CAD: The Emerging Standard of Care in Breast Imaging

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Seven years after it tiptoed onto the mammography market, breast CAD (computer-aided detection) has emerged as a standard of care. Practices and facilities that have implemented mammography CAD report a number of pluses. For starters, CAD increases clinical confidence by providing a second read and identifying suspicious areas for further review. And today, mammography CAD has been joined by CAD for breast MRI and breast ultrasound that increase accuracy and save time in making diagnoses.

Recent findings to be published in the October issue of the American Journal of Roentgenology reinforce the case for CAD. That is, it correlates with a higher rate of breast cancer detection particularly of small, earlier stage tumors. "Our experience with CAD shows a substantial increase in the cancer detection rate, a demonstrable decrease in the size of the cancer and a corresponding decrease in a woman's age at the time of diagnosis," says Tommy E. Cupples, MD, breast imaging and interventional specialist with ImageCare, LLC in Columbia, S.C. Sites that have implemented mammography CAD report that it can differentiate a practice since referring physicians and patients have become increasingly aware of CAD.

In the MRI world, CAD provides a viable solution for reviewing the 1,200 to 2,000 images generated by breast MRI studies. CAD systems provide image review and reporting tools to streamline the process. Finally, ultrasound CAD has arrived on the market. Cedara Software Corp.'s B-CAD solution received clearance earlier this summer. The new application promises to improve the breast ultrasound process with automated classification tools and standard report formats.

Mammography CAD at a glance

Most radiology departments and breast imaging centers cite similar rationales for deploying CAD. The radiology department at Hudson Valley Hospital Center (Westchester County, N.Y.) performs 15,000 mammograms annually and turned to mammography CAD in June for fairly typical reasons. "Improved patient care is the No. 1 reason for deploying CAD. No radiologist is perfect, and CAD offers another way to provide a 'second look' interpretation. We use iCAD's SecondLook, which has a very good sensitivity for microcalcifications. It also helps us review areas that might be missed," explains Maurice Poplausky, MD, director of imaging and radiology.

Other sites are implementing CAD because it has become a standard of care. Take for example Fremont Medical Center in Fremont, Neb. The center deployed Kodak Mammography CAD system in January. Mark Johannsen, MD, radiologist, explains, "We had been looking at CAD for a few years. As a community hospital, we are usually not the first to adopt a new technology, but it seemed like the time was right. Other local hospitals are using CAD, and it is becoming a standard of care [locally]."

Hudson Valley uses Second Look in conjunction with analog mammography. The system easily integrates into mammography workflow. First, a tech digitizes the mammogram. Then, Second Look uses a computer algorithm to mark suspicious areas. After the radiologist reads the film, he or she turns to the iCAD workstation, immediately dictating the report if there are no discrepancies between the findings and the CAD image. If there is an area of discrepancy, the radiologist reviews the images a second time. Second Look incorporates a variety of tools like magnification and isolation to aid image review.

Image storage is fairly straightforward. Second Look holds images on the system, and the radiology department prints and saves hard copies in the patient files. Fremont Medical Center estimates that the hard drive on its Kodak Mammography CAD system can hold four to five years' worth of studies (25,000 to 30,000 studies). The center downloads images to DVD, aiming to store studies on an optical drive in the future.

The workflow processes are similar across other analog departments. It begins with scanned films, which are routed to a CAD display placed next to a lightbox for streamlined review. Most CAD systems can be integrated with mammography tracking and reporting software, enabling radiologists to view CAD results from existing software and eliminating the need for a separate workstation.

Poplausky admits that CAD does add a few minutes to workflow for both techs and radiologists. Techs must scan the images and add stickers to charts, while radiologists must review an additional set of images. Johannsen agrees, estimating that CAD