For Dr. Roy Kite, it was like opening his eyes for the first time. When Kite, medical director of radiology at Lakeview Regional Medical Center (95 E. Fairway Drive, Covington, (985) 867-4447; www.lakeviewregional.com), first used the digital mammography system, he was amazed at the increased resolution of the images, the magnification possible, and bottom line how much sooner it could detect breast cancer in its earliest stages. Kite explains the versatility of this system, its efficiency and why it is one move to digital that women shouldn´t live without.
Q: How important is early detection in treating breast cancer?
A: It´s critical. The smaller and the earlier you catch these things that are obvious on the imaging scans, the more you can expect a complete cure. Early surveillance is key to achieving that goal. The smaller you catch it, the better chance you have of getting rid of your problem. These cells can get into the bloodstream and travel to other parts of the body like the lymph nodes, kind of the garbage can system of your body. Once they´re in the lymph system, they can go to other parts of your body, and that´s called metastatic disease, which is what you´re trying to prevent.
Q: Is it harder to detect breast cancer in some women compared to others?
A: Yes. The characteristics that we´re looking for radiographically of a cancer can vary. Sometimes there are small calcifications very specific types of calcium deposits architectural distortions and sometimes spiculation, starburst masses of tissue. All of these descriptors are worrisome to a radiologist. When you´re trying to see those things in a very dense breast tissue, it´s very difficult. That´s an individual thing. Some people´s breasts are very fatty, and those cancers stand out like a sore thumb. But when (the breasts are) very dense, it becomes tough to find the needle in the haystack. By dense, I mean normal fibroglandular tissue that exists in a breast. In some women, this is very pervasive throughout the breast and makes it tough to interrogate the breast.
Q: How are some of these problems alleviated by digital mammography?
A: The old system shot X-rays at the breast and exposed the X-rays to film. That´s what you got. We tried to regulate dose. But in some people there wasn´t enough dose, and in some there was too much. You were fixed with the exposure you took. With digital mammography, you have an X-ray being passed through the breast and exposed to an electronic plate. Now that the information is digital, we can manipulate it, meaning we can make it more bright, less bright, magnify it, contrast it etc. In other words, the final interrogation is not over once the exposure is made we control what we want to do with the image, to look at it to our advantage.
Q: In terms of accuracy, how helpful is this?
A: We see so much more than we used to see. Back then, a film sent in might not have a magnification available because they didn´t do it at the time, whereas if we have a digital and we want to magnify an area, it´s just a flip of the switch. We have the ability to continue to interrogate the breast even after the exposure has been made.
Q: The digital system comes with a review workstation. How does that increase efficiency for the attending physician?
A: It´s always good to have multiple eyes and that´s how we use it. It doesn´t become the dominant reader at all, because it really doesn´t have a brain. It´s just recognizing patterns. By clicking the button, the computer looks for right angles in a breast. Right angles are not normal anatomy; nothing normally happens in the body at a right angle. So it looks for incongruous areas or calcifications that are clustered. In other words, it´s programmed to look for some of the characteristics of cancer.
Q: Another aspect of the review station enables physicians to see previous X-rays. How do radiologists use this information?
A: It´s archived digitally just like computer information, so when a patient has a mammogram, immediately we have their last year´s mammogram right on top, which we can continue to manipulate even when it´s a year old. We can make a direct comparison. The thing we look for more than anything is change. So if we have last year´s study, or two years ago, the first thing we want to know is if there´s been a change.
Q: On the patient end, what are some of the advantages?
A: It´s much quicker. We can do a mammogram in a minute or two. The tech being in the room gets immediate feedback within five seconds, so they will know if the exposure is correct or positioned properly. It´s very easy for them to get it right before the patient leaves the room. We still do compress the breast, but not as much.
Q: How soon can a patient get her results?
A: We try to give them an idea of what´s happening while they´re here. When it´s a screening mammogram, the techs here are very good and they´ll know when there´s an area we´ll need to be concerned about, and we try to do some additional views or magnificational views. If it´s pretty normal and we´ve looked at it briefly, we´ll let the tech tell the patient that it was fine. If there are outside films we´re waiting on, it may delay us from giving a final answer. If there are other things that need to be done, we try to do them at the time the patient is here.
Q: How helpful is this advance in detection in the overall battle against breast cancer?
A: It´s kind of hard to quantitate, but having read film screen the old way for years and years, when we went to digital, it was like, ¨Oh my God!¨ We could see so much more. Seeing more means you can see smaller and smaller areas of potential difficulties, so it´s got to be ramping up the early diagnosis. There´s no doubt in my mind that we do a better job.
In conjunction with National Breast Cancer Awareness Month in October, Lakeview Regional Medical Center is offering digital mammograms and bone-density screening together for $100 throughout the month. Call (985) 867-3890 to schedule an appointment.