Anthropomorphic breast phantoms for assessing ultrasonic imaging system performance and for training ultrasonographers: Part I

Three prototype anthropomorphic breast phantoms are discussed. The phantoms were constructed using ultrasonically tissue-mimicking materials; these materials mimic various tissue parenchymae in terms of attenuation, speed of sound, density, and scatter level. Realistic artifacts related to refraction and reflection at interfaces between different simulated parenchymae are produced. The phantoms represent premenopausal breasts, and they complement one another. Two of them represent the dense breasts of women under 30 years of age, and one represents that of a woman between 35 and 40 years of age. Of the former two, one produces what is apparently above-average refraction effects in the region of the peripheral fat layer; the other produces more typical refraction effects. Simulated tumors, cysts, and calcifications of various sizes are suspended in the glandular regions. Such phantoms are valuable for use in developmental testing of state-of-the-art ultrasound machines, quality assurance testing of clinical machines, and training of sonographers in breast imaging.     

An anthropomorphic ultrasound breast phantom containing intermediate-sized scatteres

An anthropomorphic breast phantom, built from materials which mimic tissue parenchymae with respect to attenuation coefficients, speeds of sound, densities and backscatter levels, is described in detail. One of the outstanding features of the phantom is that 30% of the volume of the glandular region consists of tissue-mimicking fat, the remainder being tissue-mimicking glandular (non-adipose) tissue. The presence of these tissue-mimicking fat globules should cause ultrasound beam distortions similar to those found in clinical scans of the breasts of younger women. Halliwell (1977) has presented direct evidence for such beam distortions in real breasts. Other tissues simulated in the phantom are: skin, subcutaneous and retromammary fat, Cooper's ligaments, ducts and (abnormal) masses. The potential areas of usefulness of the phantom are: aiding in the development of more effective ultrasound imaging machines, discovering— or verifying the causes of—various artifacts in breast imaging, routine testing of instruments being used clinically for breast imaging, and training of ultrasonographers. Ultrasound images of the phantom, made using three different instruments, are displayed and discussed.     

Large-transducer measurements of wavefront distortion in the female breast.

Ultrasonic waves propagating through soft tissue experience wavefront distortion. Refraction occurs at boundaries between tissue beds having different sound speeds; scattering occurs within a tissue bed, caused by local impedance variations. This paper describes measurements of wavefront distortion in the human female breast that indicate that refraction is the dominant distortion mechanism when the ultrasonic phased array is very large. The determination that refraction dominates the wavefront distortion is based upon studies of multiple image artifacts that result from a single source radiated through in vivo breasts and breast phantoms. The receiving apertures used were 4.65 and 9.6 cm. Such image artifacts are repeatedly observed in the 10 young subjects reported in this paper, and also in older subjects. An understanding of the in vivo observations is obtained by phantom studies.     

Standardized Uptake Values of Normal Breast Tissue with 2-Deoxy-2-[F-18]Fluoro-d-glucose Positron Emission Tomography: Variations with Age, Breast Density, and Menopausal Status

Objective This study was conducted to assess the effect of breast density, age, and menopausal status on the 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) uptake in normal breast tissue by quantitative standardized uptake values (SUV).Methods A total of 96 patients (premenopausal 54; postmenopausal 42) with histologically proven unilateral breast cancer who underwent FDG-positron emission tomography (PET) scans for staging were included in this study. The median age was 52±11 years (range 32–79 years). Fifty-nine patients had grade III or IV mammographic density (dense breast), whereas 37 patients had grade I or II breast density (nondense) according to the ACR Lexicon criteria. In the present study, we analyzed maximum and average SUVs for contralateral normal breast.Results Maximum and average SUVs for normal dense breasts were 1.02±0.30 and 0.84±0.27, respectively. Similar values for the nondense breasts were 0.66±0.24 and 0.53±0.23, respectively. Both maximum and average SUVs of dense breasts were significantly higher than those of nondense breasts (p<0.001). There was no significant difference in SUVs of nipple in patients with dense and nondense breasts. There was no significant effect of age and menopausal status on SUVs of normal breast. However, there were trends of negative relationship, i.e., decreasing SUVs with increasing age.Conclusion There was a significant difference in SUVs between the dense and nondense normal breast. However, the maximum SUVs in the dense breasts were well below the threshold of 2.5, a widely used cutoff value for malignancy. Menopausal status and age do not significantly affect the uptake of FDG.     

