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GE Mammography

SenoBright* Contrast-Enhanced Spectral Mammography

* Trademark of the General Electric Company

Working together for healthier lives

MR and Ultrasound procedures and volumes vary widely by institution.This example is based on an average population

Breast Imaging pathway

Early health saves lives

GE Screening tools include:

Senographe Essential

GE Diagnosis tools include: SenoBright CESM

GE Biopsy tools include:

Stereotaxy

Is it real? Where is it? What is it? What next?

Verification Localization Analysis Action plan

Is there something?

Detection

High satisfaction Easy positioning, efficient exam time/process, clear results

Good image quality Reasonable dose, repeatable, standardized, reliable

Smooth workflow and connectivity Review station, archiving, connectivity

Proven clinical outcomes DMIST, OSLO II: better sensitivity overall and specifically on dense breast

CESM

Today Digital Mammography remains the most relevant exam to address breast cancer screening

Kolb et al. Radiology 2002; 225:165-175.

Dense breast tissue can overlap with lesions

Lesions are not always visible with x-ray

Interpretation of images can vary among radiologists

CESM

Mammography is a reliable tool, but has limitations

However:

Limited availability of other exams can

increase time to diagnosis

Delays can increase patient anxiety

Other imaging modalities can be cost-prohibitive, take a long time to access, and require long exam times, or have highly operator dependent results

… A new diagnostic paradigm is needed

CESM

Complementary techniques are therefore required

Iodine injection – Contrast agent can be used to highlight areas of unusual blood flow patterns

Modalities l ike MR and CT use contrast-enhanced imaging to highlight suspicious areas

CESM

Contrast-Enhanced areas drive increased suspicion

Idea: use contrast agents in digital mammography to provide contrast-enhanced images

Detection of unusually high blood flow can be used to increase suspicion

Iodine injection – Contrast agent can be used to highlight areas of

unusual blood flow

SenoBright

Two images per view are provided. The first uses standard mammographic techniques and represents tissue density. The second is a contrast-enhanced image in exactly the same position.

SenoBright uses multiple x-ray exposures to reduce background signal, effectively highlighting contrast enhanced areas.

Perform additional tests right away:

same equipment, same staff, same day

Clinically proven results:

As an adjunct to inconclusive mammography and ultrasound

Help reduce patient anxiety

By performing follow-up tests quickly

CESM

SenoBright. Know more now Before

After

Perform additional tests right away

same equipment, same staff, same day

Leverage a new problem-solving exam for inconclusive mammography

Helps reduce anxiety related to waiting

SenoBright. Follow up faster.

Quick learning curve

because images are acquired in standard

views

Easy correlation

With standard mammography results

Easy Communication

Surgeons and specialists can get what they

need in familiar mammography views

The information you need, in the context you know.

SenoBright. Stay in Context.

Easily fits into your practice

Administer intravenous iodine injection exactly like injected CT exams

After a 2 minute wait , perform the usual 4 mammo views in 5 minutes

Mammography Standards Respected

Dedicated quality control protocol using the usual FFDM phantom

DICOM compatible

CESM

SenoBright. Deploy with ease.

Streamlined Review on IDI MammoWorkstation (from version 4.6 on)

Dedicated hanging protocol and specific tools

Easy identification and side-by-side display of GE SenoBright low energy and contrast-enhanced images

Comparison of a current GE SenoBright with a prior exam

Enhanced Image Presentation

Simultaneous pan & zoom

Independent window width/level adjustment

Improved Ergonomics

Backlit keypad (optional)

CESM

SenoBright. Review Optimally.

SenoBright – Technology Fundamentals

Energy and Iodine Attenuation

• Iodine attenuation has a k-edge at 33KeV (dashed line in the above graph)

•Take exposures below and above that edge

•Process to suppress background tissue/highlight contrast uptake

•Recombined image represents iodine

Spectral Shaping of X-rays

• Generator/Tube capable of 49KV

• Fast KV switching to avoid motion artifacts

• Multi-layer High-Energy filter minimizes dose

• high-energy exposure adds ~20% average glandular dose.

