Breast Cup Research Articles

OA01.29. Evaluation of parasikayavanyadi capsule in the management of anidra w.s.r. to insomnia

Purpose: Insomnia is a sleeping disorder characterised by persistent difficulty in falling asleep or staying asleep despite the opportunity. It is one of the burning problems all over the world. Statistics shows that 20% - 40% adults encounter insomnia problems during a year time. Allopathic hypnotic drugs are useful for short term treatment in Insomnia which is due to acute stage. Long term uses of certain classes of sedatives cause physical dependence and withdrawal symptoms also have a number of side effects. In the present era, patient prefers readymade, cost effective, easily palatable drugs with fewer side effects for their health problems. For the present clinical trial, Parsikayavanyadi Capsule consisting of Parasikayavani, Jatamamsimoola, triturated with juice of Sankhpushpi and Kushmanda, was formulated to evaluate its efficacy in the management of insomnia Method: Total 32 patients of newly diagnosed case of insomnia who were randomly divided in to two groups. In Group P.V (Parasikayavanyadi group), 20 patients were administered 5 capsules of Pariskvayanadi Churna of 500 mg each with a cup of warm milk at bed time for one month. In Group P.C (Placebo group), 12 patients were given Starch Capsules of 500 mg each with same Anupana and duration. Assessment was done considering the overall improvement of insomnia according to Pittsburgh insomnia rating Scale, improvement of associated complains of insomnia, relieving of negative emotions, improving of positive emotions, relieving of level of anxiety according to Hamilton Anxiety Rating Scale and relieving of level of depression according to Hamilton Depression Rating scale before and after one month of treatment period. Result: parasikayavanyadi capsule provided significant effect in the management of insomnia. Conclusion: The study has revealed that parasikayavanyadi capsule provided significant effect in the management of insomnia in comparison to placebo.

Radiation dose reduction to the breast in thoracic CT: Comparison of bismuth shielding, organ‐based tube current modulation, and use of a globally decreased tube current

The purpose of this work was to evaluate dose performance and image quality in thoracic CT using three techniques to reduce dose to the breast: bismuth shielding, organ-based tube current modulation (TCM) and global tube current reduction. Semi-anthropomorphic thorax phantoms of four different sizes (15, 30, 35, and 40 cm lateral width) were used for dose measurement and image quality assessment. Four scans were performed on each phantom using 100 or 120 kV with a clinical CT scanner: (1) reference scan; (2) scan with bismuth breast shield of an appropriate thickness; (3) scan with organ-based TCM; and (4) scan with a global reduction in tube current chosen to match the dose reduction from bismuth shielding. Dose to the breast was measured with an ion chamber on the surface of the phantom. Image quality was evaluated by measuring the mean and standard deviation of CT numbers within the lung and heart regions. Compared to the reference scan, dose to the breast region was decreased by about 21% for the 15-cm phantom with a pediatric (2-ply) shield and by about 37% for the 30, 35, and 40-cm phantoms with adult (4-ply) shields. Organ-based TCM decreased the dose by 12% for the 15-cm phantom, and 34-39% for the 30, 35, and 40-cm phantoms. Global lowering of the tube current reduced breast dose by 23% for the 15-cm phantom and 39% for the 30, 35, and 40-cm phantoms. In phantoms of all four sizes, image noise was increased in both the lung and heart regions with bismuth shielding. No significant increase in noise was observed with organ-based TCM. Decreasing tube current globally led to similar noise increases as bismuth shielding. Streak and beam hardening artifacts, and a resulting artifactual increase in CT numbers, were observed for scans with bismuth shields, but not for organ-based TCM or global tube current reduction. Organ-based TCM produces dose reduction to the breast similar to that achieved with bismuth shielding for both pediatric and adult phantoms. However, organ-based TCM does not affect image noise or CT number accuracy, both of which are adversely affected by bismuth shielding. Alternatively, globally decreasing the tube current can produce the same dose reduction to the breast as bismuth shielding, with a similar noise increase, yet without the streak artifacts and CT number errors caused by the bismuth shields. Moreover, globally decreasing the tube current reduces the dose to all tissues scanned, not simply to the breast.

Stereotactic radiosurgery for early-stage breast cancer: A new paradigm.

