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2. Friends , In conformity with IEEE Vision To foster technological innovation and excellence for the benefit of humanity. I am going to deal with one of the most hazards and common ailments that the women are facing today. The problem is particularly acute and alarming among the rural and less literate women hood. Breast Cancer has now become a common ailment, the policy makers, Social Activists and people at medical profession are scratching there head to contain this dreadful disease. The age old adage says that precaution is better than prevention.2 3. Breast cancer is one of the significant causesof the mortality among women. Compared to other types of cancer, breastcancer (in women) has a higher mortality rate. Scientific investigations done in the past fewdecades do not specifically attribute causesfor the occurrence of breast cancer in women.Breast Cancer3 4. Continue .... However, there are many risk factors that are indicated as possibilities for the occurrence of breast cancer viz., age, previous medical history, early menstruation, late menopause, genetic predisposition, family history and changing life styles.Breast cancer is a malignant (cancerous) growth that begins in the fibro glandular tissue of the breast.Breast cancer is inclined towards gender specificity; more towards women and less towards men.4 5. BREAST CANCER IN THE WORLD1.15 million new casesIncidence increasing in most countries470 000 deathsHalf of the global burden in low- and medium-resourced countries5 6. 020406080100FIVE TEN TWENTYRELATIVE SURVIVAL RATESYEARSMINIMAL CARCINOMA NEGATIVE NODES POSITIVE NODES DISTANT METSBreast Cancer Survival6 7. Female Breast Anatomy Glandular Tissue7 8. The Human Breast is a well differentiated apocrine sweat gland which secretes milk during lactation. The two breast lie anterior to the right and left pectoral muscles, extending from sternum laterally to the mid auxiliary line.Virtually all breast cancers arise from the Glandular tissue.The Breast Anatomy8 9. Several studies suggests that women in whom ducts occupy 25% or more of breast volume or in whom fibroglandular density occupies more that 50% of breast volume may be at higher risk of breast cancer than average.Characteristic of breast cancer are masses, particularly ones with irregular or spiculated margin; clusters of micro calcifications; and architectural distortion of breast structures.The Breast Anatomy9 10. Breast Gland10Each breast has 15 to 20 sections (lobes) arranged like the petals of daisyInside each lobe are many smaller structures called lobulesAt the end of each lobule are tiny sacs (bulbs) that can produce milk 11. Ducts11Areola Lobes, lobules, and bulbs are Linked by a network of thin tubes (ducts) Ducts carry milk from bulbs toward dark area of skin in the center of the breast (areola) Ducts join together into larger ducts ending at the nipple, where milk is delivered 12. Blood Vessels12Oxygen, nutrients, and other life-sustaining nourishment are delivered to breast tissue by the blood in the arteries and capillaries. 13. Three Types of Vessels13Bacteria Blood VesselsCell life 2LymphNodes Lymph Vessels3 Milk LobulesDucts Nipple1 14. Signs and Symptoms14 Most common: lump or thickening in breast. Often painless Change in color or appearance of areola Redness or pitting of skin over the breast, like the skin of an orange Discharge or bleeding Change in size or contours of breast 15. Signs of Breast Cancer Masses Calcifications Bilateral Asymmetry Architectural Distortion (subtle, often missed)15 16. Masses Breast cancer causes adesmoplastic reaction inbreast tissueA mass is observed as a bright, hyper-dense object Mammogram with a mass16 17. Calcification Deposits of calcium in breast tissue Mammogram with Calcification 17 18. Bilateral Asymmetry Differences in the overall appearance of one breast with reference to the other 18 19. Architectural DistortionThird most common mammographic sign of nonpalpable breast cancerThe normal architecture of the breast is distortedNo definite mass visibleSpiculations radiating from a pointFocal retraction or distortion at the edge of the parenchyma Mammogram with Architectural Distortion 19 20. Accuracy of MammographyStage of Disease% detectionMammographyPhysical ExaminationMinimal CarcinomaNegative NodesPositive Nodes97929333517720 21. Breast Self Examination Clinical Breast Exam MammographyMethods of