A review of automatic mass detection and segmentation in mammographic images.

PubMed

Oliver, Arnau; Freixenet, Jordi; Martí, Joan; Pérez, Elsa; Pont, Josep; Denton, Erika R E; Zwiggelaar, Reyer

2010-04-01

The aim of this paper is to review existing approaches to the automatic detection and segmentation of masses in mammographic images, highlighting the key-points and main differences between the used strategies. The key objective is to point out the advantages and disadvantages of the various approaches. In contrast with other reviews which only describe and compare different approaches qualitatively, this review also provides a quantitative comparison. The performance of seven mass detection methods is compared using two different mammographic databases: a public digitised database and a local full-field digital database. The results are given in terms of Receiver Operating Characteristic (ROC) and Free-response Receiver Operating Characteristic (FROC) analysis. Copyright 2009 Elsevier B.V. All rights reserved.

Feature extraction using convolutional neural network for classifying breast density in mammographic images

NASA Astrophysics Data System (ADS)

Thomaz, Ricardo L.; Carneiro, Pedro C.; Patrocinio, Ana C.

2017-03-01

Breast cancer is the leading cause of death for women in most countries. The high levels of mortality relate mostly to late diagnosis and to the direct proportionally relationship between breast density and breast cancer development. Therefore, the correct assessment of breast density is important to provide better screening for higher risk patients. However, in modern digital mammography the discrimination among breast densities is highly complex due to increased contrast and visual information for all densities. Thus, a computational system for classifying breast density might be a useful tool for aiding medical staff. Several machine-learning algorithms are already capable of classifying small number of classes with good accuracy. However, machinelearning algorithms main constraint relates to the set of features extracted and used for classification. Although well-known feature extraction techniques might provide a good set of features, it is a complex task to select an initial set during design of a classifier. Thus, we propose feature extraction using a Convolutional Neural Network (CNN) for classifying breast density by a usual machine-learning classifier. We used 307 mammographic images downsampled to 260x200 pixels to train a CNN and extract features from a deep layer. After training, the activation of 8 neurons from a deep fully connected layer are extracted and used as features. Then, these features are feedforward to a single hidden layer neural network that is cross-validated using 10-folds to classify among four classes of breast density. The global accuracy of this method is 98.4%, presenting only 1.6% of misclassification. However, the small set of samples and memory constraints required the reuse of data in both CNN and MLP-NN, therefore overfitting might have influenced the results even though we cross-validated the network. Thus, although we presented a promising method for extracting features and classifying breast density, a greater database is

Unsupervised Deep Learning Applied to Breast Density Segmentation and Mammographic Risk Scoring.

PubMed

Kallenberg, Michiel; Petersen, Kersten; Nielsen, Mads; Ng, Andrew Y; Pengfei Diao; Igel, Christian; Vachon, Celine M; Holland, Katharina; Winkel, Rikke Rass; Karssemeijer, Nico; Lillholm, Martin

2016-05-01

Mammographic risk scoring has commonly been automated by extracting a set of handcrafted features from mammograms, and relating the responses directly or indirectly to breast cancer risk. We present a method that learns a feature hierarchy from unlabeled data. When the learned features are used as the input to a simple classifier, two different tasks can be addressed: i) breast density segmentation, and ii) scoring of mammographic texture. The proposed model learns features at multiple scales. To control the models capacity a novel sparsity regularizer is introduced that incorporates both lifetime and population sparsity. We evaluated our method on three different clinical datasets. Our state-of-the-art results show that the learned breast density scores have a very strong positive relationship with manual ones, and that the learned texture scores are predictive of breast cancer. The model is easy to apply and generalizes to many other segmentation and scoring problems.

Use of border information in the classification of mammographic masses

NASA Astrophysics Data System (ADS)

Varela, C.; Timp, S.; Karssemeijer, N.

2006-01-01

We are developing a new method to characterize the margin of a mammographic mass lesion to improve the classification of benign and malignant masses. Towards this goal, we designed features that measure the degree of sharpness and microlobulation of mass margins. We calculated these features in a border region of the mass defined as a thin band along the mass contour. The importance of these features in the classification of benign and malignant masses was studied in relation to existing features used for mammographic mass detection. Features were divided into three groups, each representing a different mass segment: the interior region of a mass, the border and the outer area. The interior and the outer area of a mass were characterized using contrast and spiculation measures. Classification was done in two steps. First, features representing each of the three mass segments were merged into a neural network classifier resulting in a single regional classification score for each segment. Secondly, a classifier combined the three single scores into a final output to discriminate between benign and malignant lesions. We compared the classification performance of each regional classifier and the combined classifier on a data set of 1076 biopsy proved masses (590 malignant and 486 benign) from 481 women included in the Digital Database for Screening Mammography. Receiver operating characteristic (ROC) analysis was used to evaluate the accuracy of the classifiers. The area under the ROC curve (Az) was 0.69 for the interior mass segment, 0.76 for the border segment and 0.75 for the outer mass segment. The performance of the combined classifier was 0.81 for image-based and 0.83 for case-based evaluation. These results show that the combination of information from different mass segments is an effective approach for computer-aided characterization of mammographic masses. An advantage of this approach is that it allows the assessment of the contribution of regions rather

Mammographic features of isolated tuberculous mastitis.

PubMed

Al-Marri, Mohammed R; Aref, Essam; Omar, Ahamed J

2005-04-01

To present the mammography findings in 8 patients with tuberculosis (TB) of the breast, with a review of the literature. This study is a retrospective data collection. Each chart with confirmed breast TB based on bacteriology or pathologic findings was analyzed for clinical presentation, gender, nationality, demographic data, prior history of TB, investigation, management, mammographic findings and ultrasound, when available. Mammograms were reviewed by 2 consultant radiologists without knowing the previous diagnosis or the nature of the study. The study was carried out at The State Tuberculosis Registry and Radiology Department, Hamad General Hospital, State of Qatar, from 1990 to 2002. Out of 13 females with TB mastitis, only 8 cases had mammograms preoperatively. The incidence of breast TB in Qatar is rare (1/1000 mammograms per year). Three types of TB mastitis were identified in our study; the nodular (50%), the diffuse (37.5%) of which 77% were limited to one sector of the breast and the sclerosing (12.5%) mastitis. Three patients (43%) were reported as carcinoma. Although mammography identified 3 types of TB, it was not helpful in differentiating TB from carcinoma of the breast. However, the careful evaluation of the degree of density and trabecular thickening of the mass in relation to it size might reduce the number of false positive cases of carcinoma diagnosed with mammograms. Biopsy specimen remains the best diagnostic tool in TB mastitis.

Mammographic parenchymal texture as an imaging marker of hormonal activity: a comparative study between pre- and post-menopausal women

NASA Astrophysics Data System (ADS)

Daye, Dania; Bobo, Ezra; Baumann, Bethany; Ioannou, Antonios; Conant, Emily F.; Maidment, Andrew D. A.; Kontos, Despina

2011-03-01

Mammographic parenchymal texture patterns have been shown to be related to breast cancer risk. Yet, little is known about the biological basis underlying this association. Here, we investigate the potential of mammographic parenchymal texture patterns as an inherent phenotypic imaging marker of endogenous hormonal exposure of the breast tissue. Digital mammographic (DM) images in the cranio-caudal (CC) view of the unaffected breast from 138 women diagnosed with unilateral breast cancer were retrospectively analyzed. Menopause status was used as a surrogate marker of endogenous hormonal activity. Retroareolar 2.5cm2 ROIs were segmented from the post-processed DM images using an automated algorithm. Parenchymal texture features of skewness, coarseness, contrast, energy, homogeneity, grey-level spatial correlation, and fractal dimension were computed. Receiver operating characteristic (ROC) curve analysis was performed to evaluate feature classification performance in distinguishing between 72 pre- and 66 post-menopausal women. Logistic regression was performed to assess the independent effect of each texture feature in predicting menopause status. ROC analysis showed that texture features have inherent capacity to distinguish between pre- and post-menopausal statuses (AUC>0.5, p<0.05). Logistic regression including all texture features yielded an ROC curve with an AUC of 0.76. Addition of age at menarche, ethnicity, contraception use and hormonal replacement therapy (HRT) use lead to a modest model improvement (AUC=0.78) while texture features maintained significant contribution (p<0.05). The observed differences in parenchymal texture features between pre- and post- menopausal women suggest that mammographic texture can potentially serve as a surrogate imaging marker of endogenous hormonal activity.

Modeling error in assessment of mammographic image features for improved computer-aided mammography training: initial experience

NASA Astrophysics Data System (ADS)

Mazurowski, Maciej A.; Tourassi, Georgia D.

2011-03-01

In this study we investigate the hypothesis that there exist patterns in erroneous assessment of BI-RADS image features among radiology trainees when performing diagnostic interpretation of mammograms. We also investigate whether these error making patterns can be captured by individual user models. To test our hypothesis we propose a user modeling algorithm that uses the previous readings of a trainee to identify whether certain BI-RADS feature values (e.g. "spiculated" value for "margin" feature) are associated with higher than usual likelihood that the feature will be assessed incorrectly. In our experiments we used readings of 3 radiology residents and 7 breast imaging experts for 33 breast masses for the following BI-RADS features: parenchyma density, mass margin, mass shape and mass density. The expert readings were considered as the gold standard. Rule-based individual user models were developed and tested using the leave one-one-out crossvalidation scheme. Our experimental evaluation showed that the individual user models are accurate in identifying cases for which errors are more likely to be made. The user models captured regularities in error making for all 3 residents. This finding supports our hypothesis about existence of individual error making patterns in assessment of mammographic image features using the BI-RADS lexicon. Explicit user models identifying the weaknesses of each resident could be of great use when developing and adapting a personalized training plan to meet the resident's individual needs. Such approach fits well with the framework of adaptive computer-aided educational systems in mammography we have proposed before.

Computer-aided diagnosis of mammographic masses using geometric verification-based image retrieval

NASA Astrophysics Data System (ADS)

Li, Qingliang; Shi, Weili; Yang, Huamin; Zhang, Huimao; Li, Guoxin; Chen, Tao; Mori, Kensaku; Jiang, Zhengang

2017-03-01

Computer-Aided Diagnosis of masses in mammograms is an important indicator of breast cancer. The use of retrieval systems in breast examination is increasing gradually. In this respect, the method of exploiting the vocabulary tree framework and the inverted file in the mammographic masse retrieval have been proved high accuracy and excellent scalability. However it just considered the features in each image as a visual word and had ignored the spatial configurations of features. It greatly affect the retrieval performance. To overcome this drawback, we introduce the geometric verification method to retrieval in mammographic masses. First of all, we obtain corresponding match features based on the vocabulary tree framework and the inverted file. After that, we grasps the main point of local similarity characteristic of deformations in the local regions by constructing the circle regions of corresponding pairs. Meanwhile we segment the circle to express the geometric relationship of local matches in the area and generate the spatial encoding strictly. Finally we judge whether the matched features are correct or not, based on verifying the all spatial encoding are whether satisfied the geometric consistency. Experiments show the promising results of our approach.

Physical Activity and Change in Mammographic Density

PubMed Central

Conroy, Shannon M.; Butler, Lesley M.; Harvey, Danielle; Gold, Ellen B.; Sternfeld, Barbara; Oestreicher, Nina; Greendale, Gail A.; Habel, Laurel A.

2010-01-01

One potential mechanism by which physical activity may protect against breast cancer is by decreasing mammographic density. Percent mammographic density, the proportion of dense breast tissue area to total breast area, declines with age and is a strong risk factor for breast cancer. The authors hypothesized that women who were more physically active would have a greater decline in percent mammographic density with age, compared with less physically active women. The authors tested this hypothesis using longitudinal data (1996–2004) from 722 participants in the Study of Women's Health Across the Nation (SWAN), a multiethnic cohort of women who were pre- and early perimenopausal at baseline, with multivariable, repeated-measures linear regression analyses. During an average of 5.6 years, the mean annual decline in percent mammographic density was 1.1% (standard deviation = 0.1). A 1-unit increase in total physical activity score was associated with a weaker annual decline in percent mammographic density by 0.09% (standard error = 0.03; P = 0.01). Physical activity was inversely associated with the change in nondense breast area (P < 0.01) and not associated with the change in dense breast area (P = 0.17). Study results do not support the hypothesis that physical activity reduces breast cancer through a mechanism that includes reduced mammographic density. PMID:20354074

Incremental clinical value of ultrasound in men with mammographically confirmed gynecomastia.

PubMed

Chen, Po-Hao; Slanetz, Priscilla J

2014-01-01

To determine whether ultrasound is of any value in male patients presenting with focal symptoms who have classic features of gynecomastia but no concerning findings on mammography. Over a 3-year period, all male patients who underwent mammographic evaluation were identified in this retrospective study. Patients with a mammographic diagnosis of gynecomastia and subsequent breast ultrasound at a large tertiary academic medical center comprised the study cohort. Men whose ultrasound diagnosis differed from the initial mammographic evaluation were analyzed for both additional benign findings as well as findings that warranted biopsy. A total of 353 mammograms were obtained from 327 unique patients (ages 18-95, mean 51 years). Of all mammographic examinations, gynecomastia was the sole finding in 73% (259). In those 259 studies, 85% were further evaluated with ultrasound, in which 6 (2.7%) showed additional benign findings, and 4 (1.8%) showed suspicious findings for which biopsy was recommended. No malignancies were detected in those patients. Furthermore, no malignancies were detected in patients whose mammogram revealed only normal fatty parenchyma or only gynecomastia. In all cases of cancer, mammography revealed visible masses. Judicious use of breast ultrasound in men improves outcome. Our data suggest that targeted ultrasound is of limited value in symptomatic male patients where mammography is negative or reveals only gynecomastia and leads to unnecessary benign biopsies in these patients. When mammography reveals concerning findings, ultrasound adds positively to clinical management. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Epidemiologic Studies of Isoflavones & Mammographic Density

PubMed Central

Maskarinec, Gertraud; Verheus, Martijn; Tice, Jeffrey A.

2010-01-01

Isoflavones, phytoestrogens in soy beans with estrogen-like properties, have been examined for their cancer protective effects. Mammographic density is a strong predictor of breast cancer. This review summarizes studies that have examined the association between isoflavones and breast density. Observational investigations in Hawaii and Singapore suggest slightly lower breast density among women of Asian descent with regular soy intake, but two larger studies from Japan and Singapore did not observe a protective effect. The findings from seven randomized trials with primarily Caucasian women indicate that soy or isoflavones do not modify mammographic density. Soy foods and isoflavone supplements within a nutritional range do not appear to modify breast cancer risk as assessed by mammographic density. PMID:22253990

Characterization of difference of Gaussian filters in the detection of mammographic regions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Catarious, David M. Jr.; Baydush, Alan H.; Floyd, Carey E. Jr.

2006-11-15

In this article, we present a characterization of the effect of difference of Gaussians (DoG) filters in the detection of mammographic regions. DoG filters have been used previously in mammographic mass computer-aided detection (CAD) systems. As DoG filters are constructed from the subtraction of two bivariate Gaussian distributions, they require the specification of three parameters: the size of the filter template and the standard deviations of the constituent Gaussians. The influence of these three parameters in the detection of mammographic masses has not been characterized. In this work, we aim to determine how the parameters affect (1) the physical descriptorsmore » of the detected regions (2) the true and false positive rates, and (3) the classification performance of the individual descriptors. To this end, 30 DoG filters are created from the combination of three template sizes and four values for each of the Gaussians' standard deviations. The filters are used to detect regions in a study database of 181 craniocaudal-view mammograms extracted from the Digital Database for Screening Mammography. To describe the physical characteristics of the identified regions, morphological and textural features are extracted from each of the detected regions. Differences in the mean values of the features caused by altering the DoG parameters are examined through statistical and empirical comparisons. The parameters' effects on the true and false positive rate are determined by examining the mean malignant sensitivities and false positives per image (FPpI). Finally, the effect on the classification performance is described by examining the variation in FPpI at the point where 81% of the malignant masses in the study database are detected. Overall, the findings of the study indicate that increasing the standard deviations of the Gaussians used to construct a DoG filter results in a dramatic decrease in the number of regions identified at the expense of missing a small

Diagnostic Performance of Mammographic Texture Analysis in the Differential Diagnosis of Benign and Malignant Breast Tumors.

PubMed

Li, Zhiming; Yu, Lan; Wang, Xin; Yu, Haiyang; Gao, Yuanxiang; Ren, Yande; Wang, Gang; Zhou, Xiaoming

2017-11-09

The purpose of this study was to investigate the diagnostic performance of mammographic texture analysis in the differential diagnosis of benign and malignant breast tumors. Digital mammography images were obtained from the Picture Archiving and Communication System at our institute. Texture features of mammographic images were calculated. Mann-Whitney U test was used to identify differences between the benign and malignant group. The receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of texture features. Significant differences of texture features of histogram, gray-level co-occurrence matrix (GLCM) and run length matrix (RLM) were found between the benign and malignant breast group (P < .05). The area under the ROC (AUROC) of histogram, GLCM, and RLM were 0.800, 0.787, and 0.761, with no differences between them (P > .05). The AUROCs of imaging-based diagnosis, texture analysis, and imaging-based diagnosis combined with texture analysis were 0.873, 0.863, and 0.961, respectively. When imaging-based diagnosis was combined with texture analysis, the AUROC was higher than that of imaging-based diagnosis or texture analysis (P < .05). Mammographic texture analysis is a reliable technique for differential diagnosis of benign and malignant breast tumors. Furthermore, the combination of imaging-based diagnosis and texture analysis can significantly improve diagnostic performance. Copyright © 2017 Elsevier Inc. All rights reserved.

Mammographic mass classification based on possibility theory

NASA Astrophysics Data System (ADS)

Hmida, Marwa; Hamrouni, Kamel; Solaiman, Basel; Boussetta, Sana

2017-03-01

Shape and margin features are very important for differentiating between benign and malignant masses in mammographic images. In fact, benign masses are usually round and oval and have smooth contours. However, malignant tumors have generally irregular shape and appear lobulated or speculated in margins. This knowledge suffers from imprecision and ambiguity. Therefore, this paper deals with the problem of mass classification by using shape and margin features while taking into account the uncertainty linked to the degree of truth of the available information and the imprecision related to its content. Thus, in this work, we proposed a novel mass classification approach which provides a possibility based representation of the extracted shape features and builds a possibility knowledge basis in order to evaluate the possibility degree of malignancy and benignity for each mass. For experimentation, the MIAS database was used and the classification results show the great performance of our approach in spite of using simple features.

Impact of contra-lateral breast reshaping on mammographic surveillance in women undergoing breast reconstruction following mastectomy for breast cancer.

PubMed

Nava, Maurizio B; Rocco, Nicola; Catanuto, Giuseppe; Falco, Giuseppe; Capalbo, Emanuela; Marano, Luigi; Bordoni, Daniele; Spano, Andrea; Scaperrotta, Gianfranco

2015-08-01

The ultimate goal of breast reconstruction is to achieve symmetry with the contra-lateral breast. Contra-lateral procedures with wide parenchymal rearrangements are suspected to impair mammographic surveillance. This study aims to evaluate the impact on mammographic detection of mastopexies and breast reductions for contralateral adjustment in breast reconstruction. We retrospectively evaluated 105 women affected by uni-lateral breast cancer who underwent mastectomy and immediate two-stage reconstruction between 2002 and 2007. We considered three groups according to the contra-lateral reshaping technique: mastopexy or breast reduction with inferior dermoglandular flap (group 1); mastopexy or breast reduction without inferior dermoglandular flap (group 2); no contra-lateral reshaping (group 3). We assessed qualitative mammographic variations and breast density in the three groups. Statistically significant differences have been found when comparing reshaped groups with non reshaped groups regarding parenchymal distortions, skin thickening and stromal edema, but these differences did not affect cancer surveillance. The surveillance mammography diagnostic accuracy in contra-lateral cancer detection was not significantly different between the three groups (p = 0.56), such as the need for MRI for equivocal findings at mammographic contra-lateral breast (p = 0.77) and the need for core-biopsies to confirm mammographic suspect of contra-lateral breast cancer (p = 0.90). This study confirms previous reports regarding the safety of mastopexies and breast reductions when performed in the setting of contra-lateral breast reshaping after breast reconstruction. Mammographic accuracy, sensitivity and specificity are not affected by the glandular re-arrangement. These results provide a further validation of the safety of current reconstructive paradigms. Copyright © 2015 Elsevier Ltd. All rights reserved.

Serum osteoprotegerin levels and mammographic density among high-risk women.

PubMed

Moran, Olivia; Zaman, Tasnim; Eisen, Andrea; Demsky, Rochelle; Blackmore, Kristina; Knight, Julia A; Elser, Christine; Ginsburg, Ophira; Zbuk, Kevin; Yaffe, Martin; Narod, Steven A; Salmena, Leonardo; Kotsopoulos, Joanne

2018-06-01

Mammographic density is a risk factor for breast cancer but the mechanism behind this association is unclear. The receptor activator of nuclear factor κB (RANK)/RANK ligand (RANKL) pathway has been implicated in the development of breast cancer. Given the role of RANK signaling in mammary epithelial cell proliferation, we hypothesized this pathway may also be associated with mammographic density. Osteoprotegerin (OPG), a decoy receptor for RANKL, is known to inhibit RANK signaling. Thus, it is of interest to evaluate whether OPG levels modify breast cancer risk through mammographic density. We quantified serum OPG levels in 57 premenopausal and 43 postmenopausal women using an enzyme-linked immunosorbent assay (ELISA). Cumulus was used to measure percent density, dense area, and non-dense area for each mammographic image. Subjects were classified into high versus low OPG levels based on the median serum OPG level in the entire cohort (115.1 pg/mL). Multivariate models were used to assess the relationship between serum OPG levels and the measures of mammographic density. Serum OPG levels were not associated with mammographic density among premenopausal women (P ≥ 0.42). Among postmenopausal women, those with low serum OPG levels had higher mean percent mammographic density (20.9% vs. 13.7%; P = 0.04) and mean dense area (23.4 cm 2 vs. 15.2 cm 2 ; P = 0.02) compared to those with high serum OPG levels after covariate adjustment. These findings suggest that low OPG levels may be associated with high mammographic density, particularly in postmenopausal women. Targeting RANK signaling may represent a plausible, non-surgical prevention option for high-risk women with high mammographic density, especially those with low circulating OPG levels.

Quantitative 3D breast magnetic resonance imaging fibroglandular tissue analysis and correlation with qualitative assessments: a feasibility study.

PubMed

Ha, Richard; Mema, Eralda; Guo, Xiaotao; Mango, Victoria; Desperito, Elise; Ha, Jason; Wynn, Ralph; Zhao, Binsheng

2016-04-01

The amount of fibroglandular tissue (FGT) has been linked to breast cancer risk based on mammographic density studies. Currently, the qualitative assessment of FGT on mammogram (MG) and magnetic resonance imaging (MRI) is prone to intra and inter-observer variability. The purpose of this study is to develop an objective quantitative FGT measurement tool for breast MRI that could provide significant clinical value. An IRB approved study was performed. Sixty breast MRI cases with qualitative assessment of mammographic breast density and MRI FGT were randomly selected for quantitative analysis from routine breast MRIs performed at our institution from 1/2013 to 12/2014. Blinded to the qualitative data, whole breast and FGT contours were delineated on T1-weighted pre contrast sagittal images using an in-house, proprietary segmentation algorithm which combines the region-based active contours and a level set approach. FGT (%) was calculated by: [segmented volume of FGT (mm(3))/(segmented volume of whole breast (mm(3))] ×100. Statistical correlation analysis was performed between quantified FGT (%) on MRI and qualitative assessments of mammographic breast density and MRI FGT. There was a significant positive correlation between quantitative MRI FGT assessment and qualitative MRI FGT (r=0.809, n=60, P<0.001) and mammographic density assessment (r=0.805, n=60, P<0.001). There was a significant correlation between qualitative MRI FGT assessment and mammographic density assessment (r=0.725, n=60, P<0.001). The four qualitative assessment categories of FGT correlated with the calculated mean quantitative FGT (%) of 4.61% (95% CI, 0-12.3%), 8.74% (7.3-10.2%), 18.1% (15.1-21.1%), 37.4% (29.5-45.3%). Quantitative measures of FGT (%) were computed with data derived from breast MRI and correlated significantly with conventional qualitative assessments. This quantitative technique may prove to be a valuable tool in clinical use by providing computer generated standardized

Volumetric mammographic density: heritability and association with breast cancer susceptibility loci.

PubMed

Brand, Judith S; Humphreys, Keith; Thompson, Deborah J; Li, Jingmei; Eriksson, Mikael; Hall, Per; Czene, Kamila

2014-12-01

Mammographic density is a strong heritable trait, but data on its genetic component are limited to area-based and qualitative measures. We studied the heritability of volumetric mammographic density ascertained by a fully-automated method and the association with breast cancer susceptibility loci. Heritability of volumetric mammographic density was estimated with a variance component model in a sib-pair sample (N pairs = 955) of a Swedish screening based cohort. Associations with 82 established breast cancer loci were assessed in an independent sample of the same cohort (N = 4025 unrelated women) using linear models, adjusting for age, body mass index, and menopausal status. All tests were two-sided, except for heritability analyses where one-sided tests were used. After multivariable adjustment, heritability estimates (standard error) for percent dense volume, absolute dense volume, and absolute nondense volume were 0.63 (0.06) and 0.43 (0.06) and 0.61 (0.06), respectively (all P < .001). Percent and absolute dense volume were associated with rs10995190 (ZNF365; P = 9.0 × 10(-6) and 8.9 × 10(-7), respectively) and rs9485372 (TAB2; P = 1.8 × 10(-5) and 1.8 × 10(-3), respectively). We also observed associations of rs9383938 (ESR1) and rs2046210 (ESR1) with the absolute dense volume (P = 2.6 × 10(-4) and 4.6 × 10(-4), respectively), and rs6001930 (MLK1) and rs17356907 (NTN4) with the absolute nondense volume (P = 6.7 × 10(-6) and 8.4 × 10(-5), respectively). Our results support the high heritability of mammographic density, though estimates are weaker for absolute than percent dense volume. We also demonstrate that the shared genetic component with breast cancer is not restricted to dense tissues only. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Occupation and mammographic density: A population-based study (DDM-Occup).