120 Background: Stereotactic radiosurgery (SRS) has not been widely used for breast cancer partly due to: 1) the lack of a suitable immobilization device; and 2) the lack of a delivery system that can concentrate a high radiation dose noninvasively. We have developed a SRS system that effectively addresses these obstacles and demonstrated the dosimetric feasibility of simultaneously ablating the intact tumor and sterilizing the tumor bed. Methods: A breast immobilization device consists of a solid outer cup with embedded stereotactic frame and a porous inner cup; the two cups join at the chest wall side by a soft goggle-like lip for comfort. A negative pressure is applied to the space between the two cups to immobilize the breast tissues. 15 patients with surgical clips in their breast underwent a geometric reproducibility trial, in which the patients received two CT scans spaced 10-60 minutes while wearing the cup. A SRS delivery system uses 36 Co-60 sources that rotate around a focal point to produce 36 non-coplanar arcs. The breast cup is locked on the treatment couch with the patient in prone position. The couch moves dynamically during treatment, allowing the focal spots to “paint” the desired 3D dose distribution. Results: The reproducibility of the 42 available clips was 1.83 mm ± 1.08 mm (2 std) and patients reported good comfort. 8 treatment plans simultaneously delivering an ablative dose of 18Gy to an intact tumor plus a 3mm margin (CTV1) and 10Gy to the tumor bed (CTV2 = CTV1+1cm) have been developed and verified with measurements. The dose-volume histograms showed very uniform dose coverage with 98% of CTV1 receiving 18Gy and 100% of tumor bed receiving 10Gy. On average, only 21% of the normal breast receives greater than 5Gy, safe to deliver 3 fractions of such doses. Conclusions: A breast-specific SRS system has been developed. Dosimetric studies illustrated the feasibility of managing early-stage breast cancer with SRS. Clinical studies that will identify patients in whom current forms of surgery and postoperative radiation may be eliminated are planned, allowing completion of local therapies noninvasively within a few days rather than months.

Point/counterpoint: dose-related issues in cardiac CT imaging

This manuscript reviews some of the more controversial dose-related issues in cardiac CT imaging. Discussion covers the relative merits of cardiac CT versus MR, advantages and concerns regarding gated versus nongated cardiac CT and advantages and concerns regarding the use of breast shields in girls undergoing cardiac CT imaging.

Impact of Time Interval Between Surgery and Radiation on Partial Breast Radiation and Infection and Cosmesis

Median followup was 491 days (min 19 and max 1115). There were 5 relapses and all were elsewhere failures. 2 died of intercurrent disease and 92 were alive with no evidence of disease. Conclusions: The initial data seem show good concordance between physicians and nurses and patients in about 50% of the patients. The presence of seroma and number of re-excisions seem to have an impact on cosmesis. We plan to continue this study by including surgeons in the cosmesis evaluation. The data required breast cup size, laterality and quadrant will be presented at the MTG. Impact of chemotherapy will also be evaluated.

Direct Quantification of Breast Dose During Coronary CT Angiography and Evaluation of Dose Reduction Strategies

The purpose of this study was to quantify the absorbed radiation dose received by the adult female breast during coronary CT angiography (CTA) and to evaluate the effectiveness of various dose reduction strategies. An adult female thoracic anthropomorphic phantom was scanned using eight different clinical coronary CTA protocols that varied in detector configuration (320 × 0.5 mm or 64 × 0.5 mm), x-ray tube activation (full R-R, 65% R-R, or 70-80% R-R), use of tube current modulation, and use of breast shields. Direct dosimetry measurements were performed using Gafchromic film to determine the absorbed breast dose. Retrospective helical data acquisition using a 64-detector array and a full cardiac cycle without dose modulation or breast shielding is associated with an average absorbed breast dose of 82.9 mGy. Optimization of coronary CTA technique using a 320-detector array and a 70-80% cardiac phase reduces the absorbed breast dose by 78.9% to 17.5 mGy, whereas breast shields used in isolation reduces breast dose by up to 46.8%. The implementation of clinically validated coronary CTA protocols using large-area detector acquisition and prospective ECG gating with limited x-ray tube activation results in substantial breast dose savings of up to 78.9% and should be used whenever possible in combination with bismuth breast shields to achieve further dose reduction.

