MAMMOMAT Revelation Tomosynthesis Unique Feature Training for Radiologists

MAMMOMAT Revelation with Tomosynthesis Unique Feature Training for Radiologists   You should now be able to:   List the unique features of the Siemens MAMMOMAT Revelation with Tomosynthesis option   Describe the Multiple Reader Multiple Case (MRMC) study conducted by Siemens prior to FDA approval   Identify the indications for Tomosynthesis use   Summarize the Quality Control procedures required for Tomosynthesis    Recognize the cautions when utilizing Tomosynthesis Upon completing this course, the physician will be able to: Understand the unique features of the Siemens MAMMOMAT Revelation with Tomosynthesis option   Review the MRMC study conducted by Siemens prior to FDA approval   Identify the indications for Tomosynthesis use along with the advantages of wide angle scanning   Summarize the Quality Control procedures required for Tomosynthesis   Recognize the cautions when utilizing Tomosynthesis In this section, we will discuss the technical features of the MAMMOMAT Revelation with Tomosynthesis Option including labeling, acquisition characteristics, and reconstruction specifications. MAMMOMAT Revelation with Tomosynthesis option   Detector Material: Amorphous Selenium Same type of detector utilized by Hologic GE utilizes an Amorphous Silicon detector   50 degree Acquisition of 25 projections* Siemens acquires its tomo sweep over a 50 degree angle obtaining 25 projection images during the scan Every 2 degrees an image is taken   This is different from other Tomo vendors Hologic: 15 degree angle with 15 projection images GE: 25 degree angle with 9 projection images   Siemens has the WIDEST angle allowing for more separation of tissue and optimum depth resolution *The projection images are acquired at an extremely low dose and should NOT be used for diagnosis -25 degrees to + 25 degrees for CC The tube completes a sweep from -25 to + 25 in the cranial caudal view.   Any 50 degree angle for MLOs When acquiring the MLO view the technologist may choose the necessary angle per patient body habitus and the unit will perform the scan and take the images from that point. Average glandular dose for a 40-49 mm breast thickness is approximately 2.0 mGy per Siemens clinical study which is within ACR guidelines. Continuous Tube Movement Hologic: continuous sweep GE: step and shoot It takes approximately 25 seconds to acquire 1 tomo scan due to the 50 degree angle and 25 projection images   W/Rh anode filter combination used for ALL breast thicknesses GRID is used for 2D and retracted for 3D Same as Hologic GE utilizes grid for 2D and 3D Multiple compression plates – Reconstruction and spatial resolution do NOT depend on the compression plate used Empowered by our 50 degree angle, EMPIRE Technology is a unique combination of iterative and machine learning algorithms that reconstruct images with unparalleled clarity in both contrast and detail. Enhanced edges of masses, calcifications, and spiculations Reduces artifacts Increases sharpness Equalizes tissue density Faster processing time 2D pixel size/ pitch : 85 Micron By acquiring 25 projection views, Siemens does NOT have to utilize pixel binning Same spatial resolution for 2D and 3D = 85 Micron Hologic utilizes binning Depending on paddle size, spatial resolution = 97 – 117 Micron GE no pixel binning Overall lower detector spatial resolution for 2D and 3D  = 100 Micron   Reconstructed Voxels .085mm x .085mm x 1mm  A voxel is simply the 3D equivalent of a pixel Smallest distinguishable element of a 3D object Reconstructed Slice Thickness 1 MM separated by 1MM Siemens takes the 25 projection images and utilizes the filtered back projection to reconstruct 1 mm slices of tissue Every patient will have the same # of projections Every patient will have a different # of reconstructed slices depending on compression thickness, compression plate, and compression force   The Multiple Reader Multiple Case (MRMC) study was performed by Siemens in order to examine radiologists' accuracy in detecting and diagnosing cancers when reading 3D as an adjunct to 2D.  The following pages will present the findings of this study. Siemens Conducted a MRMC study prior to FDA Tomosynthesis submission. Data Collection from 7 US clinical sites 22 Readers with varying experience levels 300 Cases selected for the study (50 Cancers, 85 Benign, & 165 Negative) Key finding ALL readers improved accuracy in detecting and diagnosing cancers when reading 3D as an adjunct to 2D.   