Introduction
What is Mammography?
Mammography is the process wherein a human breast is examined using a low-dose x-ray. This process is used to test if one person has a tumor or a cyst. Mammography has been verified to be an effective detector for breast cancer and trim down such cases, as well. It is said that there are no other imaging techniques developed in effectively lessening the risk of breast cancer, but of course, self-examination and a physician’s guide are crucial for proper caring of the mammary glands or breasts. For some places, older women are strongly encouraged to be screened to make a diagnosis of early-stage breast cancer. There are some researchers conducted in the 1960s which proved that mammography, indeed, keeps lives (Shapiro et al., 1966).
To create images, like all other x- rays, the mammogram uses a prescribed amount of ionizing radiation. The image produced is then analyzed by the radiologists to detect if any possible abnormalities may be harmful to the patient. Using longer wavelength X-rays (typically Mo-K) than those used for radiography of bones is more advisable and it is typical.
Nowadays, undertaking the process of mammography with the physical breast examination is preferred by women in testing their conditions. This is compared with the other imaging technologies that are available but mammography tops it all. CT Scans have a less definite function in finding tumors and cysts. Ultrasound, Ductography, and Magnetic Resonance are just optional extra to mammography. Ultrasound is normally used for supplementary assessment of masses that is possibly found on mammography or conspicuous masses that are not visible on mammograms. Ductograms are very much helpful in diagnosing bloody nipple discharge which the mammogram could not detect at all. Magnetic Resonance Imaging (MRI) which is a technique for medical imaging is primarily used to see the function and the whole system of the body. MRI provides more detailed images and can be functional for more evaluation of vague findings, or sometimes for pre-surgical evaluation to see if there are other additional injuries. Another method to evaluate the doubtful findings from the breast is the stereotactic breast biopsies (Brown et al., 1999).
However, mammography misses breast cancer detection for about 10 percent. This is due to the thick tissues which overlap with the appearance of the normal tissues and results in the unclear images seen on the screening process.
History
The History of mammography started in 1913, when a Berliner surgeon, A. Salomon comprehended roentgen-histological research on 3,000 mastectomies. This work became the basis of mammography. Until 1938, some articles were issued but were of small help to mammography. From 1947 to 1970, the second period provided the consequences of roentgenologic and clinical association. R. Leborgne was the first responsible for the general development of this method. Since 1951, lots of American and European radiologists have brought their involvement. Ch. Gros is one of the best known. He gave this method an acknowledgment throughout the world for the diagnosis of breast ailments. Since 1970, the third period underlined the charge of mammography as a technology for the detection of breast cancer.
Mammography started in 1960, but contemporary mammography has existed only since 1969 when the first x-ray gadgets bestowed to breast imaging were obtainable. By 1976, mammography as a screening apparatus became standard practice. Its importance in diagnosis was accepted. Mammography goes on to improve as lower doses of radiation are identifying even smaller probable problems earlier.
Lots of research middles are expanding some innovative technologies to detect breast growths and to advance conventional mammography, even comprising digital mammography, where computers help in the interpretation of the x-rays.
Technology
Mammography equipment has developed over at least the previous 40 years to the contemporary state of the art. While there are some dissimilarities from one producer to another, there are also lots of features that are general to all. That is what is introduced here and then plaster in more detail later.
X-ray Tube Anode: Whereas most x-ray tubes use tungsten as the anode material, mammography items use molybdenum anodes or in some variants, dual material anodes with an extra rhodium track. These materials are applied as they provide a characteristic radiation spectrum that is secure to optimum for breast research.
Filter: Whereas most x-ray gadgets use aluminum or “aluminum equivalent” to filter the x-ray stream to decrease unnecessary exposure to the patient, mammography employs filters that work on various principles and are applied to expand contrast compassion. Molybdenum (same as in the anode) is the general filter material. Some systems permit the operator (or automatic control utility) to choose either the molybdenum or a rhodium filter to optimize the spectrum for explicit breast conditions.
Focal Spots: The typical x-ray tube for mammography has two focal spots that may be selected. The spots are usually smaller than for other x-ray practices due to the requirements for minimal shadowing and good visibility of features to see the small calcifications. The smaller of the two spots is usually applied for the magnification technology.
Compression: Good compression of the breast is one of the vitals of efficient mammography (and a general source of patient distress and anxiety). Probable promotes obtained from compression entail:
- A more consistent breast thickness effecting in a better athletic exposure into the film leeway or dynamic array.
- Decreased blurring from patient movement.
- Decreased dispersed emission and expanded contrast sensitivity.
- Decreased radiation dosage.
- Better visualization of tissues near the chest wall.
Grid: A grid is applied in mammography (as in other x-ray processes) to sop up scattered radiation and increase contrast sensitivity. Contrasted to grids for general x-ray imaging, gratings for mammography have an inferior ratio and the material between the slivers is selected for low x-ray absorption. The grid is enclosed in a Bucky item that moves it during the x-ray exposure to blur and decrease the visibility of the grid lines.
Receptor: Both film/screen and digital receptors are applied for mammography.
