Programa de control de calidad para optimizar dosis-calidad de imagen en un sistema de mamografía digital FFDM con DBT / Quality control program to optimize dose-image quality in a digital mammography system FFDM with DBT

El objetivo de este estudio fue establecer y mantener activo un programa de control de calidad semanal en un sistema de mamografía digital de campo completo (FFDM) con tomosíntesis digital de mama (DBT) para optimizar la relación dosis-calidad de imagen en el tamizaje mamográfico y en el diagnóstico de las patologías de la mama, así como determinar la sensibilidad y especificidad en el periodo 2019-2022. Las imágenes mamográficas fueron obtenidas con el maniquí del Colegio Americano de Radiología (ACR) como parte del programa de control de calidad y con el uso de un dosímetro se determinó la dosis glandular media (DGM). También se midieron otras variables que afectan calidad de imagen y dosis. La imagen optimizada tiene el potencial de reducir la tasa de mortalidad por cáncer de mama debido a que el cáncer de mama es un problema de salud pública en los países en vías de desarrollo. Los resultados generales en el periodo del estudio se ilustran con graficas e intervalos de confianza al 95% (IC, 95%), además los valores numéricos se expresan en términos del error estándar de la media con 95% de confianza. Para mamografía digital de campo completo (FFDM): mAs = 160 ± 3.74, kVp = 28, dosis glandular media (DGM) = 1.69 ± 0.02 mGy, razón señal-ruido (SNR) = 62.20 ± 0.67, razón contraste-ruido (CNR) = 12.16 ± 0.15 y para tomosíntesis digital de mama (DBT): mAs = 61.42 ± 1.14, kVp = 29, dosis glandular media (DGM) = 1.54 ± 0.01 mGy. Los valores de las diferentes variables fueron determinados de acuerdo a la metodología del fabricante (Hologic, 2011). Los valores de la sensibilidad y la especificidad fueron para mamografía digital de campo completo (FFDM) sensibilidad 91% y especificidad 94% y para tomosíntesis digital de mama (DBT) sensibilidad 94% y especificidad 97%. Los resultados de dosis y calidad de imagen en ambas modalidades mamografía digital de campo completo (FFDM) y tomosíntesis digital de mama (DBT) muestran que el programa de control de calidad se mantuvo operativo durante el estudio manteniendo una relación optimizada entre dosis y calidad de imagen

The objective of this study was to establish and maintain active a weekly quality control program in a full-field digital mammography (FFDM) system with digital breast tomosynthesis (DBT) to optimize the dose-image quality relationship in mammographic screening and in diagnosis of breast pathologies, as well as determining sensitivity and specificity in the period 2019-2022. Mammographic images were obtained with the American College of Radiology (ACR) phantom as part of the quality control program and the mean glandular dose (DGM) was determined with a dosimeter. Other variables that affect image quality and dose were also measured. Optimized imaging (image quality-dose) has the potential to reduce the breast cancer mortality rate because breast cancer is a public health problem in developing countries. The general results in the study period are illustrated with graphs and 95% confidence intervals (CI, 95%), in addition the numerical values are expressed in terms of the standard error of the mean with 95% confidence, For full field digital mammography (FFDM): mAs = 160.3 ± 3.74, kVp = 28, mean glandular dose (DGM) = 1.69 ± 0.02 mGy, signalto-noise ratio (SNR) = 62.20 ± 0.67, contrast-to-noise ratio (CNR) = 12.16 ± 0.15 and for tomosynthesis digital breast (DBT): mAs = 61.42 ± 1.14, kVp = 29, mean glandular dose (DGM) = 1.54 ± 0.01 mGy. The values of the different variables were determined according to the manufacturer's methodology. Mammography facility sensitivity and specificity values were determined using pathology results during the study. For FFDM mode they were sensitivity 91% and specificity 94% and for DBT mode they were sensitivity 94% and specificity 97%. The dose and image quality results in both full field digital mammography (FFDM) and digital breast tomosynthesis (DBT) modalities show that the quality control program remained operational during

Analysis on the diagnostic value of ABUS combined with DBT in dense type of intra-mammary breast cancer / 中国医学装备