Study proved when using tomo in addition to 2D on average: Diagnostic accuracy increased Cancer detection rate increased Identification of malignant lesions  increased Non cancer recall and patient recall rate both declined Reader sensitivity increased Overall superiority for all breast densities was shown when compared to 2D FFDM alone The MAMMOMAT Revelation with Tomosynthesis Option is indicated for 2D and 3D digital mammography images to be used in screening and diagnosis of breast cancer. A screening exam may consist of a: 2D FFDM image set 3D DBT image set and 2D FFDM image set 3D DBT image set alone   Test Annually Daily  1. Average Glandular dose MP    2. Geometric accuracy in X and Y direction and Z-resolution MP    3. Radiation field MP    4. System Imaging Quality MP T - only the test with tube head at 0º   5. Artifact Detection MP   MP = Medical Physicist T = Technologist   Before conducting quality control tests for tomosynthesis, make sure that the screening quality control tests have been performed without errors.   The technologist must also peform a quarterly tomo calibration. Breast implants Use caution when imaging implants Adjust compression and system parameter settings accordingly If the swivel arm stops during exposure Release the exposure button and compression of patient Making measurements Do NOT use projection images or slices to perform critical measurements Assure the correct projection view is assigned to the correct image Ensures accurate reporting and diagnosis Avoid Injury Ensure patient is properly positioned and head is back away from face shield as this moves during exposure   Please follow the instructions below to print your Certificate of Completion Return to the list of courses Just below the "Launch" button for this course, you should now see a "Print Certificate" button Click the "Print Certificate" button. You can Open the certificate, or save it to your system   In this section we will be presenting multiple tomosynthesis case studies. Please take your time in reviewing these case studies and proceed through the knowledge checks as requested.  This is a 48 year old woman who presents with a palpable lumb in her left breast upper outer quadrant. Select the links below to review the bilateral FFDM and tomosynthesis images.                           Right CC 2D & 3D Right CC 2D & 3D   Left CC 2D & 3D Left CC 2D & 3D   Right MLO 2D & 3D Right MLO 2D & 3D   Left MLO 2D & 3D Left MLO 2D & 3D   This is a 79 year old female who presented for a screening mammogram.                       Right CC 2D & 3D Right CC 2D & 3D     Left CC 2D & 3D Left CC 2D & 3D        Right MLO 2D & 3D Right MLO 2D & 3D   Left MLO 2D & 3D Left MLO 2D & 3D     This is a 79 year old woman who presented for a screening mammogram. Review the bilateral FFDM and tomosynthesis images.                   Right CC 2D & 3D Right CC 2D & 3D     Left CC 2D & 3D Left CC 2D & 3D     Right MLO 2D & 3D Right MLO 2D & 3D   Left MLO 2D & 3D Left MLO 2D & 3D     This is a 69 year old woman who had a previous left lumpectomy 15 years ago, treated with radiation and chemotherapy she presents for her annual mammogram.                          Right CC 2D & 3D Right CC 2D & 3D   Left CC 2D & 3D Left CC 2D & 3D   Right MLO 2D & 3D Right MLO 2D & 3D   Left MLO 2D & 3D Left MLO 2D & 3D   This is a 56 year old woman who presents for a screening mammogram.  Select the links below to review the bilateral FFDM and tomosynthesis images. This study does not include any right tomo images.                     Right CC 2D Right CC 2D   Left CC 2D & 3D Left CC 2D & 3D   Right MLO 2D Right MLO 2D   Left MLO 2D & 3D Left MLO 2D & 3D   This is a 50 year old woman who presents for a screening mammogram. Her mother was diagnosed with breast cancer in her late 70's.                  Right CC 2D & 3D Right CC 2D & 3D   Left CC 2D & 3D Left CC 2D & 3D   Right MLO 2D & 3D Right MLO 2D & 3D   Left MLO 2D & 3D Left MLO 2D & 3D   This is a 64 year old female who presents for a screening mammogram. She has a family history of breast cancer with a sister diagnosed at age 48.                 Right CC 2D & 3D Right CC 2D & 3D   Left CC 2D & 3D Left CC 2D & 3D   Right MLO 2D & 3D Right MLO 2D & 3D   Left MLO 2D & 3D Left MLO 2D & 3D   This is a 61 year old female who presents for a screening mammography. There is a family history of breast cancer in her aunt, cousin and mother.                   Right CC 2D & 3D Right CC 2D & 3D   Left CC 2D & 3D Left CC 2D & 3D   Right MLO 2D & 3D Right MLO 2D & 3D   Left MLO 2D & 3D Left MLO 2D & 3D   This is a 66 year old female who presented for a screening mammogram.                   