From all possible cancer diseases the women breast cancer is the most tricky one which causes death in case an early detection is missed. Asking experts around the world the common answers to work against are “Education” and “Early Screening and Diagnosis”.
Looking into the recorded statistics it shows that according to WHO and others sources e.g. “Worldwide Breast Cancer” it says:
Nearly 1.5 million people were told “you have breast cancer”
Can you imagine if you will receive such statement from your doctor? Well, the fact to get cancer is difficult to avoid but important is the knowledge that as early it can be detected the chance to survice will dramatically increase. Doctors need to get trained frequently as the appearance of cancer is not always the same. Also the used technical equipment requires a periodically check to make sure the “constancy”. Also the women breast tissue is different from each woman and the area where cancer could appear also varies from women to women and different ages.
Dramatically, one-third of these cancer deaths could be decreased if detected and treated early. In a worldwide context, this means nearly 400,000 lives could be saved every year.
There is also a fact that women in some countries in the world have some fear to go to such mammography screening as there is low trust or another fear that such treatments may could cause cancer cases so therefore education from both sides the patient side and doctor side is a key.
From a IT technical perspective the screening and diagnostic equipment plays also a key role. It starts from the knowledge how to position the breast before the screening will be executed, because only areas of the breast could be seen when they are captured. I mention this here as several cases happened but could not be seen.
As the Breast cancer has various facettes, sometimes it appears in dark areas sometimes in bright areas. Sometimes as black or white or grey so the importance of showing all the levels of grey is a must and accuarcy is everything in bright and dark areas. Sometimes doctors misinterpret a typical breast tissue characteristic without the right education.
Mammography Screening is a very fast process where doctors are really challenged to detect some abnormal issues in a few seconds and to decide to investigate further to start diagnostic or to say “No cancer” next case. In such a few seconds looking into hundreds of cases per day the radiologists rely fully on the technical equipments. In case of the image diagnostic device it is extremly important to show the full right resolution to display all image contents and also the pixel pitch is important to show all narrow shades and the stability of the device in line with the DICOM GSDF calibrated standard is expected to be correct, too. Technical parameters like the Luminance levels low and high, Contrast ratio and Anti-Reflection not to forget.
Therefore doctors rely on their equipment suppliers, Bio-Medical engineers and consultants to select the hardware and important QA/QC implementation program. All parts in the diagnostic chain are important starting from the trained doctor on many patient cases on digital systems which is nowadays also a challenge in some countries as such database needs time to be build up and then the image detection device and the image diagostic (monitor) device which is the last part before the human eye will judge.
Therefore standardization is so important to consider all such human aspects and technical parameters to fit together. And the importance is to have one global standard not different ones to see the same information and patient breast image on the screen.
Let us memorize that cancer develops very fast so after couple of month it can be such large when the early stage was missed that a easy treatment will be so difficult and the chance to survice for the patient will be dramatically reduced.
Here are some cases as reference. Can you see the cancer on the image?
MLO (a,b) and CC (c,d) projections 24 month following the previous screening exam. The patient is still asymptomatic. A tiny stellate lesion was detected behind the left areola.
(Above medical images kindly provided from Laszlo Tabar, M.D., F.A.C.R. (Hon))
http://www.mammographyed.com/drtabar/default.aspx – Laszlo provides worldwide over many years a perfect education to all doctors in his training courses to learn from different cases to decrease the failure rate of cancer detection. His courses are always fully booked. Thanks to him and some other doctor colleagues patient lifes could be protected. And he also is supporting strong the “Supporter(s)Vision” initiative where we are proud having him on board
Here are some recommended minimum requirement regarding the Diagnostic Medical Monitor and ambient light room environment:
- Ambient light for Diagnostic Purpose ( Mammography ) between 25lx and 50lx
- Minimum Luminance (Lmax) between 350 – 500 cd/m2 (L`min of 1.2cd/m2)
- Calibrated according to DICOM GSDF
- Embedded Uniformity control and possibility to adjust (calibrate)
- Pixel Pitch size not larger than < 0.210 mm
- Resolution starting from 4M (2048×2048) per display and higher
- Periodically Constancy Tests (Visuell Check, Greyscale, Uniformity and Luminance)
- Medical Grade monitor has to be classified and certified for Mammography usage
The technology is improving fast nowadays and doctors may use soon colour diagnostic mammography medical monitors to display and diagnose greyscale and colour at the same time with additional helpful features and tools. Catching up with unify global standards and being educated frequently wil remain as the challenge we all have to overcome.