Objective:To explore the diagnostic value of automatic breast ultrasound imaging system(ABUS)combined with digital breast tomosynthesis(DBT)for dense type of intra-mammary breast cancer.Methods:A total of 96 patients with dense type of intra-mammary breast cancer who admitted to hospital were selected,and all patients completed ABUS and DBT examinations within 1 week before they underwent the invasive operations such as puncture and surgery.Taking pathological results as the gold standard,the diagnostic values of ABUS and DBT for dense type of intra-mammary breast cancer were analyzed.Results:A total of 96 lesions were detected out from 96 patients by pathological examination.Based on the pathological results as the gold standard,the sensitivity,specificity and area under curve(AUC)value of ROC of ABUS were respectively 77.32%,82.53%and 0.711(95%CI:0.635～0.792)in diagnosing dense type of intra-mammary breast cancer.The sensitivity,specificity and AUC value of DBT were respectively 81.59%,80.23%and 0.734(95%CI:0.612～0.776)in diagnosing that.The sensitivity,specificity and AUC of ABUS combined with DBT were respectively 89.38%,92.46%and 0.787(95%CI:0.659～0.824)in diagnosing that.Conclusion:ABUS combined with DBT is beneficial to improve the clinical detection rate of dense type of intra-mammary breast cancer,and reduce the missed diagnosis of tumor without company of calcification lesion.

Factors Affecting Breast Cancer Detectability on Digital Breast Tomosynthesis and Two-Dimensional Digital Mammography in Patients with Dense Breasts

OBJECTIVE: To compare digital breast tomosynthesis (DBT) and conventional full-field digital mammography (FFDM) in the detectability of breast cancers in patients with dense breast tissue, and to determine the influencing factors in the detection of breast cancers using the two techniques. MATERIALS AND METHODS: Three blinded radiologists independently graded cancer detectability of 300 breast cancers (288 women with dense breasts) on DBT and conventional FFDM images, retrospectively. Hormone status, histologic grade, T stage, and breast cancer subtype were recorded to identify factors affecting cancer detectability. The Wilcoxon signed-rank test was used to compare cancer detectability by DBT and conventional FFDM. Fisher's exact tests were used to determine differences in cancer characteristics between detectability groups. Kruskal-Wallis tests were used to determine whether the detectability score differed according to cancer characteristics. RESULTS: Forty breast cancers (13.3%) were detectable only with DBT; 191 (63.7%) breast cancers were detected with both FFDM and DBT, and 69 (23%) were not detected with either. Cancer detectability scores were significantly higher for DBT than for conventional FFDM (median score, 6; range, 0–6; p < 0.001). The DBT-only cancer group had more invasive lobular-type breast cancers (22.5%) than the other two groups (i.e., cancer detected on both types of image [both-detected group], 5.2%; cancer not detected on either type of image [both-non-detected group], 7.3%), and less detectability of ductal carcinoma in situ (5% vs. 16.8% [both-detected group] vs. 27.5% [both-non-detected group]). Low-grade cancers were more often detected in the DBT-only group than in the both-detected group (22.5% vs. 10%, p = 0.026). Human epidermal growth factor receptor-2 (HER-2)-negative cancers were more often detected in the DBT-only group than in the both-detected group (92.3% vs. 70.5%, p = 0.004). Cancers surrounded by mostly glandular tissue were detected less often in the DBT only group than in the both-non-detected group (10% vs. 31.9%, p = 0.016). DBT cancer detectability scores were significantly associated with cancer type (p = 0.012), histologic grade (p = 0.013), T and N stage (p = 0.001, p = 0.024), proportion of glandular tissue surrounding lesions (p = 0.013), and lesion type (p < 0.001). CONCLUSION: Invasive lobular, low-grade, or HER-2-negative cancer is more detectable with DBT than with conventional FFDM in patients with dense breasts, but cancers surrounded by mostly glandular tissue might be missed with both techniques.

