Towards Single Camera Human 3D-Kinematics.

Markerless estimation of 3D Kinematics has the great potential to clinically diagnose and monitor movement disorders without referrals to expensive motion capture labs; however, current approaches are limited by performing multiple de-coupled steps to estimate the kinematics of a person from videos. Most current techniques work in a multi-step approach by first detecting the pose of the body and then fitting a musculoskeletal model to the data for accurate kinematic estimation. Errors in training data of the pose detection algorithms, model scaling, as well the requirement of multiple cameras limit the use of these techniques in a clinical setting. Our goal is to pave the way toward fast, easily applicable and accurate 3D kinematic estimation. To this end, we propose a novel approach for direct 3D human kinematic estimation D3KE from videos using deep neural networks. Our experiments demonstrate that the proposed end-to-end training is robust and outperforms 2D and 3D markerless motion capture based kinematic estimation pipelines in terms of joint angles error by a large margin (35% from 5.44 to 3.54 degrees). We show that D3KE is superior to the multi-step approach and can run at video framerate speeds. This technology shows the potential for clinical analysis from mobile devices in the future.

Supplemental ultrasound screening in patients with a history of lobular neoplasia.

To investigate the role of ultrasound (US) screening as an adjunct to annual mammography (M) in breast cancer detection in women with a history of lobular neoplasia (LN) diagnosed following core needle or excisional biopsy. A retrospective review of our database was performed between 11/2006 and 11/2011 to identify patients diagnosed with LN, and underwent annual screening. Patients with a lifetime risk >20% per risk modeling were excluded. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and cancer detection rate (CDR) of each screening test were identified. Cancer type and detection modality were recorded. A total of 100 patients who had M and/or US screening were included. Mean patient age was 54.7 years (range 33-83). All 100 patients underwent a mean of 3.9 rounds of screening M and 93 (93%) received US screening (mean 3.3 rounds). Of 93 patients who received both M and US screening, 12 (13%) were diagnosed with breast cancer. Mammographic CDR was 4%. Incremental US CDR was 6.5%. The sensitivity, specificity, and NPV for M screening alone was 33% (10%, 65%), 77% (67%, 85%), and 89% (80%, 95%), respectively. US and mammography screening had a combined sensitivity: 83% (52%, 98%), Specificity: 72% (62%, 81%), NPV: 97% (89%, 100%). Supplemental US screening resulted in a significant increase in sensitivity, yielding 6.5% incremental CDR in this high-risk patient subgroup that does not fulfill ACS high-risk MRI screening criteria.

Artifacts in Digital Breast Tomosynthesis.

OBJECTIVE: Artifacts in digital breast tomosynthesis and synthesized 2D imaging reduce image quality. This article describes the appearance of these unique artifacts, reviews their causes, and discusses methods to ameliorate these artifacts. CONCLUSION: Artifacts in digital breast tomosynthesis and synthesized 2D imaging can obscure important findings on mammograms. The radiologist, mammography technologist, and medical physicist must be able to recognize these artifacts and use the vendor's new processing algorithms to mitigate the effects of such artifacts.

Performance of Mid-Treatment Breast Ultrasound and Axillary Ultrasound in Predicting Response to Neoadjuvant Chemotherapy by Breast Cancer Subtype.