Tissue-mimicking materials for teaching sonographers and evaluation of their specifications after three years

In this paper, an algorithm is introduced for making breast phantoms and abnormal masses (cyst, fibroadenoma and cancer). The evaluation of ultrasonic properties (sound velocity and amplitude attenuation coefficient) of these normal breast phantoms and abnormal masses and their ultrasonic images shows that they are stable over 3 years. The measurement and evaluation results of ultrasonic images of our phantoms show that they behave like human breast tissues. Practicing with these phantoms for developing fine-needle aspiration (FNA) skills in sonographers shows that these phantoms reduce the time required for successful FNA. The ultrasonic phantoms have different ultrasonic applications, including ultrasonic medical imaging, the quality control of ultrasound (US) instruments, processing technique evaluation and US training; moreover, they are stable in room temperature and can keep their specifications for more than 3 years. (E-mail: Mokhtarm@modares.ac.ir)     

Tissue-mimicking phantom materials with tunable optical properties suitable for assessment of diffuse reflectance spectroscopy during electrosurgery

Emerging intraoperative tumor margin assessment techniques require the development of more complex and reliable organ phantoms to assess the performance of the technique before its translation into the clinic. In this work, electrically conductive tissue-mimicking materials (TMMs) based on fat, water and agar/gelatin were produced with tunable optical properties. The composition of the phantoms allowed for the assessment of tumor margins using diffuse reflectance spectroscopy, as the fat/water ratio served as a discriminating factor between the healthy and malignant tissue. Moreover, the possibility of using polyvinyl alcohol (PVA) or transglutaminase in combination with fat, water and gelatin for developing TMMs was studied. The diffuse spectral response of the developed phantom materials had a good match with the spectral response of porcine muscle and adipose tissue, as well as in vitro human breast tissue. Using the developed recipe, anatomically relevant heterogeneous breast phantoms representing the optical properties of different layers of the human breast were fabricated using 3D-printed molds. These TMMs can be used for further development of phantoms applicable for simulating the realistic breast conserving surgery workflow in order to evaluate the intraoperative optical-based tumor margin assessment techniques during electrosurgery.     

男性乳腺发育症的临床超声分析

目的探讨男性乳腺发育症的临床和超声表现,以提高对本病的认识。方法应用高频超声探头对47例(56只)男性乳腺发育症患者进行探测,年龄12~84岁,平均41.3岁,右乳病变22例,左乳病变16例,双乳病变9例,对双侧乳腺进行测量。结果男性乳腺发育症表现为以乳头为中心呈盘状或偏向一侧的扇状低回声,与周围组织分界清楚,其内可见向乳头方向聚拢的管状回声。正常乳腺前后径平均为5.37mm,上下径平均为8.72mm,病变乳腺前后径平均为8.89mm,上下径平均为22.95mm,正常与病变乳腺各测量值有显著性区别(P<0.01)。结论男性乳腺发育症根据临床表现、声像图特点,很容易作出正确诊断,但应进一步寻找致病原因,避免延误其他疾病的诊治。     

Calculating Individual Lifetime Effective Risk from Initial Mean Glandular Dose Arising from the First Screening Mammogram