A comparative study of the effectiveness of group-based cognitive behavioral therapy and dialectical behavioral therapy in reducing depressive symptoms in Iranian women substance abusers

Various therapeutic approaches have been used to improve depressive symptoms in substance abusers. In a quasi-experimental study with a pretest-posttest design and experimental and control groups, we examined and compared the effectiveness of two group-based treatment strategies­cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)­in reducing depressive symptoms among Iranian women substance abusers. The statistical population included all female addict patients who referred to addiction treatment centers of Birjand city in 2015. A sample of 30 subjects were selected through the available sampling method and randomly assigned into experimental (CBT and DBT) and control groups (each group, 10 patients). The data collection instrument was the Beck Depression Inventory (BDI) questionnaire. The patients in the experimental groups were given skills in eight sessions of 90 min. The data were analyzed by the SPSS-19 software by using mean, standard deviation, and percentages at the descriptive level and analysis of covariance (ANCOVA) test at the inferential level. The comparison of the mean depression score before intervention in all the groups showed no significant difference. However, after intervention, the findings showed that both CBT and DBT interventions could reduce the mean scores of depression in women substance abusers, 17.5 ± 3.0 vs 29.3 ± 4.1 (F[1,17] = 51.91, p value < 0.01) and 14.7 ± 1.8 vs 29.3 ± 4.1 (F[1,17] = 106.62, p value < 0.01), respectively, for CBT and DBT. Post-treatment effect sizes were large and did not differ statistically for CBT (ηp2, 0.75) and DBT (ηp2, 0.86). Therefore, this study highlights the importance of CBT and DBT skills training to substance abusers and provides initial evidence of their effectiveness.(AU)

Diagnostic Value of FFDM Combined with DBT in Breast Diseases / 现代医院

Objective To explore the diagnostic value of full-field digital mammography (FFDM) combined with digital breast tomosynthesis (DBT) in breast diseases.Methods 506 patients receiving mammary gland molybdenum target inspection from January 1, 2014 to December 31, 2014 were selected.The images from FFDM and DBT were analyzed, respectively.The breast imaging reports and pathological results were compared to investigate the sensitivity, specificity and accuracy of FFDM, DBT alone and combined use of DBT and FFDM.Results The results of preoperative mammography in the 506 women (bilateral breast) were as follows: FFDM combined with DBT detected 202 benign cases (39.9%) and 304 malignant cases (60.1%);FFDM alone detected 194 benign cases (38.3%) and 312 malignant cases (61.7%);DBT alone detected 187 benign cases (37.0%) and 319 malignant cases (63.0%).Pathologically, 214 benign cases (42.3%) were detected and 292 malignant cases (57.7%).In terms of the sensitivity, specificity and accuracy, The combined use of DBT combined with FFDM was the best, followed by FFDM alone and DBT alone.Conclusion The sensitivity, specificity and accuracy of FFDM combined with DBT for diagnosis are better than those of FFDM alone or DBT alone.

Analysis of gene mutations among South Indian patients with maple syrup urine disease: Identification of four novel mutations.

Maple syrup urine disease (MSUD) is predominantly caused by mutations in the BCKDHA, BCKDHB and DBT genes, which encode for the E1α, E1β and E2 subunits of the branched-chain α-keto acid dehydrogenase complex, respectively. Because disease causing mutations play a major role in the development of the disease, prenatal diagnosis at gestational level may have significance in making decisions by parents. Thus, this study was aimed to screen South Indian MSUD patients for mutations and assess the genotype-phenotype correlation. Thirteen patients diagnosed with MSUD by conventional biochemical screening such as urine analysis by DNPH test, thin layer chromatography for amino acids and blood amino acid quantification by HPLC were selected for mutation analysis. The entire coding regions of the BCKDHA, BCKDHB and DBT genes were analyzed for mutations by PCR-based direct DNA sequencing. BCKDHA and BCKDHB mutations were seen in 43% of the total ten patients, while disease-causing DBT gene mutation was observed only in 14%. Three patients displayed no mutations. Novel mutations were c.130C>T in BCKDHA gene, c. 599C>T and c.121_122delAC in BCKDHB gene and c.190G>A in DBT gene. Notably, patients harbouring these mutations were non-responsive to thiamine supplementation and other treatment regimens and might have a worse prognosis as compared to the patients not having such mutations. Thus, identification of these mutations may have a crucial role in the treatment as well as understanding the molecular mechanisms in MSUD.