Advances in Breast Imaging - Wide-angle DBT in the Clinical Routine Online Training

Continue Continue Continue Continue Welcome 2 Wide-angle DBT in the Clinical Routine Online Training This training module covers the basics of tomosynthesis in breast screening and assessment and shares clinicians’ experiences from their daily routine. Completion time: 120 min DBT in Screening 1 Practical Hints 4 Indications for DBT 3 DBT in Assessment 2 Master Template HOOD05162003052540 | Effective Date: 26-Nov-2019 Welcome Srechertext: Welcome to our Web-based training “Advances in breast imaging”. The second module, “Wide-angle DBT in the clinical routine,” will describe the clinical use of digital breast tomosynthesis in breast screening and follow-up diagnostics. Numerous case discussions offer insights into the clinical routines of our experts. Dr. Maria Bernathova and Prof. Chantal Van Ongeval have been working with tomosynthesis for more than 10 years, and they share their experiences with us here. The completion of this very extensive module takes about 120 minutes. Introduction Dr. Maria Bernathova Medical University of Vienna, Austria Introduction 02_Clinical-Routine_01-Intro-to-lecture_V02.mp4 DBT in screening DBT in Screening Dr. Maria Bernathova Medical University of Vienna, Austria DBT in Screening 02_Clinical-Routine_02-DBT-in-screening_V03.mp4 Applied dose Examination time Detection rate (sensitivity) Lesion characterization What factor does not play a major role in assessing a modality for its use in breast screening programs? Knowledge Check Select the best answer. Reading time Knowledge Check Correct Incorrect The solution is: Lesion characterization Incorrect The solution is: Lesion characterization Incorrect The solution is: Lesion characterization Correct The solution is: Lesion characterization Explanation of the Correct Answer Continue Lesion characterization, i.e. specificity, is a typical issue in follow-up diagnostics. Explanation of the Correct Answer Case Discussions – Malignant Lesions Intraductal carcinoma (IDC) Ductal carcinoma in situ (DCIS) Intralobular carcinoma (ILC) 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 - Malignant Lesions Case Discussion 8 ILC in a dense breast Case Discussion 7 DCIS in a dense breast Case Discussion 6 DCIS in a heterogeneously dense breast Case Discussion 5 DCIS in a scattered breast Case Discussion 4 ILC in a scattered breast Case Discussion 3 Harmatoma and IDC in a dense breast Case Discussion 2 IDC in a heterogeneously dense breast Case Discussion IDC in a scattered breast 1 Case Discussions – Benign Lesions 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 Case Discussions - Benign Lesions Case Discussion 6 Epithelial hyperplasia in a dense breast Case Discussion 5 Papilloma a heterogeneously dense breast Case Discussion 4 Periductal mastitis in a scattered breast Case Discussion 3 Implant in a scattered breast Case Discussion 2 Radial scar in a scattered breast Case Discussion Fibroadenoma in a fatty breast 1 DBT in assessment DBT in Assessment Dr. Maria Bernathova Medical University of Vienna, Austria DBT in Assessment 02_Clinical-Routine_03-DBT-in-assessment_V03.mp4 The Use of One-view vs. Two-view DBT Prof. Dr. Chantal Van Ongeval University Hospital Leuven, Belgium The Use of One-view vs. Two-view DBT 03_How-to_implement-DBT_06_2view-1view_V02.mp4 In breast screening, one-view wide-angle digital breast tomosynthesis (wa-DBT) has a higher detection rate than two-view digital mammography (and requires less radiation dose). Although wa-DBT has high depth resolution, two-views are recommended for assessment because the evaluation of the tumor growth pattern may not be assessable on one-view only. Screening studies worldwide proved that one-view examinations with any DBT system are superior to two-view digital mammography. Which statement about one-view vs. two-view DBT examinations is wrong? Knowledge Check Select the best answer. Knowledge Check Correct Incorrect The solution is: Screening studies worldwide proved that one-view examinations with any DBT system are superior to two-view digital mammography. Incorrect The solution is: Screening studies worldwide proved that one-view examinations with any DBT system are superior to two-view digital mammography. Explanation of the Correct Answer Continue Only in wide-angle DBT has it been