Advances in Breast Imaging - Introduction to Titanium Contrast Enhanced Mammography (TiCEM) Online Training

Continue Continue Welcome 5 Introduction to Titanium Contrast Enhanced Mammography (TiCEM) Online Training This training module covers the use of TiCEM in clinical practice and validates individual experiences based on the available clinical evidence. Completion time: 65 min. Introduction to TiCEM 1 Indications 3 Clinical Experiences 2 Master Template HOOD05162003052540 | Effective Date: 26-Nov-2019 Welcome Srechertext: Welcome to our Web-based training “Advances in Breast Imaging.” The fifth module, “Introduction to titanium contrast-enhanced mammography (TiCEM),” introduces this new technology that is becoming established in the clinical routine. Prof. Dr. Luis Pina from Pamplona, Spain, and Dr. Maria Bernathova from Vienna, Austria, are among the first TiCEM users, and they’ve conducted the first clinical studies of TiCEM at their university hospitals. Drawing on their clinical experience and intensive literature reviews, the two experts give a comprehensive presentation of TiCEM and discuss its merits. Introduction to TiCEM #1 Prof. Dr. Luis Pina Clínica Universidad de Navarra Pamplona, Spain Introduction to TiCEM #1 06-1_TiCEM_01_Intro-to-lecture_NEU_aus_CEM_03.mp4 Introduction to TiCEM #2 Dr. Maria Bernathova Medical University of Vienna, Austria Introduction to TiCEM #2 06-2_TiCEM_01-Intro-to-lecture_Bernathova_NEU_aus_TiCEM_01.mp4 Clinical Experiences TiCEM vs. FFDM Prof. Dr. Luis Pina Clínica Universidad de Navarra Pamplona, Spain TiCEM vs. FFDM 06-1_TiCEM_02_TiCEM-vs-FFDM_NEU_aus_CEM_03.mp4 CEM vs. Breast MRI Dr. Maria Bernathova Medical University of Vienna, Austria CEM vs. Breast MRI 06-2_TiCEM_02-CEM-vs-Breast-MRI_Bernathova_aus_TiCEM_02.mp4 Opportunities and Limitations Dr. Maria Bernathova Medical University of Vienna, Austria Opportunities and Limitations 06-2_TiCEM_02-Opportunities-and-Limitations_Bernathova_aus_TiCEM_03.mp4 CEM results in more false-positive findings. CEM has a faster wash-out than Breast MRI, so there’s often not enough time to acquire all the necessary images. MRI offers significantly higher specificity than mammography and CEM. CEM has been found to have a higher positive predictive value (PPV) and a lower false-positive rate (FP) compared to Breast MRI. Which of the following statements about Contrast-Enhanced Mammography (CEM) is correct? Knowledge Check Select the best answer. Knowledge Check Correct Incorrect The solution is: CEM has been found to have a higher positive predictive value (PPV) and a lower false-positive rate (FP) compared to Breast MRI. Incorrect The solution is: CEM has been found to have a higher positive predictive value (PPV) and a lower false-positive rate (FP) compared to Breast MRI. Correct The solution is: CEM has been found to have a higher positive predictive value (PPV) and a lower false-positive rate (FP) compared to Breast MRI. Explanation of the Correct Answer Continue Contrast Enhanced Mammography (CEM) has been found to have a higher positive predictive value (PPV) and a lower false-positive rate (FP) compared to Breast MRI. Explanation of the Correct Answer Indications Indications and Advantages #1 Dr. Maria Bernathova Medical University of Vienna, Austria Indications and Advantages #1 06-2_TiCEM_03-Indications-and-Advantages_Bernathova_aus_TiCEM_03.mp4 Indications and Advantages #2 Prof. Dr. Luis Pina Clínica Universidad de Navarra Pamplona, Spain Indications and Advantages #2 06-1_TiCEM_03-Indications-and-Advantages_Pina_NEU_aus_CEM_03.mp4 Breast cancer detection in dense breasts. Local staging of breast cancer/measuring the extent of the disease. Assessment of response to NAC. Assessment of clusters of microcalcifications. What is not an indication for Contrast Enhanced Mammography (CEM)? Knowledge Check Select the best answer. Assessment of scars after conservative treatment. Knowledge Check Correct Incorrect The solution is: Assessment of clusters of microcalcifications. Incorrect The solution is: Assessment of clusters of microcalcifications. Incorrect The solution is: Assessment of clusters of microcalcifications. Incorrect The solution is: Assessment of clusters of microcalcifications. Explanation of the Correct Answer Continue A MAG view is the gold-standard diagnostic workup for evaluating clusters of microcalcifications. Explanation of the Correct Answer Case Discussions TiCEM vs. FFDM/DBT and Breast MRI Select the steps below or the images on the right to watch the case discussions. 