ObjectivesThe objective of the study was to use the initial mean glandular dose (MGD) arising from the first screening mammogram to estimate the individual total screening lifetime effective risk.MethodsOrgan doses from full-field digital mammography (FFDM) screening exposures (craniocaudal and mediolateral oblique for each breast) were measured using a simulated approach, with average breast thickness and adult ATOM phantoms, on 16 FFDM machines. Doses were measured using thermoluminescent dosimeters accommodated inside the ATOM phantom; examined breast MGD was calculated. Total effective risk during a client's lifetime was calculated for 150 screening scenarios of different screening commencement ages and frequencies. For each scenario, a set of conversion factors were obtained to convert MGD values into total effective risk.ResultsFor the 16 FFDM machines, MGD contributes approximately 98% of total effective risk. This contribution is approximately constant for different screening regimes of different screening commencement ages. MGD contribution remains constant, but the risk reduced because the radiosensitivity of all body tissues, including breast tissue, reduces with age. Three sets of conversion factors were obtained for three screening frequencies (annual, biennial, triennial). Three relationship graphs between screening commencement age and total effective risk, as percentages of MGD, were created.ConclusionsGraphical representation of total risk could be an easy way to illustrate the total effective risk during a client's lifetime. Screening frequency, commencement age, and MGD are good predictors for total effective risk, generating more understandable data for clients than MGD.     

Complications and Radiologic Features of Breast Augmentation via Injection of Aquafilling Gel

Many attempts have been made to augment breasts using injectable materials; however, various complications are associated with these materials. Aquafilling gel (Aquafilling, Poděbrady, Czech Republic) is a new soft tissue filler that has been used as an implant material for the face and lip and recently for breast augmentation. This article describes 3 cases of augmentation mammoplasty using Aquafilling gel, focusing on their complications and radiologic features.     

Experiences of mastectomised women. A phenomenological study

ObjectiveTo understand the life experience of women with mastectomy in relation to their disease, analysing what leads some women to have breast reconstruction and others not to do so. Identify the situation of mastectomised women with lymphoedemas, alopecia and other problems.MethodPhenomenological qualitative research. Twenty-nine in-depth interviews were conducted on the women through specific informants in the oncology services of the Hospital Vall d’Hebron; and the gynaecology unit at the Salud La Mina Primary Care Centre in Barcelona. The age range was between 20 and 69 years.ResultsThrough the analysis of the interviews it was possible to reveal the phenomenon in research. The following subjects were those of most relevance: there women with reconstructed and non-reconstructed breasts, and a mutilated body image through the loss of one or both breasts. Participation of women in social occasions, use of clothing and lifestyle. The cancer is visualised: lymphoedemas, loss of hair with an affect on the public image.ConclusionsYounger women, graduates and middle class ladies and those over 40 with a primary education are those that have a breast reconstruction. Middle-high and high class graduates do not have a breast reconstruction. They negotiate their relationship with their partner in other ways.     

正常成年女性静止期乳腺厚度的超声观察

目的对正常成年女性静止期乳腺的厚度进行超声观察,为诊断乳腺疾病提供正常乳腺结构依据。方法应用高频超声对参加乳腺普查的5484例正常成年女性静止期乳腺进行检查,于每一位受检者左右两侧乳腺的外上象限腺体最厚处分别测量乳腺厚度并记录,按20～29岁、30～39岁、40～49岁、50～59岁、60～69岁、70～79岁共6个年龄段分别观察和计算该年龄段的每侧乳腺厚度最大值平均值及95%可信区间,将各年龄段左右侧乳腺厚度最大值平均值两两进行比较并计算P值。普查人群检测资料全部记录于乳腺普查专用数据库。结果在5484例正常成年女性静止期乳腺厚度测量值中,左侧乳腺厚度测量数据范围3.15～0.50cm,全距极差为3.10cm,均值为(1.30±0.40)cm,95%可信区间在1.22～1.45cm;右侧乳腺厚度测量数据范围2.93～0.36cm,全距极差为2.57cm,均值为(1.26±0.39)cm,95%可信区间在1.17～1.33cm。左右双侧乳腺厚度均值的比较(P0.05),差异有统计学意义。两侧乳腺厚度最大值平均值的比较中,只有30至39岁与40至49岁、60至69岁与70至79岁两对年龄组的差异无统计学意义(P0.05)。余各年龄段之间比较,差异均具有统计学意义(P0.05)。结论乳腺腺体的厚度在女性的一生中是呈动态变化的,正常成人个体之间乳腺厚度有较大的差异;同一个体在不同生理阶段和不同年龄阶段都会发生改变;同一个体的左右双侧乳腺的厚度也可以有较大的差异。     