PubMed

García-Pérez, Javier; Pollán, Marina; Pérez-Gómez, Beatriz; González-Sánchez, Mario; Cortés Barragán, Rosa Ana; Maqueda Blasco, Jerónimo; González-Galarzo, María Carmen; Alba, Miguel Ángel; van der Haar, Rudolf; Casas, Silvia; Vicente, Cándida; Medina, Pilar; Ederra, María; Santamariña, Carmen; Moreno, María Pilar; Casanova, Francisco; Pedraz-Pingarrón, Carmen; Moreo, Pilar; Ascunce, Nieves; García, Montse; Salas-Trejo, Dolores; Sánchez-Contador, Carmen; Llobet, Rafael; Lope, Virginia

2017-11-01

High mammographic density is one of the main risk factors for breast cancer. Although several occupations have been associated with breast cancer, there are no previous occupational studies exploring the association with mammographic density. Our objective was to identify occupations associated with high mammographic density in Spanish female workers. We conducted a population-based cross-sectional study of occupational determinants of high mammographic density in Spain, based on 1476 women, aged 45-68 years, recruited from seven screening centers within the Spanish Breast Cancer Screening Program network. Reproductive, family, personal, and occupational history data were collected. The latest occupation of each woman was collected and coded according to the 1994 National Classification of Occupations. Mammographic density was assessed from the cranio-caudal mammogram of the left breast using a semi-automated computer-assisted tool. Association between mammographic density and occupation was evaluated by using mixed linear regression models, using log-transformed percentage of mammographic density as dependent variable. Models were adjusted for age, body mass index, menopausal status, parity, smoking, alcohol intake, educational level, type of mammography, first-degree relative with breast cancer, and hormonal replacement therapy use. Screening center and professional reader were included as random effects terms. Mammographic density was higher, although non-statistically significant, among secondary school teachers (e β = 1.41; 95%CI = 0.98-2.03) and nurses (e β = 1.23; 95%CI = 0.96-1.59), whereas workers engaged in the care of people (e β = 0.81; 95%CI = 0.66-1.00) and housewives (e β = 0.87; 95%CI = 0.79-0.95) showed an inverse association with mammographic density. A positive trend for every 5 years working as secondary school teachers was also detected (p-value = 0.035). Nurses and secondary school teachers were the occupations with the highest

Mammographic density, breast cancer risk and risk prediction

PubMed Central

Vachon, Celine M; van Gils, Carla H; Sellers, Thomas A; Ghosh, Karthik; Pruthi, Sandhya; Brandt, Kathleen R; Pankratz, V Shane

2007-01-01

In this review, we examine the evidence for mammographic density as an independent risk factor for breast cancer, describe the risk prediction models that have incorporated density, and discuss the current and future implications of using mammographic density in clinical practice. Mammographic density is a consistent and strong risk factor for breast cancer in several populations and across age at mammogram. Recently, this risk factor has been added to existing breast cancer risk prediction models, increasing the discriminatory accuracy with its inclusion, albeit slightly. With validation, these models may replace the existing Gail model for clinical risk assessment. However, absolute risk estimates resulting from these improved models are still limited in their ability to characterize an individual's probability of developing cancer. Promising new measures of mammographic density, including volumetric density, which can be standardized using full-field digital mammography, will likely result in a stronger risk factor and improve accuracy of risk prediction models. PMID:18190724

Mammographic Breast Density in a Cohort of Medically Underserved Women

DTIC Science & Technology

2012-10-01

training, faculty from MMC and VUMC will conduct a case-control study of mammographic breast density to investigate its’ association with obesity and...hormones and growth factors, 4) to perform statistical analyses to determine the associations between obesity and insulin resistance and mammographic...on obesity and insulin resistance as they relate to mammographic breast density. We hypothesize that: 1) obesity and insulin resistance, defined

Comparison of Danish dichotomous and BI-RADS classifications of mammographic density.

PubMed

Hodge, Rebecca; Hellmann, Sophie Sell; von Euler-Chelpin, My; Vejborg, Ilse; Andersen, Zorana Jovanovic

2014-06-01

In the Copenhagen mammography screening program from 1991 to 2001, mammographic density was classified either as fatty or mixed/dense. This dichotomous mammographic density classification system is unique internationally, and has not been validated before. To compare the Danish dichotomous mammographic density classification system from 1991 to 2001 with the density BI-RADS classifications, in an attempt to validate the Danish classification system. The study sample consisted of 120 mammograms taken in Copenhagen in 1991-2001, which tested false positive, and which were in 2012 re-assessed and classified according to the BI-RADS classification system. We calculated inter-rater agreement between the Danish dichotomous mammographic classification as fatty or mixed/dense and the four-level BI-RADS classification by the linear weighted Kappa statistic. Of the 120 women, 32 (26.7%) were classified as having fatty and 88 (73.3%) as mixed/dense mammographic density, according to Danish dichotomous classification. According to BI-RADS density classification, 12 (10.0%) women were classified as having predominantly fatty (BI-RADS code 1), 46 (38.3%) as having scattered fibroglandular (BI-RADS code 2), 57 (47.5%) as having heterogeneously dense (BI-RADS 3), and five (4.2%) as having extremely dense (BI-RADS code 4) mammographic density. The inter-rater variability assessed by weighted kappa statistic showed a substantial agreement (0.75). The dichotomous mammographic density classification system utilized in early years of Copenhagen's mammographic screening program (1991-2001) agreed well with the BI-RADS density classification system.

Using component technologies for web based wavelet enhanced mammographic image visualization.

PubMed

Sakellaropoulos, P; Costaridou, L; Panayiotakis, G

2000-01-01

The poor contrast detectability of mammography can be dealt with by domain specific software visualization tools. Remote desktop client access and time performance limitations of a previously reported visualization tool are addressed, aiming at more efficient visualization of mammographic image resources existing in web or PACS image servers. This effort is also motivated by the fact that at present, web browsers do not support domain-specific medical image visualization. To deal with desktop client access the tool was redesigned by exploring component technologies, enabling the integration of stand alone domain specific mammographic image functionality in a web browsing environment (web adaptation). The integration method is based on ActiveX Document Server technology. ActiveX Document is a part of Object Linking and Embedding (OLE) extensible systems object technology, offering new services in existing applications. The standard DICOM 3.0 part 10 compatible image-format specification Papyrus 3.0 is supported, in addition to standard digitization formats such as TIFF. The visualization functionality of the tool has been enhanced by including a fast wavelet transform implementation, which allows for real time wavelet based contrast enhancement and denoising operations. Initial use of the tool with mammograms of various breast structures demonstrated its potential in improving visualization of diagnostic mammographic features. Web adaptation and real time wavelet processing enhance the potential of the previously reported tool in remote diagnosis and education in mammography.

Childhood factors associated with mammographic density in adult women.

PubMed

Lope, Virginia; Pérez-Gómez, Beatriz; Moreno, María Pilar; Vidal, Carmen; Salas-Trejo, Dolores; Ascunce, Nieves; Román, Isabel González; Sánchez-Contador, Carmen; Santamariña, María Carmen; Carrete, Jose Antonio Vázquez; Collado-García, Francisca; Pedraz-Pingarrón, Carmen; Ederra, María; Ruiz-Perales, Francisco; Peris, Mercé; Abad, Soledad; Cabanes, Anna; Pollán, Marina

2011-12-01

Growth and development factors could contribute to the development of breast cancer associated with an increase in mammographic density. This study examines the influence of certain childhood-related, socio-demographic and anthropometric variables on mammographic density in adult woman. The study covered 3574 women aged 45-68 years, participating in breast cancer-screening programmes in seven Spanish cities. Based on a craniocaudal mammogram, blind, anonymous measurement of mammographic density was made by a single radiologist, using Boyd's semiquantitative scale. Data associated with the early stages of life were obtained from a direct survey. Ordinal logistic regression and generalised linear models were employed to estimate the association between mammographic density and the variables covered by the questionnaire. Screening programme was introduced as a random effects term. Age, number of children, body mass index (BMI) and other childhood-related variables were used as adjustment variables, and stratified by menopausal status. A total of 811 women (23%) presented mammographic density of over 50%, and 5% of densities exceeded 75%. Our results show a greater prevalence of high mammographic density in women with low prepubertal weight (OR: 1.18; 95% CI: 1.02-1.36); marked prepubertal height (OR: 1.25; 95% CI: 0.97-1.60) and advanced age of their mothers at their birth (>39 years: OR: 1.28; 95% CI: 1.03-1.60); and a lower prevalence of high mammographic density in women with higher prepubertal weight, low birth weight and earlier menarche. The influence of these early-life factors may be explained by greater exposure to hormones and growth factors during the development of the breast gland, when breast tissue would be particularly susceptible to proliferative and carcinogenic stimulus.

Insulin-like growth factor-I (IGF-1), IGF-binding protein-3 (IGFBP-3) and mammographic features.

PubMed

Izzo, L; Meggiorini, M L; Nofroni, I; Pala, A; De Felice, C; Meloni, P; Simari, T; Izzo, S; Pugliese, F; Impara, L; Merlini, G; Di Cello, P; Cipolla, V; Forcione, A R; Paliotta, A; Domenici, L; Bolognese, A

2012-05-01

The IGF system has recently been shown to play an important role in the regulation of breast tumor cell proliferation. However, also breast density is currently considered as the strongest breast cancer risk factor. It is not yet clear whether these factors are interrelated and if and how they are influenced by menopausal status. The purpose of this study was to examine the possible effects of IGF-1 and IGFBP-3 and IGF-1/IGFBP-3 molar ratio on mammographic density stratified by menopausal status. A group of 341 Italian women were interviewed to collect the following data: family history of breast cancer, reproductive and menstrual factors, breast biopsies, previous administration of hormonal contraceptive therapy, hormone replacement therapy (HRT) in menopause and lifestyle information. A blood sample was drawn for determination of IGF-1, IGFBP-3 levels. IGF-1/ IGFBP-3 molar ratio was then calculated. On the basis of recent mammograms the women were divided into two groups: dense breast (DB) and non-dense breast (NDB). Student's t-test was employed to assess the association between breast density and plasma level of IGF-1, IGFBP-3 and molar ratio. To assess if this relationship was similar in subgroups of pre- and postmenopausal women, the study population was stratified by menopausal status and Student's t-test was performed. Finally, multivariate analysis was employed to evaluate if there were confounding factors that might influence the relationship between growth factors and breast density. The analysis of the relationship between mammographic density and plasma level of IGF-1, IGFBP-3 and IGF-1/ IGFBP-3 molar ratio showed that IGF-1 levels and molar ratio varied in the two groups resulting in higher mean values in the DB group (IGF-1: 109.6 versus 96.6 ng/ml; p= 0.001 and molar ratio 29.4 versus 25.5 ng/ml; p= 0.001) whereas IGFBP-3 showed similar values in both groups (DB and NDB). Analysis of plasma level of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio

Influence of lifestyle factors on mammographic density in postmenopausal women.

PubMed

Brand, Judith S; Czene, Kamila; Eriksson, Louise; Trinh, Thang; Bhoo-Pathy, Nirmala; Hall, Per; Celebioglu, Fuat

2013-01-01

Mammographic density is a strong risk factor for breast cancer. Apart from hormone replacement therapy (HRT), little is known about lifestyle factors that influence breast density. We examined the effect of smoking, alcohol and physical activity on mammographic density in a population-based sample of postmenopausal women without breast cancer. Lifestyle factors were assessed by a questionnaire and percentage and area measures of mammographic density were measured using computer-assisted software. General linear models were used to assess the association between lifestyle factors and mammographic density and effect modification by body mass index (BMI) and HRT was studied. Overall, alcohol intake was positively associated with percent mammographic density (P trend  = 0.07). This association was modified by HRT use (P interaction  = 0.06): increasing alcohol intake was associated with increasing percent density in current HRT users (P trend  = 0.01) but not in non-current users (P trend  = 0.82). A similar interaction between alcohol and HRT was found for the absolute dense area, with a positive association being present in current HRT users only (P interaction  = 0.04). No differences in mammographic density were observed across categories of smoking and physical activity, neither overall nor in stratified analyses by BMI and HRT use. Increasing alcohol intake is associated with an increase in mammography density, whereas smoking and physical activity do not seem to influence density. The observed interaction between alcohol and HRT may pose an opportunity for HRT users to lower their mammographic density and breast cancer risk.

A meta-analysis of mammographic screening with and without clinical breast examination

PubMed Central

Hamashima, Chisato; Ohta, Koji; Kasahara, Yoshio; Katayama, Takafumi; Nakayama, Tomio; Honjo, Satoshi; Ohnuki, Koji

2015-01-01

Mammographic screening with clinical breast examination has been recommended in Japan since 2000. Although mammographic screening without clinical breast examination has not been recommended, its introduction is anticipated. The efficacies of mammographic screening with and without clinical breast examination were evaluated based on the results of randomized controlled trials. PubMed and other databases for studies published between 1985 and 2014 were searched. The study design was limited to randomized controlled trials to evaluate mortality reduction from breast cancer. Five studies were eligible for meta-analysis of mammographic screening without clinical breast examination. The relative risk for women aged 40–74 years was 0.75 (95% confidence interval, 0.67–0.83). Three studies evaluated the efficacy of mammographic screening with clinical breast examination. The relative risk for women aged 40–64 years was 0.87 (95% confidence interval, 0.77–0.98). The number needed to invite was always lower in mammographic screening without clinical breast examination than in mammographic screening with clinical breast examination. In both screening methods, the number needed to invite was higher in women aged 40–49 years than in women aged 50–70 years. These results suggest that mammographic screening without clinical breast examination can afford higher benefits to women aged 50 years and over. Although evidence of the efficacy of mammographic screening without clinical breast examination was confirmed based on the results of the randomized controlled trials, a Japanese study is needed to resolve local problems. PMID:25959787

Distinguishing Features and Similarities Between Descriptive Phenomenological and Qualitative Description Research.

PubMed

Willis, Danny G; Sullivan-Bolyai, Susan; Knafl, Kathleen; Cohen, Marlene Z

2016-09-01

Scholars who research phenomena of concern to the discipline of nursing are challenged with making wise choices about different qualitative research approaches. Ultimately, they want to choose an approach that is best suited to answer their research questions. Such choices are predicated on having made distinctions between qualitative methodology, methods, and analytic frames. In this article, we distinguish two qualitative research approaches widely used for descriptive studies: descriptive phenomenological and qualitative description. Providing a clear basis that highlights the distinguishing features and similarities between descriptive phenomenological and qualitative description research will help students and researchers make more informed choices in deciding upon the most appropriate methodology in qualitative research. We orient the reader to distinguishing features and similarities associated with each approach and the kinds of research questions descriptive phenomenological and qualitative description research address. © The Author(s) 2016.

Influence of Lifestyle Factors on Mammographic Density in Postmenopausal Women

PubMed Central

Brand, Judith S.; Czene, Kamila; Eriksson, Louise; Trinh, Thang; Bhoo-Pathy, Nirmala; Hall, Per; Celebioglu, Fuat

2013-01-01

Background Mammographic density is a strong risk factor for breast cancer. Apart from hormone replacement therapy (HRT), little is known about lifestyle factors that influence breast density. Methods We examined the effect of smoking, alcohol and physical activity on mammographic density in a population-based sample of postmenopausal women without breast cancer. Lifestyle factors were assessed by a questionnaire and percentage and area measures of mammographic density were measured using computer-assisted software. General linear models were used to assess the association between lifestyle factors and mammographic density and effect modification by body mass index (BMI) and HRT was studied. Results Overall, alcohol intake was positively associated with percent mammographic density (P trend  = 0.07). This association was modified by HRT use (P interaction  = 0.06): increasing alcohol intake was associated with increasing percent density in current HRT users (P trend  = 0.01) but not in non-current users (P trend  = 0.82). A similar interaction between alcohol and HRT was found for the absolute dense area, with a positive association being present in current HRT users only (P interaction  = 0.04). No differences in mammographic density were observed across categories of smoking and physical activity, neither overall nor in stratified analyses by BMI and HRT use. Conclusions Increasing alcohol intake is associated with an increase in mammography density, whereas smoking and physical activity do not seem to influence density. The observed interaction between alcohol and HRT may pose an opportunity for HRT users to lower their mammographic density and breast cancer risk. PMID:24349146

Minimization of annotation work: diagnosis of mammographic masses via active learning

NASA Astrophysics Data System (ADS)

Zhao, Yu; Zhang, Jingyang; Xie, Hongzhi; Zhang, Shuyang; Gu, Lixu

2018-06-01

The prerequisite for establishing an effective prediction system for mammographic diagnosis is the annotation of each mammographic image. The manual annotation work is time-consuming and laborious, which becomes a great hindrance for researchers. In this article, we propose a novel active learning algorithm that can adequately address this problem, leading to the minimization of the labeling costs on the premise of guaranteed performance. Our proposed method is different from the existing active learning methods designed for the general problem as it is specifically designed for mammographic images. Through its modified discriminant functions and improved sample query criteria, the proposed method can fully utilize the pairing of mammographic images and select the most valuable images from both the mediolateral and craniocaudal views. Moreover, in order to extend active learning to the ordinal regression problem, which has no precedent in existing studies, but is essential for mammographic diagnosis (mammographic diagnosis is not only a classification task, but also an ordinal regression task for predicting an ordinal variable, viz. the malignancy risk of lesions), multiple sample query criteria need to be taken into consideration simultaneously. We formulate it as a criteria integration problem and further present an algorithm based on self-adaptive weighted rank aggregation to achieve a good solution. The efficacy of the proposed method was demonstrated on thousands of mammographic images from the digital database for screening mammography. The labeling costs of obtaining optimal performance in the classification and ordinal regression task respectively fell to 33.8 and 19.8 percent of their original costs. The proposed method also generated 1228 wins, 369 ties and 47 losses for the classification task, and 1933 wins, 258 ties and 185 losses for the ordinal regression task compared to the other state-of-the-art active learning algorithms. By taking the

Minimization of annotation work: diagnosis of mammographic masses via active learning.

PubMed

Zhao, Yu; Zhang, Jingyang; Xie, Hongzhi; Zhang, Shuyang; Gu, Lixu

2018-05-22

The prerequisite for establishing an effective prediction system for mammographic diagnosis is the annotation of each mammographic image. The manual annotation work is time-consuming and laborious, which becomes a great hindrance for researchers. In this article, we propose a novel active learning algorithm that can adequately address this problem, leading to the minimization of the labeling costs on the premise of guaranteed performance. Our proposed method is different from the existing active learning methods designed for the general problem as it is specifically designed for mammographic images. Through its modified discriminant functions and improved sample query criteria, the proposed method can fully utilize the pairing of mammographic images and select the most valuable images from both the mediolateral and craniocaudal views. Moreover, in order to extend active learning to the ordinal regression problem, which has no precedent in existing studies, but is essential for mammographic diagnosis (mammographic diagnosis is not only a classification task, but also an ordinal regression task for predicting an ordinal variable, viz. the malignancy risk of lesions), multiple sample query criteria need to be taken into consideration simultaneously. We formulate it as a criteria integration problem and further present an algorithm based on self-adaptive weighted rank aggregation to achieve a good solution. The efficacy of the proposed method was demonstrated on thousands of mammographic images from the digital database for screening mammography. The labeling costs of obtaining optimal performance in the classification and ordinal regression task respectively fell to 33.8 and 19.8 percent of their original costs. The proposed method also generated 1228 wins, 369 ties and 47 losses for the classification task, and 1933 wins, 258 ties and 185 losses for the ordinal regression task compared to the other state-of-the-art active learning algorithms. By taking the

Multi-view information fusion for automatic BI-RADS description of mammographic masses

NASA Astrophysics Data System (ADS)

Narvaez, Fabián; Díaz, Gloria; Romero, Eduardo

2011-03-01

Most CBIR-based CAD systems (Content Based Image Retrieval systems for Computer Aided Diagnosis) identify lesions that are eventually relevant. These systems base their analysis upon a single independent view. This article presents a CBIR framework which automatically describes mammographic masses with the BI-RADS lexicon, fusing information from the two mammographic views. After an expert selects a Region of Interest (RoI) at the two views, a CBIR strategy searches similar masses in the database by automatically computing the Mahalanobis distance between shape and texture feature vectors of the mammography. The strategy was assessed in a set of 400 cases, for which the suggested descriptions were compared with the ground truth provided by the data base. Two information fusion strategies were evaluated, allowing a retrieval precision rate of 89.6% in the best scheme. Likewise, the best performance obtained for shape, margin and pathology description, using a ROC methodology, was reported as AUC = 0.86, AUC = 0.72 and AUC = 0.85, respectively.

Sex steroid metabolism polymorphisms and mammographic density in pre- and early perimenopausal women

PubMed Central

Crandall, Carolyn J; Sehl, Mary E; Crawford, Sybil L; Gold, Ellen B; Habel, Laurel A; Butler, Lesley M; Sowers, MaryFran R; Greendale, Gail A; Sinsheimer, Janet S

2009-01-01

Introduction We examined the association between mammographic density and single-nucleotide polymorphisms (SNPs) in genes encoding CYP1A1, CYP1B1, aromatase, 17β-HSD, ESR1, and ESR2 in pre- and early perimenopausal white, African-American, Chinese, and Japanese women. Methods The Study of Women's Health Across the Nation is a longitudinal community-based cohort study. We analyzed data from 451 pre- and early perimenopausal participants of the ancillary SWAN Mammographic Density study for whom we had complete information regarding mammographic density, genotypes, and covariates. With multivariate linear regression, we examined the relation between percentage mammographic breast density (outcome) and each SNP (primary predictor), adjusting for age, race/ethnicity, parity, cigarette smoking, and body mass index (BMI). Results After multivariate adjustment, the CYP1B1 rs162555 CC genotype was associated with a 9.4% higher mammographic density than the TC/TT genotype (P = 0.04). The CYP19A1 rs936306 TT genotype was associated with 6.2% lower mammographic density than the TC/CC genotype (P = 0.02). The positive association between CYP1A1 rs2606345 and mammographic density was significantly stronger among participants with BMI greater than 30 kg/m2 than among those with BMI less than 25 kg/m2 (Pinteraction = 0.05). Among white participants, the ESR1 rs2234693 CC genotype was associated with a 7.0% higher mammographic density than the CT/TT genotype (P = 0.01). Conclusions SNPs in certain genes encoding sex steroid metabolism enzymes and ESRs were associated with mammographic density. Because the encoded enzymes and ESR1 are expressed in breast tissue, these SNPs may influence breast cancer risk by altering mammographic density. PMID:19630952

A Review on Automatic Mammographic Density and Parenchymal Segmentation

PubMed Central

He, Wenda; Juette, Arne; Denton, Erika R. E.; Oliver, Arnau

2015-01-01

Breast cancer is the most frequently diagnosed cancer in women. However, the exact cause(s) of breast cancer still remains unknown. Early detection, precise identification of women at risk, and application of appropriate disease prevention measures are by far the most effective way to tackle breast cancer. There are more than 70 common genetic susceptibility factors included in the current non-image-based risk prediction models (e.g., the Gail and the Tyrer-Cuzick models). Image-based risk factors, such as mammographic densities and parenchymal patterns, have been established as biomarkers but have not been fully incorporated in the risk prediction models used for risk stratification in screening and/or measuring responsiveness to preventive approaches. Within computer aided mammography, automatic mammographic tissue segmentation methods have been developed for estimation of breast tissue composition to facilitate mammographic risk assessment. This paper presents a comprehensive review of automatic mammographic tissue segmentation methodologies developed over the past two decades and the evidence for risk assessment/density classification using segmentation. The aim of this review is to analyse how engineering advances have progressed and the impact automatic mammographic tissue segmentation has in a clinical environment, as well as to understand the current research gaps with respect to the incorporation of image-based risk factors in non-image-based risk prediction models. PMID:26171249

Comparison of two portable solid state detectors with an improved collimation and alignment device for mammographic x-ray spectroscopy.

PubMed

Bottigli, U; Golosio, B; Masala, G L; Oliva, P; Stumbo, S; Delogu, P; Fantacci, M E; Abbene, L; Fauci, F; Raso, G

2006-09-01

We describe a portable system for mammographic x-ray spectroscopy, based on a 2 X 2 X 1 mm3 cadmium telluride (CdTe) solid state detector, that is greatly improved over a similar system based on a 3 X 3 X 2 mm3 cadmium zinc telluride (CZT) solid state detector evaluated in an earlier work. The CdTe system utilized new pinhole collimators and an alignment device that facilitated measurement of mammographic x-ray spectra. Mammographic x-ray spectra acquired by each system were comparable. Half value layer measurements obtained using an ion chamber agreed closely with those derived from the x-ray spectra measured by either detector. The faster electronics and other features of the CdTe detector allowed its use with a larger pinhole collimator than could be used with the CZT detector. Additionally, the improved pinhole collimator and alignment features of the apparatus permitted much more rapid setup for acquisition of x-ray spectra than was possible on the system described in the earlier work. These improvements in detector technology, collimation and ease of alignment, as well as low cost, make this apparatus attractive as a tool for both laboratory research and advanced mammography quality control.

Mammographic screening practices among Chinese-Australian women.

PubMed

Kwok, Cannas; Fethney, Judith; White, Kate

2012-03-01

To report mammographic screening practice among Chinese-Australian women, and to examine the relationship between demographic characteristics, acculturation factors (English proficiency and length of stay in Australia), cultural beliefs, and having a mammogram as recommended. Cross-sectional and descriptive. The study was conducted in 2009 in Sydney, Australia. Of 988 Chinese-Australian women over 18 years of age invited to participate in the study, 785 (79%) completed and returned the questionnaire. Of these women, 320 (40.8%) were in the target age range of 50 to 69 years. The Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) was used as a data collection instrument. Analysis included descriptive statistics, bivariate analysis using chi-square and t tests, and logistic regression. Of the 320 women in the targeted age range of 50 to 69 years, 238 (74.4%) had a mammogram as recommended biannually. Being married-de facto, in the 60 to 69 age group, and speaking Cantonese at home were positively associated with women's mammographic screening practice. However, no statistically significant differences in acculturation factors and having a mammogram as recommended were found. In terms of CBCSB score, women who had mammograms as recommended had more positive attitudes toward health checkups and perceived fewer barriers to mammographic screening. Effort should be focused on specific subgroups of Chinese-Australian women in order to fully understand the barriers involved in participating in mammographic screening. Nurses can use the findings from the present study to design culturally sensitive breast cancer screening programs to encourage women's participation in mammography. © 2011 Sigma Theta Tau International.

Impact of full field digital mammography on the classification and mammographic characteristics of interval breast cancers.

PubMed

Knox, Mark; O'Brien, Angela; Szabó, Endre; Smith, Clare S; Fenlon, Helen M; McNicholas, Michelle M; Flanagan, Fidelma L

2015-06-01

Full field digital mammography (FFDM) is increasingly replacing screen film mammography (SFM) in breast screening programs. Interval breast cancers are an issue in all screening programs and the purpose of our study is to assess the impact of FFDM on the classification of interval breast cancers at independent blind review and to compare the mammographic features of interval cancers at FFDM and SFM. This study included 138 cases of interval breast cancer, 76 following an FFDM screening examination and 62 following screening with SFM. The prior screening mammogram was assessed by each of five consultant breast radiologists who were blinded to the site of subsequent cancer. Subsequent review of the diagnostic mammogram was performed and cases were classified as missed, minimal signs, occult or true interval. Mammographic features of the interval cancer at diagnosis and any abnormality identified on the prior screening mammogram were recorded. The percentages of cancers classified as missed at FFDM and SFM did not differ significantly, 10.5% (8 of 76) at FFDM and 8.1% (5 of 62) at SFM (p=.77). There were significantly less interval cancers presenting as microcalcifications (alone or in association with another abnormality) following screening with FFDM, 16% (12 of 76) than following a SFM examination, 32% (20 of 62) (p=.02). Interval breast cancers continue to pose a problem at FFDM. The switch to FFDM has changed the mammographic presentation of interval breast cancer, with less interval cancers presenting in association with microcalcifications. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Collaborating with Mammographers to Address Their Work-Related Musculoskeletal Discomfort

PubMed Central

Sommerich, Carolyn M.; Lavender, Steven A.; Evans, Kevin D.; Sanders, Elizabeth; Joines, Sharon; Lamar, Sabrina; Umar, Radin Zaid Radin; Yen, Wei-Ting; Park, SangHyun

2017-01-01

Mammographers are an understudied group of healthcare workers, yet the prevalence of musculoskeletal (MSK) symptoms in mammographers appears to be elevated, similar to many occupations in healthcare. In this study, we used a participatory approach to identify needs and opportunities for developing interventions to reduce mammographers’ exposures to risk factors that lead to development of MSK symptoms. In this paper, we present a number of those needs and several intervention concepts along with evaluations of those concepts from experienced mammographers. We include findings from a preliminary field test of a novel intervention concept to reduce the need to adopt awkward postures while positioning patients for a screening or diagnostic mammogram. PMID:26794257

Digital mammographic tumor classification using transfer learning from deep convolutional neural networks.

PubMed

Huynh, Benjamin Q; Li, Hui; Giger, Maryellen L

2016-07-01

Convolutional neural networks (CNNs) show potential for computer-aided diagnosis (CADx) by learning features directly from the image data instead of using analytically extracted features. However, CNNs are difficult to train from scratch for medical images due to small sample sizes and variations in tumor presentations. Instead, transfer learning can be used to extract tumor information from medical images via CNNs originally pretrained for nonmedical tasks, alleviating the need for large datasets. Our database includes 219 breast lesions (607 full-field digital mammographic images). We compared support vector machine classifiers based on the CNN-extracted image features and our prior computer-extracted tumor features in the task of distinguishing between benign and malignant breast lesions. Five-fold cross validation (by lesion) was conducted with the area under the receiver operating characteristic (ROC) curve as the performance metric. Results show that classifiers based on CNN-extracted features (with transfer learning) perform comparably to those using analytically extracted features [area under the ROC curve [Formula: see text

Differences in mammographic density between Asian and Caucasian populations: a comparative analysis.