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 6 6 6 7 7 7 8 8 8 Case discussions 1806_siemens_xp_academy_pina_no_audience_case_15.mp4 1806_siemens_xp_academy_pina_no_audience_case_10.mp4 1806_siemens_xp_academy_pina_no_audience_case_02.mp4 1806_siemens_xp_academy_pina_no_audience_case_12.mp4 1806_siemens_xp_academy_pina_no_audience_case_04.mp4 1806_siemens_xp_academy_pina_no_audience_case_08.mp4 1806_siemens_xp_academy_pina_no_audience_case_03.mp4 1806_siemens_xp_academy_pina_no_audience_case_13.mp4 Case Discussion 8 IDC and DCIS in a dense breast (US) Case Discussion 7 IDC in a heterogeneously dense breast (MRI) Case Discussion 6 IDC in a scattered breast (MRI) Case Discussion 5 ILC in a fatty breast (MRI) Case Discussion 4 IDC and DCIS in a dense breast (DBT) Case Discussion 3 IDC in a heterogeneously dense breast (DBT) Case Discussion 2 IDC in a scattered breast (DBT) Case Discussion IDC and DCIS in a fatty breast (DBT) 1 Conclusion Conclusion #1 Dr. Maria Bernathova Medical University of Vienna, Austria Conclusion #1 06-2_TiCEM_04-Conclusion_Bernathova_NEU_aus_TiCEM_03.mp4 Conclusion #2 Prof. Dr. Luis Pina Clínica Universidad de Navarra Pamplona, Spain Conclusion #2 06-1_TiCEM_04_Conclusion-2_Pina_NEU_aus_CEM_04.mp4 DBT’s domain are spiculated masses and distortions. CEM’s domain are aggressively growing cancers (neoangiogenesis). DBT is a morphological technique and CEM is a morpho-functional technique. DBT has no limitations in dense breasts. Which statement comparing DBT with CEM is wrong? Knowledge Check Select the best answer. CEM is mainly used in diagnostic setting. Knowledge Check Correct Incorrect The solution is: DBT has no limitations in dense breasts. Incorrect The solution is: DBT has no limitations in dense breasts. Incorrect The solution is: DBT has no limitations in dense breasts. Incorrect The solution is: DBT has no limitations in dense breasts. Explanation of the Correct Answer Continue As a morphological technique, DBT needs a minimal attenuation difference in order to separate lesions from the surrounding tissue (less than FFDM), while CEM highlights lesions based on contrast medium uptake (neoangiogenesis). Explanation of the Correct Answer Course Review Indications for CEM CEM compared to Breast MRI CEM compared to DBT and FFDM Course Review Here is a brief summary of the content covered in this training. Please select a topic to access the related information. 1 1 1 2 2 2 3 3 3 Course Review Indications for CEM Problem-solving in cases where conventional mammography, ultrasound, and/or DBT are inconclusive Staging of newly diagnosed breast cancer Evaluating response to neoadjuvant chemotherapy Scar vs. recurrence after conservative treatment CEM compared to Breast MRI CEM has slightly lower sensitivity but higher specificity than MRI. Advantages of MRI Able to image chest wall and entire axilla Lower risk of acute contrast reaction No ionizing radiation No compression Can perform MR-guided biopsy Advantages of TiCEM Lower equipment cost Shorter examination time CEM examination includes standard FFDM (able to detect calcifications) No MR imaging-specific contraindications: claustrophobia, implanted metal, pacemakers, etc. No gadolinium deposition in the brain (side-effects still unknown) CEM compared to DBT and FFDM DBT Morphological technique Screening and diagnostic setting Can be used for all patients Total room time of less than 10 minutes No puncture or contrast media needed Very good for spiculated masses and distortions Limitations with very dense breasts TiCEM Morpho-functional technique Primarily in diagnostic setting Only for selected patients Total room time of less than 30 minutes I.v. iodinated contrast media Better for aggressive cancers (neoangiogenesis) Almost no limitations with dense breasts Following the market introduction in 2009, several clinical studies on Digital Breast Tomosynthesis have proven the value of this technique for breast imaging. For a list of Siemens Healthineers-related reference studies shown in this WBT, please download the PDF file XP_Tomosynthesis_Bibliography.pdf under “Resources” in the upper right corner on this page. The questions and course reviews depicted in this WBT also refer to additional reference studies that are subject of the clinical expert presentations. Reference Studies Reference Studies The herein illustrated statements made by Siemens Healthineers customers and physicians are based on their own and discrete opinion. The speaker is responsible for obtaining permission to use any previously published figures or tables. The speaker is also responsible for obtaining permission to reproduce any photograph showing recognizable persons. The statements by Siemens Healthineers customers described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" setting and many variables exist there can be no guarantee that other customers will achieve the same results. Some products/features (here mentioned) are not necessarily commercially available in all countries. Due to regulatory reasons their availability cannot be guaranteed. Please contact your local Siemens Healthineers organization for further details. Copyright © Siemens Healthcare GmbH 2021 Siemens Healthineers Headquarters | Siemens Healthcare GmbH | Henkestr. 