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Diagnosing Breast Cancer More Accurately

February 28, 2009
Written by: , Filed in: Diagnostic Imaging
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Have you heard the one about the TSA employee and the radiologist? It’s not a joke. It turns out that airport baggage screening staff and radiologists who specialize in screening for breast cancer have something in common — and studies prove it.

Let’s start with familiarity of targets. Most people are not familiar with looking for guns, bombs and knives, so they are less likely to perceive them. Consequently, airport screeners have to be trained to look for weapons. Not surprisingly, the most experienced screeners do the best job of detection.

It’s the same for radiologists. The more time we spend doing breast cancer screenings and reading mammograms, the better we become at spotting what is troublesome, and staying away from what is not.

But it’s not all that simple. In addition to the familiarity of the target, there is also the issue of frequency of the target.

When airport screeners are training, and a gun is concealed in every fourth or fifth bag, there is a high level of detection. But when a gun is hidden in only one of 300 bags, detection can be trickier and less accurate. When airport screeners experience either long periods of calm, or distractions, they suffer from subsequent losses of concentration, and thus diminished weapons detection.

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The Diagnostic Imaging Review CME program highlights the fundamentals of each radiology subspecialty by incorporating recent technical and clinical advances pertinent to current practice. In addition to formal didactic lectures on practical techniques and organ systems, this program features multiple case sessions covering each of the diagnostic specialties. Click here to read more or order:

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Similarly, for radiologists doing breast imaging and reading mammograms, repetition, tedium, fatigue and distractions can all contribute to a loss of concentration and diminished cancer detection accuracy when screening for breast cancer.

Radiologists can expect to see approximately three to six cancers per thousand images. Therefore, breast cancer is actually a relatively infrequent event for radiologists, and that leads to one of the biggest problems with doing breast imaging and reading mammograms: missed lesions.

Lack of detection can be attributed not to carelessness, but to the overall infrequency of breast cancer findings on mammograms.

An additional issue is partial identification — being able to pick out an object or a sign of cancer when looking at only part of the lesion.

Breast imaging research studies indicate that when looking at overlapping structures, it is much more difficult to distinguish different, isolated findings. In these instances, computer-aided detection (CAD) can help by picking out a part of the feature that might not otherwise be perceived.

Another aspect of the problem with screening for breast cancer is identifying parts of objects with underlying clutter. When there are a lot of objects in one place on an image, the result can be partial visualization, which makes accurate breast imaging and mammography difficult. No matter how accurate the breast imaging technology, some lesions are going to be obscured by overlying breast tissue density.

The solution to all these issues is good solid diagnostic training. The more time we radiologists spend doing breast imaging and reading mammograms, the better we will become at spotting what is troubling, and staying away from what is not.

Remember this the next time you are in a long airport security line and wonder what is taking so long.

Author: Jessica W. T. Leung, MD

New July 2009: Diagnostic Imaging Review: For Residents, Fellows and Radiologists

The Diagnostic Imaging Review CME program highlights the fundamentals of each radiology subspecialty by incorporating recent technical and clinical advances pertinent to current practice. In addition to formal didactic lectures on practical techniques and organ systems, this program features multiple case sessions covering each of the diagnostic specialties. Click here to read more or order:

Diagnostic Imaging Review

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