luminal A-like, 9 luminal B-like HER2-, 2 luminal B-like HER2+ and 4 triple negative.CONCLUSIONThe slightly lower interval cancer rate in the trial might indicate that DBT-screening leads to the detection of clinically relevant cancers. Still, a relatively large proportion of the interval cancers had unfavorable prognostic characteristics.
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| 10. |
- Kang, Bong Joo, et al.
(författare)
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Rim Sign in Breast Lesions on Diffusion-Weighted Magnetic Resonance Imaging: Diagnostic Accuracy and Clinical Usefulness
- 2015
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Ingår i: Journal of Magnetic Resonance Imaging. - : Wiley. - 1522-2586 .- 1053-1807. ; 41:3, s. 616-623
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Tidskriftsartikel (refereegranskat)abstract
- PurposeTo investigate the diagnostic accuracy and clinical usefulness of the rim sign in breast lesions observed in diffusion-weighted magnetic resonance imaging (DWI). Materials and MethodsThe magnetic resonance imaging (MRI) findings of 98 pathologically confirmed lesions (62 malignant and 36 benign) in 84 patients were included. Five breast radiologists were asked to independently review the breast MRI results, to grade the degree of high peripheral signal, the rim sign, in the DWI, and to confirm the mean apparent diffusion coefficient (ADC(mean)) values. We analyzed the diagnostic accuracy and compared the consensus (when 4 of 5 independent reviewers agreed) results of the rim sign with the ADC(mean) values. Additionally, we evaluated the correlation between the dynamic contrast-enhanced (DCE)-MRI morphologic appearance and DWI rim sign. ResultsAccording to the consensus results, the rim sign in DWI was observed on 59.7% of malignant lesions and 19.4% of benign lesions. The sensitivity, specificity, and area under the curve (AUC) value for the rim sign in DWI were 59.7%, 80.6%, and 0.701, respectively. The sensitivity, specificity, and AUC value for the ADC(mean) value (criteria 1.46 x 10(-3) mm(2)/sec) were 82.3%, 63.9%, and 0.731, respectively. Based on consensus, no correlation was observed between the DCE-MRI and DWI rim signs. ConclusionIn DWI, a high-signal rim is a valuable morphological feature for improving specificity in DWI. J. Magn. Reson. Imaging 2015;41:616-623. (c) 2014 Wiley Periodicals, Inc.
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| 11. |
- Tingberg, Anders, et al.
(författare)
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BIRADS classification in breast tomosynthesis compared to mammography and ultrasonography
- 2008
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Ingår i: Digital Mammography, Proceedings. - Berlin, Heidelberg : Springer Berlin Heidelberg. - 1611-3349 .- 0302-9743. - 9783540705376 ; 5116, s. 67-73
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Konferensbidrag (refereegranskat)abstract
- This paper presents the Malmo Breast tomosynthesis project The tomosynthesis equipment is described as well as the patient selection and image acquisition. Special fucus is given to one of the studies of the project, which is a comparison of the diagnostic performance between breast tomosynthesis (BT), digital mammography (DM) and ultrasonography (US): tumor classification according to the BIRADS system was performed on 40 cancers imaged with DM, US and BT. The patients were selected on the basis of subtle signs of breast cancer on DM or negative findings on the basis of subtle signs of breast cancer on DM or negative findings on DM but suspicious lesions on US. The BIRADS scores based on the BT images were significantly higher than 1-view DM and 2-view DM, and equal 2-view DM, and equal to 2-view plus US. The results suggest that BT may be a suitable technique for breast cancer screening.
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