Detection of Warfare Agents in Liquid Foods Using the Brine Shrimp Lethality Assay

The brine shrimp lethality assay (BSLA) was used for rapid and non-specific detection of biological and chemical warfare agents at concentrations considerably below that which will cause harm to humans. Warfare agents detected include T-2 toxin, trimethylsilyl cyanide, and commercially available pesticides such as dichlorvos, diazinon, dursban, malathion, and parathion. The assay was performed by introducing 50 μL of milk or orange juice contaminated with each analyte into vials containing 10 freshly hatched brine shrimp nauplii in seawater. This was incubated at 28 °C for 24 h, after which mortality was determined. Mortality was converted to probits and the LC(50) was determined for each analyte by plotting probits of mortality against analyte concentration (log(10)). Our findings were the following: (1) the lethal effects of toxins dissolved in milk were observed, with T-2 toxin being the most lethal and malathion being the least, (2) except for parathion, the dosage (based on LC(50)) of analyte in a cup of milk (200 mL) consumed by a 6-y-old (20 kg) was less than the respective published rat LD(50) values, and (3) the BSLA was only suitable for detecting toxins dissolved in orange juice if incubation time was reduced to 6 h. Our results support the application of the BSLA for routine, rapid, and non-specific prescreening of liquid foods for possible sabotage by an employee or an intentional bioterrorist act. Practical Application: The findings of this study strongly indicate that the brine shrimp lethality assay can be adapted for nonspecific detection of warfare agents or toxins in food at any point during food production and distribution.

Abstract P4-10-10: The Gammapod TM: A Novel Breast Specific Stereotactic Body Radiation Therapy (SBRT) for Small Breast Cancers

Abstract Introduction: SBRT is a novel approach to precisely deliver high doses of radiation therapy to a define target, while normal tissues immediately surrounding the tumor receives a significantly lower (i.e. tolerable) dose. This technique has revolutionized the management of small medically inoperable lung cancer with local control rates recently reported in the co-operative setting of 98% now setting the stage for challenging surgery as the standard of care for select patients with lung cancer. SBRT has not been used in the breast, since the breast is a pliable organ without a suitable immobilization device and the lack of an SBRT system that can create the rapid fall off in dose necessary to deliver ablative doses of radiation safely in the breast. The purpose of this NIH funded project is to develop a dedicated SBRT system for early breast cancer which could eventually lead paradigm shift in the management of breast cancer similar to lung cancer. Materials and Methods: The SBRT system was developed such that dose distributions produced would be similar to stereotactic radiosurgery in the brain where the the drop off of the prescription isodose to 50% of the prescription dose was less than 5 mm. The device uses 36 non-coplanar Co-60 sources which rotate around a focal point to produce 36 non-coplanar arcs. The system incorporates the use of a floating/dynamic table which together with the rotatable sources enables differential dosing of target volumes similar to intensity modulated RT allowing higher ablative doses to the gross tumor and a lower sub clinical dose to treat microscopic tumor foci. In addition the SBRT system, a breast specific immobilization device was developed. This system consists of 2 layers with an air tight seal in between. Once placed on the breast a small negative pressure secures it to the breast. A prospective trial tested the reproducibility of the breast cup using the centroid of the post-operative clips on 2 consecutive CT simulations separated by 10 to 60 minutes simulating the treatment planning scenerio in the prone position. During this time, patients were also asked to fill out a questionaire regarding the comfort of this approach. Results: The issues within the specific aims of the grant have been effectively solved and have led to a breast specific immobilization device and a breast specific SBRT system — The Gammapod TM. The immobilization device demonstrated a set up error of less than 3 mm a significant decrease from the 10 mm planning target volume expansion as recommended in NSABP B39 for patients undergoing 3 dimensional conformal partial breast radiotherapy. All patients described this experience as more comfortable in comparison to a biopsy and similar to the experience of a mammogram.Dosimetric studies using Monte Carlo simulation demonstrate that tumors up to 5 cm in diameter, and 5 mm from the chest wall, lung/heart receive < 10% of the maximum dose. Conclusions: A breast specific immobilization device and SBRT system has been developed produces dose distributions similar to stereotactic radiosurgery in the brain. The first prospective studies testing this device clinically through a multi-institutional consortium are expected to open in early 2011. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-10-10.