proven that one-view DBT is better than two-view DM: No prospective studies have proven this in other systems (status: March 2021). Explanation of the Correct Answer Indications for DBT Indications for DBT Prof. Dr. Chantal Van Ongeval University Hospital Leuven, Belgium Indications for DBT 03_How-to_implement-DBT_05_Indications_V03.mp4 Case Discussions – DBT vs. Breast MRI and Ultrasound DBT vs. Breast MRI and Ultrasound (US) 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 Case Discussions - DBT vs. Breast MRI and Ultrasound 1806_siemens_xp_academy_bernathova_no_audience_case_21.mp4 1806_siemens_xp_academy_bernathova_no_audience_case_25.mp4 1806_siemens_xp_academy_bernathova_no_audience_case_14.mp4 1909_shs_xp_tomo_training_van_ongeval_case_10_v03.mp4 1909_shs_xp_tomo_training_van_ongeval_case_04_v03.mp4 1806_siemens_xp_academy_bernathova_no_audience_case_13.mp4 1909_shs_xp_tomo_training_van_ongeval_case_11_v03.mp4 Case Discussion 7 IDC in a dense breast (US) Case Discussion 6 Triple neg. IDC in a heterogeneously dense breast (US) Case Discussion 5 ILC in a scattered breast (US) Case Discussion 4 IDC in a dense breast (MRI) Case Discussion 3 Invasive micropapillary carcinoma in a heterogeneously dense breast (MRI) Case Discussion 2 DCIS in a scattered breast Case Discussion IDC in a fatty breast (MRI) 1 Case Discussions – Follow Up and Evaluation Follow up and evaluation of clinical symptoms 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 Case Discussions - Follow Up and Evaluation 1909_shs_xp_tomo_training_van_ongeval_case_06_v03.mp4 1806_siemens_xp_academy_bernathova_no_audience_case_28.mp4 1909_shs_xp_tomo_training_van_ongeval_case_01_v03.mp4 1909_shs_xp_tomo_training_van_ongeval_case_07_v03.mp4 1806_siemens_xp_academy_bernathova_no_audience_case_04.mp4 1806_siemens_xp_academy_bernathova_no_audience_case_15.mp4 1806_siemens_xp_academy_bernathova_no_audience_case_03.mp4 Case Discussion 7 Brain metastasis in a dense breast Case Discussion 6 Bloody discharge in a heterogeneously dense breast Case Discussion 5 Positive lymph node in a scattered breast Case Discussion 4 Invasive tubular carcinoma in a dense breast (follow up) Case Discussion 3 IDC in a heterogeneously dense breast (follow up: scar) Case Discussion 2 DCIS in a scattered breast (follow up) Case Discussion ILC in a fatty breast (follow up) 1 Improved diagnostic accuracy compared to FFDM. Improved lesion evaluation (size, multifocality). Wire or clip localization. Functional information on lesions. What is not an advantage of digital breast tomosynthesis in diagnostic imaging? Knowledge Check Select the best answer. Characterization and follow-up on lesions. Knowledge Check Correct Incorrect The solution is: Functional information on lesions Incorrect The solution is: Functional information on lesions Incorrect The solution is: Functional information on lesions Incorrect The solution is: Functional information on lesions Explanation of the Correct Answer Continue DBT provides morphological information while CEM provides functional information (see WBT 5). Explanation of the Correct Answer Practical hints Practical Hints – Feedback Radiographer Prof. Dr. Chantal Van Ongeval University Hospital Leuven, Belgium Practical Hints - Feedback Radiographer 03_How-to_implement-DBT_02_Feedback-radiographer_V03.mp4 Practical Hints – Billing and Coding Prof. Dr. Chantal Van Ongeval University Hospital Leuven, Belgium Practical Hints - Billing and Coding 03_How-to_implement-DBT_07_Billing-and-coding_V03.mp4 Course Review Practical Hints Indications for DBT DBT in Assessment DBT in Screening 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 4 4 4 Course Review Practical Hints Implementation of DBT involves teamwork: Radiographers, radiologists, other medical disciplines, IT specialists. Training of radiographers and radiologists is advised. Radiographers’ feedback on wa-DBT: Software interface: User-friendly and similar to 2D mammography. Larger compression paddle requires dedicated positioning. Movement of face shield requires advance warning. Billing and coding (status: March 2021) DBT often can’t be additionally reimbursed. DBT can sometimes be billed as additional mammography examinations (MAG view, Eklund, etc.). In the U.S., fees ranging from $25 to $250 with an average fee of $69 were found. (Hardesty L. AJR 2015;204 p681; survey