detection of breast cancer21 22. Breast Self Examination 22 23. Clinical Breast Exam 23 24. Mammography 24 25. Mammography An IntroductionMammography is a radiographic examination that is specially designed for detecting early breast cancer, yielding a significant improvement in breast cancer survival.Mammography has been used in clinical practice since 1927 in the diagnosis of breast abnormalities.In the late 1950s, the pioneering work of Gershon Cohen and Egan demonstrated that even clinically occult cancers of early detection of breast cancer by screening asymptotic women.25 26. Continue..Since the first mammography units (xeromammography and screen-film mammography in the 1970s) became available, both the equipment and the examination procedure have changed and progressed.A high degree of accuracy was developed with this technique to differentiate between Benign and Malignant disease. 26 27. At 40 and older mammography is used to screen for breast cancer in women without symptoms.Mammography is the most sensitive examination for detection of early breast cancers.At 40 and older Breast Self Examination and Clinical Breast Examination are used to detect breast cancers not seen on a mammogram because of technical limitations, interval tumor growth or breast cancers missed on the mammogram.Continue.. 27 28. Past Present ANALOGICAL TECHNOLOGY DIGITAL TECHNOLOGYScreeningClinical mammographyComputed radiography (CR)Digital directComputed Aided Diagnosis (CAD)Tomosynthesis - 3DCESMMammography 28 29. Analog MammographyIn analog mammography a screen film is used to capture the image. A low energy X-ray is focused on the breast and the breast is compressed. Automatic exposure control is provided to avoid unnecessary exposure to the patient.A screen film in the form of cassette is placed beneath the breast position. On the exposure of x-ray radiation the image is collected in the screen film.In screening mammography, two x-ray images of each breast, in the mediolateral oblique and craniocaudal views, are routinely acquired. 29 30. Constraints and Limitations of analog mammography Films provide benchmark quality images. However, lost, destroyed, poorly processed or misplaced films cause retakes and increases in patient radiation dose.Images on film cannot be further enhanced because film does not have separate processes for image capture and display.Unable to recognise the presence of micro calcifications which represent the most sensitive mammographic sign of early breast cancer .30 31. The film serves as an image acquisition detector , a storage mechanism and a display device , performing these several functions results in limitations such as poor contrast and defects in recapturing the image .Over exposure of X- ray results in dark images and under exposure of X- ray results in light images.Constraints and Limitations of analog mammography 31 32. 32 33. Digital MammographyIn a digital mammographic system the film/screen cassette is replaced by a chemical screen along with a digital detector which detect the x-ray photons leaving the breast. The chemical screen converts the x-ray photons into light which transferred through a fiber optical reducer to the CCD (Charged Couple Device) detector. The CCD converts the incident light into a digitized analogue signal and this signal is displayed on a computer monitor. The exposure is terminated when a sufficient signal to noise ratio is achieved. The most fertile territory for major advances in the detection and diagnosis of minimal breast cancers 33 34. Advantages of Digital MammographyImproved detection efficiencyA linear dynamic rangeIncreased signal-to-noise ratio (SNR)Excellent Image HandlingData in Digital formComputer Aided DetectionCompatibility with PACS and Telemammography34 35. In digital mammography screen-film system has been replaced by Detectors to give the digital images 35 36. Side by side 36 37. 37 38. Directed Digital Radiography (DDR)Directed digital radiography, aterm used to describe totalelectronic imaging capturing.Eliminates the need for an image plate altogether.38 39. 