BACKGROUND: The primary objective was to determine whether mid-treatment ultrasound measurements of index breast tumors and index axillary nodes of different cancer subtypes associate with residual cancer burden (RCB). METHODS: Patients with invasive breast cancer who underwent neoadjuvant chemotherapy and had pre-treatment and mid-treatment breast and axillary ultrasound were included in this single-institution, retrospective cohort study. Linear regression analysis assessed associations between RCB with (a) change in index breast tumor size, (b) change in index node size, and (c) absolute number of abnormal nodes at mid-treatment. Multivariate linear regression was used to calculate best-fit models for RCB. RESULTS: One hundred fifty-nine patients (68 triple negative breast cancer [TNBC], 45 hormone receptor [HR]+/human epidermal growth factor receptor 2 [HER2]-, and 46 HR-/HER2+) were included. Median age at diagnosis was 50 years, range 30-76. Median tumor size was 3.4 cm, range 0.9-10.4. Pathological complete response/RCB-I rates were 36.8% (25/68) for TNBC patients, 24.4% (11/45) for HR+/HER2- patients, and 71.7% (33/46) for HR-/HER2+ patients. Linear regression analyses demonstrated associations between percent change in tumor ultrasound measurements at mid-treatment with RCB index score in TNBC and HR+/HER2- (p < .05) but not in HR-/HER2+ (p > .05) tumors and an association between axillary ultrasound assessment of number of abnormal nodes at mid-treatment with RCB index score across all subtypes (p < .05). CONCLUSION: Performance characteristics of breast ultrasound associated with RCB vary by cancer subtype, whereas the performance characteristics of axillary ultrasound associated with RCB are consistent across cancer subtype. Breast and axillary ultrasound may be valuable in monitoring response to neoadjuvant therapy. The Oncologist 2017;22:394-401 IMPLICATIONS FOR PRACTICE: The differential performance characteristics of breast ultrasound by molecular subtype and the consistent performance characteristics of axillary ultrasound across molecular subtypes can have clinical utility in monitoring response to neoadjuvant therapy.

Paradigm Shifts in Breast Care Delivery: Impact of Imaging in a Multidisciplinary Environment.

OBJECTIVE: The practice of breast imaging in a collaborative multidisciplinary environment adds significant value to outcomes in women's health care. In this article, we describe multidisciplinary considerations in breast cancer screening and early detection, the impact of imaging and histopathologic findings in the diagnostic evaluation and management of breast abnormalities, and the contribution of imaging to surgical and radiation therapy planning for the breast cancer patient. CONCLUSION: The multidisciplinary delivery of breast care for women that incorporates screening, diagnosis of borderline and high-risk lesions, and management of the breast cancer patient adds considerable value to outcomes in health care.

Multimodality Imaging for Evaluating Response to Neoadjuvant Chemotherapy in Breast Cancer.

OBJECTIVE: Neoadjuvant chemotherapy is becoming the standard of care for patients with locally advanced breast cancer. Conventional imaging modalities used for the assessment of tumor response to neoadjuvant chemotherapy rely on changes in size or morphologic characteristics and, therefore, are inherently limited. CONCLUSION: Functional imaging technologies evaluate vascular, metabolic, biochemical, and molecular changes in cancer cells and have a unique ability to detect specific biologic tumor markers, assess therapeutic targets, predict early response to neoadjuvant chemotherapy, and guide individualized cancer therapy.

Imaging Factors That Influence Surgical Margins After Preoperative 125I Radioactive Seed Localization of Breast Lesions: Comparison With Wire Localization.

OBJECTIVE: The objective of this study was to compare the potential influence of imaging variables on surgical margins after preoperative radioactive seed localization (RSL) and wire localization (WL) techniques. MATERIALS AND METHODS: A total of 565 women with 660 breast lesions underwent RSL or WL between May 16, 2012, and May 30, 2013. Patient age, lesion type (mass, calcifications, mass with associated calcifications, other), lesion size, number of seeds or wires used, surgical margin status (close positive or negative margins), and reexcision and mastectomy rates were recorded. RESULTS: Of 660 lesions, 127 (19%) underwent RSL and 533 (81%) underwent WL preoperatively. Mean lesion size was 1.8 cm in the RSL group and 1.8 cm in the WL group (p = 0.35). No difference in lesion type was identified in the RSL and WL groups (p = 0.63). RSL with a single seed was used in 105 of 127 (83%) RSLs compared with WL with a single wire in 349 of 533 (65%) WLs (p = 0.0003). The number of cases with a close positive margin was similar for RSLs (26/127, 20%) and WLs (104/533, 20%) (p = 0.81). There was no difference between the RSL group and the WL group in close positive margin status (20% each, p = 0.81), reexcision rates (20% vs 16%, respectively; p = 0.36), or mastectomy rates (6% each, p = 0.96). Lesions containing calcifications were more likely to require more than one wire (odds ratio [OR], 4.44; 95% CI, 2.8-7.0) or more than one seed (OR, 7.03; 95% CI, 1.6-30.0) when compared with masses alone (p < 0.0001). Increasing lesion size and the presence of calcifications were significant predictors of positive margins, whereas the use of more than one wire or seed was not (OR, 0.9; 95% CI, 0.5-1.5) (p = 0.75). CONCLUSION: Close positive margin, reexcision, and mastectomy rates remained similar in the WL group and RSL group. The presence of calcifications and increasing lesion size increased the odds of a close positive margin in both the WL and RSL groups, whereas the use of one versus more than one seed or wire did not.