GE Mammography

SenoBright* Contrast-Enhanced Spectral Mammography

Case Studies

* Trademark of the General Electric Company

Working together for healthier lives

79 yo w palpable mass on left breast, original mammography

SenoBright – Case 1 Mammographically equivocal (occult?) lesion

Images courtesy of Mikawa Breast Center, Mikawa, Japan

SenoBright – Case 1 Clarification of mammographically equivocal lesion

79 yo

Palpable mass on left breast


79 yo w palpable mass on left breast

SenoBright contrast-enhanced images clearly localize the lesion


CC @ 2min

Low Energy Contrast-Enhanced

MLO @ 4 min

Contrast-Enhanced Low Energy


79 yo w palpable mass on left breast

Unsuspected finding on right breast with , 2 small fibroadenomas


CC @ 3min

Low Energy Contrast-Enhanced

MLO @ 5 min

Contrast-Enhanced Low Energy


SenoBright – Case 2 Mammographically heterogenous density

RCC L CC R MLO L MLO

72 y/o, screening mammo

Previous operation for a benign nodule on the right external superior quadrant .

Clinical exam reveals a dense area at 9 o’clock (right) and 3 o’clock (left)

Images courtesy of Centre D’imagerie Medicale, Creil , France

SenoBright – Case 2 Mammographically heterogenous density


RCC L CC R MLO L MLO

Convergence visible only on L MLO, but not

seen with ultrasound

Conclusion : Birads 0.

SenoBright – Case 2 Mammographically equivocal lesion

US : Two hypoechoic zones at 9 o’clock on the right breast:

--) left Image : 15mm at 9h resembling very hypoechoic glandular tissue.

--) right Image : deep nodule, resembling pseudo-cyst with discrete reinforcement beyond 14mm.

Conclusion : Birads 0. CESM Ordered.



CESM : Two disctinct contrast enhanced zones that correspond to the ultrasound imaging.

Superficial « cloudy » enhancement

Deeper nodular enhancement

--) Birads 4. Next step : U/S guided micro-biopsy showed:

Superficial zone : ductal hyperplasia without atypia

Profound zone : Invasive ductal carcinoma

1st

2nd



Images courtesy of Armentieres Hospital, France


Images courtesy of Armentieres Hospital, France

Contrast-enhanced images reveal the lesion by hiding the cyst

Biopsy : Infiltrating ductal carcinoma

Large cluster of microcalcifications noted on screening mammogram

SenoBright – Case 4


SenoBright– Case 4

Large cluster of microcalcifications noted on screening mammogram



57 years old, presented to screening

Normal clinical exam

Image of convergence lower quadrant right breast.




US

US : Tissue formation at 4:00 4cm from the nipple measuring 6x4x5mm.

Conclusion : Birads 5.



3 contrast enhanced areas



Second look US : Visualisation of the second contrast-enhanced area found under SenoBright.

Spiculated appearance 19mm in front of the primary suspected lesion.

Third contrast-enhanced area not visualized

Biopsy: Three IDCs, 12mm, 6mm, and 1mm diameters


Images courtesy of Dr JL Cárdenas, Hospital Príncipe de Asturias, Madrid


Mx reveals group of suspicions microcalcifications on left , present but less suspicius on right



Contrast-Enhanced areas are revealed corresponding to the microcalcifications

Surgery : High grade DCIS




Contrast-Enhanced areas are also revealed on the right breast

Surgery : IDC



Clinical: Assymetry, nipple retraction

Mammography : Spiculated nodule 20x19mm, 2 suspicious satellite nodules



SenoBright : 4 nodules are contrast enhanced, 25x20mm and three 7x7mm

Mastectomy : multifocal IDC, Ductal hyperplasia, axillary adenopathy with MTX



SenoBright : 24x24mm nodule, and 6mmx3.5mm

Biopsy : IDC & DCIS, malignant lymph node



SenoBright : two suspicious nodules 15mm apart, 28x21mm

Biopsy : IDC & DCIS


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