Last year's gaming sensation, Overwatch, and Czech born mathematician, Johann Karl August Radon, have both contributed to improving breast Imaging on the North Coast of New South Wales.
Digital breast tomosynthesis generates three dimensional images of the breast using the same principles as those used in the past for intravenous pyelograms. Modern radiology equipment can reconstruct an image of the breast in seconds, which allows the radiologist to hone in on areas of interest and get a clearer view of possible lesions. Such lesions, obscured by overlapping breast tissue, may not have been detected on 2D mammography.
The high speed of the image rendering combined with the better spatial orientation also enables accurate placement of localisation wires for excision biopsy of putative lesions.
Local radiology company, North Coast Radiology, has installed the Genius 3D Mammography system, which takes a series of x-rays over a 30 degree arc yielding computer generated images that can be visualised in 1 millimetre slices.
The new technique has been shown in clinical trials to decrease the frequency of false positives by 15 to 40% and detect 41% more invasive breast cancers. However, there are no studies to date to show improved mortality.
Digital breast tomosynthesis (DBT) requires breast compression and hence is no more comfortable than its 2D predecessor. DBT captures more images and takes slightly longer to perform. It uses very low x-ray energy to ensure that levels are within recommended guidelines. The greatly improved accuracy of DBT more than offsets the slightly increased radiation exposure compared to 2D.
Breast screening mammography is not covered by Medicare. Diagnostic mammography is covered for patients with a past or family history of breast cancer or if there are indications found by the clinician on examination. Breast tomography can be added to the request in these circumstances.
Breast tomography (MBS item number 60100) is not listed in most general practitioners’ electronic health record software but can be added as a custom request.
Request for mammography (59300) and breast tomography (60100) in Best Practice software.
So, Radon and Overwatch? Radon first described the mathematics of the filtered back projection used to reconstruct the images and Overwatch along with the latest generation of first person shooter games has driven the innovation in graphic computer cards that are used to perform the calculations and render the breast images.