Three-Dimensional Kinematics of the Breast during a Two-Step Star Jump

Anecdotal reports suggest two-step star jumps cause excessive breast movement and discomfort, leading to recommendations for this activity as a diagnostic tool to determine effective breast support in a retail environment. The aim was to investigate multiplanar bare-breast kinematics during the two-step star jump and to establish the relationship between breast kinematics, discomfort and cup size. Thirty-nine females completed five two-step star jumps with no breast support after which breast discomfort was rated. To establish relative breast kinematics infrared cameras tracked the 3D co-ordinates of breast and body markers. Maximum resultant breast displacement, velocity and acceleration during jumping reached 18.7 cm, 93.1 cm·s⁻¹ and 3.6 g, respectively. Significantly more vertical breast displacement (p < 0.01) and velocity (p < 0.01) occurred compared with mediolateral and anteroposterior kinematics. Breast discomfort increased as cup size increased (r = .61). Two-step star jumping stimulated multiplanar breast kinematics and high levels of breast discomfort. Therefore, this activity may be useful in a retail outlet to determine the function and comfort of a sports bra.

The use of breast shielding for dose reduction in pediatric CT: arguments against the proposition

The use of breast shielding for dose reduction in pediatric CT: arguments against the proposition

Nutritional Factors That Influence Change in Bone Density and Stress Fracture Risk Among Young Female Cross-Country Runners

To identify nutrients, foods, and dietary patterns associated with stress fracture risk and changes in bone density among young female distance runners. Two-year, prospective cohort study. Observational data were collected in the course of a multicenter randomized trial of the effect of oral contraceptives on bone health. One hundred and twenty-five female competitive distance runners ages 18-26 years. Dietary variables were assessed with a food frequency questionnaire. Bone mineral density and content (BMD/BMC) of the spine, hip, and total body were measured annually by dual x-ray absorptiometry (DEXA). Stress fractures were recorded on monthly calendars, and had to be confirmed by radiograph, bone scan, or magnetic resonance imaging. Seventeen participants had at least one stress fracture during follow-up. Higher intakes of calcium, skim milk, and dairy products were associated with lower rates of stress fracture. Each additional cup of skim milk consumed per day was associated with a 62% reduction in stress fracture incidence (P < .05); and a dietary pattern of high dairy and low fat intake was associated with a 68% reduction (P < .05). Higher intakes of skim milk, dairy foods, calcium, animal protein, and potassium were associated with significant (P < .05) gains in whole-body BMD and BMC. Higher intakes of calcium, vitamin D, skim milk, dairy foods, potassium, and a dietary pattern of high dairy and low fat were associated with significant gains in hip BMD. In young female runners, low-fat dairy products and the major nutrients in milk (calcium, vitamin D, and protein) were associated with greater bone gains and a lower stress fracture rate. Potassium intake was also associated with greater gains in hip and whole-body BMD.

Precautions Related to Midline Sternotomy in Cardiac Surgery: A Review of Mechanical Stress Factors Leading to Sternal Complications

After midline sternotomy patients are instructed on activity precautions to avoid sternal wound complications. We questioned how restrictive these precautions must be, since they can lead to a postoperative decrease in quality of life. To identify mechanical stress factors causing sternal instability and infection in order to create evidence based guidelines for activity following sternotomy. Literature review. No evidence was found to support weight limitation regarding activity, as long as the upper arms are kept close to the body and activity is within a pain-free range. Avoid stretching both arms backwards at the same time (10 days); loaded activities should be done with the elbows close to the body (eight weeks); only move arms within a pain-free range; use leg rolling with counterweighing when getting in and out of bed; when coughing cross the arms in a "self-hugging" posture; supportive bra or vest is recommended when breast cup>or=D, body mass index>or=35 or frequent cough. This study provides insights into mechanical stress factors acting upon sternum and the overlying skin. RECOMMENDATIONS on activity precautions based on these finding have a patient supportive approach focusing on possibilities and not restrictions.

Systematic Review: Effective Management Strategies for Lactose Intolerance

Lactose intolerance resulting in gastrointestinal symptoms is a common health concern. Diagnosis and management of this condition remain unclear. To assess the maximum tolerable dose of lactose and interventions for reducing symptoms of lactose intolerance among persons with lactose intolerance and malabsorption. Multiple electronic databases, including MEDLINE and the Cochrane Library, for trials published in English from 1967 through November 2009. Randomized, controlled trials of individuals with lactose intolerance or malabsorption. Three investigators independently reviewed articles, extracted data, and assessed study quality. 36 unique randomized studies (26 on lactase- or lactose-hydrolyzed milk supplements, lactose-reduced milk, or tolerable doses of lactose; 7 on probiotics; 2 on incremental lactose administration for colonic adaptation; and 1 on another agent) met inclusion criteria. Moderate-quality evidence indicated that 12 to 15 g of lactose (approximately 1 cup of milk) is well tolerated by most adults. Evidence was insufficient that lactose-reduced solution or milk with a lactose content of 0 to 2 g, compared with greater than 12 g, is effective in reducing symptoms of lactose intolerance. Evidence for probiotics, colonic adaptation, and other agents was also insufficient. Most studies evaluated persons with lactose malabsorption rather than lactose intolerance. Variation in enrollment criteria, outcome reporting, and the composition and dosing of studied agents precluded pooling of results and limited interpretation. Most individuals with presumed lactose intolerance or malabsorption can tolerate 12 to 15 g of lactose. Additional studies are needed to determine the effectiveness of lactose intolerance treatment.

