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Tamara Miner Haygood,
Elsa Arribas,
Qing Mary Ashley Liu,
E Neely Atkinson,
Patrick C Brennan,
Lumarie Santiago,
Selin Carkaci,
Deanna Lane, Tanya W Stephens,
Huong LePetross,
Beatriz Adrada,
Paul Davis,
Gary J Whitman
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ABSTRACT: The American College of Radiology recommends that mammogram images be viewed at 100% resolution (also called one-to-one or full resolution). We tested the effect of this and three other levels of zooming on the ability of radiologists to identify malignant calcifications on screening mammographic views.
Seven breast imagers viewed 77 mammographic images, 32 with and 45 without malignant microcalcifications, using four different degrees of monitor zooming. The readers indicated whether they thought a cluster of potentially malignant calcifications was present and where the cluster was located. Tested degrees of zooming included fit screen, a size midway between fit screen and 100%, 100%, and a size slightly larger than 100%.
Readers failed to detect 17 clusters of malignant calcifications with fit-screen images, 12 clusters with midway images, 13 clusters with 100% images, and 11 clusters with slightly larger images. When viewing images without malignant microcalcifications, the readers marked false-positive areas on 25 images using fit-screen images, 43 of the midway images, 40 of the 100% images, and 29 of the slightly larger images.
All four tested levels of zooming functioned well. There was a trend for the fit-screen images to function slightly less well than the others with regard to sensitivity, so it may not be prudent to rely on those images without other levels of zooming. The 100% resolution images did not function noticeably better than the others.
American Journal of Roentgenology 10/2011; 197(4):W761-8. · 2.78 Impact Factor
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Gautam S. Muralidhar MS,
Alan C. Bovik PhD,
Mehul P. Sampat PhD,
Gary J. Whitman MD,
MD Tamara Miner Haygood PhD,
Tanya W. Stephens MD,
Mia K. Markey PhD,
Gautam S. Muralidhar,
Alan C. Bovik,
Mehul P. Sampat,
Gary J. Whitman,
Tamara Miner Haygood, Tanya W. Stephens,
Mia K. Markey
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ABSTRACT: In this paper, we review the role played by breast magnetic resonance imaging in the detection and diagnosis of breast cancer. This is followed by a discussion of clinical decision support systems in medicine and their contributions in breast magnetic resonance imaging interpretation. We conclude by discussing the future of computer-aided diagnosis in breast magnetic resonance imaging. Mt Sinai J Med 78:280–290, 2011. © 2011 Mount Sinai School of Medicine
Mount Sinai Journal of Medicine A Journal of Translational and Personalized Medicine 02/2011; 78(2):280 - 290. · 2.00 Impact Factor
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ABSTRACT: To prospectively determine the interpretation time associated with computer-aided detection (CAD) and to analyze how CAD affected radiologists' decisions and their level of confidence in their interpretations of digital screening mammograms.
An Institutional Review Board exemption was obtained, and patient consent was waived in this HIPAA compliant study. The participating radiologists gave informed consent. Five radiologists were prospectively studied as they interpreted 267 clinical digital screening mammograms. Interpretation times, recall decisions, and confidence levels were recorded without CAD and then with CAD. Software was used for linear regression fitting of interpretation times. P values less than .05 were considered to indicate statistically significant differences.
Mean interpretation time without CAD was 118 seconds ± 4.2 (standard error of the mean). Mean time for reviewing CAD images was 23 seconds ± 1.5. CAD identified additional findings in five cases, increased confidence in 38 cases, and decreased confidence in 21 cases. Interpretation time without CAD increased with the number of mammographic views (P < .0001). Mean times for interpretation without CAD and review of the CAD images both increased with the number of CAD marks (P < .0001). The interpreting radiologist was a significant variable for all interpretation times (P < .0001). Interpretation time with CAD increased by 3.2 seconds (95% confidence interval: 1.8, 4.6) for each calcification cluster marked and by 7.3 seconds (95% confidence interval: 4.7, 9.9) for each mass marked.
The additional time required to review CAD images represented a 19% increase in the mean interpretation time without CAD. CAD requires a considerable time investment for digital screening mammography but may provide less measureable benefits in terms of confidence of the radiologists.
Radiology 10/2010; 257(1):40-6. · 5.73 Impact Factor
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ABSTRACT: We have developed a novel, model-based active contour algorithm, termed "snakules", for the annotation of spicules on mammography. At each suspect spiculated mass location that has been identified by either a radiologist or a computer-aided detection (CADe) algorithm, we deploy snakules that are converging open-ended active contours also known as snakes. The set of convergent snakules have the ability to deform, grow and adapt to the true spicules in the image, by an attractive process of curve evolution and motion that optimizes the local matching energy. Starting from a natural set of automatically detected candidate points, snakules are deployed in the region around a suspect spiculated mass location. Statistics of prior physical measurements of spiculated masses on mammography are used in the process of detecting the set of candidate points. Observer studies with experienced radiologists to evaluate the performance of snakules demonstrate the potential of the algorithm as an image analysis technique to improve the specificity of CADe algorithms and as a CADe prompting tool.
