Practitioner compression force variability in mammography: a preliminary study.

OBJECTIVE: This preliminary study determines whether the absolute amount of breast compression in mammography varies between and within practitioners. METHODS: Ethics approval was granted. 488 clients met the inclusion criteria. Clients were imaged by 14 practitioners. Collated data included Breast Imaging Reporting and Data System (BI-RADS) density, breast volume, compression and practitioner code. RESULTS: A highly significant difference in mean compression used by different practitioners (p<0.0001 for each BI-RADS density) was demonstrated. Practitioners applied compression in one of three ways using either low, intermediate or high compression force, with no significant difference in mean compression within each group (p=0.99, p=0.70, p=0.54, respectively). Six practitioners showed a significant correlation (p<0.05) between compression and BI-RADS grade, with a tendency to apply less compression with increasing BI-RADS density. When compression was analysed by breast volume there was a wide variation in compression for a given volume. The general trend was the application of higher compression to larger breast volumes by all three practitioner groups. CONCLUSION: This study presents an insight into practitioner variation of compression application in mammography. Three groups of practitioners were identified: those who used low, intermediate and high compression across the BI-RADS density grades. There was wide variation in compression for any given breast volume, with trends of higher compression demonstrated for increasing breast volumes. Collation of further studies will facilitate a new perspective on the analysis of practitioner, client and equipment variables in mammography imaging. ADVANCES IN KNOWLEDGE: For the first time, it has been practically demonstrated that practitioners vary in the amount of compression applied to breast tissue during routine mammography.

A novel breast tissue density classification methodology.

It has been shown that the accuracy of mammographic abnormality detection methods is strongly dependent on the breast tissue characteristics, where a dense breast drastically reduces detection sensitivity. In addition, breast tissue density is widely accepted to be an important risk indicator for the development of breast cancer. Here, we describe the development of an automatic breast tissue classification methodology, which can be summarized in a number of distinct steps: 1) the segmentation of the breast area into fatty versus dense mammographic tissue; 2) the extraction of morphological and texture features from the segmented breast areas; and 3) the use of a Bayesian combination of a number of classifiers. The evaluation, based on a large kappa = 0.81 and 0.67 for the two data sets) between automatic and expert-based Breast Imaging Reporting and Data System mammographic density assessment.

Acute visual loss induced by dexamethasone during neoadjuvant docetaxol.

We present a case of a female patient who developed acute onset of visual loss due to central serous retinopathy as a consequence of steroid premedication for docetaxol given as second line neoadjuvant chemotherapy for breast cancer. Central serous retinopathy is a recognised association with steroids but has not been previously reported in association with the management of solid tumours. Reduction in steroid dose and duration permitted recovery of her visual acuity while allowing completion of the prescribed chemotherapy regimen. An overview of the presentation, pathogenesis, aetiologies and management of central serous retinopathy is given.

Can radiographers read screening mammograms?

AIM: To evaluate the ability of radiographers to read screening mammograms in the National Health Service Breast Screening Programme (NHSBSP). MATERIALS AND METHODS: Two radiographers read a test set of 1000 screening mammograms previously reported by a consultant radiologist. Three radiographers then acted as a second reader for 54,000 screening mammograms, their recall results are presented. Four consultant radiologists and three film reading radiographers were timed while reading 2500 mammograms each. RESULTS: When reading the test mammograms the two radiographers recalled all the cancers previously detected by the radiologist at the original screen read. They also recalled 32/90 women who subsequently presented with interval cancers. As a second reader the radiographers had similar recall and cancer detection rates to the radiologists (P>0.05). Double reading detected 9% more cancers. The radiographers take the same length of time to film read as radiologists (P>0.05). CONCLUSION: Radiographers are able to read screening mammograms at least as well as radiologists and do not take longer to do so.