Innovations for Cancer Detection Technique
Digital technology is growing faster and faster. In the United States, there exists at least one digital machine in 32 percent of the clinics, compared to 10 percent two years ago. And apparently, the film will be out of use.
The fast innovation for digital machines is existing in part because some women, especially those younger ones and those with dense tissues, are detected more of the tumors by using films than the new technologies. Digital Machines are effective in detecting tiny calcium deposits or calcifications which could be a sign of growing cancer. However, no studies yet are developed by radiologists but they are doing a lot of things in encouraging women to come back (Mattson et al., 1996).
Full Field Digital Mammography (FFDM)
Before, mammography was done with screen-film cassettes. Now, innovations have come their way, a digital detector is developed and is known as Full Field Digital Mammography (FFDM). This development is years later than general radiology because of some factors which are; mammography demands a higher resolution, the equipment is too costly, and the fact that digital mammography has not yet been proven greater than film-screen mammography for the detection of breast cancer (Burnett et al., 1995).
A newly developed digital technology, Full Field Digital Mammography (FFDM) also called digital mammography, is designed to improve high-quality images, adds details, and lessens the doses of radiation (Mattson et al., 1996). This machine also improves the visualization of dense breasts and the ability to do the after-processing picture of the breasts. A lot of facilities are shifting into this new kind of technology which is very much important to the whole department of imaging.
training of 8 hours is required before conducting such procedures for the examinations of the patients using the new technology. This is upon the requirement of the Mammography Quality Standards Act (MQSA). The seminar will complete the requirement of the MQSA and assures to advance of the skills in the operation of the new technology (Shapiro et al., 1966).
Digital mammography with CAD
A technique for capturing x-ray images in the computer code instead of using x-ray film is developed and it is called Digital mammography with CAD. Computer-Aided Detection (CAD) is a technology used as a backup for the original mammogram and in some way gives accurate highlights on the areas which the radiologists have to focus. The pictures or images are then displayed on a computer monitor and can be changed, whether darken or lighten. Also, it can be zoomed in on a particular area. The point of view of the patients in this technology is not different from the conventional type of mammography (Shapiro et al., 1966).
On the other hand, digital mammography has more benefits than traditional mammography. The images captured can be saved and recover electronically, which makes consultations with the other equipment in mammography more light. Delicate differences that can occur between tissues may be observed because the radiologists can make adjustments to the images. The initial results of digital mammography may lessen the chance of having the next procedures (Mattson et al., 1996).
Conclusion
During the transition period, some troubles may come in comparing the previous x- rays of the patients from the present result of the digital mammograms. This is a very important part of the whole test to see what changes had happened. Sometimes, the digital and film versions are difficult to compare and come up with a definite result so the radiologists will tend to request another series of tests such as additional x- rays, ultrasound exams, and biopsies. This case occurs more often than not in women who do not have breast cancer (Mattson et al., 1996).
Some researches show that ‘false positive’ mammograms can bring anxiety to the woman. The woman will keep on coming back for more tests and think that for a big possibility of having breast cancer. A negative impact may depict on the behavior of the woman.
In some cases, mammograms can also have the disadvantage of missing signs of cancers, and this is regarded as ‘false negatives. This is a very critical issue because the tests say that the woman is safe for that person has no cancerous tissue inside the body and definitely will not have a breast cancer is somewhat unsure just because the mammography failed to conduct the processes accurately and resulted from the misinterpretation of the radiologists. Another problem is, many women do not come back for the next procedures of the examination and ignore the chances of being a ‘false negative patient’. The precise data is hard to identify because the mastectomies cannot be done in all women who has had a ‘false negative’ mammogram result. Researchers have found out that women in young ages have denser tissues and it is really hard to detect such signs of cancers. Because of that, ‘false negative mammograms more likely occur twice. And that is why the screening process is restricted to women the age of 50 and above (Burnett, 1995).
Mammography is not just the thing, it does not give the answers to our questions in a definite manner and failure to detect tumors is possible, but despite its inefficiency, many critics have praised the lowering of the possible death rate for cancer patients during the evolution of the digital mammography. Although some women do not agree with the examination processes because they are afraid that they might get admitted into the clinic or the hospital for further observations, many believed that it will bring a miracle to the second deadliest disease next to lung cancer (Burnett, 1995).
References
Burnett, C.B., Steakley, C. S., & Tefft, M. C. Low- income, minority women: Barriers to cancer screening. Annals of the New York Academy of Sciences, 768, 277. 1995
Gianolli, D., Physics: Principles with Applications, Prentice Hall publishing, 5th edition 1997.
James Mattson and Merrill Simon. The Pioneers of NMR and Magnetic Resonance in Medicine: The Story of MRI. Jericho & New York: Bar-Ilan University Press, 1996.
Mammogram, History of Procedure eMedicineHealth. 2008. Web.
Nobels, W. African Philosophy: Foundation for Black Psychology. In E. L. Jones (Ed.), Black Psychology (pp. 47-63). Berkely, CA: Cobb & Henry. 1991.
Shapiro S, Strax P, Venet L Evaluation of Periodic Breast Cancer Screening With Mammography. Journal of the American Medical Association (JAMA) 195(9): 111. 1966.