Sonography and Sonographically Guided Needle Biopsy of Internal Mammary Nodes in Staging of Patients With Breast Cancer.

OBJECTIVE: The purpose of this study was to identify the prevalence of occult nodal metastases on routine ultrasound examination of internal mammary (IM) nodal basins in patients with breast cancer. MATERIALS AND METHODS: Patients with primary breast cancer (n = 595) underwent breast ultrasound evaluation between September 1, 2011, and April 1, 2012. For all patients, ultrasound examination included a survey of the axillary, infraclavicular, IM, and supraclavicular nodal basins. Patient demographics, breast cancer histopathologic type, and grade, size, location, and presence of metastatic nodes in regional nodal basins were recorded. Fisher exact test and Wilcoxon rank test were used for statistical analysis. RESULTS: Fifty-eight of 595 (10%) patients had positive IM ultrasound finding, with eight (1.3%) patients having isolated IM involvement. Patients with positive IM ultrasound findings were statistically significantly younger than those without such findings (median age, 42 vs 57 years; p < 0.0001). Of the 58 patients with positive IM ultrasound, 29 (50%) underwent ultrasound-guided needle biopsy, which confirmed malignancy in 26 of 29 (90%) patients. Nonlateral (p < 0.001) grade 3 (p < 0.001) tumors larger than 5 cm (p < 0.0006) with the estrogen receptor-negative HER2/neu-negative subtype (p < 0.001) associated with axillary, infraclavicular, or supraclavicular metastases (p < 0.001) were more likely to be associated with positive IM ultrasound findings. IM ultrasound resulted in an N status change for 46 of 595 (8%) patients and of the overall clinical stage for 38 (6.4%) patients. CONCLUSION: IM ultrasound and ultrasound-guided fine-needle aspiration biopsy are feasible, sensitive, and specific. Application of IM ultrasound and ultrasound-guided needle biopsy in a selected subpopulation of young patients with medial or central estrogen receptor-negative HER2/neu-negative breast cancer may result in a change in clinical stage and modify the treatment plan.

Role of sonography for the locoregional staging of breast cancer.

OBJECTIVE: This article describes the use of sonography for the locoregional staging of breast cancer. Sonography may identify mammographically occult disease within the breast. Sonography of the regional nodal basins, including the axilla, infraclavicular, supraclavicular, and internal mammary regions, can identify nodal metastases, which may upstage disease and have implications for prognosis. CONCLUSION: The anatomy of the regional nodal basins and the TNM staging system for breast cancer are reviewed, and the implications of ultrasound-detected disease on clinical management and treatment decisions are discussed.

Primary neuroendocrine carcinoma of the breast: clinical, imaging, and histologic features.

OBJECTIVE: The purpose of this study was to evaluate the clinical, imaging, and histopathologic findings of primary neuroendocrine carcinoma of the breast. MATERIALS AND METHODS: A pathology database was searched for the records of patients with a histopathologic diagnosis of primary neuroendocrine carcinoma of the breast who had undergone mammography, sonography, or MRI between 1984 and 2011. The imaging studies of eligible patients were retrospectively reviewed according to the BI-RADS lexicon, and clinical presentation and histopathologic characteristics were documented. Imaging characteristics were compared with historical controls of invasive mammary carcinoma. RESULTS: Eighty-seven patients (84 women, three men; mean age, 62.9 years; range, 28-89 years) were included in the study. The mean tumor size was 3.1 cm (range, 0.6-11 cm). Sixty-five of 84 (77.4%) cancers were estrogen and progesterone receptor positive and ERBB2 negative. A palpable mass (55.8%) was a common clinical manifestation. A high-density, round or oval, or lobular mass with nonspiculated margins on mammograms and an irregular (65.4%), hypoechoic (78.4%) mass, with indistinct margins (43.5%), no or enhanced posterior acoustic features (77.9%) on sonograms were common findings. MRI revealed an irregular mass (83.3%), irregular margins (63.6%), and washout kinetics (85.7%). Neuroendocrine carcinoma presented more frequently as masses on mammograms. Calcifications were infrequent compared with their occurrence in invasive mammary cancer. CONCLUSION: Primary neuroendocrine carcinoma of the breast has mammographic features that differ from those of invasive mammary carcinoma. A round, oval, or lobular mass with nonspiculated margins, positive estrogen and progesterone receptor results, and negative ERBB2 results should raise suspicion of primary neuroendocrine carcinoma.

