Abstract
It is time to reconsider how we image the breast. Although the breast is a 3D structure, we have traditionally used 2D mammography to perform screening and diagnostic imaging. Mammography has been continuously modified and improved, most recently with tomosynthesis and contrast mammography, but it is still using modifications of compression 2D mammography. It is time to consider 3D imaging for this 3D structure. Cone-beam breast computed tomography (CBBCT) is a revolutionary modality that will assist in overcoming the limitations of current imaging for dense breast tissue and overlapping structures. It also allows easy administration of contrast material for functional imaging. With a radiation dose on par with diagnostic mammography, rapid 10 s acquisition, no breast compression, and true high-resolution isotropic imaging, CBBCT has the potential to usher in a new era in breast imaging. These advantages could translate into lower morbidity and mortality from breast cancer.
Highlights
With greater than 50% of women categorized as heterogeneously or extremely dense in their 40’s and 50’s (ACR density categories c or d), this is a non-trivial problem [7,14]. This places additional burdens on imaging; is the sensitivity of mammography less than 50% in extremely dense breasts, but there is the additional burden of more cancer
Computed new consideration of privacy andTomography cultural reservations not previously addressed with current technologies
Contrast technologies, which have been developed to address an urgent need to screen for breast enhanced mammography still has to contend with compression and distortion, and still requires cancer
Summary
42,000 deaths from breast cancer in the United States and 500,000 deaths worldwide [1,2]. With greater than 50% of women categorized as heterogeneously or extremely dense in their 40’s and 50’s (ACR density categories c or d), this is a non-trivial problem [7,14] This places additional burdens on imaging; is the sensitivity of mammography less than 50% in extremely dense breasts, but there is the additional burden of more cancer. Supplemental screening with other imaging modalities is available to women with extremely dense breasts, family history of cancer, or other risk factors [17]. After reconstruction of the initial image in all 3 planes (transverse, sagittal and coronal), all the information needed can be retrieved This modality would have the availability of functional imaging with contrast enhancement without having undue radiation exposure. This ideal modality is of 12 currently a reality with cone-beam breast computed tomography (CBBCT)
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