39 40. CR vs DRCRImaging plateProcessed in a Digital ReaderSignal sent to computerViewed on a monitorDRTransistor receiver (like bucky) Directly into digital signalseen immediately on monitor40 41. Computer-Aided DiagnosisMammography allows for efficient diagnosis of breast cancers at an earlier stageRadiologists misdiagnose 10-30% of the malignant casesOf the cases sent for surgical biopsy, only 10-20% are actually malignant41 CAD systems can assist radiologists to Reduce these problems 42. Database Approach to Computer-Aided Diagnosis 42 Content-based image retrieval techniques can provide radiologists visual aids to increase confidence in their diagnosis The database consists of a large number of images with verified pathology results Diagnosis is done by submitting the suspected mass region as a query to retrieve similar cases from the database 43. A Mammography CAD System [Giger et al.]43 Probability of malignancy Similar images of known diagnosis Indicates the unknown lesion relative to all lesions in the database 44. What do the potential technical advantages of digital mammography mean for radiologists, patients and institutions 44 45. Technical AdvantageFor radiologists, the advantages mean consistently better. Clinically, image quality is judged in terms of the adequacy of the portrayed normal anatomy and the ability to characterise detected lesions. Consistent improvement, even if minimal, in one or both of these areas means a decrease in the number of errors due to poor imaging technique and poor human judgment, as well as an increase in the efficiency and accuracy of mammography.45 46. Major improvement, however, is expected in cases where analog mammography is currently less successful. These cases include women with radiodense breasts who can comprise upto 40% of the general population, cases where lesions are located in thinner, less absorbing regions of the breast, and cases with inhomogeneous parenchymal density distributions.Technical Advantage 46 47. Technical developmentsFull Field Digital Mammography applicationsCADTomosynthesisCESM 47 48. Full-field digital mammography (FFDM)Recently approved by the U.S. Food and Drug Administration (FDA), this technique involves taking digital images of the breast. Digital images are captured electronically and can be viewed on a computer. Their magnification, brightness and contrast can be adjusted and enhanced to better reveal abnormalities. 48 49. DBT may improve cancer detection by mammography by enabling readers to detect lesions which are very difficult or impossible to visualize on conventional imaging due to overlying glandular tissueDigital Breast Tomosynthesis49 50. Digital Breast Tomosynthesis (DBT) L. Pescarini et al. Attualit in senologia; 2008Digital Breast Tomosynthesis50 51. Contrast Enhanced Digital MammographyDual Energy subtraction Digital Mammography (DEDM) Double exposure with iodine contrast and acquisition of two different images to "high" and "low" energyProperly choosing the two energies, you can basically "erase" the background and emphasize the contrast of the pathological structuresTemporal Subtraction51 52. Dual Energy subtraction Digital MammographyCourtesy of G.E.52 53. X-ray mammography Ultrasound Magnetic Resonance Imaging (MRI) Positron Emission Mammography (PEM)Screening Methods 53 54. Breast UltrasoundDiagnostic test for evaluation of mammographic and palpable abnormalities Can differentiate cystic from solid Characterize solid masses Evaluate the axilla for metastatic disease First exam for patients less than age 30Breast ultrasound is a noninvasive (the skin is not pierced) procedure used to assess the breasts. Ultrasound technology allows quick visualization of the breast tissue. Ultrasound may also be used to assess blood flow to areas inside the breasts. The examination is often used along with mammography.54 55. Breast UltrasoundScreening ultrasound No radiation, no compression 28% increase cancer detection over mammography aloneNot ready for widespread useLow specificity, higher cost, lack of availabilityLow sensitivity for calcifications of DCISA breast ultrasound uses sound waves to make a picture of the tissues inside the breast.A breast ultrasound can show all areas of the breast, including the area closest to the chest wall, which is hard to study with a mammogram.Breast ultrasound does not use X-rays or other potentially harmful types of radiation.55 56. Breast MRI Excellent tissue differentiation High sensitivity for breast cancer Not limited by breast density No ionizing radiation56Magnetic resonance imaging (MRI) is a diagnostic procedure that uses a combination of a large magnet, radio waves, and a computer to produce detailed images of organs and structures within the body. 57. Breast MRI ApplicationsImplant evaluationInconclusive mammography/ultrasoundCancer stagingResponse to chemotherapySearch for occult primary neoplasmCancer screening57 58. MRI Breast Cancer ScreeningWhy not everyone?ExpenseInvasive procedureContraindicated in some patientsLack of expertise and MRI availabilityLow specificity results in excess biopsies and additional follow-up58However, in the circumstance of both a negative mammogram and a negative physical examination, the probability of a breast cancer being diagnosed by MRI is extremely low.MRI sensitivity for invasive cancer approches 100%, but is only 60% at best for DCIS . 