of members of the Society of Breast Imaging) Indications for DBT Screening Dense breast High risk patients Population-based screening (U.S.; under evaluation in other countries) Assessment (diagnostic follow-up) Improved diagnostic accuracy Improved evaluation of lesion size and margins Multifocal disease – bilateral disease Wire/clip localization Lesion characterization and follow-up Second-look “mammogram” after MRI Assessment of recalled cases or second opinion Pre-operative assessment DBT in Assessment DBT is an established and proven procedure for diagnostic follow-up/assessment: The type and number of views depend on the individual patient. Characterization of the lesion’s type, number, and size are possible (staging) based on the growth pattern. There’s often a high correlation with breast MRI. DBT in Screening Clinical practice and numerous studies have proven that DBT in screening… can be performed as a standardized procedure. has a low dose (within the limits of the European guidelines). has a higher detection rate (sensitivity) than FFDM alone. Before DBT is introduced into European guidelines, the results of ongoing prospective randomized controlled trials (pRCT) are needed. DBT has already been implemented in screening guidelines in the U.S. 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 Because wa-DBT has high depth resolution, two-views are never recommended for assessment; the tumor growth pattern is always assessable on a one-view examination. Screening studies worldwide proved that one-view examinations with any DBT system are superior to two-view digital mammography. In breast screening, one-view wide-angle digital breast tomosynthesis (wa-DBT) has a higher detection rate than two-view digital mammography (and requires less radiation dose). Which of the following statements about one-view vs. two-view DBT examinations is correct? Question 1 of 5 Select the best answer. Question1 of 5 Correct Incorrect You did not select the correct answer. Incorrect You did not select the correct answer. Improved diagnostic accuracy compared to FFDM. Improved lesion evaluation (size, multifocality). Characterization of and follow-up on lesions. Functional information on lesions. Which of the following isn’t an advantage of digital breast tomosynthesis in diagnostic imaging? Question 2 of 5 Select the best answer. Question 2 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. can’t be performed in a standardized procedure. entails a high dose above the achievable value (2.0 mGy) defined by the European protocol. will finally be introduced into European guidelines. has a high detection rate (sensitivity). Clinical practice and numerous studies have proven that DBT in screening… Question 3 of 5 Select the best answer. Question 3 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. The type and number of views of patients follow a strictly standardized protocol. Characterization of the lesion’s type number, and size (staging) can only be performed as an adjunct to ultrasound and Breast MRI. There’s no correlation with Breast MRI. DBT is an established and proven procedure for diagnostic follow-up/assessment. Which of the following statements is true regarding DBT in assessment? 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. worldwide for patients with dense breasts. worldwide for high-risk patients. in Europe. in the U.S. DBT is already used in screening programs… 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. 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. 2 from training series “Advances in Breast Imaging”. Completion Sprechertext: Thank you for your attention! You have completed the training module no. 2 from training series “Advances in Breast Imaging”. olt_adv-breast-imaging_02_clinical-routine_en_v1 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 2.1 DBT in Screening 2.2 Knowledge Check 2.4 Case Discussions - Malignant Lesions 2.5 Case Discussions - Benign Lesions 3.1 DBT in Assessment 3.2 The Use of One-view vs. Two-view DBT 3.3 Knowledge Check 4.1 Indications for DBT 4.2 Case Discussions - DBT vs. Breast MRI and Ultrasound 4.3 Case Discussions - Follow Up and Evaluation 4.4 Knowledge Check 5.1 Practical Hints - Feedback Radiographer 5.2 Practical Hints - Billing and Coding 6.1 Course Review 6.2 Reference Studies 6.3 Disclaimer 7.1 Assessment 7.8 Completion