IEEE transactions on medical imaging. 10/2010; 29(10):1768-80.
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IEEE Trans. Med. Imaging. 01/2010; 29:1768-1780.
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J. Digital Imaging. 01/2010; 23:701-705.
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Tamara Miner Haygood,
Elsa Arribas,
Patrick C Brennan,
E Neely Atkinson,
Mark Herndon,
Joseph Dieber,
William Geiser,
Lumarie Santiago,
Chadwick M Mills,
Paul Davis,
Beatriz Adrada,
Selin Carkaci, Tanya W Stephens,
Gary J Whitman
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ABSTRACT: American College of Radiology guidelines suggest that digital screening mammographic images should be viewed at the full resolution at which they were acquired. This slows interpretation speed. The aim of this study was to examine the effect of various levels of zooming on the detection and conspicuity of microcalcifications.
Six radiologists viewed 40 mammographic images five times in different random orders using five different levels of zooming: full resolution (100%) and 30%, 61%, 88%, and 126% of that size. Thirty-three images contained microcalcifications varying in subtlety, all associated with breast cancer. The clusters were circled. Seven images contained no malignant calcifications but also had randomly placed circles. The radiologists graded the presence or absence and visual conspicuity of any calcifications compared to calcifications in a reference image. They also counted the microcalcifications.
The radiologists saw the microcalcifications in 94% of the images at 30% size and in either 99% or 100% of the other tested levels of zooming. Conspicuity ratings were worst for the 30% size and fairly similar for the others. Using the 30% size, two radiologists failed to see the microcalcifications on either the craniocaudal or mediolateral oblique view taken from one patient. Interobserver agreement regarding the number of calcifications was lowest for the 30% images and second lowest for the 100% images.
Images at 30% size should not be relied on alone for systematic scanning for microcalcifications. The other four levels of magnification all performed well enough to warrant further testing.
Academic radiology 12/2009; 16(12):1509-17. · 2.09 Impact Factor
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ABSTRACT: OBJECTIVE: This article describes the manifestations of fat necrosis on mammography, sonography, and MRI and correlates the imaging findings with the pathologic findings. CONCLUSION: On imaging studies, the appearance of fat necrosis ranges from typically benign to worrisome for malignancy. Mammography is more specific than sonography, and emphasis should be placed on mammography in making the diagnosis of fat necrosis. In selected cases, MRI may be helpful in showing findings consistent with fat necrosis.
American Journal of Roentgenology 04/2009; 192(3):815-25. · 2.78 Impact Factor
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ABSTRACT: Our objective was to compare interpretation speeds for digital and film-screen screening mammograms to test whether other variables might affect interpretation times and thus contribute to the apparent difference in interpretation speed between digital mammograms and film-screen mammograms, and to test whether the use of digital rather than film comparison studies might result in significant time savings.
Four readers were timed in the course of actual clinical interpretation of digital mammograms and film-screen mammograms. Interpretation times were compared for subgroups of studies based on the interpretation of the study by BI-RADS code, the number of images, the presence or absence of comparison studies and the type of comparison study, and whether the radiologist personally selected and hung additional films; the same comparisons were made among individual readers.
For all four readers, mean interpretation times were longer for digital mammograms than for film-screen mammograms, with differences ranging from 76 to 202 seconds. The difference in interpretation speed between digital and film-screen mammograms was independent of other variables. Digital mammogram interpretation times were significantly longer than film-screen mammogram interpretation times regardless of whether the digital mammograms were matched with film or digital comparison studies.
In screening mammography interpretation, digital mammograms take longer to read than film-screen mammograms, independent of other variables. Exclusive use of digital comparison studies may not cause interpretation times to drop enough to approach the interpretation time required for film-screen mammograms.
American Journal of Roentgenology 02/2009; 192(1):216-20. · 2.78 Impact Factor
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ABSTRACT: The use of computer-aided detection (CAD) systems in mammography has been the subject of intense research for many years. These systems have been developed with the aim of helping radiologists to detect signs of breast cancer. However, the effectiveness of CAD systems in practice has sparked recent debate. In this commentary, we argue that computer-aided detection will become an increasingly important tool for radiologists in the early detection of breast cancer, but there are some important issues that need to be given greater focus in designing CAD systems if they are to reach their full potential.
Breast cancer 01/2008; 2:5-9.