PubMed

Rajaram, Nadia; Mariapun, Shivaani; Eriksson, Mikael; Tapia, Jose; Kwan, Pui Yoke; Ho, Weang Kee; Harun, Faizah; Rahmat, Kartini; Czene, Kamila; Taib, Nur Aishah Mohd; Hall, Per; Teo, Soo Hwang

2017-01-01

Mammographic density is a measurable and modifiable biomarker that is strongly and independently associated with breast cancer risk. Paradoxically, although Asian women have lower risk of breast cancer, studies of minority Asian women in predominantly Caucasian populations have found that Asian women have higher percent density. In this cross-sectional study, we compared the distribution of mammographic density for a matched cohort of Asian women from Malaysia and Caucasian women from Sweden, and determined if variations in mammographic density could be attributed to population differences in breast cancer risk factors. Volumetric mammographic density was compared for 1501 Malaysian and 4501 Swedish healthy women, matched on age and body mass index. We used multivariable log-linear regression to determine the risk factors associated with mammographic density and mediation analysis to identify factors that account for differences in mammographic density between the two cohorts. Compared to Caucasian women, percent density was 2.0% higher among Asian women (p < 0.001), and dense volume was 5.7 cm 3 higher among pre-menopausal Asian women (p < 0.001). Dense volume was 3.0 cm 3 lower among post-menopausal Asian women (p = 0.009) compared to post-menopausal Caucasian women, and this difference was attributed to population differences in height, weight, and parity (p < 0.001). Our analysis suggests that among post-menopausal women, population differences in mammographic density and risk to breast cancer may be accounted for by height, weight, and parity. Given that pre-menopausal Asian and Caucasian women have similar population risk to breast cancer but different dense volume, development of more appropriate biomarkers of risk in pre-menopausal women is required.

Dietary vitamin D and calcium intake and mammographic density in postmenopausal women.

PubMed

Bertone-Johnson, Elizabeth R; Chlebowski, Rowan T; Manson, Joann E; Wactawski-Wende, Jean; Aragaki, Aaron K; Tamimi, Rulla M; Rexrode, Kathryn M; Thomson, Cynthia A; Rohan, Thomas E; Peck, Jennifer D; Pisano, Etta D; Martin, Christopher F; Sarto, Gloria; McTiernan, Anne

2010-01-01

Dietary intake of vitamin D and calcium may be related to risk of breast cancer, possibly by affecting mammographic density. However, the few studies that have evaluated the association between these nutrients and mammographic density in postmenopausal women have had inconsistent results. We conducted a cross-sectional analysis in 808 participants of the Mammogram Density Ancillary Study of the Women's Health Initiative. Mammographic percent density was measured using baseline mammograms taken before randomization of participants in the intervention trials. Vitamin D and calcium intake was assessed with a validated food frequency questionnaire and an inventory of current supplement use, both completed at baseline. After adjustment for age, body mass index, regional solar irradiance, and other factors, we did not find a relationship between vitamin D or calcium intake and mammographic density. Mean mammographic percent densities in women reporting total vitamin D intakes of less than 100, 100 to 199, 200 to 399, 400 to 599, and 600 or greater IU/day were 5.8%, 10.4%, 6.2%, 3.8%, and 5.1%, respectively (P trend = 0.67). Results in women reporting a total calcium intake of less than 500, 500 to 749, 750 to 999, 1,000 to 1,199, and 1,200 or greater mg/day were 7.3%, 4.9%, 7.3%, 6.9%, and 7.11%, respectively (P trend = 0.51). We did not observe any effect modification by overall level of mammographic density or solar irradiance, but supplemental vitamin D use was associated with lower density in younger women (P interaction = 0.009). These findings do not support a relationship between dietary vitamin D or calcium intake and mammographic density in postmenopausal women. Additional studies should explore these associations in women of different ages and in relation to serum vitamin D levels.

Optimum processing of mammographic film.

PubMed

Sprawls, P; Kitts, E L

1996-03-01

Underprocessing of mammographic film can result in reduced contrast and visibility of breast structures and an unnecessary increase in radiation dose to the patient. Underprocessing can be caused by physical factors (low developer temperature, inadequate development time, insufficient developer agitation) or chemical factors (developer not optimized for film type; overdiluted, underreplenished, contaminated, or frequently changed developer). Conventional quality control programs are designed to produce consistent processing but do not address the issue of optimum processing. Optimum processing is defined as the level of processing that produces the film performance characteristics (contrast and sensitivity) specified by the film manufacturer. Optimum processing of mammographic film can be achieved by following a two-step protocol. The first step is to set up the processing conditions according to recommendations from the film and developer chemistry manufacturers. The second step is to verify the processing results by comparing them with sensitometric data provided by the film manufacturer.

Robust estimation of mammographic breast density: a patient-based approach

NASA Astrophysics Data System (ADS)

Heese, Harald S.; Erhard, Klaus; Gooßen, Andre; Bulow, Thomas

2012-02-01

Breast density has become an established risk indicator for developing breast cancer. Current clinical practice reflects this by grading mammograms patient-wise as entirely fat, scattered fibroglandular, heterogeneously dense, or extremely dense based on visual perception. Existing (semi-) automated methods work on a per-image basis and mimic clinical practice by calculating an area fraction of fibroglandular tissue (mammographic percent density). We suggest a method that follows clinical practice more strictly by segmenting the fibroglandular tissue portion directly from the joint data of all four available mammographic views (cranio-caudal and medio-lateral oblique, left and right), and by subsequently calculating a consistently patient-based mammographic percent density estimate. In particular, each mammographic view is first processed separately to determine a region of interest (ROI) for segmentation into fibroglandular and adipose tissue. ROI determination includes breast outline detection via edge-based methods, peripheral tissue suppression via geometric breast height modeling, and - for medio-lateral oblique views only - pectoral muscle outline detection based on optimizing a three-parameter analytic curve with respect to local appearance. Intensity harmonization based on separately acquired calibration data is performed with respect to compression height and tube voltage to facilitate joint segmentation of available mammographic views. A Gaussian mixture model (GMM) on the joint histogram data with a posteriori calibration guided plausibility correction is finally employed for tissue separation. The proposed method was tested on patient data from 82 subjects. Results show excellent correlation (r = 0.86) to radiologist's grading with deviations ranging between -28%, (q = 0.025) and +16%, (q = 0.975).

Adolescent intake of animal fat and red meat in relation to premenopausal mammographic density

PubMed Central

Bertrand, Kimberly A.; Burian, Rosemarie A.; Eliassen, A. Heather; Willett, Walter C.; Tamimi, Rulla M.

2016-01-01

Purpose Adolescence is hypothesized to be a time period of particular susceptibility to breast cancer risk factors. Red meat and fat intake during high school was positively associated with risk of breast cancer among premenopausal women in the Nurses’ Health Study II (NHSII). High mammographic density is a strong predictor of breast cancer risk but there is limited research on dietary factors associated with breast density. To test the hypothesis that high intake of animal fat or red meat during adolescence is associated with mammographic density, we analyzed data from premenopausal women in the NHSII. Methods Participants recalled adolescent diet on a high school food frequency questionnaire. We assessed absolute and percent mammographic density on digitized analog film mammograms for 687 premenopausal women with no history of cancer. We used generalized linear regression to quantify associations of adolescent animal fat and red meat intake with mammographic density, adjusting for age, body mass index, and other predictors of mammographic density. Results Adolescent animal fat intake was significantly positively associated with premenopausal mammographic density, with a mean percent density of 39.2% in the lowest quartile of adolescent animal fat intake vs. 43.1% in the highest quartile (p-trend: 0.03). A non-significant positive association was also observed for adolescent red meat intake (p-trend: 0.14). Conclusions These findings suggest that higher adolescent animal fat intake is weakly associated with percent mammographic density in premenopausal women. PMID:26791521

Biologic and Computational Modeling of Mammographic Density and Stromal Patterning

DTIC Science & Technology

2009-07-01

research effort. INTRODUCTION: Mammographic density serves as independent marker of short term breast cancer risk and a surrogate marker of...response to a variety of prevention agents1-3. Although a majority of breast cancers are epithelial in origin, there is evidence that stromal content of...the breast is an important predictor or mammographic density. There is increasing evidence that the stroma plays a role in breast cancer initiation4

Developing a new case based computer-aided detection scheme and an adaptive cueing method to improve performance in detecting mammographic lesions

PubMed Central

Tan, Maxine; Aghaei, Faranak; Wang, Yunzhi; Zheng, Bin

2017-01-01

The purpose of this study is to evaluate a new method to improve performance of computer-aided detection (CAD) schemes of screening mammograms with two approaches. In the first approach, we developed a new case based CAD scheme using a set of optimally selected global mammographic density, texture, spiculation, and structural similarity features computed from all four full-field digital mammography (FFDM) images of the craniocaudal (CC) and mediolateral oblique (MLO) views by using a modified fast and accurate sequential floating forward selection feature selection algorithm. Selected features were then applied to a “scoring fusion” artificial neural network (ANN) classification scheme to produce a final case based risk score. In the second approach, we combined the case based risk score with the conventional lesion based scores of a conventional lesion based CAD scheme using a new adaptive cueing method that is integrated with the case based risk scores. We evaluated our methods using a ten-fold cross-validation scheme on 924 cases (476 cancer and 448 recalled or negative), whereby each case had all four images from the CC and MLO views. The area under the receiver operating characteristic curve was AUC = 0.793±0.015 and the odds ratio monotonically increased from 1 to 37.21 as CAD-generated case based detection scores increased. Using the new adaptive cueing method, the region based and case based sensitivities of the conventional CAD scheme at a false positive rate of 0.71 per image increased by 2.4% and 0.8%, respectively. The study demonstrated that supplementary information can be derived by computing global mammographic density image features to improve CAD-cueing performance on the suspicious mammographic lesions. PMID:27997380

A completely automated CAD system for mass detection in a large mammographic database.

PubMed

Bellotti, R; De Carlo, F; Tangaro, S; Gargano, G; Maggipinto, G; Castellano, M; Massafra, R; Cascio, D; Fauci, F; Magro, R; Raso, G; Lauria, A; Forni, G; Bagnasco, S; Cerello, P; Zanon, E; Cheran, S C; Lopez Torres, E; Bottigli, U; Masala, G L; Oliva, P; Retico, A; Fantacci, M E; Cataldo, R; De Mitri, I; De Nunzio, G

2006-08-01

Mass localization plays a crucial role in computer-aided detection (CAD) systems for the classification of suspicious regions in mammograms. In this article we present a completely automated classification system for the detection of masses in digitized mammographic images. The tool system we discuss consists in three processing levels: (a) Image segmentation for the localization of regions of interest (ROIs). This step relies on an iterative dynamical threshold algorithm able to select iso-intensity closed contours around gray level maxima of the mammogram. (b) ROI characterization by means of textural features computed from the gray tone spatial dependence matrix (GTSDM), containing second-order spatial statistics information on the pixel gray level intensity. As the images under study were recorded in different centers and with different machine settings, eight GTSDM features were selected so as to be invariant under monotonic transformation. In this way, the images do not need to be normalized, as the adopted features depend on the texture only, rather than on the gray tone levels, too. (c) ROI classification by means of a neural network, with supervision provided by the radiologist's diagnosis. The CAD system was evaluated on a large database of 3369 mammographic images [2307 negative, 1062 pathological (or positive), containing at least one confirmed mass, as diagnosed by an expert radiologist]. To assess the performance of the system, receiver operating characteristic (ROC) and free-response ROC analysis were employed. The area under the ROC curve was found to be Az = 0.783 +/- 0.008 for the ROI-based classification. When evaluating the accuracy of the CAD against the radiologist-drawn boundaries, 4.23 false positives per image are found at 80% of mass sensitivity.

Positive association between mammographic breast density and bone mineral density in the Postmenopausal Estrogen/Progestin Interventions Study

PubMed Central

Crandall, Carolyn; Palla, Shana; Reboussin, Beth A; Ursin, Giske; Greendale, Gail A

2005-01-01

Introduction Mammographic breast density is a strong independent risk factor for breast cancer. We hypothesized that demonstration of an association between mammographic breast density and bone mineral density (BMD) would suggest a unifying underlying mechanism influencing both breast density and BMD. Methods In a cross-sectional analysis of baseline data from the Postmenopausal Estrogen/Progestin Interventions Study (PEPI), participants were aged 45 to 64 years and were at least 1 year postmenopausal. Mammographic breast density (percentage of the breast composed of dense tissue), the outcome, was assessed with a computer-assisted percentage-density method. BMD, the primary predictor, was measured with dual-energy X-ray absorptiometry. Women quitting menopausal hormone therapy to join PEPI were designated recent hormone users. Results The mean age of the 594 women was 56 years. The average time since menopause was 5.6 years. After adjustment for age, body mass index, and cigarette smoking, in women who were not recent hormone users before trial enrollment (n = 415), mammographic density was positively associated with total hip (P = 0.04) and lumbar (P = 0.08) BMD. Mammographic density of recent hormone users (n = 171) was not significantly related to either total hip (P = 0.51) or lumbar (P = 0.44) BMD. In participants who were not recent hormone users, mammographic density was 4% greater in the highest quartile of total hip BMD than in the lowest. In participants who were not recent hormone users, mammographic density was 5% greater in the highest quartile of lumbar spine BMD than in the lowest. Conclusion Mammographic density and BMD are positively associated in women who have not recently used postmenopausal hormones. A unifying biological mechanism may link mammographic density and BMD. Recent exogenous postmenopausal hormone use may obscure the association between mammographic density and BMD by having a persistent effect on breast tissue. PMID:16280044

Applying a new mammographic imaging marker to predict breast cancer risk

NASA Astrophysics Data System (ADS)

Aghaei, Faranak; Danala, Gopichandh; Hollingsworth, Alan B.; Stoug, Rebecca G.; Pearce, Melanie; Liu, Hong; Zheng, Bin

2018-02-01

Identifying and developing new mammographic imaging markers to assist prediction of breast cancer risk has been attracting extensive research interest recently. Although mammographic density is considered an important breast cancer risk, its discriminatory power is lower for predicting short-term breast cancer risk, which is a prerequisite to establish a more effective personalized breast cancer screening paradigm. In this study, we presented a new interactive computer-aided detection (CAD) scheme to generate a new quantitative mammographic imaging marker based on the bilateral mammographic tissue density asymmetry to predict risk of cancer detection in the next subsequent mammography screening. An image database involving 1,397 women was retrospectively assembled and tested. Each woman had two digital mammography screenings namely, the "current" and "prior" screenings with a time interval from 365 to 600 days. All "prior" images were originally interpreted negative. In "current" screenings, these cases were divided into 3 groups, which include 402 positive, 643 negative, and 352 biopsy-proved benign cases, respectively. There is no significant difference of BIRADS based mammographic density ratings between 3 case groups (p < 0.6). When applying the CAD-generated imaging marker or risk model to classify between 402 positive and 643 negative cases using "prior" negative mammograms, the area under a ROC curve is 0.70+/-0.02 and the adjusted odds ratios show an increasing trend from 1.0 to 8.13 to predict the risk of cancer detection in the "current" screening. Study demonstrated that this new imaging marker had potential to yield significantly higher discriminatory power to predict short-term breast cancer risk.

Polymorphisms in the estrogen receptor alpha gene (ESR1), daily cycling estrogen and mammographic density phenotypes.

PubMed

Fjeldheim, F N; Frydenberg, H; Flote, V G; McTiernan, A; Furberg, A-S; Ellison, P T; Barrett, E S; Wilsgaard, T; Jasienska, G; Ursin, G; Wist, E A; Thune, I

2016-10-07

Single nucleotide polymorphisms (SNPs) involved in the estrogen pathway and SNPs in the estrogen receptor alpha gene (ESR1 6q25) have been linked to breast cancer development, and mammographic density is an established breast cancer risk factor. Whether there is an association between daily estradiol levels, SNPs in ESR1 and premenopausal mammographic density phenotypes is unknown. We assessed estradiol in daily saliva samples throughout an entire menstrual cycle in 202 healthy premenopausal women in the Norwegian Energy Balance and Breast Cancer Aspects I study. DNA was genotyped using the Illumina Golden Gate platform. Mammograms were taken between days 7 and 12 of the menstrual cycle, and digitized mammographic density was assessed using a computer-assisted method (Madena). Multivariable regression models were used to study the association between SNPs in ESR1, premenopausal mammographic density phenotypes and daily cycling estradiol. We observed inverse linear associations between the minor alleles of eight measured SNPs (rs3020364, rs2474148, rs12154178, rs2347867, rs6927072, rs2982712, rs3020407, rs9322335) and percent mammographic density (p-values: 0.002-0.026), these associations were strongest in lean women (BMI, ≤23.6 kg/m 2. ). The odds of above-median percent mammographic density (>28.5 %) among women with major homozygous genotypes were 3-6 times higher than those of women with minor homozygous genotypes in seven SNPs. Women with rs3020364 major homozygous genotype had an OR of 6.46 for above-median percent mammographic density (OR: 6.46; 95 % Confidence Interval 1.61, 25.94) when compared to women with the minor homozygous genotype. These associations were not observed in relation to absolute mammographic density. No associations between SNPs and daily cycling estradiol were observed. However, we suggest, based on results of borderline significance (p values: 0.025-0.079) that the level of 17β-estradiol for women with the minor genotype for rs

The relative effect of mammographic screening on breast cancer mortality by socioeconomic status

PubMed Central

Ripping, Theodora M.; van der Waal, Danielle; Verbeek, André L.M.; Broeders, Mireille J.M.

2016-01-01

Abstract Breast cancer incidence and mortality are higher in women with a high socioeconomic status (SES). The potential to prevent death from breast cancer is therefore greater in the high SES group. This does, however, require that the effectiveness of screening in the high SES group is equal to or greater than the effectiveness in the low SES group. The aim of this study is to assess the relative effectiveness of mammographic screening on breast cancer mortality by SES. In Nijmegen, the Netherlands, women are invited to participate in biennial mammographic screening since 1975. Postal code is collected at each round and is used to calculate the SES of each woman based on the SES indicator of the Netherlands Institute for Social Research. The Dutch average was used to classify the SES score of each woman as either high or low. We designed a case-control study to investigate the effect of mammographic screening in women aged 50 to 75, 40 to 75, and 50 to 69 years, and calculated the odds ratios (ORs) and 95% confidence intervals (CIs). Among the women invited to the mammographic screening program in Nijmegen, 10% had a high SES. In women aged 50 to 75 years, the breast cancer death rate was 38% lower in screened women than in unscreened women. The ORs for women with high SES (OR 0.82, 95% CI 0.31–2.19) and low SES did not differ significantly (OR 0.61, 95% CI 0.47–0.78). Mammographic screening reduces breast cancer mortality, but we did not observe a significant difference in the relative effectiveness of screening by SES. If the effectiveness of mammographic screening is indeed not dependent on SES status, the absolute number of breast cancer deaths prevented by mammographic screening will be greater in the high SES than low SES group, because women with a high SES have a greater risk of breast cancer death. PMID:27495038

Performance of a subsidised mammographic screening programme in Malaysia, a middle-income Asian country.

PubMed

Lee, Marianne; Mariapun, Shivaani; Rajaram, Nadia; Teo, Soo-Hwang; Yip, Cheng-Har

2017-01-28

The incidence of breast cancer in Asia is increasing because of urbanization and lifestyle changes. In the developing countries in Asia, women present at late stages, and mortality is high. Mammographic screening is the only evidence-based screening modality that reduces breast cancer mortality. To date, only opportunistic screening is offered in the majority of Asian countries because of the lack of justification and funding. Nevertheless, there have been few reports on the effectiveness of such programmes. In this study, we describe the cancer detection rate and challenges experienced in an opportunistic mammographic screening programme in Malaysia. From October 2011 to June 2015, 1,778 asymptomatic women, aged 40-74 years, underwent subsidised mammographic screening. All patients had a clinical breast examination before mammographic screening, and women with mammographic abnormalities were referred to a surgeon. The cancer detection rate and variables associated with a recommendation for adjunct ultrasonography were determined. The mean age for screening was 50.8 years and seven cancers (0.39%) were detected. The detection rate was 0.64% in women aged 50 years and above, and 0.12% in women below 50 years old. Adjunct ultrasonography was recommended in 30.7% of women, and was significantly associated with age, menopausal status, mammographic density and radiologist's experience. The main reasons cited for recommendation of an adjunct ultrasound was dense breasts and mammographic abnormalities. The cancer detection rate is similar to population-based screening mammography programmes in high-income Asian countries. Unlike population-based screening programmes in Caucasian populations where the adjunct ultrasonography rate is 2-4%, we report that 3 out of 10 women attending screening mammography were recommended for adjunct ultrasonography. This could be because Asian women attending screening are likely premenopausal and hence have denser breasts. Radiologists who

Correlating the ground truth of mammographic histology with the success or failure of imaging.

PubMed

Tot, Tibor

2005-02-01

Detailed and systematic mammographic-pathologic correlation is essential for evaluation of the advantages and disadvantages of mammography as an imaging method as well as for establishing the role of additional methods or alternatives. Two- and three-dimensional large section histopathology represents an ideal tool for this correlation. This kind of interdisciplinary approach ("mammographic histology") is slowly but irrevocably becoming accepted as the new golden standard in diagnosing breast abnormalities. In this review, upon summarizing the theoretical background and our practical experience in routine diagnostic use of these advantageous techniques, we report on the accuracy of the preoperative radiological diagnosis. As compared to the final diagnostic outcome, stellate lesions on the mammogram and microcalcifications of casting type indicate malignancy with very high accuracy while predicting malignancy in cases of powdery and crushed stone type microcalcifications is problematic. The extent of the disease is regularly underestimated on the mammogram by the radiologist. Combining different radiological signs, and comparing repeated static images taken in regular intervals in screening or postoperative follow-up, the mammographer may type and grade the lesions properly in a considerable number of cases. Regular mammographic-pathologic correlation may increase the specificity and sensitivity of mammographic diagnosis. This correlation is essential for establishing the proper pre- and postoperative histological diagnosis, too.

Grid-enabled mammographic auditing and training system

NASA Astrophysics Data System (ADS)

Yap, M. H.; Gale, A. G.

2008-03-01

Effective use of new technologies to support healthcare initiatives is important and current research is moving towards implementing secure grid-enabled healthcare provision. In the UK, a large-scale collaborative research project (GIMI: Generic Infrastructures for Medical Informatics), which is concerned with the development of a secure IT infrastructure to support very widespread medical research across the country, is underway. In the UK, there are some 109 breast screening centers and a growing number of individuals (circa 650) nationally performing approximately 1.5 million screening examinations per year. At the same, there is a serious, and ongoing, national workforce issue in screening which has seen a loss of consultant mammographers and a growth in specially trained technologists and other non-radiologists. Thus there is a need to offer effective and efficient mammographic training so as to maintain high levels of screening skills. Consequently, a grid based system has been proposed which has the benefit of offering very large volumes of training cases that the mammographers can access anytime and anywhere. A database, spread geographically across three university systems, of screening cases is used as a test set of known cases. The GIMI mammography training system first audits these cases to ensure that they are appropriately described and annotated. Subsequently, the cases are utilized for training in a grid-based system which has been developed. This paper briefly reviews the background to the project and then details the ongoing research. In conclusion, we discuss the contributions, limitations, and future plans of such a grid based approach.

Association of Catechol-O-methyltransferase polymorphism Val158Met and mammographic density: A meta-analysis.

PubMed

Kallionpää, Roope A; Uusitalo, Elina; Peltonen, Juha

2017-08-15

The Val158Met polymorphism in catechol-O-methyltransferase (COMT) enzyme reduces the methylation of catechol estrogens, which may affect mammographic density. High mammographic density is a known risk factor of breast cancer. Our aim was to perform meta-analysis of the effect of COMT Val158Met polymorphism on mammographic density. Original studies reporting data on mammographic density, stratified by the presence of COMT Val158Met polymorphism, were identified and combined using genetic models Met/Val vs. Val/Val, Met/Met vs. Val/Val, Val/Met+Met/Met vs. Val/Val (dominant model) and Met/Met vs. Val/Met+Val/Val (recessive model). Subgroup analyses by breast cancer status, menopausal status and use of hormone replacement therapy (HRT) were also performed. Eight studies were included in the meta-analysis. The overall effect in percent mammographic density was -1.41 (CI -2.86 to 0.05; P=0.06) in the recessive model. Exclusion of breast cancer patients increased the effect size to -1.93 (CI -3.49 to -0.37; P=0.02). The results suggested opposite effect of COMT Val158Met for postmenopausal users of HRT versus premenopausal women or postmenopausal non-users of HRT. COMT Val158Met polymorphism may be associated with mammographic density at least in healthy women. Menopausal status and HRT should be taken into account in future studies to avoid masking of the underlying effects. Copyright © 2017 Elsevier B.V. All rights reserved.

Breast Tenderness after Initiation of Conjugated Equine Estrogens and Mammographic Density Change

PubMed Central

Crandall, Carolyn J.; Aragaki, Aaron K.; Cauley, Jane A.; McTiernan, Anne; Manson, JoAnn E.; Anderson, Garnet L.; Wactawski-Wende, Jean; Chlebowski, Rowan T.

2013-01-01

Background We examined the association between new-onset breast tenderness and change in mammographic density after initiation of conjugated equine estrogens (CEE). Methods We analyzed baseline, year 1, and year 2 data from 695 participants of the Women's Health Initiative Estrogen + Progestin (daily CEE 0.625 mg + medroxyprogesterone acetate 2.5 mg [MPA] or placebo) and Estrogen-Alone (CEE 0.625 mg or placebo) trials who participated in the Mammogram Density Ancillary Study. Using multivariable repeated measures models, we analyzed the association between new-onset breast tenderness (i.e. absence of baseline tenderness and presence of tenderness at year 1 follow-up) and change from baseline in percent mammographic density. Results Active therapy increased the odds of new-onset breast tenderness (CEE + MPA vs. placebo risk ratio [RR] 3.01, 95% confidence interval [95% CI] 1.96-4.62; CEE vs. placebo RR 1.70, 95% CI 1.14-2.53). Among women assigned to CEE + MPA, mean increase in mammographic density was greater among participants reporting new-onset of breast tenderness than among participants without new-onset breast tenderness (11.3% vs. 3.9% at year 1, 9.4% vs. 3.2% at year 2, P < 0.001). Among women assigned to CEE alone, increase in mammographic density at year 1 follow-up was not significantly different in women with new-onset breast tenderness compared to women without new-onset breast tenderness (2.4% vs. 0.6% at year 1, 2.2% vs. 1.0% at year 2, P = 0.30). Conclusions The new-onset of breast tenderness after initiation of CEE + MPA, but not CEE alone, is associated with greater increases in mammographic density. PMID:21979747

The quality mammographic image. A review of its components.

PubMed

Rickard, M T

1989-11-01

Seven major factors resulting in a quality or high contrast and high resolution mammographic image have been discussed. The following is a summary of their key features: 1) Dedicated mammographic equipment. --Molybdenum target material --Molybdenum filter, beryllium window --Low kVp usage, in range of 24 to 30 --Routine contact mammography performed at 25 kVp --Slightly lower kVp for coned compression --Slightly higher kVp for microfocus magnification 2) Film density --Phototimer with adjustable position --Calibration of phototimer to optimal optical density of approx. 1.4 over full kVp range 3) Breast Compression --General and focal (coned compression). --Essential to achieve proper contrast, resolution and breast immobility. --Foot controls preferable. 4) Focal Spot. --Size recommendation for contact work 0.3 mm. --Minimum power output of 100 mA at 25 kVp desirable to avoid movement blurring in contact grid work. --Size recommendation for magnification work 0.1 mm. 5) Grid. --Usage recommended as routine in all but magnification work. 6) Film-screen Combination. --High contrast--high speed film. --High resolution screen. --Specifically designed cassette for close film-screen contact and low radiation absorption. --Use of faster screens for magnification techniques. 7) Dedicated processing. --Increased developing time--40 to 45 seconds. --Increased developer temperature--35 to 38 degrees. --Adjusted replenishment rate and dryer temperature. All seven factors contributing to image contrast and resolution affect radiation dosage to the breast. The risk of increased dosage associated with the use of various techniques needs to be balanced against the risks of incorrect diagnosis associated with their non-use.(ABSTRACT TRUNCATED AT 250 WORDS)

Genetic variation in peroxisome proliferator-activated receptor gamma, soy, and mammographic density in Singapore Chinese women.