Tissue phantoms in multicenter clinical trials for diffuse optical technologies

Tissue simulating phantoms are an important part of instrumentation validation, standardization/training and clinical translation. Properly used, phantoms form the backbone of sound quality control procedures. We describe the development and testing of a series of optically turbid phantoms used in a multi-center American College of Radiology Imaging Network (ACRIN) clinical trial of Diffuse Optical Spectroscopic Imaging (DOSI). The ACRIN trial is designed to measure the response of breast tumors to neoadjuvant chemotherapy. Phantom measurements are used to determine absolute instrument response functions during each measurement session and assess both long and short-term operator and instrument reliability.     

Radiation dose from digital breast tomosynthesis screening – A comparison with full field digital mammography

ObjectivesTo compare Mean Glandular Dose (MGD) and effective dose from digital breast tomosynthesis (DBT) screening with that from full field digital mammography (FFDM) screening.MethodTo simulate compressed breasts, two Perspex-polyethylene breast phantoms were used, one phantom for compressed breast in craniocaudal and the other for compressed breast in mediolateral oblique. An adult ATOM dosimetry phantom was loaded with high sensitivity thermoluminescence dosimeters; the phantom was then positioned on Hologic Selenia Dimensions mammographic machine to imitate DBT and 4-view FFDM screening. Organ radiation doses were measured from 4-view DBT and 4-view FFDM (craniocaudal and mediolateral oblique views for each breast). Organ radiation doses were used to calculate effective dose from one screening session.ResultsMGD for DBT was 3.6 mGy; MGD for FFDM was 2.8 mGy. For DBT, other organs (e.g. thymus, lungs, salivary glands, thyroid, contralateral breast and bone marrow) radiation dose was also higher than for FFDM. The use of DBT for breast cancer screening increases the effective dose (E) of one screening session by 22%. E for DBT was 0.44 mSv; E for FFDM was 0.34 mSv.ConclusionThe use of DBT for breast cancer screening increases the radiation dose to screening clients.     

Educating women about benign breast disease

The occupational health nurse can be a valuable resource for women by teaching how their bodies work and how female hormones affect their breasts. Nurses who work in primary care should view their role as one of education and advocacy on behalf of the client. Nurses can model a healthy attitude about breast self examination, encouraging women to perform it and to discuss openly their questions and concerns. Women should be encouraged to have mammograms, following ACS guidelines: a baseline mammogram between the ages of 35 and 40, a mammogram every 1 to 2 years between the ages of 40 and 49, and a yearly mammogram after age 50.     

Copolymer-in-oil Phantom Materials for Elastography

Phantoms that mimic mechanical and acoustic properties of soft biological tissues are essential to elasticity imaging investigation and to elastography device characterization. Several materials including agar/gelatin, polyvinyl alcohol and polyacrylamide gels have been used successfully in the past to produce tissue phantoms, as reported in the literature. However, it is difficult to find a phantom material with a wide range of stiffness, good stability over time and high resistance to rupture. We aim at developing and testing a new copolymer-in-oil phantom material for elastography. The phantom is composed of a mixture of copolymer, mineral oil and additives for acoustic scattering. The mechanical properties of phantoms were evaluated with a mechanical test instrument and an ultrasound-based elastography technique. The acoustic properties were investigated using a through-transmission water-substituting method. We showed that copolymer-in-oil phantoms are stable over time. Their mechanical and acoustic properties mimic those of most soft tissues: the Young's modulus ranges from 2.2–150 kPa, the attenuation coefficient from 0.4–4.0 dB.cm^–1 and the ultrasound speed from 1420–1464 m/s. Their density is equal to 0.90 ± 0.04 g/cm³. The results suggest that copolymer-in-oil phantoms are attractive materials for elastography. (E-mail: jennifer.oudry@echosens.com)     

