Biomedical subjects
Publications and source records attributed to R McLelland.
There are numerous political issues concerned with the roles of breast imaging in the detection, diagnosis, and management of breast cancer. These include issues regarding screening mammography, quality control, and results including cost-effectiveness of medical-legal considerations, but also their relation to overall health care of other societal needs.
Digital mammography can potentially improve mammography image and interpretation quality. On-line interpretation from a workstation may improve interpretation logistics and increase availability of comparison images. Interpretation of eight 4k- x 5k-pixel mammograms on two to four 2k- x 2.5k-pixel monitors is problematic because of the time spent in choosing which images display on which monitors, and zooming and roaming on individual images that are too large to display completely at full resolution. The authors used an eyetracker to measure radiologists viewing behavior during mammography interpretation with film on a viewbox. It was observed that a significant portion of the mammographers' time is spent viewing "comparison pairs" (typically two or more comparisons per case), such as the left mediolateral and craniocaudal images or old and new images. From the eyetracker measurements, we estimated that the number of image display, roam, and zoom operations decreases from an average of 64 for one monitor to 31 for four monitors, with the largest change going from one to two monitors. We also show that fewer monitors with a faster response time is superior to more monitors with a slower response time. Finally, the authors demonstrate the applicability of time-motion analysis to mammographic workstation design.
We present a paradigm for empirical evaluation of digital image enhancement algorithms for mammography that uses psychophysical methods for implementation and analysis of a clinically relevant detection task. In the experiment, the observer is asked to detect and assign to a quadrant, or indicate the absence of, a simulated mammographic structure characteristic of cancer embedded in a background image of normal breast tissue. Responses are indicated interactively on a computer workstation. The parameter values for the enhancement applied to the composite image may be varied on each trial, and structure detection performance is estimated for each enhancement condition. Preliminary investigations have provided insight into an appropriate viewing duration, and furthermore, suggest that nonradiologists may be used under this methodology for the tasks investigated thus far, for predicting parameter values for clinical investigation. We are presently using this method in evaluating several contrast enhancement algorithms of possible benefit in mammography. These methods enable an objective, clinically relevant evaluation, for the purpose of optimal parameter determination or performance assessment, of digital image-processing methods potentially used in mammography.
RATIONAL AND OBJECTIVES: Training in breast imaging is highly variable among radiology programs. The authors have developed a standardized breast imaging curriculum for radiology residents. METHODS: This curriculum has been implemented within the residency program at the University of North Carolina at Chapel Hill. It includes nine standardized components: 1) the clinical activities of the service; 2) the study of breast imaging teaching file films and contribution of new cases; 3) selected readings; 4) formal discussion with faculty on the readings; 5) review of this material using an interactive computer program; 6) formal conferences; 7) technical and quality control activities; 8) research activities; and 9) an evaluation. The participating residents have been surveyed regarding their opinions of their educational experience. RESULTS AND CONCLUSION: The standardized curriculum has been well received by the participating residents. Conclusions about the educational efficacy of such a curriculum cannot be made until more residents have used it.
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Mammography has had a major impact on the earlier detection, treatment options, and management decisions and survival and mortality rates of breast cancer. Consequences include overwhelming demand for mammography; problems with optimum response by radiology; limited availability of the examination, especially to the socioeconomically disadvantaged; self-referral for mammography by unqualified physicians for less than altruistic reasons; and unrealistic expectations of mammography by women, physicians, and lawyers. Responses to the overwhelming demand for high-quality mammography include ACR postgraduate and continuing education courses and its mammography accreditation program; a more comprehensive examination on mammography for certification by the ABR; and increasing state and federal government interest and legislation for reimbursement, quality assurance, and delivery of mammography. The precedents this sets for radiology if not all of medicine suggests that collaboration of the private and public sectors offers the greatest promise of an appropriate response, namely reproducible optimum mammography accurately interpreted with the lowest possible radiation dose for all eligible women in the United States.
Screening mammography can reduce mortality from breast cancer and is the only means of detecting nonpalpable cancers that are often more curable. Based on this, guidelines have evolved but compliance with them has been slow. Reservations are based on yield-cost-benefit-harm considerations, but uniformed and/or disadvantaged women and reluctance if not resistance to screening mammography by primary care physicians are major problems. The challenges are to overcome these obstacles and to obtain sufficient competent personnel and facilities to make reproducibly optimum screening mammography, which is accurately interpreted, widely available to all eligible women at the lowest possible cost.
This article discusses the background, goals, criteria, current results, impact, and future directions of the American College of Radiology's (ACR's) Mammography Accreditation Program. To date, approximately one half of the mammographic units in the United States have voluntarily applied for accreditation through the ACR program, with approximately one quarter of the units in the United States now accredited. Application rates have increased steadily since the start of the program in August 1987. The equipment performance criteria and professional criteria defined and employed in the ACR Mammography Accreditation Program have been adopted as standards for the performance of screening mammography by the ACR and have served as a basis for quality assurance standards in state and federal legislation on mammography.
Mammography, breast physical examination, and breast self-examination are recommended for breast cancer screening. Although in randomized trials of screening, mammography demonstrated a reduction in breast cancer mortality for women over 50, such data are not available for breast physical or self-examination. The Canadian National Breast Screening Study should provide data regarding the efficacy of breast physical examination alone. The World Health Organization has established trials to evaluate self-examination in the USSR and Germany. There is still controversy regarding routine mammographic screening and the optimal screening interval for women under age 50. The costs of mammographic screening remain a concern, but these costs can be lessened considerably through efficiency of mammographic services and a reduction in the number of false-positive interpretations that prompt biopsy. Primary care physicians can help to reduce breast cancer mortality by referring their patients for screening mammography and by performing breast physical examinations.
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The goals of screening mammography are reproducibly optimum images, accurately interpreted, at the lowest possible cost. This can reduce the mortality from breast cancer. Despite this, screening mammography has not been widely used because of the controversy over the age at onset and interval of screening, charge for the examination, misinformed primary care physicians, uninformed women, and other factors. The American College of Radiology's educational efforts and mammography accreditation program are overcoming some of these obstacles.
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Screening mammography and physical examination have made major contributions to the earlier detection of breast cancer. Mammography is the only reliable means of detecting nonpalpable cancers and can detect many minimal breast cancers when they appear to be curable. Low-cost, high-quality mass screening mammography, accurately interpreted, is feasible and could reduce overall mortality from breast cancer if it were more widely applied. Recognition of the need and desire to provide the service are essential initial motivating factors. The challenge to radiology is to obtain sufficient competent personnel and facilities.
Mammography is a screening method that has been proven effective and could significantly reduce the overall mortality from breast cancer if it were more widely applied. The challenge to radiology is to provide sufficient competent personnel and adequate facilities such that reproducibly optimal screening mammography, accurately interpreted at the lowest possible cost, is made widely available.
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