PubMed

Lee, Eunjung; Hsu, Chris; Van den Berg, David; Ursin, Giske; Koh, Woon-Puay; Yuan, Jian-Min; Stram, Daniel O; Yu, Mimi C; Wu, Anna H

2012-04-01

PPARγ is a transcription factor important for adipogenesis and adipocyte differentiation. Data from animal studies suggest that PPARγ may be involved in breast tumorigenesis, but results from epidemiologic studies on the association between PPARγ variation and breast cancer risk have been mixed. Recent data suggest that soy isoflavones can activate PPARγ. We investigated the interrelations of soy, PPARγ, and mammographic density, a biomarker of breast cancer risk in a cross-sectional study of 2,038 women who were members of the population-based Singapore Chinese Health Study Cohort. We assessed mammographic density using a computer-assisted method. We used linear regression to examine the association between 26 tagging single-nucleotide polymorphisms (SNP) of PPARγ and their interaction with soy intake and mammographic density. To correct for multiple testing, we calculated P values adjusted for multiple correlated tests (P(ACT)). Out of the 26 tested SNPs in the PPARγ, seven SNPs were individually shown to be statistically significantly associated with mammographic density (P(ACT) = 0.008-0.049). A stepwise regression procedure identified that only rs880663 was independently associated with mammographic density which decreased by 1.89% per-minor allele (P(ACT) = 0.008). This association was significantly stronger in high-soy consumers as mammographic density decreased by 3.97% per-minor allele of rs880663 in high-soy consumers (P(ACT) = 0.006; P for interaction with lower soy intake = 0.017). Our data support that PPARγ genetic variation may be important in determining mammographic density, particularly in high-soy consumers. Our findings may help to identify molecular targets and lifestyle intervention for future prevention research. ©2012 AACR.

Relationship between breast sound speed and mammographic percent density

NASA Astrophysics Data System (ADS)

Sak, Mark; Duric, Nebojsa; Boyd, Norman; Littrup, Peter; Myc, Lukasz; Faiz, Muhammad; Li, Cuiping; Bey-Knight, Lisa

2011-03-01

Despite some shortcomings, mammography is currently the standard of care for breast cancer screening and diagnosis. However, breast ultrasound tomography is a rapidly developing imaging modality that has the potential to overcome the drawbacks of mammography. It is known that women with high breast densities have a greater risk of developing breast cancer. Measuring breast density is accomplished through the use of mammographic percent density, defined as the ratio of fibroglandular to total breast area. Using an ultrasound tomography (UST) prototype, we created sound speed images of the patient's breast, motivated by the fact that sound speed in a tissue is proportional to the density of the tissue. The purpose of this work is to compare the acoustic performance of the UST system with the measurement of mammographic percent density. A cohort of 251 patients was studied using both imaging modalities and the results suggest that the volume averaged breast sound speed is significantly related to mammographic percent density. The Spearman correlation coefficient was found to be 0.73 for the 175 film mammograms and 0.69 for the 76 digital mammograms obtained. Since sound speed measurements do not require ionizing radiation or physical compression, they have the potential to form the basis of a safe, more accurate surrogate marker of breast density.

Mammographic interpretation training in the UK: current difficulties and future outlook

NASA Astrophysics Data System (ADS)

Chen, Yan; Gale, Alastair G.; Scott, Hazel

2009-02-01

In the UK, most mammographic interpretation training needs to be undertaken where there is a mammo-alternator or other suitable light box; consequently limiting the time and places where training can take place. However, the gradual introduction of digital mammography is opening up new opportunities of providing such training without the restriction of current viewing devices. Whilst high-resolution monitors in appropriate viewing environments are de rigour for actual reporting; advantages of the digital image over film are in the flexibility of training opportunity afforded, e.g. training whenever, wherever suits the individual. A previous study indicated the possible potential for reporting mammographic cases utilising handheld devices with suitable interaction techniques. In a pilot study, a group of mammographers (n=4) were questioned in semi-structured interviews in order to help establish current UK film-readers' training profile. On the basis of the pilot study data, 109 Breast Screening Units (601 film readers) were approached to complete a structured questionnaire in order to establish the potential role of smaller computer devices in mammographic interpretation training (given the use of digital mammography). Subsequently, a study of radiologists' visual search behaviour in digital screening has begun. This has highlighted different image manipulations than found in structured experiments in this area and poses new challenges for visualising the inspection process. Overall the results indicate that using different display sizes for training is possible but is also a challenging task requiring novel interaction approaches.

Geometry and Gesture-Based Features from Saccadic Eye-Movement as a Biometric in Radiology

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hammond, Tracy; Tourassi, Georgia; Yoon, Hong-Jun

In this study, we present a novel application of sketch gesture recognition on eye-movement for biometric identification and estimating task expertise. The study was performed for the task of mammographic screening with simultaneous viewing of four coordinated breast views as typically done in clinical practice. Eye-tracking data and diagnostic decisions collected for 100 mammographic cases (25 normal, 25 benign, 50 malignant) and 10 readers (three board certified radiologists and seven radiology residents), formed the corpus for this study. Sketch gesture recognition techniques were employed to extract geometric and gesture-based features from saccadic eye-movements. Our results show that saccadic eye-movement, characterizedmore » using sketch-based features, result in more accurate models for predicting individual identity and level of expertise than more traditional eye-tracking features.« less

Effects of processing conditions on mammographic image quality.

PubMed

Braeuning, M P; Cooper, H W; O'Brien, S; Burns, C B; Washburn, D B; Schell, M J; Pisano, E D

1999-08-01

Any given mammographic film will exhibit changes in sensitometric response and image resolution as processing variables are altered. Developer type, immersion time, and temperature have been shown to affect the contrast of the mammographic image and thus lesion visibility. The authors evaluated the effect of altering processing variables, including film type, developer type, and immersion time, on the visibility of masses, fibrils, and speaks in a standard mammographic phantom. Images of a phantom obtained with two screen types (Kodak Min-R and Fuji) and five film types (Kodak Min-R M, Min-R E, Min-R H; Fuji UM-MA HC, and DuPont Microvision-C) were processed with five different developer chemicals (Autex SE, DuPont HSD, Kodak RP, Picker 3-7-90, and White Mountain) at four different immersion times (24, 30, 36, and 46 seconds). Processor chemical activity was monitored with sensitometric strips, and developer temperatures were continuously measured. The film images were reviewed by two board-certified radiologists and two physicists with expertise in mammography quality control and were scored based on the visibility of calcifications, masses, and fibrils. Although the differences in the absolute scores were not large, the Kodak Min-R M and Fuji films exhibited the highest scores, and images developed in White Mountain and Autex chemicals exhibited the highest scores. For any film, several processing chemicals may be used to produce images of similar quality. Extended processing may no longer be necessary.

How does the 'rest-self overlap' mediate the qualitative and automatic features of self-reference?

PubMed

Northoff, Georg

2016-01-01

The target article points out the qualitative and automatic features of self-reference while leaving open the underlying neural mechanisms. Based on empirical evidence about rest-self overlap and rest-stimulus interaction being special for self-related stimuli, I postulate that the resting state shows self-specific organization. The resting state's self-specific organization may be encoded by activity balances between different networks which in turn predispose the qualitative features of subsequent self-related stimulus-induced activity in, for instance, SAN as well as the automatic features of self-reference effects.

Ethnic Differences in Mammographic Densities: An Asian Cross-Sectional Study

PubMed Central

Mariapun, Shivaani; Li, Jingmei; Yip, Cheng Har; Taib, Nur Aishah Mohd; Teo, Soo-Hwang

2015-01-01

Background Mammographic density is a strong risk factor for breast cancer and is highly variable, but, to date, few studies have examined density in Asian women, particularly those in low and middle-income Asian countries where genetic and lifestyle determinants may be significantly different. Methods A total of 1,240 women who attended an opportunistic mammogram screening programme were eligible for analysis. Mammographic density was estimated using a fully-automated thresholding method and differences across ethnic groups were examined using linear regression in 205 randomly selected Chinese women, 138 Malay and 199 Indian women. Results Percent density was significantly higher in Chinese women (28.5%; 95% CI 27.0%, 30.0%) compared to Malay (24.2%; 95% CI 22.5%, 26.0%) and Indian (24.3%; 95% CI 22.8%, 25.7%) women (p<0.001), after adjustment for age, BMI, menopausal status, parity and age at first full term pregnancy. Correspondingly, adjusted nondense area was significantly lower in Chinese (72.2cm2; 95% CI 67.9cm2, 76.5cm2) women compared to Malay (92.1cm2; 95% CI 86.9cm2, 97.2cm2) and Indian (97.7cm2; 95% CI 93.4cm2, 101.9cm2) women (p<0.001), but dense area did not differ across the three ethnic groups. Conclusions Our study shows that higher percent density and lower nondense area reflect the higher incidence of breast cancer in Chinese compared to Malay and Indian women in Malaysia. Known lifestyle determinants of mammographic density do not fully account for the ethnic variations observed in mammographic density in this Asian cohort. PMID:25659139

Ethnic differences in mammographic densities: an Asian cross-sectional study.

PubMed

Mariapun, Shivaani; Li, Jingmei; Yip, Cheng Har; Taib, Nur Aishah Mohd; Teo, Soo-Hwang

2015-01-01

Mammographic density is a strong risk factor for breast cancer and is highly variable, but, to date, few studies have examined density in Asian women, particularly those in low and middle-income Asian countries where genetic and lifestyle determinants may be significantly different. A total of 1,240 women who attended an opportunistic mammogram screening programme were eligible for analysis. Mammographic density was estimated using a fully-automated thresholding method and differences across ethnic groups were examined using linear regression in 205 randomly selected Chinese women, 138 Malay and 199 Indian women. Percent density was significantly higher in Chinese women (28.5%; 95% CI 27.0%, 30.0%) compared to Malay (24.2%; 95% CI 22.5%, 26.0%) and Indian (24.3%; 95% CI 22.8%, 25.7%) women (p<0.001), after adjustment for age, BMI, menopausal status, parity and age at first full term pregnancy. Correspondingly, adjusted nondense area was significantly lower in Chinese (72.2cm2; 95% CI 67.9cm2, 76.5cm2) women compared to Malay (92.1cm2; 95% CI 86.9cm2, 97.2cm2) and Indian (97.7cm2; 95% CI 93.4cm2, 101.9cm2) women (p<0.001), but dense area did not differ across the three ethnic groups. Our study shows that higher percent density and lower nondense area reflect the higher incidence of breast cancer in Chinese compared to Malay and Indian women in Malaysia. Known lifestyle determinants of mammographic density do not fully account for the ethnic variations observed in mammographic density in this Asian cohort.

Mammographic and sonographic findings of steatocystoma multiplex presenting as breast lumps.

PubMed

Wan, John Mun Chin; Wong, Jill Su Lin; Tee, Shang-Ian

2012-12-01

Steatocystoma multiplex (SM) is an uncommon cutaneous disorder characterised by multiple intradermal cysts distributed over the trunk and proximal extremities. This condition affects both genders and is often inherited as an autosomal dominant trait, although sporadic cases have been described. This report describes the mammographic and sonographic features of the cysts, which presented as breast lumps, for evaluation. The cysts appeared as numerous well-circumscribed, radiolucent nodules with thin radiodense rims on mammography. On sonography, the cysts could be hypoechoic, isoechoic or demonstrate mixed echoes containing debris-fluid levels, depending on the amount of clear oily liquid and keratinous material. SM can be diagnosed based on a clinical setting of multiple asymptomatic small intradermal nodules over the trunk and proximal extremities, positive family history and imaging findings.

The relationship between bone mineral density and mammographic density in Korean women: the Healthy Twin study.

PubMed

Sung, Joohon; Song, Yun-Mi; Stone, Jennifer; Lee, Kayoung

2011-09-01

Mammographic density is one of the strong risk factors for breast cancer. A potential mechanism for this association is that cumulative exposure to mammographic density may reflect cumulative exposure to hormones that stimulate cell division in breast stroma and epithelium, which may have corresponding effects on breast cancer development. Bone mineral density (BMD), a marker of lifetime estrogen exposure, has been found to be associated with breast cancer. We examined the association between BMD and mammographic density in a Korean population. Study subjects were 730 Korean women selected from the Healthy Twin study. BMD (g/cm(2)) was measured with dual-energy X-ray absorptiometry. Mammographic density was measured from digital mammograms using a computer-assisted thresholding method. Linear mixed model considering familial correlations and a wide range of covariates was used for analyses. Quantitative genetic analysis was completed using SOLAR. In premenopausal women, positive associations existed between absolute dense area and BMD at ribs, pelvis, and legs, and between percent dense area and BMD at pelvis and legs. However, in postmenopausal women, there was no association between BMD at any site and mammographic density measures. An evaluation of additive genetic cross-trait correlation showed that absolute dense area had a weak-positive additive genetic cross-trait correlation with BMD at ribs and spines after full adjustment of covariates. This finding suggests that the association between mammographic density and breast cancer could, at least in part, be attributable to an estrogen-related hormonal mechanism.

Fractal Analysis of Visual Search Activity for Mass Detection During Mammographic Screening

DOE PAGES

Alamudun, Folami T.; Yoon, Hong-Jun; Hudson, Kathy; ...

2017-02-21

Purpose: The objective of this study was to assess the complexity of human visual search activity during mammographic screening using fractal analysis and to investigate its relationship with case and reader characteristics. Methods: The study was performed for the task of mammographic screening with simultaneous viewing of four coordinated breast views as typically done in clinical practice. Eye-tracking data and diagnostic decisions collected for 100 mammographic cases (25 normal, 25 benign, 50 malignant) and 10 readers (three board certified radiologists and seven radiology residents), formed the corpus data for this study. The fractal dimension of the readers’ visual scanning patternsmore » was computed with the Minkowski–Bouligand box-counting method and used as a measure of gaze complexity. Individual factor and group-based interaction ANOVA analysis was performed to study the association between fractal dimension, case pathology, breast density, and reader experience level. The consistency of the observed trends depending on gaze data representation was also examined. Results: Case pathology, breast density, reader experience level, and individual reader differences are all independent predictors of the visual scanning pattern complexity when screening for breast cancer. No higher order effects were found to be significant. Conclusions: Fractal characterization of visual search behavior during mammographic screening is dependent on case properties and image reader characteristics.« less

Amount of stroma is associated with mammographic density and stromal expression of oestrogen receptor in normal breast tissues.

PubMed

Gabrielson, Marike; Chiesa, Flaminia; Paulsson, Janna; Strell, Carina; Behmer, Catharina; Rönnow, Katarina; Czene, Kamila; Östman, Arne; Hall, Per

2016-07-01

Following female sex and age, mammographic density is considered one of the strongest risk factors for breast cancer. Despite the association between mammographic density and breast cancer risk, little is known about the underlying histology and biological basis of breast density. To better understand the mechanisms behind mammographic density we assessed morphology, proliferation and hormone receptor status in relation to mammographic density in breast tissues from healthy women. Tissues were obtained from 2012-2013 by ultrasound-guided core needle biopsy from 160 women as part of the Karma (Karolinska mammography project for risk prediction for breast cancer) project. Mammograms were collected through routine mammography screening and mammographic density was calculated using STRATUS. The histological composition, epithelial and stromal proliferation status and hormone receptor status were assessed through immunohistochemical staining. Higher mammographic density was significantly associated with a greater proportion of stromal and epithelial tissue and a lower proportion of adipose tissue. Epithelial expression levels of Ki-67, oestrogen receptor (ER) and progesterone receptor (PR) were not associated with mammographic density. Epithelial Ki-67 was associated with a greater proportion of epithelial tissue, and epithelial PR was associated with a greater proportion of stromal and a lower proportion of adipose tissue. Epithelial ER was not associated with any tissues. In contrast, expression of ER in the stroma was significantly associated with a greater proportion of stroma, and negatively associated with the amount of adipose tissue. High mammographic density is associated with higher amount of stroma and epithelium and less amount of fat, but is not associated with a change in epithelial proliferation or receptor status. Increased expressions of both epithelial PR and stromal ER are associated with a greater proportion of stroma, suggesting hormonal involvement

Radiologist Agreement for Mammographic Recall by Case Difficulty and Finding Type.

PubMed

Onega, Tracy; Smith, Megan; Miglioretti, Diana L; Carney, Patricia A; Geller, Berta A; Kerlikowske, Karla; Buist, Diana S M; Rosenberg, Robert D; Smith, Robert A; Sickles, Edward A; Haneuse, Sebastien; Anderson, Melissa L; Yankaskas, Bonnie

2016-11-01

The aim of this study was to assess agreement of mammographic interpretations by community radiologists with consensus interpretations of an expert radiology panel to inform approaches that improve mammographic performance. From 6 mammographic registries, 119 community-based radiologists were recruited to assess 1 of 4 randomly assigned test sets of 109 screening mammograms with comparison studies for no recall or recall, giving the most significant finding type (mass, calcifications, asymmetric density, or architectural distortion) and location. The mean proportion of agreement with an expert radiology panel was calculated by cancer status, finding type, and difficulty level of identifying the finding at the patient, breast, and lesion level. Concordance in finding type between study radiologists and the expert panel was also examined. For each finding type, the proportion of unnecessary recalls, defined as study radiologist recalls that were not expert panel recalls, was determined. Recall agreement was 100% for masses and for examinations with obvious findings in both cancer and noncancer cases. Among cancer cases, recall agreement was lower for lesions that were subtle (50%) or asymmetric (60%). Subtle noncancer findings and benign calcifications showed 33% agreement for recall. Agreement for finding responsible for recall was low, especially for architectural distortions (43%) and asymmetric densities (40%). Most unnecessary recalls (51%) were asymmetric densities. Agreement in mammographic interpretation was low for asymmetric densities and architectural distortions. Training focused on these interpretations could improve the accuracy of mammography and reduce unnecessary recalls. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Qualitative research methods: key features and insights gained from use in infection prevention research.

PubMed

Forman, Jane; Creswell, John W; Damschroder, Laura; Kowalski, Christine P; Krein, Sarah L

2008-12-01

Infection control professionals and hospital epidemiologists are accustomed to using quantitative research. Although quantitative studies are extremely important in the field of infection control and prevention, often they cannot help us explain why certain factors affect the use of infection control practices and identify the underlying mechanisms through which they do so. Qualitative research methods, which use open-ended techniques, such as interviews, to collect data and nonstatistical techniques to analyze it, provide detailed, diverse insights of individuals, useful quotes that bring a realism to applied research, and information about how different health care settings operate. Qualitative research can illuminate the processes underlying statistical correlations, inform the development of interventions, and show how interventions work to produce observed outcomes. This article describes the key features of qualitative research and the advantages that such features add to existing quantitative research approaches in the study of infection control. We address the goal of qualitative research, the nature of the research process, sampling, data collection and analysis, validity, generalizability of findings, and presentation of findings. Health services researchers are increasingly using qualitative methods to address practical problems by uncovering interacting influences in complex health care environments. Qualitative research methods, applied with expertise and rigor, can contribute important insights to infection prevention efforts.

Novel Associations between Common Breast Cancer Susceptibility Variants and Risk-Predicting Mammographic Density Measures

PubMed Central

Stone, Jennifer; Thompson, Deborah J.; dos-Santos-Silva, Isabel; Scott, Christopher; Tamimi, Rulla M.; Lindstrom, Sara; Kraft, Peter; Hazra, Aditi; Li, Jingmei; Eriksson, Louise; Czene, Kamila; Hall, Per; Jensen, Matt; Cunningham, Julie; Olson, Janet E.; Purrington, Kristen; Couch, Fergus J.; Brown, Judith; Leyland, Jean; Warren, Ruth M. L.; Luben, Robert N.; Khaw, Kay-Tee; Smith, Paula; Wareham, Nicholas J.; Jud, Sebastian M.; Heusinger, Katharina; Beckmann, Matthias W.; Douglas, Julie A.; Shah, Kaanan P.; Chan, Heang-Ping; Helvie, Mark A.; Le Marchand, Loic; Kolonel, Laurence N.; Woolcott, Christy; Maskarinec, Gertraud; Haiman, Christopher; Giles, Graham G.; Baglietto, Laura; Krishnan, Kavitha; Southey, Melissa C.; Apicella, Carmel; Andrulis, Irene L.; Knight, Julia A.; Ursin, Giske; Grenaker Alnaes, Grethe I.; Kristensen, Vessela N.; Borresen-Dale, Anne-Lise; Gram, Inger Torhild; Bolla, Manjeet K.; Wang, Qin; Michailidou, Kyriaki; Dennis, Joe; Simard, Jacques; Paroah, Paul; Dunning, Alison M.; Easton, Douglas F.; Fasching, Peter A.; Pankratz, V. Shane; Hopper, John; Vachon, Celine M.

2015-01-01

Mammographic density measures adjusted for age and body mass index (BMI) are heritable predictors of breast cancer risk but few mammographic density-associated genetic variants have been identified. Using data for 10,727 women from two international consortia, we estimated associations between 77 common breast cancer susceptibility variants and absolute dense area, percent dense area and absolute non-dense area adjusted for study, age and BMI using mixed linear modeling. We found strong support for established associations between rs10995190 (in the region of ZNF365), rs2046210 (ESR1) and rs3817198 (LSP1) and adjusted absolute and percent dense areas (all p <10−5). Of 41 recently discovered breast cancer susceptibility variants, associations were found between rs1432679 (EBF1), rs17817449 (MIR1972-2: FTO), rs12710696 (2p24.1), and rs3757318 (ESR1) and adjusted absolute and percent dense areas, respectively. There were associations between rs6001930 (MKL1) and both adjusted absolute dense and non-dense areas, and between rs17356907 (NTN4) and adjusted absolute non-dense area. Trends in all but two associations were consistent with those for breast cancer risk. Results suggested that 18% of breast cancer susceptibility variants were associated with at least one mammographic density measure. Genetic variants at multiple loci were associated with both breast cancer risk and the mammographic density measures. Further understanding of the underlying mechanisms at these loci could help identify etiological pathways implicated in how mammographic density predicts breast cancer risk. PMID:25862352

Mammographic density measured as changes in tissue structure caused by HRT

NASA Astrophysics Data System (ADS)

Raundahl, Jakob; Loog, Marco; Nielsen, Mads

2006-03-01

Numerous studies have investigated the relation between mammographic density and breast cancer risk. These studies indicate that women with high breast density have a four to six fold risk increase. An investigation of whether or not this relation is causal is important for, e.g., hormone replacement therapy (HRT), which has been shown to actually increase the density. No gold standard for automatic assessment of mammographic density exists. Manual methods such as Wolfe patterns and BI-RADS are helpful for communication of diagnostic sensitivity, but they are both time consuming and crude. They may be sufficient in certain cases and for single measurements, but for serial, temporal analysis it is necessary to be able to detect more subtle changes and, in addition, to be more reproducible. In this work an automated method for measuring the effect of HRT w.r.t. changes in biological density in the breast is presented. This measure is a novel measure, which provides structural information orthogonal to intensity-based methods. Hessian eigenvalues at different scales are used as features and a clustering of these is employed to divide a mammogram into four structurally different areas. Subsequently, based on the relative size of the areas, a density score is determined. In the experiments, two sets of mammograms of 50 patients from a double blind, placebo controlled HRT experiment were used. The change in density for the HRT group, measured with the new method, was significantly higher (p = 0.0002) than the change in the control group.

Residential particulate matter and distance to roadways in relation to mammographic density: results from the Nurses' Health Studies.

PubMed

DuPre, Natalie C; Hart, Jaime E; Bertrand, Kimberly A; Kraft, Peter; Laden, Francine; Tamimi, Rulla M

2017-11-23

High mammographic density is a strong, well-established breast cancer risk factor. Three studies conducted in various smaller geographic settings reported inconsistent findings between air pollution and mammographic density. We assessed whether particulate matter (PM) exposures (PM 2.5 , PM 2.5-10 , and PM 10 ) and distance to roadways were associated with mammographic density among women residing across the United States. The Nurses' Health Studies are prospective cohorts for whom a subset has screening mammograms from the 1990s (interquartile range 1990-1999). PM was estimated using spatio-temporal models linked to residential addresses. Among 3258 women (average age at mammogram 52.7 years), we performed multivariable linear regression to assess associations between square-root-transformed mammographic density and PM within 1 and 3 years before the mammogram. For linear regression estimates of PM in relation to untransformed mammographic density outcomes, bootstrapped robust standard errors are used to calculate 95% confidence intervals (CIs). Analyses were stratified by menopausal status and region of residence. Recent PM and distance to roadways were not associated with mammographic density in premenopausal women (PM 2.5 within 3 years before mammogram β = 0.05, 95% CI -0.16, 0.27; PM 2.5-10 β = 0, 95%, CI -0.15, 0.16; PM 10 β = 0.02, 95% CI -0.10, 0.13) and postmenopausal women (PM 2.5 within 3 years before mammogram β = -0.05, 95% CI -0.27, 0.17; PM 2.5-10 β = -0.01, 95% CI -0.16, 0.14; PM 10 β = -0.02, 95% CI -0.13, 0.09). Largely null associations were observed within regions. Suggestive associations were observed among postmenopausal women in the Northeast (n = 745), where a 10-μg/m 3 increase in PM 2.5 within 3 years before the mammogram was associated with 3.4 percentage points higher percent mammographic density (95% CI -0.5, 7.3). These findings do not support that recent PM or roadway exposures influence

Background risk of breast cancer and the association between physical activity and mammographic density.

PubMed

Trinh, Thang; Eriksson, Mikael; Darabi, Hatef; Bonn, Stephanie E; Brand, Judith S; Cuzick, Jack; Czene, Kamila; Sjölander, Arvid; Bälter, Katarina; Hall, Per

2015-04-02

High physical activity has been shown to decrease the risk of breast cancer, potentially by a mechanism that also reduces mammographic density. We tested the hypothesis that the risk of developing breast cancer in the next 10 years according to the Tyrer-Cuzick prediction model influences the association between physical activity and mammographic density. We conducted a population-based cross-sectional study of 38,913 Swedish women aged 40-74 years. Physical activity was assessed using the validated web-questionnaire Active-Q and mammographic density was measured by the fully automated volumetric Volpara method. The 10-year risk of breast cancer was estimated using the Tyrer-Cuzick (TC) prediction model. Linear regression analyses were performed to assess the association between physical activity and volumetric mammographic density and the potential interaction with the TC breast cancer risk. Overall, high physical activity was associated with lower absolute dense volume. As compared to women with the lowest total activity level (<40 metabolic equivalent hours [MET-h] per day), women with the highest total activity level (≥50 MET-h/day) had an estimated 3.4 cm(3) (95% confidence interval, 2.3-4.7) lower absolute dense volume. The inverse association was seen for any type of physical activity among women with <3.0% TC 10-year risk, but only for total and vigorous activities among women with 3.0-4.9% TC risk, and only for vigorous activity among women with ≥5.0% TC risk. The association between total activity and absolute dense volume was modified by the TC breast cancer risk (P interaction = 0.05). As anticipated, high physical activity was also associated with lower non-dense volume. No consistent association was found between physical activity and percent dense volume. Our results suggest that physical activity may decrease breast cancer risk through reducing mammographic density, and that the physical activity needed to reduce mammographic density may depend

Mammographic findings of breast cancer screening in patients with positive family history in South-East Nigeria.