Nonmastectomy treatment of breast cancer. Current status of excision plus radiation

Treatment of primary breast cancer with excision of the tumor plus radiation is now an accepted alternative to mastectomy in women who desire breast preservation and have a suitable clinical presentation. Tumor size and location should be carefully considered before applying treatment with this method, the primary consideration being whether the breast will be grossly distorted by excision. Women with large breasts are technically more difficult to treat and often have less satisfactory cosmetic results, but large breast size is not a contraindication to nonmastectomy procedures. A patient of any age can be treated with these procedures, but young women who undergo radiation treatment will have a longer period at risk for any late complications of irradiation. Compulsive attention to surgical and radiotherapeutic detail produces the best results. Careful and close long-term follow-up of these patients is essential because local recurrence is treatable with mastectomy.     

Can breast characteristics predict upper torso musculoskeletal pain?

BackgroundSeveral studies have associated a large breast size with an increased prevalence and severity of musculoskeletal pain, particularly pain in the upper torso. Despite this evidence, no research has explored whether breast size or related characteristics are risk factors for upper torso musculoskeletal pain.MethodsA backward multiple regression analysis was performed to identify whether characteristics of the breasts and upper torso, as well as physical factors known to be associated with musculoskeletal pain, could predict musculoskeletal pain among a cohort of 378 Australian women aged 18 years and over who had a wide range of breast sizes.FindingsThe model identified that breast volume, age and nipple-to-nipple distance predicted 23% of the variance in upper torso musculoskeletal pain reported by the participants.InterpretationWomen with a larger breast volume, lower age and a greater nipple-to-nipple distance were predicted to report a higher upper torso musculoskeletal pain score.     

Paraffin-Gel Tissue-Mimicking Material for Ultrasound-Guided Needle Biopsy Phantom

Paraffin-gel waxes have been investigated as new soft tissue–mimicking materials for ultrasound-guided breast biopsy training. Breast phantoms were produced with a broad range of acoustical properties. The speed of sound for the phantoms ranged from 1425.4 ± 0.6 to 1480.3 ± 1.7 m/s at room temperature. The attenuation coefficients were easily controlled between 0.32 ± 0.27 dB/cm and 2.04 ± 0.65 dB/cm at 7.5 MHz, depending on the amount of carnauba wax added to the base material. The materials do not suffer dehydration and provide adequate needle penetration, with a Young's storage modulus varying between 14.7 ± 0.2 kPa and 34.9 ± 0.3 kPa. The phantom background material possesses long-term stability and can be employed in a supine position without changes in geometry. These results indicate that paraffin-gel waxes may be promising materials for training radiologists in ultrasound biopsy procedures.     

African American women's breast memories, cancer beliefs, and screening behaviors

African American women experience higher breast cancer mortality and lower survival rates compared with white women of comparable age and cancer stage. The literature is lacking in studies that address the influence of past events on current health behaviors among women of diverse cultural groups. This qualitative exploratory study used participant narratives to examine associations between women's memories and feelings concerning their breasts and current breast cancer screening behaviors. Twelve professional African American women, aged 42 to 64 years, shared stories about memories and feelings regarding their breasts. Codes grouped together with related patterns and recurrences revealed categories that encompassed the language and culture of the participants. The categories identified were Seasons of Breast Awareness, Womanhood, Self-Portraits, Breast Cancer and Cancer Beliefs, Breast Cancer Screening Experiences, and Participants' Advice for Change. These categories provide direction for further exploration of barriers to health promotion practices among African American women and women in general.