Strain elastography of abnormal axillary nodes in breast cancer patients does not improve diagnostic accuracy compared with conventional ultrasound alone.

OBJECTIVE: The purpose of this study was to determine the diagnostic value of strain elastography (SE) alone and in combination with gray-scale ultrasound in the diagnosis of benign versus metastatic disease for abnormal axillary lymph nodes in breast cancer patients. SUBJECTS AND METHODS: Patients with breast cancer and axillary lymph nodes suspicious for metastatic disease on conventional ultrasound who underwent SE of the suspicious node before ultrasound-guided fine-needle aspiration biopsy (FNAB) were included in this study. On conventional ultrasound, the long- and short-axis diameters, long-axis-to-short-axis ratio, cortical echogenicity, thickness, and evenness were documented. The nodal vascularity was assessed on power Doppler imaging. Elastograms were evaluated for the percentage of black (hard) areas in the lymph node, and the SE-ultrasound size ratio was calculated. Two readers assessed the images independently and then in consensus in cases of disagreement. ROC AUCs were calculated for conventional ultrasound, SE, and both methods combined. Interreader reliability was assessed using kappa statistics. RESULTS: A total of 101 patients with 104 nodes were examined; 35 nodes were benign, and 69 had metastases. SE alone showed a significantly lower AUC (62%) than did conventional ultrasound (92%) (p<0.001). There was no difference between the AUC of conventional ultrasound and the AUC of the combination of conventional ultrasound and SE (93%) (p=0.16). Interreader reliability was moderate for all variables (κ≥0.60) except the SE-ultrasound size ratio (κ=0.35). CONCLUSION: Added SE does not improve the diagnostic ability of conventional ultrasound when evaluating abnormal axillary lymph nodes.

Imaging-pathologic correlation of diseases in the axilla.

OBJECTIVE: This article reviews the imaging and histopathologic findings of various axillary diseases and suggests management guidelines for radiologists based on imaging findings with clinical correlation. CONCLUSION: Although axillary diseases may reveal nonspecific imaging findings, a knowledge of the characteristic radiologic manifestations of specific diseases according to anatomic origin (nodal, accessory breast, adipocytic, fibrous, nerve, vascular, stromal, and dermal) and postsurgical lesions aids in establishing an appropriate differential diagnosis and determining whether intervention is necessary.

Imaging features of benign adenomyoepithelioma of the breast.

PURPOSE: The purpose of our study was to evaluate the imaging features of benign adenomyoepithelioma of the breast with a focus on sonographic (US) appearances. METHODS: Ten benign adenomyoepitheliomas in 9 patients were included in this study. Mammographic and US findings were analyzed retrospectively by 2 radiologists according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The BI-RADS final assessment category was also recorded. RESULTS: Of the 8 lesions for which mammography was available, 4 lesions presented with abnormal findings. Two lesions presented with an indistinct, irregular, isodense mass and a circumscribed, oval, isodense mass. The other 2 lesions presented with areas of focal asymmetry and asymmetry, respectively. On US, all of 10 lesions presented as a mass. The masses measured 0.5-1.2 cm (mean, 0.8 cm), were irregular (n = 8) or oval (n = 2) with microlobulated (n = 5), indistinct (n = 3), or angular (n = 2) margins. They were all hypoechoic, had non parallel orientation in 6 cases, and increased peripheral vascularity in 7 cases. The BI-RADS final assessment category was 4B in 6, and 4A in 4. CONCLUSIONS: Mammographic findings of benign adenomyoepithelioma were nonspecific. An irregular, non parallel orientation, microlobulated or indistinct margin, hypoechogenicity, and increased peripheral vascularity were the most frequent US features.

