Alternative Approaches to Breast Cancer Screening

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Breast Sonography: 2.00
Patient Care: 2.00
Patient Interactions and Management: 2.00

Mammography: 2.00
Procedures: 2.00
Mammographic Positioning, Special Needs, and Imaging Procedures: 2.00

Magnetic Resonance Imaging: 1.00
Patient Care: 0.50
Patient Interactions and Management: 0.50
Procedures: 0.50
Body: 0.50

Nuclear Medicine Technology: 1.00
Patient Care: 0.50
Patient Interactions and Management: 0.50
Procedures: 0.50
Endocrine and Oncology Procedures: 0.50

Registered Radiologist Assistant: 2.00
Procedures: 2.00
Thoracic Section: 2.00

Sonography: 1.00
Patient Care: 0.50
Patient Interactions and Management: 0.50
Procedures: 0.50
Superficial Structures and Other Sonographic Procedures: 0.50

Radiation Therapy: 2.00
Patient Care: 2.00
Patient and Medical Record Management: 2.00

Outline

1. Introduction
2. Mammography
   1. Digital Breast Tomosynthesis
   2. Contrast Material-Enhanced Spectral Mammography
3. US Examination
   1. Microvascular Imaging
   2. Elastography
   3. Automated Breast US
   4. US Transmission Tomography
   5. Optoacoustic US
   6. Fusion Imaging
4. MRI Examination
   1. Abbreviated Breast MRI
   2. Ultrafast Breast MRI
   3. Diffusion-Weighted Imaging
5. Nuclear Medicine Techniques
   1. MBI Examination
   2. Breast PET Imaging
6. Artificial Intelligence and Machine Learning
7. Non-Imaging Novel Screening Techniques
8. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the basic facts about DBT
2. know the advantages of combining DBT with DM
3. be familiar with potential results of ongoing technologic advances in DBT algorithms
4. understand the requirements for contrast-enhanced spectral mammography
5. know how most contrast-enhanced spectral mammography compares with breast MRI
6. know a common criticism of breast ultrasound
7. be familiar with the roles, advantages, and disadvantages of the various breast ultrasound techniques
8. know the basics of Doppler ultrasound
9. be familiar with the advantages of microvascular ultrasound imaging
10. know how elastography improves ultrasound specificity and sensitivity
11. know the similarities and differences between strain and 2D shear wave elastography
12. know how the addition of elastography and Doppler benefits screening with B-mode ultrasound
13. recognize the advantages of automated breast ultrasound
14. know why enthusiasm for automated breast ultrasound as a supplemental screening modality has been hampered
15. identify the basic components of the transmission tomography ultrasound technique
16. know how the speed of sound map is dependent on the density of various tissues
17. be familiar with the basic facts and uses of optoacoustic ultrasound
18. understand the need for and usefulness of fusion imaging
19. recognize the reasons why breast MRI is not used for population-wide screening
20. know the ACR accreditation requirements for breast MRI
21. know the necessary sequences for an abbreviated breast MRI protocol
22. understand how abbreviated breast MRI protocols compared with full breast MRI protocols in the multi-study review cited in the article
23. be familiar with the potential causes for the lower-than-expected gains in patient flow rate for abbreviated MRI examinations
24. know what ultrafast breast MRI can help to document in breast cancer cases
25. understand the benefit of ultrafast breast MRI when added to abbreviated breast MRI protocols
26. know what diffusion-weighted images can help to demonstrate and how they can benefit breast imaging
27. know the benefits of dual-panel, CZT MBI systems over single-panel, breast-specific gamma imaging systems using either sodium or cesium iodide crystals
28. be familiar with the basics of MBI protocol and ⁹⁹mTc Sestamibi uptake
29. know the patient population(s) for which MBI is a good supplemental screening exam
30. know the patient and imaging preparation steps for ¹⁸F-FDG PET imaging
31. be familiar with the current limitations on the utility of breast PET imaging for widespread screening
32. be familiar with the average supplemental cancer detection rates of the various vascular-based screening techniques
33. be familiar with the clinical roles for AI use in the various breast imaging modality options
34. understand why deep learning algorithm research has focused on screening mammography
35. be familiar with where AI is currently focused in breast ultrasound and what benefits may be obtained
36. understand why AI can deliver both lesion classification and lesion detection in automated breast ultrasound
37. understand how the use of MRI radiomics benefits patients
38. know how an acceptable sensitivity is currently achieved for deep learning-based automated detection algorithms for MRI breast cancer screening
39. know what debris growing cancers actively or passively shed into the bloodstream
40. understand the potential benefits of liquid biopsy assessment for breast cancer patients