Milk intake and milk‐related perception of Korean middle and high school students

The purpose of this study was to investigate milk intake and milk‐related perception of Korean middle and high school students. The subject of study was 160 middle school students (80 males and 80 females) and 170 high school students (85 males and 85 females) in Kunggi Province area. This cross‐sectional survey was conducted using a questionnaire. There was significant difference in BMI distribution between male and female students. More than 30% of the subject did not drink milk at all and there was significant difference in milk intake between male (29.4% did not drink milk) and female (41.8% did not drink milk) students. The low weight group according to BMI answered significantly more ′do not drink milk′ compared to overweight and obese groups. The nutritional knowledge score of milk and dairy products is 6.3 out of 10 and that score was significantly lower in female students compared to male students. As for milk‐related perception, 62.4% of the subjects were willing to drink milk and 70.7% of them thought that 1 or 2 cups of milk is enough for a daily requirement. Most of the subjects thought that taste of milk and sanitation system during milk processing and distribution need to be improved. Therefore, production of milk with better taste and sanitation, and milk‐related nutrition education are necessary for increase of milk intake in Korean middle and high school students.

Improved nutrient intake and diet quality associated with lean beef consumption in the US: National Health and Nutrition Examination Survey (NHANES) 1999–2004

The dietary guidelines recommend consuming meats in its lowest fat form. NHANES 1999–2004 24‐hr dietary recall data were used to compare nutrient intake and diet quality (HEI‐2005) between highest lean/lowest fat (HLLF) beef consumers and lowest lean/highest fat (LLHF) beef consumers aged 4+ y (n = 11,507). Beef intakes were determined by summing amounts of beef contained in survey foods. The fat content of beef consumed was linked to the survey‐specific Nutrient Database for Standard Reference. Beef consumers were classified into tertile groups based on the fat content of beef consumed. HLLF beef consumers had higher protein intake; lower energy; total, saturated, and monounsaturated fat; and carbohydrate than LLHF beef consumers. HLLF beef consumers also had significantly higher intakes of vitamins A, C, B3, B6, B12; phosphorus; magnesium; iron; zinc; and potassium; and lower intake of calcium than LLHF beef consumers. Compared to the LLHF beef group, HLLF beef consumers also had higher cup equivalent intakes of total vegetables, dark green/orange vegetables, and legumes, higher meat oz equiv, lower grain oz equiv, lower milk cup equiv, and lower energy from solid fat and SoFAAS. Additionally, HLLF beef consumers had higher total HEI scores than LLHF beef consumers (51.0 ± 0.3 vs. 45.2 ± 0.3). Improved nutrient intake and diet quality were associated with consumption of lean beef. Support: USDA and Beef Checkoff

Radiation dose savings for adult pulmonary embolus 64-MDCT using bismuth breast shields, lower peak kilovoltage, and automatic tube current modulation

Radiation dose savings for adult pulmonary embolus 64-MDCT using bismuth breast shields, lower peak kilovoltage, and automatic tube current modulation

Iodine sources and iodine levels in pregnant women from an area without known iodine deficiency

An adequate iodine intake during pregnancy is essential for normal development of the foetus. The World Health Organization (WHO) recommends that the median urinary iodine concentration (UIC) in a population of pregnant women should range between 150 and 249 microg/l. The aim of this study was to evaluate iodine status and to examine the main sources of iodine in pregnant women from an apparently iodine-sufficient area. Six hundred pregnant women in the third trimester completed a food frequency questionnaire, and iodine was measured in urine samples. Urinary iodine concentrations were described in the whole population and in subgroups according to their frequency of intake of milk, fish, eggs, bread and iodized salt, as iodine supplements. The median UIC was 104 microg/l (n = 600), however, the median was higher among women who had a high milk intake (117 microg/l), used iodized salt (117 microg/l) or who were supplemented with iodine (141 microg/l). Women receiving iodine supplementation who also consumed more than one cup of milk per day had median UIC higher than 150 microg/l. In multivariate models, women with moderate and high milk intake had lower risk of having UIC below 150 microg/l [OR (95% CI): 0.42 (0.22-0.82) and 0.29 (0.15-0.55) respectively], after adjustment for potential confounders. On the basis of WHO criteria, the iodine status of pregnant women was inadequate in this area. Milk was the most important dietary source of iodine, and iodine supplementation was also an important source of iodine, although not enough to reach the current recommendations.