PubMed

Ebubedike, U R; Umeh, E O; C Anyanwu, S N

2018-06-01

A positive family history of breast cancer is an important risk factor associated with the development of breast cancer in women. Early detection required regular screening in these women. To determine the mammographic findings of breast cancer screening in patients with a positive family history in Iyienu, Southeast Nigeria. Forty-three consenting females with a positive family history of breast cancer who underwent mammographic screening at Radiology Department, Iyienu Mission Hospital, Anambra State, were enrolled in the study. Mammographic findings were compared with those of females with a negative family history. The mean age was 49.6 years with a range of 35-69 years. The mammographic findings were asymmetric density, nipple retraction, tissue retraction, skin thickening, lymphadenopathy, and calcification within a mass with varying frequency for the right and left breasts. A significant statistical difference was found in lymphadenopathy and calcification for the right and left breasts, respectively, when compared with those without positive family history.

Economic savings and costs of periodic mammographic screening in the workplace.

PubMed

Griffiths, R I; McGrath, M M; Vogel, V G

1996-03-01

This article discusses the costs and benefits of mammographic screening in the workplace. The cost of mammography itself and of diagnostic work-up are two of the largest costs involved. Therefore, the most efficient approach to providing mammography depends on the number of employees receiving mammography; and the diagnostic accuracy of mammography and underlying incidence of breast cancer in the screened population strongly influence the number of suspicious mammograms that are not associated with breast cancer. The health benefit of mammographic screening is due to reduced mortality and morbidity through early detection and more effective treatment, which may also result in economic savings if early-stage cancer is less expensive to treat. However, the total lifetime cost of treating early-stage cancer may be greater than treating late-stage cancer because of improved survival of early-stage patients. Thus, although periodic mammographic screening is not likely to result in overall economic savings, in many populations of working-age women, especially those with identifiable risk factors, screening is cost-effective because the expenditure required to save a year of life through early detection of breast cancer is low compared to other types of health services for which employers commonly pay.

Morphological filtering and multiresolution fusion for mammographic microcalcification detection

NASA Astrophysics Data System (ADS)

Chen, Lulin; Chen, Chang W.; Parker, Kevin J.

1997-04-01

Mammographic images are often of relatively low contrast and poor sharpness with non-stationary background or clutter and are usually corrupted by noise. In this paper, we propose a new method for microcalcification detection using gray scale morphological filtering followed by multiresolution fusion and present a unified general filtering form called the local operating transformation for whitening filtering and adaptive thresholding. The gray scale morphological filters are used to remove all large areas that are considered as non-stationary background or clutter variations, i.e., to prewhiten images. The multiresolution fusion decision is based on matched filter theory. In addition to the normal matched filter, the Laplacian matched filter which is directly related through the wavelet transforms to multiresolution analysis is exploited for microcalcification feature detection. At the multiresolution fusion stage, the region growing techniques are used in each resolution level. The parent-child relations between resolution levels are adopted to make final detection decision. FROC is computed from test on the Nijmegen database.

The association between mammographic breast density and bone mineral density in the study of women's health across the nation.

PubMed

Crandall, Carolyn J; Zheng, Yan; Karlamangla, Arun; Sternfeld, Barbara; Habel, Laurel A; Oestreicher, Nina; Johnston, Janet; Cauley, Jane A; Greendale, Gail A

2007-08-01

Bone mineral density and mammographic breast density are each associated with markers of lifetime estrogen exposure. The association between mammographic breast density and bone mineral density in early perimenopausal women is unknown. We analyzed data from a cohort (n = 501) of premenopausal (no change in menstrual regularity) and early perimenopausal (decreased menstrual regularity in past 3 months) participants of African-American, Caucasian, Chinese, and Japanese ethnicity in the Study of Women's Health Across the Nation. Using multivariable linear regression, we examined the cross-sectional association between percent mammographic density and bone mineral density (BMD). Percent mammographic density was statistically significantly inversely associated with hip BMD and lumbar spine BMD after adjustment (body mass index, ethnicity, age, study site, parity, alcohol intake, cigarette smoking, physical activity, age at first childbirth) in early perimenopausal, but not premenopausal, women. In early perimenopausal women, every 0.1g/cm(2) greater hip BMD predicted a 2% lower percent mammographic density (95% confidence interval -37.0 to -0.6%, p = 0.04). Mammographic breast density is inversely associated with BMD in the perimenopausal participants of this community-based cohort. The biological underpinnings of these findings may reflect differential responsiveness of breast and bone mineral density to the steroid milieu.

Correlating mammographic and pathologic findings in clinical decision support using natural language processing and data mining methods.

PubMed

Patel, Tejal A; Puppala, Mamta; Ogunti, Richard O; Ensor, Joe E; He, Tiancheng; Shewale, Jitesh B; Ankerst, Donna P; Kaklamani, Virginia G; Rodriguez, Angel A; Wong, Stephen T C; Chang, Jenny C

2017-01-01

A key challenge to mining electronic health records for mammography research is the preponderance of unstructured narrative text, which strikingly limits usable output. The imaging characteristics of breast cancer subtypes have been described previously, but without standardization of parameters for data mining. The authors searched the enterprise-wide data warehouse at the Houston Methodist Hospital, the Methodist Environment for Translational Enhancement and Outcomes Research (METEOR), for patients with Breast Imaging Reporting and Data System (BI-RADS) category 5 mammogram readings performed between January 2006 and May 2015 and an available pathology report. The authors developed natural language processing (NLP) software algorithms to automatically extract mammographic and pathologic findings from free text mammogram and pathology reports. The correlation between mammographic imaging features and breast cancer subtype was analyzed using one-way analysis of variance and the Fisher exact test. The NLP algorithm was able to obtain key characteristics for 543 patients who met the inclusion criteria. Patients with estrogen receptor-positive tumors were more likely to have spiculated margins (P = .0008), and those with tumors that overexpressed human epidermal growth factor receptor 2 (HER2) were more likely to have heterogeneous and pleomorphic calcifications (P = .0078 and P = .0002, respectively). Mammographic imaging characteristics, obtained from an automated text search and the extraction of mammogram reports using NLP techniques, correlated with pathologic breast cancer subtype. The results of the current study validate previously reported trends assessed by manual data collection. Furthermore, NLP provides an automated means with which to scale up data extraction and analysis for clinical decision support. Cancer 2017;114-121. © 2016 American Cancer Society. © 2016 American Cancer Society.

21 CFR 892.1710 - Mammographic x-ray system.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Mammographic x-ray system. 892.1710 Section 892.1710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED.... This generic type of device may include signal analysis and display equipment, patient and equipment...

21 CFR 892.1710 - Mammographic x-ray system.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Mammographic x-ray system. 892.1710 Section 892.1710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED.... This generic type of device may include signal analysis and display equipment, patient and equipment...

21 CFR 892.1710 - Mammographic x-ray system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Mammographic x-ray system. 892.1710 Section 892.1710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED.... This generic type of device may include signal analysis and display equipment, patient and equipment...

21 CFR 892.1710 - Mammographic x-ray system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Mammographic x-ray system. 892.1710 Section 892.1710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED.... This generic type of device may include signal analysis and display equipment, patient and equipment...

21 CFR 892.1710 - Mammographic x-ray system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Mammographic x-ray system. 892.1710 Section 892.1710 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED.... This generic type of device may include signal analysis and display equipment, patient and equipment...

The implementation of an AR (augmented reality) approach to support mammographic interpretation training: an initial feasibility study

NASA Astrophysics Data System (ADS)

Tang, Qiang; Chen, Yan; Gale, Alastair G.

2017-03-01

Appropriate feedback plays an important role in optimising mammographic interpretation training whilst also ensuring good interpretation performance. The traditional keyboard, mouse and workstation technical approach has a critical limitation in providing supplementary image-related information and providing complex feedback in real time. Augmented Reality (AR) provides a possible superior approach in this situation, as feedback can be provided directly overlaying the displayed mammographic images so making a generic approach which can also be vendor neutral. In this study, radiological feedback was dynamically remapped virtually into the real world, using perspective transformation, in order to provide a richer user experience in mammographic interpretation training. This is an initial attempt of an AR approach to dynamically superimpose pre-defined feedback information of a DICOM image on top of a radiologist's view, whilst the radiologist is examining images on a clinical workstation. The study demonstrates the feasibility of the approach, although there are limitations on interactive operations which are due to the hardware used. The results of this fully functional approach provide appropriate feedback/image correspondence in a simulated mammographic interpretation environment. Thus, it is argued that employing AR is a feasible way to provide rich feedback in the delivery of mammographic interpretation training.

Differentiation of Uterine Leiomyosarcoma from Atypical Leiomyoma: Diagnostic Accuracy of Qualitative MR Imaging Features and Feasibility of Texture Analysis.

PubMed

Lakhman, Yulia; Veeraraghavan, Harini; Chaim, Joshua; Feier, Diana; Goldman, Debra A; Moskowitz, Chaya S; Nougaret, Stephanie; Sosa, Ramon E; Vargas, Hebert Alberto; Soslow, Robert A; Abu-Rustum, Nadeem R; Hricak, Hedvig; Sala, Evis

2017-07-01

To investigate whether qualitative magnetic resonance (MR) features can distinguish leiomyosarcoma (LMS) from atypical leiomyoma (ALM) and assess the feasibility of texture analysis (TA). This retrospective study included 41 women (ALM = 22, LMS = 19) imaged with MRI prior to surgery. Two readers (R1, R2) evaluated each lesion for qualitative MR features. Associations between MR features and LMS were evaluated with Fisher's exact test. Accuracy measures were calculated for the four most significant features. TA was performed for 24 patients (ALM = 14, LMS = 10) with uniform imaging following lesion segmentation on axial T2-weighted images. Texture features were pre-selected using Wilcoxon signed-rank test with Bonferroni correction and analyzed with unsupervised clustering to separate LMS from ALM. Four qualitative MR features most strongly associated with LMS were nodular borders, haemorrhage, "T2 dark" area(s), and central unenhanced area(s) (p ≤ 0.0001 each feature/reader). The highest sensitivity [1.00 (95%CI:0.82-1.00)/0.95 (95%CI: 0.74-1.00)] and specificity [0.95 (95%CI:0.77-1.00)/1.00 (95%CI:0.85-1.00)] were achieved for R1/R2, respectively, when a lesion had ≥3 of these four features. Sixteen texture features differed significantly between LMS and ALM (p-values: <0.001-0.036). Unsupervised clustering achieved accuracy of 0.75 (sensitivity: 0.70; specificity: 0.79). Combination of ≥3 qualitative MR features accurately distinguished LMS from ALM. TA was feasible. • Four qualitative MR features demonstrated the strongest statistical association with LMS. • Combination of ≥3 these features could accurately differentiate LMS from ALM. • Texture analysis was a feasible semi-automated approach for lesion categorization.

Significance of MPEG-7 textural features for improved mass detection in mammography.

PubMed

Eltonsy, Nevine H; Tourassi, Georgia D; Fadeev, Aleksey; Elmaghraby, Adel S

2006-01-01

The purpose of the study is to investigate the significance of MPEG-7 textural features for improving the detection of masses in screening mammograms. The detection scheme was originally based on morphological directional neighborhood features extracted from mammographic regions of interest (ROIs). Receiver Operating Characteristics (ROC) was performed to evaluate the performance of each set of features independently and merged into a back-propagation artificial neural network (BPANN) using the leave-one-out sampling scheme (LOOSS). The study was based on a database of 668 mammographic ROIs (340 depicting cancer regions and 328 depicting normal parenchyma). Overall, the ROC area index of the BPANN using the directional morphological features was Az=0.85+/-0.01. The MPEG-7 edge histogram descriptor-based BPNN showed an ROC area index of Az=0.71+/-0.01 while homogeneous textural descriptors using 30 and 120 channels helped the BPNN achieve similar ROC area indexes of Az=0.882+/-0.02 and Az=0.877+/-0.01 respectively. After merging the MPEG-7 homogeneous textural features with the directional neighborhood features the performance of the BPANN increased providing an ROC area index of Az=0.91+/-0.01. MPEG-7 homogeneous textural descriptor significantly improved the morphology-based detection scheme.

Mammographic phenotypes of breast cancer risk driven by breast anatomy

NASA Astrophysics Data System (ADS)

Gastounioti, Aimilia; Oustimov, Andrew; Hsieh, Meng-Kang; Pantalone, Lauren; Conant, Emily F.; Kontos, Despina

2017-03-01

Image-derived features of breast parenchymal texture patterns have emerged as promising risk factors for breast cancer, paving the way towards personalized recommendations regarding women's cancer risk evaluation and screening. The main steps to extract texture features of the breast parenchyma are the selection of regions of interest (ROIs) where texture analysis is performed, the texture feature calculation and the texture feature summarization in case of multiple ROIs. In this study, we incorporate breast anatomy in these three key steps by (a) introducing breast anatomical sampling for the definition of ROIs, (b) texture feature calculation aligned with the structure of the breast and (c) weighted texture feature summarization considering the spatial position and the underlying tissue composition of each ROI. We systematically optimize this novel framework for parenchymal tissue characterization in a case-control study with digital mammograms from 424 women. We also compare the proposed approach with a conventional methodology, not considering breast anatomy, recently shown to enhance the case-control discriminatory capacity of parenchymal texture analysis. The case-control classification performance is assessed using elastic-net regression with 5-fold cross validation, where the evaluation measure is the area under the curve (AUC) of the receiver operating characteristic. Upon optimization, the proposed breast-anatomy-driven approach demonstrated a promising case-control classification performance (AUC=0.87). In the same dataset, the performance of conventional texture characterization was found to be significantly lower (AUC=0.80, DeLong's test p-value<0.05). Our results suggest that breast anatomy may further leverage the associations of parenchymal texture features with breast cancer, and may therefore be a valuable addition in pipelines aiming to elucidate quantitative mammographic phenotypes of breast cancer risk.

Training system for digital mammographic diagnoses of breast cancer

NASA Astrophysics Data System (ADS)

Thomaz, R. L.; Nirschl Crozara, M. G.; Patrocinio, A. C.

2013-03-01

As the technology evolves, the analog mammography systems are being replaced by digital systems. The digital system uses video monitors as the display of mammographic images instead of the previously used screen-film and negatoscope for analog images. The change in the way of visualizing mammographic images may require a different approach for training the health care professionals in diagnosing the breast cancer with digital mammography. Thus, this paper presents a computational approach to train the health care professionals providing a smooth transition between analog and digital technology also training to use the advantages of digital image processing tools to diagnose the breast cancer. This computational approach consists of a software where is possible to open, process and diagnose a full mammogram case from a database, which has the digital images of each of the mammographic views. The software communicates with a gold standard digital mammogram cases database. This database contains the digital images in Tagged Image File Format (TIFF) and the respective diagnoses according to BI-RADSTM, these files are read by software and shown to the user as needed. There are also some digital image processing tools that can be used to provide better visualization of each single image. The software was built based on a minimalist and a user-friendly interface concept that might help in the smooth transition. It also has an interface for inputting diagnoses from the professional being trained, providing a result feedback. This system has been already completed, but hasn't been applied to any professional training yet.

Common variants in ZNF365 are associated with both mammographic density and breast cancer risk.

PubMed

Lindström, Sara; Vachon, Celine M; Li, Jingmei; Varghese, Jajini; Thompson, Deborah; Warren, Ruth; Brown, Judith; Leyland, Jean; Audley, Tina; Wareham, Nicholas J; Loos, Ruth J F; Paterson, Andrew D; Rommens, Johanna; Waggott, Darryl; Martin, Lisa J; Scott, Christopher G; Pankratz, V Shane; Hankinson, Susan E; Hazra, Aditi; Hunter, David J; Hopper, John L; Southey, Melissa C; Chanock, Stephen J; Silva, Isabel dos Santos; Liu, JianJun; Eriksson, Louise; Couch, Fergus J; Stone, Jennifer; Apicella, Carmel; Czene, Kamila; Kraft, Peter; Hall, Per; Easton, Douglas F; Boyd, Norman F; Tamimi, Rulla M

2011-03-01

High-percent mammographic density adjusted for age and body mass index is one of the strongest risk factors for breast cancer. We conducted a meta analysis of five genome-wide association studies of percent mammographic density and report an association with rs10995190 in ZNF365 (combined P = 9.6 × 10(-10)). Common variants in ZNF365 have also recently been associated with susceptibility to breast cancer.

Mammographic compression in Asian women.

PubMed

Lau, Susie; Abdul Aziz, Yang Faridah; Ng, Kwan Hoong

2017-01-01

To investigate: (1) the variability of mammographic compression parameters amongst Asian women; and (2) the effects of reducing compression force on image quality and mean glandular dose (MGD) in Asian women based on phantom study. We retrospectively collected 15818 raw digital mammograms from 3772 Asian women aged 35-80 years who underwent screening or diagnostic mammography between Jan 2012 and Dec 2014 at our center. The mammograms were processed using a volumetric breast density (VBD) measurement software (Volpara) to assess compression force, compression pressure, compressed breast thickness (CBT), breast volume, VBD and MGD against breast contact area. The effects of reducing compression force on image quality and MGD were also evaluated based on measurement obtained from 105 Asian women, as well as using the RMI156 Mammographic Accreditation Phantom and polymethyl methacrylate (PMMA) slabs. Compression force, compression pressure, CBT, breast volume, VBD and MGD correlated significantly with breast contact area (p<0.0001). Compression parameters including compression force, compression pressure, CBT and breast contact area were widely variable between [relative standard deviation (RSD)≥21.0%] and within (p<0.0001) Asian women. The median compression force should be about 8.1 daN compared to the current 12.0 daN. Decreasing compression force from 12.0 daN to 9.0 daN increased CBT by 3.3±1.4 mm, MGD by 6.2-11.0%, and caused no significant effects on image quality (p>0.05). Force-standardized protocol led to widely variable compression parameters in Asian women. Based on phantom study, it is feasible to reduce compression force up to 32.5% with minimal effects on image quality and MGD.

Mammographic Breast Density in a Cohort of Medically Underserved Women

DTIC Science & Technology

2014-10-01

chronic diseases, adult weight history, diet , and health literacy. A trained radiologic technician completed full- field digital screening mammograms on... Mediterranean population. Int J Cancer 118:1782-1789 12. El-Bastawissi AY, White E, Mandelson MT, Taplin S (2001) Variation in mammographic breast

Multi-image CAD employing features derived from ipsilateral mammographic views

NASA Astrophysics Data System (ADS)

Good, Walter F.; Zheng, Bin; Chang, Yuan-Hsiang; Wang, Xiao Hui; Maitz, Glenn S.; Gur, David

1999-05-01

On mammograms, certain kinds of features related to masses (e.g., location, texture, degree of spiculation, and integrated density difference) tend to be relatively invariant, or at last predictable, with respect to breast compression. Thus, ipsilateral pairs of mammograms may contain information not available from analyzing single views separately. To demonstrate the feasibility of incorporating multi-view features into CAD algorithm, `single-image' CAD was applied to each individual image in a set of 60 ipsilateral studies, after which all possible pairs of suspicious regions, consisting of one from each view, were formed. For these 402 pairs we defined and evaluated `multi-view' features such as: (1) relative position of centers of regions; (2) ratio of lengths of region projections parallel to nipple axis lines; (3) ratio of integrated contrast difference; (4) ratio of the sizes of the suspicious regions; and (5) measure of relative complexity of region boundaries. Each pair was identified as either a `true positive/true positive' (T) pair (i.e., two regions which are projections of the same actual mass), or as a falsely associated pair (F). Distributions for each feature were calculated. A Bayesian network was trained and tested to classify pairs of suspicious regions based exclusively on the multi-view features described above. Distributions for all features were significantly difference for T versus F pairs as indicated by likelihood ratios. Performance of the Bayesian network, which was measured by ROC analysis, indicates a significant ability to distinguish between T pairs and F pairs (Az equals 0.82 +/- 0.03), using information that is attributed to the multi-view content. This study is the first demonstration that there is a significant amount of spatial information that can be derived from ipsilateral pairs of mammograms.

Computerized quantitative evaluation of mammographic accreditation phantom images

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Yongbum; Tsai, Du-Yih; Shinohara, Norimitsu

2010-12-15

Purpose: The objective was to develop and investigate an automated scoring scheme of the American College of Radiology (ACR) mammographic accreditation phantom (RMI 156, Middleton, WI) images. Methods: The developed method consisted of background subtraction, determination of region of interest, classification of fiber and mass objects by Mahalanobis distance, detection of specks by template matching, and rule-based scoring. Fifty-one phantom images were collected from 51 facilities for this study (one facility provided one image). A medical physicist and two radiologic technologists also scored the images. The human and computerized scores were compared. Results: In terms of meeting the ACR's criteria,more » the accuracies of the developed method for computerized evaluation of fiber, mass, and speck were 90%, 80%, and 98%, respectively. Contingency table analysis revealed significant association between observer and computer scores for microcalcifications (p<5%) but not for masses and fibers. Conclusions: The developed method may achieve a stable assessment of visibility for test objects in mammographic accreditation phantom image in whether the phantom image meets the ACR's criteria in the evaluation test, although there is room left for improvement in the approach for fiber and mass objects.« less

Computer-aided Classification of Mammographic Masses Using Visually Sensitive Image Features

PubMed Central

Wang, Yunzhi; Aghaei, Faranak; Zarafshani, Ali; Qiu, Yuchen; Qian, Wei; Zheng, Bin

2017-01-01

Purpose To develop a new computer-aided diagnosis (CAD) scheme that computes visually sensitive image features routinely used by radiologists to develop a machine learning classifier and distinguish between the malignant and benign breast masses detected from digital mammograms. Methods An image dataset including 301 breast masses was retrospectively selected. From each segmented mass region, we computed image features that mimic five categories of visually sensitive features routinely used by radiologists in reading mammograms. We then selected five optimal features in the five feature categories and applied logistic regression models for classification. A new CAD interface was also designed to show lesion segmentation, computed feature values and classification score. Results Areas under ROC curves (AUC) were 0.786±0.026 and 0.758±0.027 when to classify mass regions depicting on two view images, respectively. By fusing classification scores computed from two regions, AUC increased to 0.806±0.025. Conclusion This study demonstrated a new approach to develop CAD scheme based on 5 visually sensitive image features. Combining with a “visual aid” interface, CAD results may be much more easily explainable to the observers and increase their confidence to consider CAD generated classification results than using other conventional CAD approaches, which involve many complicated and visually insensitive texture features. PMID:27911353

Common variants in ZNF365 are associated with both mammographic density and breast cancer risk

PubMed Central

Lindström, Sara; Vachon, Celine M.; Li, Jingmei; Varghese, Jajini; Thompson, Deborah; Warren, Ruth; Brown, Judith; Leyland, Jean; Audley, Tina; Wareham, Nicholas J.; Loos, Ruth J.F.; Paterson, Andrew D.; Waggott, Darryl; Martin, Lisa J.; Scott, Christopher G.; Pankratz, V. Shane; Hankinson, Susan E.; Hazra, Aditi; Hunter, David J.; Hopper, John L.; Southey, Melissa C.; Chanock, Stephen J.; Silva, Isabel dos Santos; Liu, JianJun; Eriksson, Louise; Couch, Fergus J.; Stone, Jennifer; Apicella, Carmel; Czene, Kamila; Kraft, Peter; Hall, Per; Easton, Douglas F.; Boyd, Norman F.; Tamimi, Rulla M.

2011-01-01

High percent mammographic density adjusted for age and body mass index (BMI) is one of the strongest risk factors for breast cancer. We conducted a meta-analysis of five genome-wide association studies of percent mammographic density and report an association with rs10995190 in ZNF365 (combined P=9×6·10−10). This finding might partly explain the underlying biology of the recently discovered association between common variants in ZNF365 and breast cancer risk. PMID:21278746

The Mammographic Head Demonstrator Developed in the Framework of the “IMI” Project:. First Imaging Tests Results

NASA Astrophysics Data System (ADS)

Bisogni, Maria Giuseppina

2006-04-01

In this paper we report on the performances and the first imaging test results of a digital mammographic demonstrator based on GaAs pixel detectors. The heart of this prototype is the X-ray detection unit, which is a GaAs pixel sensor read-out by the PCC/MEDIPIXI circuit. Since the active area of the sensor is 1 cm2, 18 detectors have been organized in two staggered rows of nine chips each. To cover the typical mammographic format (18 × 24 cm2) a linear scanning is performed by means of a stepper motor. The system is integrated in mammographic equipment comprehending the X-ray tube, the bias and data acquisition systems and the PC-based control system. The prototype has been developed in the framework of the integrated Mammographic Imaging (IMI) project, an industrial research activity aiming to develop innovative instrumentation for morphologic and functional imaging. The project has been supported by the Italian Ministry of Education, University and Research (MIUR) and by five Italian High Tech companies in collaboration with the universities of Ferrara, Roma “La Sapienza”, Pisa and the INFN.

Do mammographic technologists affect radiologists’ diagnostic mammography interpretative performance?

PubMed Central

Henderson, Louise M.; Benefield, Thad; Bowling, J. Michael; Durham, Danielle; Marsh, Mary W.; Schroeder, Bruce F.; Yankaskas, Bonnie C.

2015-01-01

Objective The purpose of this study was to determine whether the technologist has an effect on the radiologists’ interpretative performance of diagnostic mammography. Materials and Methods Using data from a community based mammography registry from 1994 to 2009, we identified 162,755 diagnostic mammograms interpreted by 286 radiologists and performed by 303 mammographic technologists. We calculated sensitivity, false positive rate, and positive predictive value of biopsy (PPV2) for examinations performed (images taken) by each mammographic technologist, separately for film and digital modalities. We assessed the variability of these performance measures among mammographic technologists, using mixed effects logistic regression and taking into account the clustering of examinations within women, radiologists, and radiology practice. Results Among the 291 technologists performing film examinations, mean sensitivity of the examinations they performed was 83.0% (95% Confidence Interval (CI)=80.8–85.2%), mean false positive rate was 8.5 per 1000 examinations (95%CI: 8.0–9.0%), and mean PPV2 was 27.1% (95%CI: 24.8–29.4). For the 45 technologists performing digital examinations, mean sensitivity of the examinations they performed was 79.6% (95%CI: 73.1–86.2%), mean false positive rate was 8.8 (95%CI: 7.5–10.0%), and mean PPV2 was 23.6% (95%CI: 18.8–28.4%). We found significant variation by technologist in the sensitivity, false positive rate, and PPV2 for film but not digital mammography (p<0.0001 for all 3 film performance measures). Conclusions Our results suggest that the technologist has an influence on radiologists’ performance of diagnostic film mammography but not digital. Future work should examine why this difference by modality exists and determine if similar patterns are observed for screening mammography. PMID:25794085

Red clover-derived isoflavones and mammographic breast density: a double-blind, randomized, placebo-controlled trial [ISRCTN42940165

PubMed Central

Atkinson, Charlotte; Warren, Ruth ML; Sala, Evis; Dowsett, Mitch; Dunning, Alison M; Healey, Catherine S; Runswick, Shirley; Day, Nicholas E; Bingham, Sheila A

2004-01-01

Introduction Isoflavones are hypothesized to protect against breast cancer, but it is not clear whether they act as oestrogens or anti-oestrogens in breast tissue. Our aim was to determine the effects of taking a red clover-derived isoflavone supplement daily for 1 year on mammographic breast density. Effects on oestradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), lymphocyte tyrosine kinase activity and menopausal symptoms were also assessed. Methods A total of 205 women (age range 49–65 years) with Wolfe P2 or DY mammographic breast patterns were randomly assigned to receive either a red clover-derived isoflavone tablet (26 mg biochanin A, 16 mg formononetin, 1 mg genistein and 0.5 mg daidzein) or placebo. Change in mammographic breast density, serum oestradiol, FSH, LH, menopausal symptoms and lymphocyte tyrosine kinase activity from baseline to 12 months were assessed. Results A total of 177 women completed the trial. Mammographic breast density decreased in both groups but the difference between the treatment and placebo was not statistically significant. There was a significant interaction between treatment group and oestrogen receptor (ESR1) PvuII polymorphism for the change in estimated percentage breast density (mean ± standard deviation): TT isoflavone 1.4 ± 12.3% and TT placebo -9.6 ± 14.2%; CT isoflavone -5.2 ± 12.0% and CT placebo -2.8 ± 10.3%; and CC isoflavone -3.4 ± 9.7% and CC placebo -1.1 ± 9.5%. There were no statistically significant treatment effects on oestradiol, FSH, or LH (assessed only in postmenopausal women), or on lymphocyte tyrosine kinase activity. Baseline levels of menopausal symptoms were low, and there were no statistically significant treatment effects on frequency of hot flushes or other menopausal symptoms. Conclusion In contrast to studies showing that conventional hormone replacement therapies increase mammographic breast density, the isoflavone supplement did not increase mammographic breast

Automated detection of qualitative spatio-temporal features in electrocardiac activation maps.