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ABSTRACT: Myeloid sarcoma (MS) of the lower urinary tract is rare. We describe a 47-year-old man with hematuria, who was subsequently found to have MS involving bladder and epididymis. The neoplasm was composed predominantly of blasts that expressed CD68, CD117, myeloperoxidase, and lysozyme, with occasional immature eosinophils. Although blood and bone marrow examinations showed no morphologic evidence of leukemia, conventional cytogenetic studies of marrow demonstrated inv(16)(p13q22) in 4 of 20 metaphases; fluorescence in situ hybridization of the bladder neoplasm also showed inv(16). Following chemotherapy, the patient has been in complete remission for 32 months. In our literature review, we identified 7 cases of MS involving bladder, only 3 without evidence of an associated myeloid neoplasm in marrow, none with cytogenetic data. A high index of suspicion is required to establish the diagnosis of MS involving bladder. Cytogenetic analysis is useful for both demonstrating minimal marrow disease and classifying MS in paraffin-embedded tissue sections.
Archives of pathology & laboratory medicine 07/2006; 130(6):862-6. · 2.58 Impact Factor
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Proceedings of the International Conference on Image Processing, ICIP 2006, October 8-11, Atlanta, Georgia, USA; 01/2006
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American Journal of Roentgenology 11/2005; 185(4):971-2. · 2.78 Impact Factor
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ABSTRACT: There is no consensus about the use of the various diagnostic tests and surgical procedures available to confirm or rule out breast cancer in patients presenting with nipple discharge. This study was designed to identify patient and nipple-discharge characteristics associated with the diagnosis of breast cancer and to determine the utility of mammography, sonography, ductography, and cytology in surgical decision making in patients presenting with pathologic nipple discharge.
We reviewed the medical records of all patients who presented with nipple discharge at our institution between August 1993 and September 2000. Patient and nipple-discharge characteristics and findings on imaging studies and cytologic examination were analyzed.
A total of 146 patients presented at our institution with nipple discharge during the study period. Of these, 52 had clinically benign discharge and were managed without surgical intervention; 94 patients had pathologic discharge and underwent a biopsy procedure for histologic diagnosis, treatment, or both. Logistic regression analysis identified mammographic (relative risk [RR] = 10.47, 95% confidence interval [CI] 2.36 to 46.39, p = 0.0002) and sonographic (RR = 5.54, 95% CI 1.27 to 25.40, p = 0.028) abnormalities as independent factors associated with a malignant diagnosis. Nineteen cancers, 62 papillomas, and 13 other benign lesions were identified among the patients with pathologic discharge. In 3 patients with cancer (15.8%) and 30 patients with a papilloma (48.4%), ductography was the only means of identifying lesions to be resected. Patients who underwent ductography-guided operation (n = 42, 50%) or any surgical procedure including a localization study (n = 66, 78.6%) were significantly more likely than patients who underwent central duct excision alone to have a specific underlying lesion identified (p = 0.045 and p = 0.033, respectively).
Abnormalities on mammography and sonography in patients with nipple discharge should alert physicians to the possibility of a breast cancer diagnosis. In patients with pathologic discharge with normal findings on physical examination and other imaging studies, ductography might be the only means of localizing and resecting breast lesions associated with nipple discharge.
Journal of the American College of Surgeons 04/2003; 196(3):354-64. · 4.55 Impact Factor
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Xiujiang J Rong,
Chris C Shaw,
Dennis A Johnston,
Michael R Lemacks,
Xinming Liu,
Gary J Whitman,
Mark J Dryden, Tanya W Stephens,
Stephen K Thompson,
Kerry T Krugh,
Chao-Jen Lai
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ABSTRACT: Amorphous silicon/cesium iodide (a-Si:H/CsI:Tl) flat-panel (FP)-based full-field digital mammography systems have recently become commercially available for clinical use. Some investigations on physical properties and imaging characteristics of these types of detectors have been conducted and reported. In this perception study, a phantom containing simulated microcalcifications (microCs) of various sizes was imaged with four detector systems: a FP system, a small field-of-view charge coupled device (CCD) system, a high resolution computed radiography (CR) system, and a conventional mammography screen/film (SF) system. The images were reviewed by mammographers as well as nonradiologist participants. Scores reflecting confidence ratings were given and recorded for each detection task. The results were used to determine the average confidence-rating scores for the four imaging systems. Receiver operating characteristics (ROC) analysis was also performed to evaluate and compare the overall detection accuracy for the four detector systems. For calcifications of 125-140 microm in size, the FP system was found to have the best performance with the highest confidence-rating scores and the greatest detection accuracy (Az = 0.9) in the ROC analysis. The SF system was ranked second while the CCD system outperformed the CR system. The p values obtained by applying a Student t-test to the results of the ROC analysis indicate that the differences between any two systems are statistically significant (p<0.005). Differences in microC detectability for the large (150-160 microm) and small (112-125 microm) size microC groups showed a wider range of p values (not all p values are smaller than 0.005, ranging from 0.6 to <0.001) compared to the p values obtained for the medium (125-140 microm) size microC group. Using the p values to assess the statistical significance, the use of the average confidence-rating scores was not as significant as the use of the ROC analysis p value for p value.
Medical Physics 10/2002; 29(9):2052-61. · 2.83 Impact Factor