Adolescent Nutrition

Adolescent Nutrition

Radiation Dose to the Thyroid Gland and Breast From Multidetector Computed Tomography of the Cervical Spine

This study aimed to assess the radiation dose reduction that could be achieved using an in-line bismuth shielding over the thyroid gland and breast and to determine the effect of a cervical spine collar on thyroid dose reduction and image noise when performing computed tomography of the cervical spine using automatic tube current modulation. An anthropomorphic phantom was scanned using a commercially available 64-channel computed tomographic scanner. A standardized trauma cervical spine protocol was used. Scans were obtained with and without a standard cervical spine immobilization collar and with and without bismuth-impregnated thyroid and breast shields. Thermoluminescent dosimeters were placed over the thyroid gland and breasts for each scan. A paired t test was used to determine whether the skin entry dose differed significantly between the shielded and unshielded thyroid and breast and to determine whether placing the thyroid shield over a cervical immobilization collar resulted in a significant dose reduction. Region of interest of pixel values was used to determine image noise. The average measured skin entry dose for the unshielded thyroid gland was 21.9 mGy (95% confidence interval, 18.9-4.7). With a bismuth shield applied directly over the skin, the dose to the thyroid gland was reduced by 22.5% (P < 0.05). With the bismuth shield applied over the cervical spine collar, the dose reduction to the thyroid was 10.4%, which was not statistically significant (P = 0.16) compared with the dose reduction without the cervical collar. Skin entry dose over the breasts was significant, although they were outside the primary scan range. Without bismuth shielding, the skin entry dose was 1.5 mGy, and with bismuth shielding, the dose was significantly reduced by 36.6% (P < 0.01). Image noise increased most when shielding was used with an immobilization collar. There is a significant dose reduction to the thyroid gland and breasts when a bismuth shield is placed on the skin. The dose saving achieved by placing the shield on the cervical collar is approximately halved compared with placement on the skin, and this did not reach statistical significance, and this was accompanied by an increase on image noise. Bismuth shields should not be used in combination with cervical immobilization collars.

SU‐FF‐I‐60: Reduction in Breast Dose in Routine Chest CT Through the Use of Bismuth Breast Shields As Measured by DOT Dosimeters

Purpose: The goal of our research is to determine the effectiveness of commercially available Bismuth (Bi) breast shields for reduction of breast dose in routine chest computed tomography (CT) exams without having a negative impact on image quality, through the use of DOT dosimeters. Methods &amp; Materials: We used a Siemens 16‐slice CT scanner, an acrylic chest phantom with cork lungs and one acrylic breast (Phase I), a RANDO phantom (Phase II), Bi breast shields from AttenuRad (0.06 mmPb equivalent) with the two included ¼ inch thick foam pads, and aluminum oxide DOT dosimeters. These DOT dosimeters are optically stimulated luminescent (OSL) dosimeters read by the Landauer InLight® microStar system. Each exposure was made with our routine chest protocol using Caredose4D. Five dosimeters were placed on the breast, one each at 12, 3, 6, and 9 o'clock positions (12 being superior to 9) and one central to the others. Doses were read both with and without the Bi shield to calculate the dose reduction with three time reading repetition. Results: Our initial study with a Radcal ionization chamber showed an exposure to the center of the breast of about 1.92 R unshielded and 1.52 R shielded (21% reduction). Results of Phase I found an average dose of 1.58 rad unshielded and 1.14 rad shielded (28% reduction). Use of foam pads between the shield and the phantom surface reduced streaking artifacts that occurred where the shield previously made direct contact. The expected increase in CT number of underlying tissues was not seen. Conclusion: Our results from Phase I showed a significant reduction of the breast skin entrance dose with the use of Bi breast shields. We will repeat the tests with the RANDO phantom, and investigate whether the thicker foam pads are able to further decrease image artifacts.