Responsive Web-based Breast Imaging Core Curriculum for International Radiology Residents with Self-Assessment: A Pilot Study.

RATIONALE AND OBJECTIVES: Lack of uniformity in radiology resident education is partially attributable to variable access to subspecialty education. Web-based courses improve standardization, but with growing emphasis on competency based education, more evaluation of their effectiveness is needed. We created a responsive web-based breast imaging curriculum for radiology residents including self-assessment and a satisfaction survey. MATERIALS AND METHODS: Two global academic institutions collaboratively developed a breast imaging curriculum to address radiology residents' educational needs. This virtual course comprised 11 video lectures, nine didactic (with attached pre-test and post-test assessments) and two case review sessions. In April 2020, this optional curriculum was made available to all 56 radiology residents in one residency program cluster in Singapore, to be accessed alongside the breast imaging rotation as a supplement. A voluntary anonymous satisfaction survey was provided upon completion. RESULTS: A total of 39 of the 56 radiology residents (70%) completed the course. For the average score of nine lectures (maximum score 5), there was a significant increase in mean pre and post - test scores (mean = 2.2, SD = 0.7), p < 0.001. The proportion of residents with improvement between the pre-test score and the post-test score ranged from 74% to 100% (mean, 84%). Thirty three of the 39 participants (85%) completed the satisfaction survey, and all agreed or strongly agreed that the curriculum increased their knowledge of breast imaging. CONCLUSION: This web based breast imaging curriculum supplement was viewed positively by participating residents and improved their self-assessed knowledge. Curriculum access could be expanded to improve global radiology education.

T1-weighted 3D dynamic contrast-enhanced MRI of the breast using a dual-echo Dixon technique at 3 T.

PURPOSE: To evaluate a single-pass fast spoiled gradient echo (FSPGR) two-point Dixon sequence and a gradient echo sequence with spectral fat suppression in their performance at 3 T for fat suppressed contrast-enhanced bilateral breast imaging. MATERIALS AND METHODS: Twenty patients were prospectively enrolled in an imaging protocol that included axial Dixon and 3D FSPGR with spectrally selective fat saturation sequences as part of patient care in this study. Qualitative analysis was performed retrospectively by two readers who scored the images for homogeneity and degree of fat saturation, severity of artifacts, and quality of normal anatomical structures. Enhancing lesions were scored according to the confidence with which American College of Radiology (ACR) BI-RADS magnetic resonance imaging (MRI) features were identified. RESULTS: The Dixon sequence showed superior fat saturation homogeneity, quality of posterior anatomical structures, and decreased artifact severity that were statistically significant (P < 0.0001). The degree of fat saturation was scored higher in the Dixon sequence, although the difference did not reach statistical significance. There were no significant differences between the 3D T1-weighted FSPGR and Dixon groups for assessing lesion features. CONCLUSION: Our findings suggest that the Dixon technique is an effective fat suppression method for contrast-enhanced breast MRI. The Dixon technique also seemed to provide better anatomical definition of posterior structures and improvement in severity of artifacts.

Emerging techniques and molecular imaging in breast cancer.

The sensitivity of screening mammography is limited in the evaluation of dense breasts, with as few as 45% of cancers visible in extremely dense breasts. Supplementary imaging for improved sensitivity in women with dense breasts is necessary to overcome this limitation. Emerging technologies that advance the applications of digital mammography include digital breast tomosynthesis and dedicated breast cone-beam computed tomography. Molecular imaging goes beyond structural imaging. A functional imaging technique that provides information on the biology, physiology, and metabolic pathways of cancer might help to improve the sensitivity and specificity of breast cancer diagnosis, facilitate early assessment of treatment response, and help individualize therapy options for patients. Advanced magnetic resonance, nuclear medicine, and optical imaging techniques in the realm of molecular imaging will be explored in this article.

Staging of breast cancer with ultrasound.

