Breast Imaging

Breast imaging includes imaging modalities used for breast cancer screenings and planning therapy once cancer is detected. Mammography is the primary modality used. Mammogram technology is moving from 2D full-field digital mammography (FFDM) to breast tomosynthesis, or 3D mammography, which helps reduce false positive exams by allowing radiologists to look through the layers of tissue. Overlapping areas of dense breast tissue on 2D mammograms appear similar to cancers and 3D tomo helps determine if suspect areas are cancer or not. About 50% of women have dense breast tissue, which appears white on mammograms, the same as cancers, making diagnosis difficult. Radiologists use the Breast Imaging Reporting and Data System (BI-RADS) scoring system to define the density of breast tissue. Many states now require patients to be notified if they have dense breasts so they understand their mammograms might be suboptimal and they should use supplemental imaging that can see through the dense areas. This includes tomosythesis, breast ultrasound, automated breast ultrasound (ABUS), breast MRI, contrast enhanced mammography and nuclear imaging, including positron emission mammography (PEM).

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An example of commercially available artificial intelligence (AI) automated grading of breast density on mammograms from the vendor Densitas..

VIDEO: Role of AI in breast imaging with radiomics, detection of breast density and lesions

Connie Lehman, MD, chief of breast imaging, co-director of the Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital, discusses how artificial intelligence (AI) is being implemented in breast imaging.

Example of a cancer that is difficult to see in dense breast tissue, but can be seen easier using 3D mammography digital breast tomosynthesis (DBT) breast imaging because the radiologist can go through the breast layer by layer if tissue..

VIDEO: The rapid adoption of 3D mammography and use of AI to address dense breasts

Stamatia Destounis, MD, a radiologist and managing partner at Elizabeth Wende Breast Care in Rochester, New York, chair of the American College of Radiology (ACR) Breast Commission, explains the rapid adoption of 3D mammogram digital breast tomosynthesis (DBT) technology.
 

Society of Breast Imaging (SBI) President John Lewin, MD, explains some of new initiatives and technology in mammography to increase earlier breast cancer detection. #SBI #breastimaging #mammography

VIDEO: SBI president outlines trends in breast imaging

Society of Breast Imaging President John Lewin, MD, explains some of the new initiatives and technology in mammography that are designed to increase early breast cancer detection.

Interview with Stamatia Destounis, MD, FACR, a radiologist and managing partner at Elizabeth Wende Breast Care in Rochester, New York, chair of the American College of Radiology (ACR) Breast Commission, serves on the Public Information Advisors Committee for Radiological Society of North America (RSNA) and on the Society of Breast Imaging (SBI) Communication Committee. She discusses post-COVID economic issues facing breast imaging centers, including the "great resignation" and lower reimbursements.

VIDEO: Issues with the great resignation and lower reimbursements in breast imaging

Stamatia Destounis, MD, FACR, a radiologist and managing partner at Elizabeth Wende Breast Care in Rochester, New York, and chair of the ACR Breast Commission, discusses post-COVID-19 economic issues facing breast imaging centers, including staffing problems from the "Great Resignation" and lower reimbursements. 

Example of the four types of breast tissue density. The density of fibroglandular tissue inside the breast impacts the ability to easily see cancers. Cancers are very easy to spot in fatty breasts, but are almost impossible to find in extremely dense breasts. These examples show craniocaudal mammogram findings characterized as almost entirely fatty (far left), scattered areas of fibroglandular density (second from left), heterogeneously dense (second from right), and extremely dense (far right). RSNA

Breast density notification laws blanket 90% of U.S. women, yet still no national reporting standard is at hand. Why is that?

Dense breast experts Wendie Berg, MD, and JoAnn Pushkin, executive director of DenseBreast-info Inc., explain the current status of breast density patient inform laws, reimbursement and new technologies to aid cancer detection. 

Illustration of the four types of breast tissue densities. The more dense, the harder it is for radiologists to detect cancers, which had led to about 40 states to now require notiofication of patients if they have dense breasts and the impact on their care, with possible miss-reads and that they may need supplemental imaging.

VIDEO: What is the impact of breast density notification laws?

Society of Breast Imaging (SBI) President John Lewin, MD, discusses how legislation concerning breast density notifications has impacted mammography.

black woman breast cancer pink ribbon

Disparities in breast cancer detection and care persist, despite a drop in mortality, new ACS report reveals

While Black women have lower incidence of breast cancer diagnosis, their mortality rates are 40% higher than those observed in white women.  

A slice from a tomosynthesis 3D mammography mammogram. Image courtesy of Mass General

VIDEO: 3D mammography is becoming the standard-of-care in breast imaging

Society of Breast Imaging (SBI) President John Lewin, MD, explains breast tomosynthesis has already become the default standard in mammography today. 

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