59. Positron Emission Mammography (PEM) PEM is an alternative for women who cannot tolerate MR imaging PEM has improved specificity compared with MR imaging and is therefore likely to prompt unnecessary biopsies Review of mammograms together with MR or PEM images, or both, improves the detection of additional diseaseImplications for patient care59 60. Positron Emission MammographyInjection of fluorodeoxyglucose (FDG)Cancers take up FDGHigh specificity but lower sensitivity than MRIHigh radiation dose and expense preclude use in routine screeningAssess extent of disease, response to treatment, evaluation for recurrence60 61. 61 62. Breast Computed TomographyLindfors KK, et al, Dedicated breast CT: initial clinical experience. Radiology 2008;246(3):725733.Good resolutionImproved patient comfort over mammographyHigher radiation dose, expense and lack of availability makes widespread use unlikely62 63. Nuclear medicine is a branch of radiology that involves administering small amounts of radioactive material (called radiopharmaceuticals or radiotracers) to a patient by injection, inhalation, or pill.Nuclear Medicine or scintimammography The radiopharmaceutical eventually accumulates in a particular organ or area of the body, where it gives off energy in the form of gamma rays. Nuclear medicine breast imaging (you may also hear the term molecular breast imaging) uses short-term radioactive agents that are given through an IV.63 64. Nuclear medicine breast imaging is a supplemental breast exam that may be used in some patients to investigate a breast abnormality. A nuclear medicine test is not a primary investigative tool for breast cancer but can be helpful in selected cases after diagnostic mammography has been performed.Limitations . . . Nuclear medicine breast imaging involves injecting a radioactive tracer (dye) into the patient. Since the dye accumulates differently in cancerous and non-cancerous tissues, scintimammography can help physicians determine whether cancer is present.64 65. Early Detection Is Your BEST PROTECTIONIf breast cancer is found and treated early, the five-year survival rate is 98 percent.The social prejudices and stigma associated in screening of breast is to be sensitized.The success of the scheme depends upon the involvement of radiologists and lab attendants who have to handle with delicate and humane.Another success of the scheme rests upon instead of bringing the people to lab, the lab itself has to go in search of the patient. For which a handy and portable mammogram has to developed for instant and hassle free Service. 65 66. Portable MammographyGE unveiled an impressive portable mammography concept as part of a portfolio of integrated technologies aimed at combating cancer.The SenoCase is mobile mammography system which can be folded and easily stored in a car boot.66 67. According to GE, such portability could remove geographical barriers to regular breast screening for many women on a global scale.The system could also be more cost effective than conventional mammography systems, making it more accessible to smaller practices and clinics.A standard field of view Cesium Iodide detectorSimilar image quality to a full-field digital mammography systemA user-friendly interface, operable by a single clinician67 68. Digital Portable Mammography model was preferred in employee surveys. Employee feedback confirmed that Women Diagnostic Center mammograms are more convenient, private and familiar because employees feel more comfortable. 68 69. Digital mammography has proven to be an essential tool in the diagnosis, treatment and fight against breast cancer. And studies have shown that routine mammograms can help reduce breast cancer mortality.The important thing is that you make annual mammography screening a top priority for yourself and the women you care about. 69 70. 70