PubMed

Ironi, Liliana; Tentoni, Stefania

2007-02-01

This paper describes a piece of work aiming at the realization of a tool for the automated interpretation of electrocardiac maps. Such maps can capture a number of electrical conduction pathologies, such as arrhytmia, that can be missed by the analysis of traditional electrocardiograms. But, their introduction into the clinical practice is still far away as their interpretation requires skills that belongs to very few experts. Then, an automated interpretation tool would bridge the gap between the established research outcome and clinical practice with a consequent great impact on health care. Qualitative spatial reasoning can play a crucial role in the identification of spatio-temporal patterns and salient features that characterize the heart electrical activity. We adopted the spatial aggregation (SA) conceptual framework and an interplay of numerical and qualitative information to extract features from epicardial maps, and to make them available for reasoning tasks. Our focus is on epicardial activation isochrone maps as they are a synthetic representation of spatio-temporal aspects of the propagation of the electrical excitation. We provide a computational SA-based methodology to extract, from 3D epicardial data gathered over time, (1) the excitation wavefront structure, and (2) the salient features that characterize wavefront propagation and visually correspond to specific geometric objects. The proposed methodology provides a robust and efficient way to identify salient pieces of information in activation time maps. The hierarchical structure of the abstracted geometric objects, crucial in capturing the prominent information, facilitates the definition of general rules necessary to infer the correlation between pathophysiological patterns and wavefront structure and propagation.

Mammographic density and breast cancer risk: current understanding and future prospects

PubMed Central

2011-01-01

Variations in percent mammographic density (PMD) reflect variations in the amounts of collagen and number of epithelial and non-epithelial cells in the breast. Extensive PMD is associated with a markedly increased risk of invasive breast cancer. The PMD phenotype is important in the context of breast cancer prevention because extensive PMD is common in the population, is strongly associated with risk of the disease, and, unlike most breast cancer risk factors, can be changed. Work now in progress makes it likely that measurement of PMD will be improved in the near future and that understanding of the genetics and biological basis of the association of PMD with breast cancer risk will also improve. Future prospects for the application of PMD include mammographic screening, risk prediction in individuals, breast cancer prevention research, and clinical decision making. PMID:22114898

Common Breast Cancer Susceptibility Variants in LSP1 and RAD51L1 Are Associated with Mammographic Density Measures that Predict Breast Cancer Risk

PubMed Central

Vachon, Celine M.; Scott, Christopher G.; Fasching, Peter A.; Hall, Per; Tamimi, Rulla M.; Li, Jingmei; Stone, Jennifer; Apicella, Carmel; Odefrey, Fabrice; Gierach, Gretchen L.; Jud, Sebastian M.; Heusinger, Katharina; Beckmann, Matthias W.; Pollan, Marina; Fernández-Navarro, Pablo; González-Neira, Anna; Benítez, Javier; van Gils, Carla H.; Lokate, Mariëtte; Onland-Moret, N. Charlotte; Peeters, Petra H.M.; Brown, Judith; Leyland, Jean; Varghese, Jajini S.; Easton, Douglas F.; Thompson, Deborah J.; Luben, Robert N.; Warren, Ruth ML; Wareham, Nicholas J.; Loos, Ruth JF; Khaw, Kay-Tee; Ursin, Giske; Lee, Eunjung; Gayther, Simon A.; Ramus, Susan J.; Eeles, Rosalind A.; Leach, Martin O.; Kwan-Lim, Gek; Couch, Fergus J.; Giles, Graham G.; Baglietto, Laura; Krishnan, Kavitha; Southey, Melissa C.; Le Marchand, Loic; Kolonel, Laurence N.; Woolcott, Christy; Maskarinec, Gertraud; Haiman, Christopher A; Walker, Kate; Johnson, Nichola; McCormack, Valerie A.; Biong, Margarethe; Alnæs, Grethe I.G.; Gram, Inger Torhild; Kristensen, Vessela N.; Børresen-Dale, Anne-Lise; Lindström, Sara; Hankinson, Susan E.; Hunter, David J.; Andrulis, Irene L.; Knight, Julia A.; Boyd, Norman F.; Figueroa, Jonine D.; Lissowska, Jolanta; Wesolowska, Ewa; Peplonska, Beata; Bukowska, Agnieszka; Reszka, Edyta; Liu, JianJun; Eriksson, Louise; Czene, Kamila; Audley, Tina; Wu, Anna H.; Pankratz, V. Shane; Hopper, John L.; dos-Santos-Silva, Isabel

2013-01-01

Background Mammographic density adjusted for age and body mass index (BMI) is a heritable marker of breast cancer susceptibility. Little is known about the biological mechanisms underlying the association between mammographic density and breast cancer risk. We examined whether common low-penetrance breast cancer susceptibility variants contribute to inter-individual differences in mammographic density measures. Methods We established an international consortium (DENSNP) of 19 studies from 10 countries, comprising 16,895 Caucasian women, to conduct a pooled cross-sectional analysis of common breast cancer susceptibility variants in 14 independent loci and mammographic density measures. Dense and non-dense areas, and percent density, were measured using interactive-thresholding techniques. Mixed linear models were used to assess the association between genetic variants and the square roots of mammographic density measures adjusted for study, age, case status, body mass index (BMI) and menopausal status. Results Consistent with their breast cancer associations, the C-allele of rs3817198 in LSP1 was positively associated with both adjusted dense area (p=0.00005) and adjusted percent density (p=0.001) whereas the A-allele of rs10483813 in RAD51L1 was inversely associated with adjusted percent density (p=0.003), but not with adjusted dense area (p=0.07). Conclusion We identified two common breast cancer susceptibility variants associated with mammographic measures of radio-dense tissue in the breast gland. Impact We examined the association of 14 established breast cancer susceptibility loci with mammographic density phenotypes within a large genetic consortium and identified two breast cancer susceptibility variants, LSP1-rs3817198 and RAD51L1-rs10483813, associated with mammographic measures and in the same direction as the breast cancer association. PMID:22454379

The use of lower resolution viewing devices for mammographic interpretation: implications for education and training.

PubMed

Chen, Yan; James, Jonathan J; Turnbull, Anne E; Gale, Alastair G

2015-10-01

To establish whether lower resolution, lower cost viewing devices have the potential to deliver mammographic interpretation training. On three occasions over eight months, fourteen consultant radiologists and reporting radiographers read forty challenging digital mammography screening cases on three different displays: a digital mammography workstation, a standard LCD monitor, and a smartphone. Standard image manipulation software was available for use on all three devices. Receiver operating characteristic (ROC) analysis and ANOVA (Analysis of Variance) were used to determine the significance of differences in performance between the viewing devices with/without the application of image manipulation software. The effect of reader's experience was also assessed. Performance was significantly higher (p < .05) on the mammography workstation compared to the other two viewing devices. When image manipulation software was applied to images viewed on the standard LCD monitor, performance improved to mirror levels seen on the mammography workstation with no significant difference between the two. Image interpretation on the smartphone was uniformly poor. Film reader experience had no significant effect on performance across all three viewing devices. Lower resolution standard LCD monitors combined with appropriate image manipulation software are capable of displaying mammographic pathology, and are potentially suitable for delivering mammographic interpretation training. • This study investigates potential devices for training in mammography interpretation. • Lower resolution standard LCD monitors are potentially suitable for mammographic interpretation training. • The effect of image manipulation tools on mammography workstation viewing is insignificant. • Reader experience had no significant effect on performance in all viewing devices. • Smart phones are not suitable for displaying mammograms.

The influence of mammographic technologists on radiologists’ ability to interpret screening mammograms in community practice

PubMed Central

Henderson, Louise M.; Benefield, Thad; Marsh, Mary W.; Schroeder, Bruce F.; Durham, Danielle; Yankaskas, Bonnie C.; Bowling, J. Michael

2014-01-01

Purpose To determine whether the mammographic technologist has an effect on the radiologists’ interpretative performance of screening mammography in community practice. Materials and Methods In this institutional review board approved retrospective cohort study, we included Carolina Mammography Registry (CMR) data from 372 radiologists and 356 mammographic technologists from 1994 to 2009 who performed 1,003,276 screening mammograms. Measures of interpretative performance (recall rate, sensitivity, specificity, positive predictive value (PPV1), and cancer detection rate (CDR)) were ascertained prospectively with cancer outcomes collected from the state cancer registry and pathology reports. To determine if the mammographic technologist influenced the radiologists’ performance, we employed mixed effects logistic regression models, including a radiologist-specific random effect and taking into account the clustering of examinations across women, separately for screen-film mammography (SFM) and full field digital mammography (FFDM). Results Of the 356 mammographic technologists included, 343 performed 889,347 SFM examinations and 51 performed 113,929 FFDM examinations, and 38 performed both SFM and FFDM. A total of 4,328 cancers were reported for SFM and 564 cancers for FFDM. The technologists had a statistically significant effect on the radiologists’ recall rate, sensitivity, specificity and CDR for both SFM and FFDM (p-values<0.01). For PPV1, variability by technologist was observed for SFM (p-value<0.0001) but not for FFDM (p-value=0.088). Conclusion The interpretative performance of radiologists in screening mammography varies substantially by the technologist performing the examination. Additional studies should aim to identify technologist characteristics that may explain this variation. PMID:25435185

Mammographic evidence of microenvironment changes in tumorous breasts.

PubMed

Marin, Zach; Batchelder, Kendra A; Toner, Brian C; Guimond, Lyne; Gerasimova-Chechkina, Evgeniya; Harrow, Amy R; Arneodo, Alain; Khalil, Andre

2017-04-01

The microenvironment of breast tumors plays a critical role in tumorigenesis. As long as the structural integrity of the microenvironment is upheld, the tumor is suppressed. If tissue structure is lost through disruptions in the normal cell cycle, the microenvironment may act as a tumor promoter. Therefore, the properties that distinguish between healthy and tumorous tissues may not be solely in the tumor characteristics but rather in surrounding non-tumor tissue. The goal of this paper was to show preliminary evidence that tissue disruption and loss of homeostasis in breast tissue microenvironment and breast bilateral asymmetry can be quantitatively and objectively assessed from mammography via a localized, wavelet-based analysis of the whole breast. A wavelet-based multifractal formalism called the 2D Wavelet Transform Modulus Maxima (WTMM) method was used to quantitate density fluctuations from mammographic breast tissue via the Hurst exponent (H). Each entire mammogram was cut in hundreds of 360 × 360 pixel subregions in a gridding scheme of overlapping sliding windows, with each window boundary separated by 32 pixels. The 2D WTMM method was applied to each subregion individually. A data mining approach was set up to determine which metrics best discriminated between normal vs. cancer cases. These same metrics were then used, without modification, to discriminate between normal vs. benign and benign vs. cancer cases. The density fluctuations in healthy mammographic breast tissue are either monofractal anti-correlated (H < 1/2) for fatty tissue or monofractal long-range correlated (H>1/2) for dense tissue. However, tissue regions with H~1/2, as well as left vs. right breast asymetries, were found preferably in tumorous (benign or cancer) breasts vs. normal breasts, as quantified via a combination metric yielding a P-value ~ 0.0006. No metric considered showed significant differences between cancer vs. benign breasts. Since mammographic tissue regions associated

Prognosis for Mammographically Occult, Early-Stage Breast Cancer Patients Treated With Breast-Conservation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Tzu-I. J.; Yang Qifeng; Department of Breast Surgery, Qilu Hospital, Shandong University, Jinan

2010-01-15

Purpose: To compare mammographically occult (MamOcc) and mammographically positive (MamPos) early-stage breast cancer patients treated with breast-conservation therapy (BCT), to analyze differences between the two cohorts. Methods and Materials: Our two cohorts consisted of 214 MamOcc and 2168 MamPos patients treated with BCT. Chart reviews were conducted to assess mammogram reports and method of detection. All clinical-pathologic and outcome parameters were analyzed to detect differences between the two cohorts. Results: Median follow-up was 7 years. There were no differences in final margins, T stage, nodal status, estrogen/progesterone receptor status, or 'triple-negative' status. Significant differences included younger age at diagnosis (pmore » < 0.0001), more positive family history (p = 0.0033), less HER-2+ disease (p = 0.0294), and 1{sup o} histology (p < 0.0001). At 10 years, the differences in overall survival, cause-specific survival, and distant relapse between the two groups did not differ significantly. The MamOcc cohort had more breast relapses (15% vs. 8%; p = 0.0357), but on multivariate analysis this difference was not significant (hazard ratio 1.0, 95% confidence interval 0.993-1.007, p = 0.9296). Breast relapses were mammographically occult in 32% of the MamOcc and 12% of the MamPos cohorts (p = 0.0136). Conclusions: Although our study suggests that there are clinical-pathologic variations for the MamOcc cohort vs. MamPos patients that may ultimately affect management, breast relapse after BCT was not significantly different. Breast recurrences were more often mammographically occult in the MamOcc cohort; consideration should be given to closer follow-up and alternative imaging strategies (ultrasound, breast MRI) for routine posttreatment examination. To our knowledge, this represents the largest series addressing the prognostic significance of MamOcc cancers treated with BCT.« less

Mammographic quantitative image analysis and biologic image composition for breast lesion characterization and classification

DOE Office of Scientific and Technical Information (OSTI.GOV)

Drukker, Karen, E-mail: kdrukker@uchicago.edu; Giger, Maryellen L.; Li, Hui

2014-03-15

Purpose: To investigate whether biologic image composition of mammographic lesions can improve upon existing mammographic quantitative image analysis (QIA) in estimating the probability of malignancy. Methods: The study population consisted of 45 breast lesions imaged with dual-energy mammography prior to breast biopsy with final diagnosis resulting in 10 invasive ductal carcinomas, 5 ductal carcinomain situ, 11 fibroadenomas, and 19 other benign diagnoses. Analysis was threefold: (1) The raw low-energy mammographic images were analyzed with an established in-house QIA method, “QIA alone,” (2) the three-compartment breast (3CB) composition measure—derived from the dual-energy mammography—of water, lipid, and protein thickness were assessed, “3CBmore » alone”, and (3) information from QIA and 3CB was combined, “QIA + 3CB.” Analysis was initiated from radiologist-indicated lesion centers and was otherwise fully automated. Steps of the QIA and 3CB methods were lesion segmentation, characterization, and subsequent classification for malignancy in leave-one-case-out cross-validation. Performance assessment included box plots, Bland–Altman plots, and Receiver Operating Characteristic (ROC) analysis. Results: The area under the ROC curve (AUC) for distinguishing between benign and malignant lesions (invasive and DCIS) was 0.81 (standard error 0.07) for the “QIA alone” method, 0.72 (0.07) for “3CB alone” method, and 0.86 (0.04) for “QIA+3CB” combined. The difference in AUC was 0.043 between “QIA + 3CB” and “QIA alone” but failed to reach statistical significance (95% confidence interval [–0.17 to + 0.26]). Conclusions: In this pilot study analyzing the new 3CB imaging modality, knowledge of the composition of breast lesions and their periphery appeared additive in combination with existing mammographic QIA methods for the distinction between different benign and malignant lesion types.« less

Understanding Clinical Mammographic Breast Density Assessment: a Deep Learning Perspective.

PubMed

Mohamed, Aly A; Luo, Yahong; Peng, Hong; Jankowitz, Rachel C; Wu, Shandong

2017-09-20

Mammographic breast density has been established as an independent risk marker for developing breast cancer. Breast density assessment is a routine clinical need in breast cancer screening and current standard is using the Breast Imaging and Reporting Data System (BI-RADS) criteria including four qualitative categories (i.e., fatty, scattered density, heterogeneously dense, or extremely dense). In each mammogram examination, a breast is typically imaged with two different views, i.e., the mediolateral oblique (MLO) view and cranial caudal (CC) view. The BI-RADS-based breast density assessment is a qualitative process made by visual observation of both the MLO and CC views by radiologists, where there is a notable inter- and intra-reader variability. In order to maintain consistency and accuracy in BI-RADS-based breast density assessment, gaining understanding on radiologists' reading behaviors will be educational. In this study, we proposed to leverage the newly emerged deep learning approach to investigate how the MLO and CC view images of a mammogram examination may have been clinically used by radiologists in coming up with a BI-RADS density category. We implemented a convolutional neural network (CNN)-based deep learning model, aimed at distinguishing the breast density categories using a large (15,415 images) set of real-world clinical mammogram images. Our results showed that the classification of density categories (in terms of area under the receiver operating characteristic curve) using MLO view images is significantly higher than that using the CC view. This indicates that most likely it is the MLO view that the radiologists have predominately used to determine the breast density BI-RADS categories. Our study holds a potential to further interpret radiologists' reading characteristics, enhance personalized clinical training to radiologists, and ultimately reduce reader variations in breast density assessment.

Mammographic screening: measurement of the cost in a population based programme in Victoria, Australia.

PubMed

Hurley, S F; Livingston, P M; Thane, N; Quang, L

1994-08-01

To estimate the cost per woman participating in a mammographic screening programme, and to describe methods for measuring costs. Expenditure, resource usage, and throughput were monitored over a 12 month period. Unit costs for each phase of the screening process were estimated and linked with the probabilities of each screening outcome to obtain the cost per woman screened and the cost per breast cancer detected. A pilot, population based Australian programme offering free two-view mammographic screening. A total of 5986 women aged 50-69 years who lived in the target area, were listed on the electoral roll, had no previous breast cancer, and attended the programme. Unit costs for recruitment, screening, and recall mammography were $17.54, $60.04, and $175.54, respectively. The costs of clinical assessment for women with subsequent clear, benign, malignant (palpable), and malignant (impalpable) diagnoses were $173.71, $527.29, $436.62, and $567.22, respectively. The cost per woman screened was $117.70, and the cost per breast cancer detected was $11,550. The cost per woman screened is a key variable in assessment of the cost effectiveness of mammographic screening, and is likely to vary between health care settings. Its measurement is justified if decisions about health care services are to be based on cost effectiveness criteria.

Percent Mammographic Density and Dense Area as Risk Factors for Breast Cancer.

PubMed

Rauh, C; Hack, C C; Häberle, L; Hein, A; Engel, A; Schrauder, M G; Fasching, P A; Jud, S M; Ekici, A B; Loehberg, C R; Meier-Meitinger, M; Ozan, S; Schulz-Wendtland, R; Uder, M; Hartmann, A; Wachter, D L; Beckmann, M W; Heusinger, K

2012-08-01

Purpose: Mammographic characteristics are known to be correlated to breast cancer risk. Percent mammographic density (PMD), as assessed by computer-assisted methods, is an established risk factor for breast cancer. Along with this assessment the absolute dense area (DA) of the breast is reported as well. Aim of this study was to assess the predictive value of DA concerning breast cancer risk in addition to other risk factors and in addition to PMD. Methods: We conducted a case control study with hospital-based patients with a diagnosis of invasive breast cancer and healthy women as controls. A total of 561 patients and 376 controls with available mammographic density were included into this study. We describe the differences concerning the common risk factors BMI, parital status, use of hormone replacement therapy (HRT) and menopause between cases and controls and estimate the odds ratios for PMD and DA, adjusted for the mentioned risk factors. Furthermore we compare the prediction models with each other to find out whether the addition of DA improves the model. Results: Mammographic density and DA were highly correlated with each other. Both variables were as well correlated to the commonly known risk factors with an expected direction and strength, however PMD (ρ = -0.56) was stronger correlated to BMI than DA (ρ = -0.11). The group of women within the highest quartil of PMD had an OR of 2.12 (95 % CI: 1.25-3.62). This could not be seen for the fourth quartile concerning DA. However the assessment of breast cancer risk could be improved by including DA in a prediction model in addition to common risk factors and PMD. Conclusions: The inclusion of the parameter DA into a prediction model for breast cancer in addition to established risk factors and PMD could improve the breast cancer risk assessment. As DA is measured together with PMD in the process of computer-assisted assessment of PMD it might be considered to include it as one additional breast

Insulin-like growth factor-1, insulin-like growth factor-binding protein-3, growth hormone, and mammographic density in the Nurses' Health Studies.

PubMed

Rice, Megan S; Tworoger, Shelley S; Rosner, Bernard A; Pollak, Michael N; Hankinson, Susan E; Tamimi, Rulla M

2012-12-01

Higher circulating insulin-like growth factor I (IGF-1) levels have been associated with higher mammographic density among women in some, but not all studies. Also, few studies have examined the association between mammographic density and circulating growth hormone (GH) in premenopausal women. We conducted a cross-sectional study among 783 premenopausal women and 436 postmenopausal women who were controls in breast cancer case-control studies nested in the Nurses' Health Study (NHS) and NHSII. Participants provided blood samples in 1989-1990 (NHS) or in 1996-1999 (NHSII), and mammograms were obtained near the time of blood draw. Generalized linear models were used to assess the associations of IGF-1, IGF-binding protein-3 (IGFBP-3), IGF-1:IGFBP-3 ratio, and GH with percent mammographic density, total dense area, and total non-dense area. Models were adjusted for potential confounders including age and body mass index (BMI), among others. We also assessed whether the associations varied by age or BMI. In both pre- and postmenopausal women, percent mammographic density was not associated with plasma levels of IGF-1, IGFBP-3, or the IGF-1:IGFBP-3 ratio. In addition, GH was not associated with percent density among premenopausal women in the NHSII. Similarly, total dense area and non-dense area were not significantly associated with any of these analytes. In postmenopausal women, IGF-1 was associated with higher percent mammographic density among women with BMI <25 kg/m(2), but not among overweight/obese women. Overall, plasma IGF-1, IGFBP-3, and GH levels were not associated with mammographic density in a sample of premenopausal and postmenopausal women.

Improving classification with forced labeling of other related classes: application to prediction of upstaged ductal carcinoma in situ using mammographic features

NASA Astrophysics Data System (ADS)

Hou, Rui; Shi, Bibo; Grimm, Lars J.; Mazurowski, Maciej A.; Marks, Jeffrey R.; King, Lorraine M.; Maley, Carlo C.; Hwang, E. Shelley; Lo, Joseph Y.

2018-02-01

Predicting whether ductal carcinoma in situ (DCIS) identified at core biopsy contains occult invasive disease is an import task since these "upstaged" cases will affect further treatment planning. Therefore, a prediction model that better classifies pure DCIS and upstaged DCIS can help avoid overtreatment and overdiagnosis. In this work, we propose to improve this classification performance with the aid of two other related classes: Atypical Ductal Hyperplasia (ADH) and Invasive Ductal Carcinoma (IDC). Our data set contains mammograms for 230 cases. Specifically, 66 of them are ADH cases; 99 of them are biopsy-proven DCIS cases, of whom 25 were found to contain invasive disease at the time of definitive surgery. The remaining 65 cases were diagnosed with IDC at core biopsy. Our hypothesis is that knowledge can be transferred from training with the easier and more readily available cases of benign but suspicious ADH versus IDC that is already apparent at initial biopsy. Thus, embedding both ADH and IDC cases to the classifier will improve the performance of distinguishing upstaged DCIS from pure DCIS. We extracted 113 mammographic features based on a radiologist's annotation of clusters.Our method then added both ADH and IDC cases during training, where ADH were "force labeled" or treated by the classifier as pure DCIS (negative) cases, and IDC were labeled as upstaged DCIS (positive) cases. A logistic regression classifier was built based on the designed training dataset to perform a prediction of whether biopsy-proven DCIS cases contain invasive cancer. The performance was assessed by repeated 5-fold CrossValidation and Receiver Operating Characteristic(ROC) curve analysis. While prediction performance with only training on DCIS dataset had an average AUC of 0.607(%95CI, 0.479-0.721). By adding both ADH and IDC cases for training, we improved the performance to 0.691(95%CI, 0.581-0.801).

Predictors of invasive breast cancer in mammographically detected microcalcification in patients with a core biopsy diagnosis of flat epithelial atypia, atypical ductal hyperplasia or ductal carcinoma in situ and recommendations for a selective approach to sentinel lymph node biopsy.

PubMed

Catteau, Xavier; Simon, Philippe; Noël, Jean-Christophe

2012-04-15

15±30% of malignancies detected through screening programs are ductal carcinoma in situ (DCIS), and the majority of DCIS cases present in the form of mammographic microcalcification. This study was performed in order to determine the value of features in predicting invasive disease in patients with mammographic calcification and to help determine which patients (with, Core Needle Biopsy-diagnosed DCIS) are the most appropriate candidates for Sentinel Lymph Node (SLN) biopsy. The original aspect of this study was to select patients with mammographic microcalcification but without an associated mass. The factor that we identified to be associated with invasive disease at final surgical excision was the presence of necrosis at core histology. SLN biopsy or complete axillary lymph node dissection was performed in 22 (40%) patients of whom only one (4.5%) had a micrometastasis. Further larger studies are needed to see if it would be interesting to propose a SLN biopsy in case of necrosis on CNB-diagnosed DCIS with microcalcifications but not associated with a mass. Copyright © 2012 Elsevier GmbH. All rights reserved.

Computer-aided classification of mammographic masses using the deep learning technology: a preliminary study

NASA Astrophysics Data System (ADS)

Qiu, Yuchen; Yan, Shiju; Tan, Maxine; Cheng, Samuel; Liu, Hong; Zheng, Bin

2016-03-01

Although mammography is the only clinically acceptable imaging modality used in the population-based breast cancer screening, its efficacy is quite controversy. One of the major challenges is how to help radiologists more accurately classify between benign and malignant lesions. The purpose of this study is to investigate a new mammographic mass classification scheme based on a deep learning method. In this study, we used an image dataset involving 560 regions of interest (ROIs) extracted from digital mammograms, which includes 280 malignant and 280 benign mass ROIs, respectively. An eight layer deep learning network was applied, which employs three pairs of convolution-max-pooling layers for automatic feature extraction and a multiple layer perception (MLP) classifier for feature categorization. In order to improve robustness of selected features, each convolution layer is connected with a max-pooling layer. A number of 20, 10, and 5 feature maps were utilized for the 1st, 2nd and 3rd convolution layer, respectively. The convolution networks are followed by a MLP classifier, which generates a classification score to predict likelihood of a ROI depicting a malignant mass. Among 560 ROIs, 420 ROIs were used as a training dataset and the remaining 140 ROIs were used as a validation dataset. The result shows that the new deep learning based classifier yielded an area under the receiver operation characteristic curve (AUC) of 0.810+/-0.036. This study demonstrated the potential superiority of using a deep learning based classifier to distinguish malignant and benign breast masses without segmenting the lesions and extracting the pre-defined image features.