127 | 91052 Erlangen, Germany Telephone: +49 9131 84-0 | siemens-healthineers.com Disclaimer Disclaimer Assessment Assessment This assessment will test your retention of the presented content. A passing score of 80% or higher is required to complete the course and earn your certificate. You may repeat the assessment as many times as needed. Start Assessment CEM results in more false-positive findings. CEM has a faster wash-out than breast MRI, so there’s often not enough time to acquire all the necessary images. MRI offers significantly higher specificity than mammography and CEM. CEM has been found to have a higher positive predictive value (PPV) and a lower false-positive rate (FP) compared to breast MRI. Which of the following statements about Contrast-Enhanced Mammography (CEM) is correct? Question 1 of 5 Select the best answer. Question 1 of 5 Correct Incorrect You did not select the correct answer. Incorrect You did not select the correct answer. Incorrect You did not select the correct answer. Breast cancer detection in dense breasts. Local staging of breast cancer/measuring the extent of the disease. Assessment of response to NAC. Assessment of clusters of microcalcifications. What’s not an indication for contrast-enhanced mammography (CEM)? Question 2 of 5 Select the best answer. Assessment of scars after conservative treatment. Question 2 of 5 Incorrect You did not select the correct answer. Correct Incorrect You did not select the correct answer. Incorrect You did not select the correct answer. Incorrect You did not select the correct answer. DBT’s domain includes spiculated masses and distortions. CEM’s domain includes aggressively growing cancers (neoangiogenesis). DBT is a morphological technique and CEM is a morpho-functional technique. DBT has no limitations in imaging dense breasts. Which of the following statements comparing DBT with CEM is wrong? Question 3 of 5 Select the best answer. CEM is mainly used in a diagnostic setting. Question 3 of 5 Incorrect You did not select the correct answer. Correct Incorrect You did not select the correct answer. Incorrect You did not select the correct answer. Incorrect You did not select the correct answer. DBT is used in diagnostic settings, while TiCEM is only used in screening settings. DBT and TiCEM have no limitations in imaging dense breasts. DBT is a functional technique, while TiCEM is a morphological technique. DBT is very good for spiculated masses while TiCEM is better for aggressive cancers. When comparing TiCEM to DBT and FFDM, which of the following statements is true? Question 4 of 5 Select the best answer. Question 4 of 5 Correct Incorrect You did not select the correct answer. Incorrect You did not select the correct answer. Incorrect You did not select the correct answer. Breast MRI is performed without a contrast medium, while TiCEM is performed using gadolinium. Both examinations are performed without breast compression, because otherwise the contrast medium couldn’t enhance the breast tissue. Breast MRI is performed without ionizing radiation, while TiCEM is based on the subtraction of a high and low energy mammogram. When comparing TiCEM with Breast MRI, which of the following statements is true? Question 5 of 5 Select the best answer. Question 5 of 5 Correct Incorrect You did not select the correct answer. Incorrect You did not select the correct answer. Review Review Retry Assessment Results %Results.ScorePercent%% %Results.PassPercent%% Continue YOUR SCORE: PASSING SCORE: Results Slide You did not pass the course. Take time to review the assessment then select Retry to continue. Congratulations. You passed the course. Exit To access your Certificate of Completion, select the Launch button drop down on the course overview page. You can also access the certificate from your PEPconnect transcript. You have completed the training module no. 5 from training series “Advances in Breast Imaging”. Completion Sprechertext: Thank you for your attention! You have completed the training module no. 5 from training series “Advances in Breast Imaging”. HOOD05162003171396 | Effective Date: 20-APR-2021 XP_Tomosynthesis_Bibliography.pdf 2D Two-dimensional 3D Three-dimensional AI Artificial Intelligence AUC Area Under the Curve BPE Background Parenchymal Enhancement CAD Computer Aided Detection CC Cranio-caudal CEM Contrast Enhanced Mammography CESM Contrast Enhanced Spectral Mammography CNB Core Needle Biopsy DBT Digital Breast Tomosynthesis DCIS Ductal carcinoma in situ DM Digital Mammography FFDM Full Field Digital Mammography FN False Negative FP False Positive i.m. intramuscular IDC Invasive ductal carcinoma ILC Invasive lobular carcinoma IN Insight = Sythetic Mammogram for wide-angle Tomosynthesis IT Information Technology MAG Magnification View MB Megabyte MG Mammogramm ML Medio-lateral MLO Medio-lateral-oblique MP Megapixel MRI Magnetic Resonance Imaging NCB Needle Core Biopsy NPV Negative Predictive Value PPV Positive Predictive Value pRCT Prospective, Randomized, Controlled Trial ROC Receiver Operating Characteristic STX Stereotaxis TiCEM Titanium Contrast Enhanced Mammography TN True Negative TP True Positive US Ultrasound wa-DBT wide-angle Digital Breast Tomosynthesis WBT Web-based Training 1.1 Welcome 1.2 Introduction to TiCEM #1 1.3 Introduction to TiCEM #2 2 Clinical Experiences 2.1 TiCEM vs. FFDM 2.2 CEM vs. Breast MRI 2.3 Opportunities and Limitations 2.4 Knowledge Check 3 Indications 3.1 Indications and Advantages #1 3.2 Indications and Advantages #2 3.3 Knowledge Check 3.5 Case discussions 4 Conclusion 4.1 Conclusion #1 4.2 Conclusion #2 4.3 Knowledge Check 5.1 Course Review 5.2 Reference Studies 5.3 Disclaimer 6.1 Assessment 6.8 Completion