The prognosis of women with breast cancer depends on tumor size and regional lymph node status. Clinical assessment combined with imaging is important in the staging of primary breast cancer, particularly in a multidisciplinary setting where radiologists, pathologists, medical, surgical, and radiation oncologists work together to optimize patient care. Delineation of loco-regional (multifocal vs multicentric) disease is critical in surgical planning to enable a curative procedure with clear margins and good cosmetic outcome. Regional (ipsilateral axillary, infraclavicular, internal mammary, and supraclavicular) nodal information helps determine patient eligibility for neoadjuvant protocols and also aids in radiation planning. The role of high-resolution ultrasound in staging breast cancer is discussed in conjunction with mammography, and magnetic resonance imaging.

Streamlining the Quantitative Metrics Workflow at a Comprehensive Cancer Center.

INTRODUCTION: The objective of the project was to describe an efficient workflow for quantifying and disseminating tumor imaging metrics essential for assessing tumor response in clinical therapeutic trials. The clinical research utility of integration of the workflow into the electronic health record for radiology reporting was measured before and after the intervention. MATERIALS AND METHODS: A search of institutional clinical trial databases was performed to identify trials with radiology department collaborators. Investigator initiated trials, or those which lacked a standardized or automated system of collaboration with the research team were selected for the study. A web based application integrated in the electronic health record platform, the Quantitative Imaging Analysis Core (QIAC) initiative was established as a divisional resource with institutional support to provide standardized and reproducible imaging metrics across the institution. The turnaround time for radiology reports before (phase 1) and after web based application workflow (phase 2) was measured. During our test period (November 2014 to June 2015), a total of 68 requests with 37 from phase 1 and 31 from phase 2 were analyzed for patients who were enrolled in prospective clinical therapeutic interventional trials. RESULTS: The mean turnaround time for generation of quantitative tumor metric results after implementation of the web based QIAC workflow (phase 2) was significantly lower than prior (phase 1) (15.9 ± 21.3 vs 31.7 ± 35.4 hours, p= 0.0005). The mean time from the scan to the preliminary assessment was 19.6 ± 25.6 hours before and significantly reduced to 8.0 ± 9.9 hours with implementation of web based QIAC workflow. CONCLUSION: Implementation of a web based QIAC workflow platform enabled significantly improved turnaround time for quantitative tumor metrics reports and enabled faster access to the reports.

Decreased TGFbeta signaling and increased COX2 expression in high risk women with increased mammographic breast density.

High mammographic density is associated with a increased risk of breast cancer. We hypothesized that specific pathways exist that are associated with increased mammographic density, and may therefore be used to identify potential targets for chemoprevention. Histologically confirmed normal breast tissue was collected from women undergoing breast surgery who had available demographic data and mammograms for review. Women with low versus high mammographic breast density were compared. Differentially expressed genes using Affymetrix HG U133Plus2 chips were identified in dense versus non-dense tissue. Immunohistochemical analysis (IHC) of estrogen receptor, progesterone receptor, Ki67, and COX2 expression was performed. About 66 women were identified, 28 (42%) had high, and 38 (58%) had low mammographic density. About 73 genes had differential expression between normal breast tissue with high and low mammographic density (P < 0.001, fold change > or = 1.5 with a low false discovery rate (<10%). Network and canonical pathway analysis indicated decreased TGFbeta signaling (TGFBR2, SOS, SMAD3, CD44 and TNFRSF11B) in dense breast tissue relative to non-dense breast. By IHC, only COX2 expression in the stroma was statistically significant on multivariate analysis. TGFbeta ligands are currently the only growth factors known to prevent mammary epithelial cell proliferation. TGFbeta signaling has been reported to be inhibited by COX-2, and these molecules are highly differentially expressed in individuals at high risk of developing breast cancer. These results strongly suggest that COX2 inhibition should be investigated for breast cancer prevention despite possible increase in cardiovascular risk.

Multimodality imaging of triple receptor-negative tumors with mammography, ultrasound, and MRI.

OBJECTIVE: We retrospectively reviewed imaging findings for 44 patients with triple receptor-negative breast carcinomas on mammography, sonography, and MRI to determine the imaging characteristics of triple receptor-negative cancers that may improve diagnosis at the time of presentation. CONCLUSION: Despite their large size at presentation, triple receptor-negative cancers may be occult on mammography or sonography and frequently have benign or indeterminate features. MRI identified all triple receptor-negative cancers and showed features that had a high positive predictive value for malignancy.