Cone-beam volume CT mammographic imaging: feasibility study

NASA Astrophysics Data System (ADS)

Chen, Biao; Ning, Ruola

2001-06-01

X-ray projection mammography, using a film/screen combination or digital techniques, has proven to be the most effective imaging modality for early detection of breast cancer currently available. However, the inherent superimposition of structures makes small carcinoma (a few millimeters in size) difficult to detect in the occultation case or in dense breasts, resulting in a high false positive biopsy rate. The cone-beam x-ray projection based volume imaging using flat panel detectors (FPDs) makes it possible to obtain three-dimensional breast images. This may benefit diagnosis of the structure and pattern of the lesion while eliminating hard compression of the breast. This paper presents a novel cone-beam volume CT mammographic imaging protocol based on the above techniques. Through computer simulation, the key issues of the system and imaging techniques, including the x-ray imaging geometry and corresponding reconstruction algorithms, x-ray characteristics of breast tissues, x-ray setting techniques, the absorbed dose estimation and the quantitative effect of x-ray scattering on image quality, are addressed. The preliminary simulation results support the proposed cone-beam volume CT mammographic imaging modality in respect to feasibility and practicability for mammography. The absorbed dose level is comparable to that of current two-view mammography and would not be a prominent problem for this imaging protocol. Compared to traditional mammography, the proposed imaging protocol with isotropic spatial resolution will potentially provide significantly better low contrast detectability of breast tumors and more accurate location of breast lesions.

Genome-wide association study identifies multiple loci associated with both mammographic density and breast cancer risk

PubMed Central

Lindström, Sara; Thompson, Deborah J.; Paterson, Andrew D.; Li, Jingmei; Gierach, Gretchen L.; Scott, Christopher; Stone, Jennifer; Douglas, Julie A.; dos-Santos-Silva, Isabel; Fernandez-Navarro, Pablo; Verghase, Jajini; Smith, Paula; Brown, Judith; Luben, Robert; Wareham, Nicholas J.; Loos, Ruth J.F.; Heit, John A.; Pankratz, V. Shane; Norman, Aaron; Goode, Ellen L.; Cunningham, Julie M.; deAndrade, Mariza; Vierkant, Robert A.; Czene, Kamila; Fasching, Peter A.; Baglietto, Laura; Southey, Melissa C.; Giles, Graham G.; Shah, Kaanan P.; Chan, Heang-Ping; Helvie, Mark A.; Beck, Andrew H.; Knoblauch, Nicholas W.; Hazra, Aditi; Hunter, David J.; Kraft, Peter; Pollan, Marina; Figueroa, Jonine D.; Couch, Fergus J.; Hopper, John L.; Hall, Per; Easton, Douglas F.; Boyd, Norman F.; Vachon, Celine M.; Tamimi, Rulla M.

2015-01-01

Mammographic density reflects the amount of stromal and epithelial tissues in relation to adipose tissue in the breast and is a strong risk factor for breast cancer. Here we report the results from meta-analysis of genome-wide association studies (GWAS) of three mammographic density phenotypes: dense area, non-dense area and percent density in up to 7,916 women in stage 1 and an additional 10,379 women in stage 2. We identify genome-wide significant (P<5×10−8) loci for dense area (AREG, ESR1, ZNF365, LSP1/TNNT3, IGF1, TMEM184B, SGSM3/MKL1), non-dense area (8p11.23) and percent density (PRDM6, 8p11.23, TMEM184B). Four of these regions are known breast cancer susceptibility loci, and four additional regions were found to be associated with breast cancer (P<0.05) in a large meta-analysis. These results provide further evidence of a shared genetic basis between mammographic density and breast cancer and illustrate the power of studying intermediate quantitative phenotypes to identify putative disease susceptibility loci. PMID:25342443

Comparison of Mammographic Changes Across Three Different Fractionation Schedules for Early-Stage Breast Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tian, Sibo; Paster, Lina F.; Kim, Sinae

Purpose: As the use of hypofractionated breast radiation therapy (RT) increases, so will the need for long-term data on post-RT mammographic changes. The purpose of the present study was to longitudinally compare the incidence of common mammographic sequelae seen after breast conserving surgery and RT in patients treated with accelerated partial breast irradiation (APBI), hypofractionated whole breast irradiation (HWBI), and conventionally fractionated whole breast irradiation (WBI). Methods and Materials: Patients treated with either APBI or HWBI after breast conserving therapy and with ≥3 mammograms of the treated breast were identified. They were matched 1:1 by age ±5 years to patients treatedmore » with WBI. The mammograms were evaluated for common post-RT breast findings by a mammographer who was unaware of the treatment. The outcomes were analyzed using a cumulative logistic regression model; P<.05 indicated statistically significance. Results: Of 89 patients treated with RT from 2006 to 2011, 29 had received APBI, 30 had received HWBI, and 30 had received WBI. Their median age was 60 years (range 33-83). A total of 605 mammograms were evaluated, with a median follow-up of 48 months. The treatment technique did not affect the severity of architectural distortion when the groups were evaluated longitudinally. The likelihood of finding skin thickening decreased with increasing follow-up duration (odds ratio 0.6; P<.001) adjusted for fractionation schemes. No differences were seen with respect to changes in skin thickening, fluid collections, or calcifications among the treatment groups, after adjustment for the follow-up time. The clinical characteristics, including age, race, T stage, and chemotherapy use, were not linked to the likelihood of finding several mammographic phenomena over time. Conclusions: Although specific post-treatment imaging findings evolved over time, RT fractionation did not alter the relative incidence or severity of

Relationship Between Mammographic Density and Breast Cancer Death in the Breast Cancer Surveillance Consortium

PubMed Central

2012-01-01

Background Women with elevated mammographic density have an increased risk of developing breast cancer. However, among women diagnosed with breast cancer, it is unclear whether higher density portends reduced survival, independent of other factors. Methods We evaluated relationships between mammographic density and risk of death from breast cancer and all causes within the US Breast Cancer Surveillance Consortium. We studied 9232 women diagnosed with primary invasive breast carcinoma during 1996–2005, with a mean follow-up of 6.6 years. Mammographic density was assessed using the Breast Imaging Reporting and Data System (BI-RADS) density classification. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox proportional hazards regression; women with scattered fibroglandular densities (BI-RADS 2) were the referent group. All statistical tests were two-sided. Results A total of 1795 women died, of whom 889 died of breast cancer. In multivariable analyses (adjusted for site, age at and year of diagnosis, American Joint Committee on Cancer stage, body mass index, mode of detection, treatment, and income), high density (BI-RADS 4) was not related to risk of death from breast cancer (HR = 0.92, 95% CI = 0.71 to 1.19) or death from all causes (HR = 0.83, 95% CI = 0.68 to 1.02). Analyses stratified by stage and other prognostic factors yielded similar results, except for an increased risk of breast cancer death among women with low density (BI-RADS 1) who were either obese (HR = 2.02, 95% CI = 1.37 to 2.97) or had tumors of at least 2.0cm (HR = 1.55, 95% CI = 1.14 to 2.09). Conclusions High mammographic breast density was not associated with risk of death from breast cancer or death from any cause after accounting for other patient and tumor characteristics. Thus, risk factors for the development of breast cancer may not necessarily be the same as factors influencing the risk of death after breast cancer has developed. PMID:22911616

Vitamin D and calcium supplementation and one-year change in mammographic density in the Women’s Health Initiative Calcium and Vitamin D Trial

PubMed Central

Bertone-Johnson, Elizabeth R.; McTiernan, Anne; Thomson, Cynthia A.; Wactawski-Wende, Jean; Aragaki, Aaron K.; Rohan, Thomas E.; Vitolins, Mara Z.; Tamimi, Rulla M.; Johnson, Karen C.; Lane, Dorothy; Rexrode, Kathryn M.; Peck, Jennifer D.; Chlebowski, Rowan T.; Sarto, Gloria; Manson, JoAnn E.

2012-01-01

Background Calcium and vitamin D may be inversely related to breast cancer risk, in part by affecting mammographic density. However, results from previous, mostly cross-sectional studies have been mixed, and there have been few randomized clinical trials of the effect of calcium and vitamin D supplementation on change in mammographic density. Methods We assessed the effect of one year of supplementation on mammographic density in 330 postmenopausal women enrolled in the Women’s Health Initiative Hormone Therapy (HT) and Calcium and Vitamin D (CaD) trials. Women were randomized to receive 1000 mg/day of elemental calcium carbonate plus 400 IU/day of vitamin D3 or placebo. Results After approximately one year, mammographic density decreased 2% in the CaD supplementation group and increased 1% in the placebo group (ratio of means = 0.97; 95% confidence interval (CI) = 0.81–1.17). Results suggested potential interaction by HT use (P = 0.08). Among women randomized to HT placebo, the ratio of mean density comparing CaD supplementation and placebo groups was 0.82 (95%CI = 0.61–1.11) vs. 1.16 (95%CI = 0.92–1.45) in women randomized to active HT. In sensitivity analyses limited to women taking ≥80% of study supplements, ratios were 0.67 (95%CI = 0.41–1.07) in women not assigned to HT and 1.07 (95%CI = 0.79–1.47) women assigned to HT. Conclusions We observed no overall effect of vitamin D and calcium supplementation on mammographic density after one year. Impact Potential interaction between these nutrients and estrogen as related to mammographic density warrants further study. PMID:22253296

Computing the scatter component of mammographic images.

PubMed

Highnam, R P; Brady, J M; Shepstone, B J

1994-01-01

The authors build upon a technical report (Tech. Report OUEL 2009/93, Engng. Sci., Oxford Uni., Oxford, UK, 1993) in which they proposed a model of the mammographic imaging process for which scattered radiation is a key degrading factor. Here, the authors propose a way of estimating the scatter component of the signal at any pixel within a mammographic image, and they use this estimate for model-based image enhancement. The first step is to extend the authors' previous model to divide breast tissue into "interesting" (fibrous/glandular/cancerous) tissue and fat. The scatter model is then based on the idea that the amount of scattered radiation reaching a point is related to the energy imparted to the surrounding neighbourhood. This complex relationship is approximated using published empirical data, and it varies with the size of the breast being imaged. The approximation is further complicated by needing to take account of extra-focal radiation and breast edge effects. The approximation takes the form of a weighting mask which is convolved with the total signal (primary and scatter) to give a value which is input to a "scatter function", approximated using three reference cases, and which returns a scatter estimate. Given a scatter estimate, the more important primary component can be calculated and used to create an image recognizable by a radiologist. The images resulting from this process are clearly enhanced, and model verification tests based on an estimate of the thickness of interesting tissue present proved to be very successful. A good scatter model opens the was for further processing to remove the effects of other degrading factors, such as beam hardening.

Tumor characteristics and family history in relation to mammographic density and breast cancer: The French E3N cohort.

PubMed

Maskarinec, Gertraud; Dartois, Laureen; Delaloge, Suzette; Hopper, John; Clavel-Chapelon, Françoise; Baglietto, Laura

2017-08-01

Mammographic density is a known heritable risk factor for breast cancer, but reports how tumor characteristics and family history may modify this association are inconsistent. Dense and total breast areas were assessed using Cumulus™ from pre-diagnostic mammograms for 820 invasive breast cancer cases and 820 matched controls nested within the French E3N cohort study. To allow comparisons across models, percent mammographic density (PMD) was standardized to the distribution of the controls. Odds ratios (OR) and 95% confidence intervals (CI) of breast cancer risk for mammographic density were estimated by conditional logistic regression while adjusting for age and body mass index. Heterogeneity according to tumor characteristic and family history was assessed using stratified analyses. Overall, the OR per 1 SD for PMD was 1.50 (95% CI, 1.33-1.69). No evidence for significant heterogeneity by tumor size, lymph node status, grade, and hormone receptor status (estrogen, progesterone, and HER2) was detected. However, the association of PMD was stronger for women reporting a family history of breast cancer (OR 1SD =2.25; 95% CI, 1.67-3.04) than in women reporting none (OR 1SD =1.41; 95% CI, 1.24-1.60; p heterogeneity =0.002). Similarly, effect modification by FHBC was observed using categories of PMD (p heterogeneity =0.02) with respective ORs of 15.16 (95% CI, 4.23-54.28) vs. 3.14 (95% CI, 1.89-5.22) for ≥50% vs. <10% PMD. The stronger association between mammographic density and breast cancer risk with a family history supports the hypothesis of shared genetic factors responsible for familial aggregation of breast cancer and the heritable component of mammographic density. Copyright © 2017 Elsevier Ltd. All rights reserved.

Association between mammographic density and pregnancies relative to age and BMI: a breast cancer case-only analysis.

PubMed

Hack, Carolin C; Emons, Julius; Jud, Sebastian M; Heusinger, Katharina; Adler, Werner; Gass, Paul; Haeberle, Lothar; Heindl, Felix; Hein, Alexander; Schulz-Wendtland, Rüdiger; Uder, Michael; Hartmann, Arndt; Beckmann, Matthias W; Fasching, Peter A; Pöhls, Uwe G

2017-12-01

Percentage mammographic density (PMD) is a major risk factor for breast cancer (BC). It is strongly associated with body mass index (BMI) and age, which are themselves risk factors for breast cancer. This analysis investigated the association between the number of full-term pregnancies and PMD in different subgroups relative to age and BMI. Patients were identified in the breast cancer database of the University Breast Center for Franconia. A total of 2410 patients were identified, for whom information on parity, age, and BMI, and a mammogram from the time of first diagnosis were available for assessing PMD. Linear regression analyses were conducted to investigate the influence on PMD of the number of full-term pregnancies (FTPs), age, BMI, and interaction terms between them. As in previous studies, age, number of FTPs, and BMI were found to be associated with PMD in the expected direction. However, including the respective interaction terms improved the prediction of PMD even further. Specifically, the association between PMD and the number of FTPs differed in young patients under the age of 45 (mean decrease of 0.37 PMD units per pregnancy) from the association in older age groups (mean decrease between 2.29 and 2.39 PMD units). BMI did not alter the association between PMD and the number of FTPs. The effect of pregnancies on mammographic density does not appear to become apparent before the age of menopause. The mechanism that drives the effect of pregnancies on mammographic density appears to be counter-regulated by other influences on mammographic density in younger patients.

IGF-I and mammographic density in four geographic locations: a pooled analysis.

PubMed

Maskarinec, Gertraud; Takata, Yumie; Chen, Zhao; Gram, Inger Torhild; Nagata, Chisato; Pagano, Ian; Hayashi, Kentaro; Arendell, Leslie; Skeie, Guri; Rinaldi, Sabina; Kaaks, Rudolph

2007-10-15

Insulin-like growth factor (IGF-I) and prolactin have been found to be associated with breast cancer risk and with mammographic density. In a pooled analysis from 4 geographic locations, we investigated the association of percent mammographic density with serum levels of IGF-I, IGFBP-3 and prolactin. The pooled data set included 1,327 pre- and postmenopausal women: Caucasians from Norway, Arizona and Hawaii, Japanese from Hawaii and Japan, Latina from Arizona, and Native Hawaiians from Hawaii. Serum samples were assayed for IGF-I, IGFBP-3 and prolactin levels using ELISA assays. Mammographic density was quantified using a computer-assisted density method. After stratification by menopausal status, multiple regression models estimated the relation between serum analytes and breast density. All serum analytes except prolactin among postmenopausal women differed significantly by location/ethnicity group. Among premenopausal subjects, IGF-I levels and the molar ratio were highest in Hawaii, intermediate in Japan and lowest in Arizona. For IGFBP-3, the order was reversed. Among postmenopausal subjects, Norwegian women had the highest IGF-I levels and women in Arizona had the lowest while women in Japan and Hawaii had intermediate levels. We observed no significant relation between percent density and IGF-I or prolactin levels among pre-and postmenopausal women. The significant differences in IGF-I levels by location but not ethnicity suggest that environmental factors influence IGF-I levels, whereas percent breast density varies more according to ethnic background than by location. Based on this analysis, the influence of circulating levels of IGF-I, IGFBP-3, and prolactin on percent density appears to be very small. (c) 2007 Wiley-Liss, Inc.

Prediction of Occult Invasive Disease in Ductal Carcinoma in Situ Using Deep Learning Features.

PubMed

Shi, Bibo; Grimm, Lars J; Mazurowski, Maciej A; Baker, Jay A; Marks, Jeffrey R; King, Lorraine M; Maley, Carlo C; Hwang, E Shelley; Lo, Joseph Y

2018-03-01

The aim of this study was to determine whether deep features extracted from digital mammograms using a pretrained deep convolutional neural network are prognostic of occult invasive disease for patients with ductal carcinoma in situ (DCIS) on core needle biopsy. In this retrospective study, digital mammographic magnification views were collected for 99 subjects with DCIS at biopsy, 25 of which were subsequently upstaged to invasive cancer. A deep convolutional neural network model that was pretrained on nonmedical images (eg, animals, plants, instruments) was used as the feature extractor. Through a statistical pooling strategy, deep features were extracted at different levels of convolutional layers from the lesion areas, without sacrificing the original resolution or distorting the underlying topology. A multivariate classifier was then trained to predict which tumors contain occult invasive disease. This was compared with the performance of traditional "handcrafted" computer vision (CV) features previously developed specifically to assess mammographic calcifications. The generalization performance was assessed using Monte Carlo cross-validation and receiver operating characteristic curve analysis. Deep features were able to distinguish DCIS with occult invasion from pure DCIS, with an area under the receiver operating characteristic curve of 0.70 (95% confidence interval, 0.68-0.73). This performance was comparable with the handcrafted CV features (area under the curve = 0.68; 95% confidence interval, 0.66-0.71) that were designed with prior domain knowledge. Despite being pretrained on only nonmedical images, the deep features extracted from digital mammograms demonstrated comparable performance with handcrafted CV features for the challenging task of predicting DCIS upstaging. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Calculated mammographic spectra confirmed with attenuation curves for molybdenum, rhodium, and tungsten targets.

PubMed

Blough, M M; Waggener, R G; Payne, W H; Terry, J A

1998-09-01

A model for calculating mammographic spectra independent of measured data and fitting parameters is presented. This model is based on first principles. Spectra were calculated using various target and filter combinations such as molybdenum/molybdenum, molybdenum/rhodium, rhodium/rhodium, and tungsten/aluminum. Once the spectra were calculated, attenuation curves were calculated and compared to measured attenuation curves. The attenuation curves were calculated and measured using aluminum alloy 1100 or high purity aluminum filtration. Percent differences were computed between the measured and calculated attenuation curves resulting in an average of 5.21% difference for tungsten/aluminum, 2.26% for molybdenum/molybdenum, 3.35% for rhodium/rhodium, and 3.18% for molybdenum/rhodium. Calculated spectra were also compared to measured spectra from the Food and Drug Administration [Fewell and Shuping, Handbook of Mammographic X-ray Spectra (U.S. Government Printing Office, Washington, D.C., 1979)] and a comparison will also be presented.

Cost-benefit analysis of biopsy methods for suspicious mammographic lesions; discussion 994-5.

PubMed

Fahy, B N; Bold, R J; Schneider, P D; Khatri, V; Goodnight, J E

2001-09-01

Stereotactic core biopsy (SCB) is more cost-effective than needle-localized biopsy (NLB) for evaluation and treatment of mammographic lesions. A computer-generated mathematical model was developed based on clinical outcome modeling to estimate costs accrued during evaluation and treatment of suspicious mammographic lesions. Total costs were determined for evaluation and subsequent treatment of cancer when either SCB or NLB was used as the initial biopsy method. Cost was estimated by the cumulative work relative value units accrued. The risk of malignancy based on the Breast Imaging Reporting Data System (BIRADS) score and mammographic suspicion of ductal carcinoma in situ were varied to simulate common clinical scenarios. Total cost accumulated during evaluation and subsequent surgical therapy (if required). Evaluation of BIRADS 5 lesions (highly suggestive, risk of malignancy = 90%) resulted in equivalent relative value units for both techniques (SCB, 15.54; NLB, 15.47). Evaluation of lesions highly suspicious for ductal carcinoma in situ yielded similar total treatment relative value units (SCB, 11.49; NLB, 10.17). Only for evaluation of BIRADS 4 lesions (suspicious abnormality, risk of malignancy = 34%) was SCB more cost-effective than NLB (SCB, 7.65 vs. NLB, 15.66). No difference in cost-benefit was found when lesions highly suggestive of malignancy (BIRADS 5) or those suspicious for ductal carcinoma in situ were evaluated initially with SCB vs. NLB, thereby disproving the hypothesis. Only for intermediate-risk lesions (BIRADS 4) did initial evaluation with SCB yield a greater cost savings than with NLB.

Various doses of soy isoflavones do not modify mammographic density in postmenopausal women

USDA-ARS?s Scientific Manuscript database

Soy isoflavones have functional similarity to human estrogens and may protect against breast cancer as a result of their antiestrogenic activity or increase risk as a result of their estrogen-like properties. We examined the relation between isoflavone supplementation and mammographic density, a str...

A GaAs pixel detectors-based digital mammographic system: Performances and imaging tests results

NASA Astrophysics Data System (ADS)

Annovazzi, A.; Amendolia, S. R.; Bigongiari, A.; Bisogni, M. G.; Catarsi, F.; Cesqui, F.; Cetronio, A.; Colombo, F.; Delogu, P.; Fantacci, M. E.; Gilberti, A.; Lanzieri, C.; Lavagna, S.; Novelli, M.; Passuello, G.; Paternoster, G.; Pieracci, M.; Poletti, M.; Quattrocchi, M.; Rosso, V.; Stefanini, A.; Testa, A.; Venturelli, L.

2007-06-01

The prototype presented in this paper is based on GaAs pixel detectors read-out by the PCC/MEDIPIX I circuit. The active area of a sensor is about 1 cm 2 therefore to cover the typical irradiation field used in mammography (18×24 cm 2), 18 GaAs detection units have been organized in two staggered rows of nine chips each and moved by a stepper motor in the orthogonal direction. The system is integrated in a mammographic equipment which comprehends the X-ray tube, the bias and data acquisition systems and the PC-based control system. The prototype has been developed in the framework of the Integrated Mammographic Imaging (IMI) project, an industrial research activity aiming to develop innovative instrumentation for morphologic and functional imaging. The project has been supported by the Italian Ministry of Education, University and Research (MIUR) and by five Italian High Tech companies, Alenia Marconi Systems (AMS), CAEN, Gilardoni, LABEN and Poli.Hi.Tech., in collaboration with the universities of Ferrara, Roma "La Sapienza", Pisa and the Istituto Nazionale di Fisica Nucleare (INFN). In this paper, we report on the electrical characterization and the first imaging test results of the digital mammographic system. To assess the imaging capability of such a detector we have built a phantom, which simulates the breast tissue with malignancies. The radiographs of the phantom, obtained by delivering an entrance dose of 4.8 mGy, have shown particulars with a measured contrast below 1%.

Postmenopausal hormone therapy and changes in mammographic density.

PubMed

van Duijnhoven, Fränzel J B; Peeters, Petra H M; Warren, Ruth M L; Bingham, Sheila A; van Noord, Paulus A H; Monninkhof, Evelyn M; Grobbee, Diederick E; van Gils, Carla H

2007-04-10

Hormone therapy (HT) use has been associated with an increased breast cancer risk. We explored the underlying mechanism further by determining the effects of HT on mammographic density, a measure of dense tissue in the breast and a consistent breast cancer risk factor. A total of 620 HT users and 620 never users from the Dutch Prospect-European Prospective Investigation into Cancer and Nutrition (EPIC) cohort and 175 HT users and 161 never users from the United Kingdom EPIC-Norfolk cohort were included. For HT users, one mammogram before and one mammogram during HT use was included. For never users, mammograms with similar time intervals were included. Mammographic density was assessed using a computer-assisted method. Changes in density were analyzed using linear regression. The median time between mammograms was 3.0 years and the median duration of HT use was 1 year. The absolute mean decline in percent density was larger in never users (7.3%) than in estrogen therapy users (6.4%; P = .22) and combined HT users (3.5%; P < .01). The effect of HT appeared to be high in a small number of women, whereas most women were unaffected. Our results suggest that HT use, and especially estrogen and progestin use, slows the changes from dense patterns to more fatty patterns that are normally seen in women with increasing age. Given that it is postulated that lifetime cumulative exposure to high density may be related to breast cancer risk, a delay in density decline in HT users potentially could explain their increased breast cancer risk.

The Problem of Mammographic Breast Density - The Position of the DEGUM Working Group on Breast Ultrasound.

PubMed

Mueller-Schimpfle, M P; Brandenbusch, V C; Degenhardt, F; Duda, V; Madjar, H; Mundinger, A; Rathmann, R; Hahn, M

2016-04-01

Mammographic breast density correlates with breast cancer risk and also with the number of false-negative calls. In the USA these facts lead to the "Breast Density and Mammography Reporting Act" of 2011. In the case of mammographically dense breasts, the Working Group on Breast Ultrasound in Germany recommends explaining the advantages of adjunct imaging to women, depending on the individual breast cancer risk. Due to the particular structure of German healthcare, quality-assured breast ultrasound would be the first choice. Possible overdiagnosis, costs, potentially increased emotional stress should be addressed. In high familial breast cancer risk, genetic counselling and an intensified early detection program should be performed. © Georg Thieme Verlag KG Stuttgart · New York.

High mammographic density is associated with an increase in stromal collagen and immune cells within the mammary epithelium.

PubMed

Huo, Cecilia W; Chew, Grace; Hill, Prue; Huang, Dexing; Ingman, Wendy; Hodson, Leigh; Brown, Kristy A; Magenau, Astrid; Allam, Amr H; McGhee, Ewan; Timpson, Paul; Henderson, Michael A; Thompson, Erik W; Britt, Kara

2015-06-04

Mammographic density (MD), after adjustment for a women's age and body mass index, is a strong and independent risk factor for breast cancer (BC). Although the BC risk attributable to increased MD is significant in healthy women, the biological basis of high mammographic density (HMD) causation and how it raises BC risk remain elusive. We assessed the histological and immunohistochemical differences between matched HMD and low mammographic density (LMD) breast tissues from healthy women to define which cell features may mediate the increased MD and MD-associated BC risk. Tissues were obtained between 2008 and 2013 from 41 women undergoing prophylactic mastectomy because of their high BC risk profile. Tissue slices resected from the mastectomy specimens were X-rayed, then HMD and LMD regions were dissected based on radiological appearance. The histological composition, aromatase immunoreactivity, hormone receptor status and proliferation status were assessed, as were collagen amount and orientation, epithelial subsets and immune cell status. HMD tissue had a significantly greater proportion of stroma, collagen and epithelium, as well as less fat, than LMD tissue did. Second harmonic generation imaging demonstrated more organised stromal collagen in HMD tissues than in LMD tissues. There was significantly more aromatase immunoreactivity in both the stromal and glandular regions of HMD tissues than in those regions of LMD tissues, although no significant differences in levels of oestrogen receptor, progesterone receptor or Ki-67 expression were detected. The number of macrophages within the epithelium or stroma did not change; however, HMD stroma exhibited less CD206(+) alternatively activated macrophages. Epithelial cell maturation was not altered in HMD samples, and no evidence of epithelial-mesenchymal transition was seen; however, there was a significant increase in vimentin(+)/CD45(+) immune cells within the epithelial layer in HMD tissues. We confirmed increased

Mammographic density and breast cancer risk in breast screening assessment cases and women with a family history of breast cancer.

PubMed

Duffy, Stephen W; Morrish, Oliver W E; Allgood, Prue C; Black, Richard; Gillan, Maureen G C; Willsher, Paula; Cooke, Julie; Duncan, Karen A; Michell, Michael J; Dobson, Hilary M; Maroni, Roberta; Lim, Yit Y; Purushothaman, Hema N; Suaris, Tamara; Astley, Susan M; Young, Kenneth C; Tucker, Lorraine; Gilbert, Fiona J

2018-01-01

Mammographic density has been shown to be a strong independent predictor of breast cancer and a causative factor in reducing the sensitivity of mammography. There remain questions as to the use of mammographic density information in the context of screening and risk management, and of the association with cancer in populations known to be at increased risk of breast cancer. To assess the association of breast density with presence of cancer by measuring mammographic density visually as a percentage, and with two automated volumetric methods, Quantra™ and VolparaDensity™. The TOMosynthesis with digital MammographY (TOMMY) study of digital breast tomosynthesis in the Breast Screening Programme of the National Health Service (NHS) of the United Kingdom (UK) included 6020 breast screening assessment cases (of whom 1158 had breast cancer) and 1040 screened women with a family history of breast cancer (of whom two had breast cancer). We assessed the association of each measure with breast cancer risk in these populations at enhanced risk, using logistic regression adjusted for age and total breast volume as a surrogate for body mass index (BMI). All density measures showed a positive association with presence of cancer and all declined with age. The strongest effect was seen with Volpara absolute density, with a significant 3% (95% CI 1-5%) increase in risk per 10 cm 3 of dense tissue. The effect of Volpara volumetric density on risk was stronger for large and grade 3 tumours. Automated absolute breast density is a predictor of breast cancer risk in populations at enhanced risk due to either positive mammographic findings or family history. In the screening context, density could be a trigger for more intensive imaging. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Mass Detection in Mammographic Images Using Wavelet Processing and Adaptive Threshold Technique.