Right CC 2D & 3D Right CC 2D & 3D   Left CC 2D & 3D Left CC 2D & 3D   Right MLO 2D & 3D Right MLO 2D & 3D   Left MLO 2D & 3D Left MLO 2D & 3D   This is a 47 year old woman presenting for a screening mammogram.  She has a family history of her mother and several aunts having breast cancer. Note: Tomosynthesis images are not available for this case, but representative slices will be used in the knowledge check section                  Right CC Right CC   Left CC Left CC   Right MLO Right MLO   Left MLO Left MLO   Siemens offers EMPIRE technology, which is Enhanced Multiple Parameter Iterative Reconstruction.                  Reduces noice and artifact, improving the the display of  microcalcifations and their morphology along with improved skin-line visualization.                                                        EMPIRE technology is iterative analysis in all directions to distinguish anatomic structures from noise. Insight Technology is available with 2D and 3D imaging.                                                 Can be used as a navigational with digital breast tomosynthesis.                         Ideal for an easy comparison with prior FFDM and tomosynthesis exams.                                                    MALMO study European study of appoximately 15,000 women which investigated the potential of using a one view tomo image as a stand alone screening modality. The outcomes which were investigated included: recall rate positive predictive rate cancel detection rate                 At Siemens we are always looking at ways to make the patient more comfortable which is why we offer mood lighting and slim ergonomic design.                                                                                                          Soft comp paddles allow for higher patient comfort and easier positioning due to the soft edges and breast-optimized shape.                                                                                                                  HD Breast Biopsy with Inspect Image quality will be the same Target findings you detected in tomosynthesis Rely on target accuracy of +/-1mm based on wide angle technology                                                                                           Inspect Insert Holder (Specimen Cup) Used to produce specimen image with the biopsy unit and a compressed breast.     Insight BD calculates sets of breast density values consisting of: Vfg: Volumetric of fibroglandular tissues [cm3] Vb: Volume of whole breast [cm3] Vbd: Volumetric breast density [5]=vfg/vb DGI: Density Grade Index [a-d] Insight BD works for standard MLO and CC views (not on ML, implants or TiCEM) Work for FFDM and tomosynthesis (middle projection is used) Density informaton is visible for tomo only in first and last view.    Case Study 1 Summary:                                                 This case illustrates the ability to clearly see calcifications on the tomosynthesis slices. Final pathology revealed invasive ductal carcinoma with ductal carcinoma in situ.                                             Case Study 2 Summary: This case illustrates the increased conspicuity of lesions with wide angle tomosynthesis.   Case Study Summary 3: Final pathology revealed invasive ductal carcinoma. Case Study 5 Summary: Final pathology revealed two areas of invasive ductal carcinoma with a metastic lymph node. This case illustrates the ability to see multiple lesions and their relationships in the breast. Case Study 10 Summary: This case illustrates the wide-angle imaging which allows lesions to be seen through the dense tissue. Final pathology revealed invasive ductal carcinoma.   Case Study 7 Summary: Digital breast tomosynthesis allows small lesions to be appreciated as well as additional lesions.   Case Study 9 Summary: This case illustrates the ability to sample small lesions seen only with tomosynthesis. Final pathology revealed invasive ductal carcinoma. Case Study 6 Summary: This case illustrates the decreased artifact from the previous biopsy clip in addition to the small irregular lesion.  Final pathology revealed invasive ductal carcinoma and ductal carcinoma in situ. Case Study 4 Summary: This case illustrates the change in architecture with wide angle tomosynthesis. We are also able to ensure that only scar tissue is seen in the contralateral breast. Final pathology revealed ductal carcinoma in situ. Case Study 8 Summary: This case illustrates the ability to see small areas of distortion on tomosynthesis. Final pathology revealed invasive ductal carcinoma.