PubMed

Vikhe, P S; Thool, V R

2016-04-01

Detection of mass in mammogram for early diagnosis of breast cancer is a significant assignment in the reduction of the mortality rate. However, in some cases, screening of mass is difficult task for radiologist, due to variation in contrast, fuzzy edges and noisy mammograms. Masses and micro-calcifications are the distinctive signs for diagnosis of breast cancer. This paper presents, a method for mass enhancement using piecewise linear operator in combination with wavelet processing from mammographic images. The method includes, artifact suppression and pectoral muscle removal based on morphological operations. Finally, mass segmentation for detection using adaptive threshold technique is carried out to separate the mass from background. The proposed method has been tested on 130 (45 + 85) images with 90.9 and 91 % True Positive Fraction (TPF) at 2.35 and 2.1 average False Positive Per Image(FP/I) from two different databases, namely Mammographic Image Analysis Society (MIAS) and Digital Database for Screening Mammography (DDSM). The obtained results show that, the proposed technique gives improved diagnosis in the early breast cancer detection.

Mammographic Screening of Women Attending a Reference Service Center in Southern Brazil.

PubMed

Romeiro Lopes, Tiara Cristina; Franca Gravena, Angela Andreia; Demitto, Marcela de Oliveira; Brischiliari, Sheila Cristina Rocha; Borghesan, Deise Helena Pelloso; Dell Agnolo, Catia Millene; Carvalho, Maria Dalva de Barros; Pelloso, Sandra Marisa

2016-01-01

To investigate the prevalence of and factors associated with performance of annual mammography by women above 40 years of age. This cross-sectional retrospective study was conducted at an oncology reference service in Southern Brazil from October 2013 to October 2014 with 525 women aged 40 years or older. The prevalence of annual mammography was 54.1%; annual mammographic screening was performed for women without private medical insurance, who were under hormone replacement therapy and who had used contraception in the past. An association was found between non-performance of breast clinical and self-examination and non-performance of mammographic screening. Use of mammography for breast cancer screening in the public health care setting proved to be accessible; nevertheless, the proportion of screened women was low, and they exhibited poor adherence to the basic measures of care recommended for breast assessment. Thus, control of breast cancer requires implementing actions targeting the population most vulnerable to non-adherence to screening in addition to continuously monitoring and assessing that population to reduce the prevalence of this disease.

Are qualitative and quantitative sleep problems associated with delinquency when controlling for psychopathic features and parental supervision?

PubMed

Backman, Heidi; Laajasalo, Taina; Saukkonen, Suvi; Salmi, Venla; Kivivuori, Janne; Aronen, Eeva T

2015-10-01

The aim of this study was to explore the relationship between sleep, including both qualitative and quantitative aspects, and delinquent behaviour while controlling for psychopathic features of adolescents and parental supervision at bedtime. We analysed data from a nationally representative sample of 4855 Finnish adolescents (mean age 15.3 years, 51% females). Sleep problems, hours of sleep and delinquency were evaluated via self-report. Psychopathic features were measured with the Antisocial Process Screening Device - Self-Report. In negative binomial regressions, gender and sleep-related variables acted as predictors for both property and violent crime after controlling for psychopathic features and parental supervision at bedtime. The results suggest that both sleep problems (at least three times per week, at least for a year) and an insufficient amount of sleep (less than 7 h) are associated with property crime and violent behaviour, and the relationship is not explained by gender, degree of parental supervision at bedtime or co-occurring psychopathic features. These results suggest that sleep difficulties and insufficient amount of sleep are associated with delinquent behaviour in adolescents. The significance of addressing sleep-related problems, both qualitative and quantitative, among adolescents is thus highlighted. Implications for a prevention technique of delinquent behaviour are discussed. © 2015 European Sleep Research Society.

Development of a sampling strategy and sample size calculation to estimate the distribution of mammographic breast density in Korean women.

PubMed

Jun, Jae Kwan; Kim, Mi Jin; Choi, Kui Son; Suh, Mina; Jung, Kyu-Won

2012-01-01

Mammographic breast density is a known risk factor for breast cancer. To conduct a survey to estimate the distribution of mammographic breast density in Korean women, appropriate sampling strategies for representative and efficient sampling design were evaluated through simulation. Using the target population from the National Cancer Screening Programme (NCSP) for breast cancer in 2009, we verified the distribution estimate by repeating the simulation 1,000 times using stratified random sampling to investigate the distribution of breast density of 1,340,362 women. According to the simulation results, using a sampling design stratifying the nation into three groups (metropolitan, urban, and rural), with a total sample size of 4,000, we estimated the distribution of breast density in Korean women at a level of 0.01% tolerance. Based on the results of our study, a nationwide survey for estimating the distribution of mammographic breast density among Korean women can be conducted efficiently.

A comparison of five methods of measuring mammographic density: a case-control study.

PubMed

Astley, Susan M; Harkness, Elaine F; Sergeant, Jamie C; Warwick, Jane; Stavrinos, Paula; Warren, Ruth; Wilson, Mary; Beetles, Ursula; Gadde, Soujanya; Lim, Yit; Jain, Anil; Bundred, Sara; Barr, Nicola; Reece, Valerie; Brentnall, Adam R; Cuzick, Jack; Howell, Tony; Evans, D Gareth

2018-02-05

High mammographic density is associated with both risk of cancers being missed at mammography, and increased risk of developing breast cancer. Stratification of breast cancer prevention and screening requires mammographic density measures predictive of cancer. This study compares five mammographic density measures to determine the association with subsequent diagnosis of breast cancer and the presence of breast cancer at screening. Women participating in the "Predicting Risk Of Cancer At Screening" (PROCAS) study, a study of cancer risk, completed questionnaires to provide personal information to enable computation of the Tyrer-Cuzick risk score. Mammographic density was assessed by visual analogue scale (VAS), thresholding (Cumulus) and fully-automated methods (Densitas, Quantra, Volpara) in contralateral breasts of 366 women with unilateral breast cancer (cases) detected at screening on entry to the study (Cumulus 311/366) and in 338 women with cancer detected subsequently. Three controls per case were matched using age, body mass index category, hormone replacement therapy use and menopausal status. Odds ratios (OR) between the highest and lowest quintile, based on the density distribution in controls, for each density measure were estimated by conditional logistic regression, adjusting for classic risk factors. The strongest predictor of screen-detected cancer at study entry was VAS, OR 4.37 (95% CI 2.72-7.03) in the highest vs lowest quintile of percent density after adjustment for classical risk factors. Volpara, Densitas and Cumulus gave ORs for the highest vs lowest quintile of 2.42 (95% CI 1.56-3.78), 2.17 (95% CI 1.41-3.33) and 2.12 (95% CI 1.30-3.45), respectively. Quantra was not significantly associated with breast cancer (OR 1.02, 95% CI 0.67-1.54). Similar results were found for subsequent cancers, with ORs of 4.48 (95% CI 2.79-7.18), 2.87 (95% CI 1.77-4.64) and 2.34 (95% CI 1.50-3.68) in highest vs lowest quintiles of VAS, Volpara and Densitas

Metabolic syndrome and mammographic density in Mexican women

PubMed Central

Rice, Megan; Biessy, Carine; Lajous, Martin; Bertrand, Kimberly A.; Tamimi, Rulla M.; Torres-Mejía, Gabriela; López-Ridaura, Ruy; Romieu, Isabelle

2014-01-01

Background Metabolic syndrome has been associated with an increased risk of breast cancer; however little is known about the association between metabolic syndrome and percent mammographic density, a strong predictor of breast cancer. Methods We analyzed cross-sectional data from 789 premenopausal and 322 postmenopausal women in the Mexican Teacher's Cohort (ESMaestras). Metabolic syndrome was defined according to the harmonized definition. We measured percent density on mammograms using a computer-assisted thresholding method. Multivariable linear regression was used to estimate the association between density and metabolic syndrome, as well as its components by state (Jalisco, Veracruz) and menopausal status (premenopausal, postmenopausal). Results Among premenopausal women in Jalisco, women with metabolic syndrome had higher percent density compared to those without after adjusting for potential confounders including BMI (difference = 4.76, 95%CI: 1.72, 7.81). Among the metabolic syndrome components, only low high-density lipoprotein levels (<50mg/dl) were associated with significantly higher percent density among premenopausal women in Jalisco (difference=4.62, 95%CI: 1.73, 7.52). Metabolic syndrome was not associated with percent density among premenopausal women in Veracruz (difference=-2.91, 95% CI: -7.19, 1.38), nor among postmenopausal women in either state. Conclusion Metabolic syndrome was associated with higher percent density among premenopausal women in Jalisco, Mexico, but was not associated with percent density among premenopausal women in Veracruz, Mexico or among postmenopausal women in either Jalisco or Veracruz. These findings provide some support for a possible role of metabolic syndrome in mammographic density among premenopausal women; however results were inconsistent across states and require further confirmation in larger studies. PMID:23682074

Menstrual and reproductive factors in relation to mammographic density: the Study of Women’s Health Across the Nation (SWAN)

PubMed Central

Butler, Lesley M.; Gold, Ellen B.; Greendale, Gail A.; Crandall, Carolyn J.; Modugno, Francesmary; Oestreicher, Nina; Quesenberry, Charles P.; Habel, Laurel A.

2009-01-01

Menstrual and reproductive factors may increase breast cancer risk through a pathway that includes increased mammographic density. We assessed whether known or suspected menstrual and reproductive breast cancer risk factors were cross-sectionally associated with mammographic density, by measuring area of radiographic density and total breast area on mammograms from 801 participants in the Study of Women’s Health Across the Nation (SWAN), a multi-ethnic cohort of pre- and early perimenopausal women. From multivariable linear regression, the following menstrual or reproductive factors were independently associated with percent mammographic density (area of dense breast/breast area): older age at menarche (β = 10.3, P < 0.01, for >13 vs. <12 years), premenstrual cravings and bloating (β = −3.36, P = 0.02), younger age at first full-term birth (β = −8.12, P < 0.01 for ≤23 years versus no births), greater number of births (β = −6.80, P < 0.01 for ≥3 births versus no births), and premenopausal status (β = 3.78, P < 0.01 versus early perimenopausal). Only number of births remained associated with percent density after adjustment for age, race/ethnicity, study site, body mass index (BMI), and smoking. In addition, stratified analyses revealed that the association with number of births was confined to women within the lowest BMI tertile (β = −12.2, P < 0.01 for ≥3 births versus no births). Our data support a mechanism for parity and breast cancer that involves mammographic density among pre- and early perimenopausal women that may be modified by body size. PMID:18066689

Features of Coping with Disease in Iranian Multiple Sclerosis Patients: a Qualitative Study.

PubMed

Dehghani, Ali; Dehghan Nayeri, Nahid; Ebadi, Abbas

2018-03-01

Introduction: Coping with disease is of the main components improving the quality of life in multiple sclerosis patients. Identifying the characteristics of this concept is based on the experiences of patients. Using qualitative research is essential to improve the quality of life. This study was conducted to explore the features of coping with the disease in patients with multiple sclerosis. Method: In this conventional content analysis study, eleven multiple sclerosis patients from Iran MS Society in Tehran (Iran) participated. Purposive sampling was used to select participants. Data were gathered using semi structured interviews. To analyze data, a conventional content analysis approach was used to identify meaning units and to make codes and categories. Results: Results showed that features of coping with disease in multiple sclerosis patients consists of (a) accepting the current situation, (b) maintenance and development of human interactions, (c) self-regulation and (d) self-efficacy. Each of these categories is composed of sub-categories and codes that showed the perception and experience of patients about the coping with disease. Conclusion: Accordingly, a unique set of features regarding features of coping with the disease were identified among the patients with multiple sclerosis. Therefore, working to ensure the emergence of, and subsequent reinforcement of these features in MS patients can be an important step in improving the adjustment and quality of their lives.

Qualitative features of the HIV-specific CD8+ T-cell response associated with immunologic control.

PubMed

Hersperger, Adam R; Migueles, Stephen A; Betts, Michael R; Connors, Mark

2011-05-01

Over the past 2 years, a clearer picture has emerged regarding the properties of HIV-specific CD8+ T cells associated with immunologic control of HIV replication. These properties represent a potential mechanism by which rare patients might control HIV replication in the absence of antiretroviral therapy. This review addresses the background and recent findings that have lead to our current understanding of these mechanism(s). Patients with immunologic control of HIV are not distinguished by targeted specificities, or greater numbers or breadth of their HIV-specific CD8+ T-cell response. For this reason, recent work has focused greater attention on qualitative features of this response. The qualitative features most closely associated with immunologic control of HIV are related to the granule-exocytosis-mediated elimination of HIV-infected CD4 T cells. The ability of HIV-specific CD8+ T cells to increase their contents of proteins known to mediate cytotoxicity, such as granzyme B and perforin, appears to be a critical means by which HIV-specific cytotoxic capacity is regulated. Investigation from multiple groups has now focused upon HIV-specific CD8+ T-cell granule-exocytosis-mediated cytotoxicity as a correlate of immunologic control of HIV. In the near future, a more detailed understanding of the qualities associated with immunologic control may provide critical insights regarding the necessary features of a response that should be stimulated by immunotherapies or T-cell-based vaccines.

An alignment method for mammographic X-ray spectroscopy under clinical conditions.

PubMed

Miyajima, S; Imagawa, K; Matsumoto, M

2002-09-01

This paper describes an alignment method for mammographic X-ray spectroscopy under clinical conditions. A pinhole, a fluorescent screen, a laser device and the case for a detector are used for alignment of the focal spot, a collimator and a detector. The method determines the line between the focal spot and the point of interest in an X-ray field radiographically. The method allows alignment for both central axis and off-axis directions.

Clinical features distinguishing grief from depressive episodes: A qualitative analysis.

PubMed

Parker, Gordon; McCraw, Stacey; Paterson, Amelia

2015-05-01

The independence or interdependence of grief and major depression has been keenly argued in relation to recent DSM definitions and encouraged the current study. We report a phenomenological study seeking to identify the experiential and phenomenological differences between depression and grief as judged qualitatively by those who had experienced clinical (n=125) or non-clinical depressive states (n=28). Analyses involving the whole sample indicated that, in contrast to grief, depression involved feelings of hopelessness and helplessness, being endless and was associated with a lack of control, having an internal self-focus impacting on self-esteem, being more severe and stressful, being marked by physical symptoms and often lacking a justifiable cause. Grief was distinguished from depression by the individual viewing their experience as natural and to be expected, a consequence of a loss, and with an external focus (i.e. the loss of the other). Some identified differences may have reflected the impact of depressive "type" (e.g. melancholia) rather than depression per se, and argue for a two-tiered model differentiating normative depressive and grief states at their base level and then "clinical" depressive and 'pathological' grief states by their associated clinical features. Comparative analyses between the clinical and non-clinical groups were limited by the latter sub-set being few in number. The provision of definitions may have shaped subjects׳ nominated differentiating features. The study identified a distinct number of phenomenological and clinical differences between grief and depression and few shared features, but more importantly, argued for the development of a two-tiered model defining both base states and clinical expressions. Copyright © 2015 Elsevier B.V. All rights reserved.

Double-blind randomized 12-month soy intervention had no effects on breast MRI fibroglandular tissue density or mammographic density

PubMed Central

Wu, Anna H.; Spicer, Darcy; Garcia, Agustin; Tseng, Chiu-Chen; Hovanessian-Larsen, Linda; Sheth, Pulin; Martin, Sue Ellen; Hawes, Debra; Russell, Christy; McDonald, Heather; Tripathy, Debu; Su, Min-Ying; Ursin, Giske; Pike, Malcolm C.

2015-01-01

Soy supplementation by breast cancer patients remains controversial. No controlled intervention studies have investigated the effects of soy supplementation on mammographic density in breast cancer patients. We conducted a double-blind, randomized, placebo-controlled intervention study in previously treated breast cancer patients (n=66) and high-risk women (n=29). We obtained digital mammograms and breast magnetic resonance imaging (MRI) scans at baseline and after 12 months of daily soy (50 mg isoflavones per day) (n=46) or placebo (n=49) tablet supplementation. The total breast area (MA) and the area of mammographic density (MD) on the mammogram was measured using a validated computer-assisted method, and mammographic density percent (MD% = 100 × MD/MA) was determined. A well-tested computer algorithm was used to quantitatively measure the total breast volume (TBV) and fibroglandular tissue volume (FGV) on the breast MRI, and the FGV percent (FGV% = 100 × FGV/TBV) was calculated. On the basis of plasma soy isoflavone levels, compliance was excellent. Small decreases in MD% measured by the ratios of month 12 to baseline levels, were seen in the soy (0.95) and the placebo (0.87) groups; these changes did not differ between the treatments (P=0.38). Small decreases in FGV% were also found in both the soy (0.90) and the placebo (0.92) groups; these changes also did not differ between the treatments (P=0.48). Results were comparable in breast cancer patients and high-risk women. We found no evidence that soy supplementation would decrease mammographic density and that MRI might be more sensitive to changes in density than mammography. PMID:26276750

Cytochrome P450 1A2 (CYP1A2) activity, mammographic density, and oxidative stress: a cross-sectional study

PubMed Central

Hong, Chi-Chen; Tang, Bing-Kou; Rao, Venketeshwer; Agarwal, Sanjiv; Martin, Lisa; Tritchler, David; Yaffe, Martin; Boyd, Norman F

2004-01-01

Introduction Mammographically dense breast tissue is a strong predictor of breast cancer risk, and is influenced by both mitogens and mutagens. One enzyme that is able to affect both the mitogenic and mutagenic characteristics of estrogens is cytochrome P450 1A2 (CYP1A2), which is principally responsible for the metabolism of 17β-estradiol. Methods In a cross-sectional study of 146 premenopausal and 149 postmenopausal women, we examined the relationships between CYP1A2 activity, malondialdehyde (MDA) levels, and mammographic density. In vivo CYP1A2 activity was assessed by measuring caffeine metabolites in urine. Levels of serum and urinary MDA, and MDA–deoxyguanosine adducts in DNA were measured. Mammograms were digitized and measured using a computer-assisted method. Results CYP1A2 activity in postmenopausal women, but not in premenopausal women, was positively associated with mammographic density, suggesting that increased CYP1A2 activity after the menopause is a risk factor for breast cancer. In premenopausal women, but not in postmenopausal women, CYP1A2 activity was positively associated with serum and urinary MDA levels; there was also some evidence that CYP1A2 activity was more positively associated with percentage breast density when MDA levels were high, and more negatively associated with percentage breast density when MDA levels were low. Conclusion These findings provide further evidence that variation in the activity level of enzymes involved in estrogen metabolism is related to levels of mammographic density and potentially to breast cancer risk. PMID:15217501

Varying performance in mammographic interpretation across two countries: Do results indicate reader or population variances?

NASA Astrophysics Data System (ADS)

Soh, BaoLin P.; Lee, Warwick B.; Wong, Jill; Sim, Llewellyn; Hillis, Stephen L.; Tapia, Kriscia A.; Brennan, Patrick C.

2016-03-01

Aim: To compare the performance of Australian and Singapore breast readers interpreting a single test-set that consisted of mammographic examinations collected from the Australian population. Background: In the teleradiology era, breast readers are interpreting mammographic examinations from different populations. The question arises whether two groups of readers with similar training backgrounds, demonstrate the same level of performance when presented with a population familiar only to one of the groups. Methods: Fifty-three Australian and 15 Singaporean breast radiologists participated in this study. All radiologists were trained in mammogram interpretation and had a median of 9 and 15 years of experience in reading mammograms respectively. Each reader interpreted the same BREAST test-set consisting of sixty de-identified mammographic examinations arising from an Australian population. Performance parameters including JAFROC, ROC, case sensitivity as well as specificity were compared between Australian and Singaporean readers using a Mann Whitney U test. Results: A significant difference (P=0.036) was demonstrated between the JAFROC scores of the Australian and Singaporean breast radiologists. No other significant differences were observed. Conclusion: JAFROC scores for Australian radiologists were higher than those obtained by the Singaporean counterparts. Whilst it is tempting to suggest this is down to reader expertise, this may be a simplistic explanation considering the very similar training and audit backgrounds of the two populations of radiologists. The influence of reading images that are different from those that radiologists normally encounter cannot be ruled out and requires further investigation, particularly in the light of increasing international outsourcing of radiologic reporting.

Force balancing in mammographic compression

DOE Office of Scientific and Technical Information (OSTI.GOV)

Branderhorst, W., E-mail: w.branderhorst@amc.nl; Groot, J. E. de; Lier, M. G. J. T. B. van

Purpose: In mammography, the height of the image receptor is adjusted to the patient before compressing the breast. An inadequate height setting can result in an imbalance between the forces applied by the image receptor and the paddle, causing the clamped breast to be pushed up or down relative to the body during compression. This leads to unnecessary stretching of the skin and other tissues around the breast, which can make the imaging procedure more painful for the patient. The goal of this study was to implement a method to measure and minimize the force imbalance, and to assess itsmore » feasibility as an objective and reproducible method of setting the image receptor height. Methods: A trial was conducted consisting of 13 craniocaudal mammographic compressions on a silicone breast phantom, each with the image receptor positioned at a different height. The image receptor height was varied over a range of 12 cm. In each compression, the force exerted by the compression paddle was increased up to 140 N in steps of 10 N. In addition to the paddle force, the authors measured the force exerted by the image receptor and the reaction force exerted on the patient body by the ground. The trial was repeated 8 times, with the phantom remounted at a slightly different orientation and position between the trials. Results: For a given paddle force, the obtained results showed that there is always exactly one image receptor height that leads to a balance of the forces on the breast. For the breast phantom, deviating from this specific height increased the force imbalance by 9.4 ± 1.9 N/cm (6.7%) for 140 N paddle force, and by 7.1 ± 1.6 N/cm (17.8%) for 40 N paddle force. The results also show that in situations where the force exerted by the image receptor is not measured, the craniocaudal force imbalance can still be determined by positioning the patient on a weighing scale and observing the changes in displayed weight during the procedure. Conclusions: In mammographic

Recognition of lesion correspondence on two mammographic views: a new method of false-positive reduction for computerized mass detection

NASA Astrophysics Data System (ADS)

Sahiner, Berkman; Petrick, Nicholas; Chan, Heang-Ping; Paquerault, Sophie; Helvie, Mark A.; Hadjiiski, Lubomir M.

2001-07-01

We used the correspondence of detected structures on two views of the same breast for false-positive (FP) reduction in computerized detection of mammographic masses. For each initially detected object on one view, we considered all possible pairings with objects on the other view that fell within a radial band defined by the nipple-to-object distances. We designed a 'correspondence classifier' to classify these pairs as either the same mass (a TP-TP pair) or a mismatch (a TP-FP, FP-TP or FP-FP pair). For each pair, similarity measures of morphological and texture features were derived and used as input features in the correspondence classifier. Two-view mammograms from 94 cases were used as a preliminary data set. Initial detection provided 6.3 FPs/image at 96% sensitivity. Further FP reduction in single view resulted in 1.9 FPs/image at 80% sensitivity and 1.1 FPs/image at 70% sensitivity. By combining single-view detection with the correspondence classifier, detection accuracy improved to 1.5 FPs/image at 80% sensitivity and 0.7 FPs/image at 70% sensitivity. Our preliminary results indicate that the correspondence of geometric, morphological, and textural features of a mass on two different views provides valuable additional information for reducing FPs.

Mammographic density defined by higher than conventional brightness thresholds better predicts breast cancer risk

PubMed Central

Nguyen, Tuong L; Aung, Ye K; Evans, Christopher F; Dite, Gillian S; Stone, Jennifer; MacInnis, Robert J; Dowty, James G; Bickerstaffe, Adrian; Aujard, Kelly; Rommens, Johanna M; Song, Yun-Mi; Sung, Joohon; Jenkins, Mark A; Southey, Melissa C; Giles, Graham G; Apicella, Carmel; Hopper, John L

2017-01-01

Abstract Background: Mammographic density defined by the conventional pixel brightness threshold, and adjusted for age and body mass index (BMI), is a well-established risk factor for breast cancer. We asked if higher thresholds better separate women with and without breast cancer. Methods: We studied Australian women, 354 with breast cancer over-sampled for early-onset and family history, and 944 unaffected controls frequency-matched for age at mammogram. We measured mammographic dense area and percent density using the CUMULUS software at the conventional threshold, which we call Cumulus, and at two increasingly higher thresholds, which we call Altocumulus and Cirrocumulus, respectively. All measures were Box–Cox transformed and adjusted for age and BMI. We estimated the odds per adjusted standard deviation (OPERA) using logistic regression and the area under the receiver operating characteristic curve (AUC). Results: Altocumulus and Cirrocumulus were correlated with Cumulus (r ∼ 0.8 and 0.6, respectively). For dense area, the OPERA was 1.62, 1.74 and 1.73 for Cumulus, Altocumulus and Cirrocumulus, respectively (all P < 0.001). After adjusting for Altocumulus and Cirrocumulus, Cumulus was not significant (P > 0.6). The OPERAs for percent density were less but gave similar findings. The mean of the standardized adjusted Altocumulus and Cirrocumulus dense area measures was the best predictor; OPERA = 1.87 [95% confidence interval (CI): 1.64–2.14] and AUC = 0.68 (0.65–0.71). Conclusions: The areas of higher mammographically dense regions are associated with almost 30% stronger breast cancer risk gradient, explain the risk association of the conventional measure and might be more aetiologically important. This has substantial implications for clinical translation and molecular, genetic and epidemiological research. PMID:28338721

Mammographic density defined by higher than conventional brightness thresholds better predicts breast cancer risk.

PubMed

Nguyen, Tuong L; Aung, Ye K; Evans, Christopher F; Dite, Gillian S; Stone, Jennifer; MacInnis, Robert J; Dowty, James G; Bickerstaffe, Adrian; Aujard, Kelly; Rommens, Johanna M; Song, Yun-Mi; Sung, Joohon; Jenkins, Mark A; Southey, Melissa C; Giles, Graham G; Apicella, Carmel; Hopper, John L

2017-04-01

Mammographic density defined by the conventional pixel brightness threshold, and adjusted for age and body mass index (BMI), is a well-established risk factor for breast cancer. We asked if higher thresholds better separate women with and without breast cancer. We studied Australian women, 354 with breast cancer over-sampled for early-onset and family history, and 944 unaffected controls frequency-matched for age at mammogram. We measured mammographic dense area and percent density using the CUMULUS software at the conventional threshold, which we call Cumulus , and at two increasingly higher thresholds, which we call Altocumulus and Cirrocumulus , respectively. All measures were Box-Cox transformed and adjusted for age and BMI. We estimated the odds per adjusted standard deviation (OPERA) using logistic regression and the area under the receiver operating characteristic curve (AUC). Altocumulus and Cirrocumulus were correlated with Cumulus (r ∼ 0.8 and 0.6 , respectively) . For dense area, the OPERA was 1.62, 1.74 and 1.73 for Cumulus, Altocumulus and Cirrocumulus , respectively (all P  < 0.001). After adjusting for Altocumulus and Cirrocumulus , Cumulus was not significant ( P  > 0.6). The OPERAs for percent density were less but gave similar findings. The mean of the standardized adjusted Altocumulus and Cirrocumulus dense area measures was the best predictor; OPERA = 1.87 [95% confidence interval (CI): 1.64-2.14] and AUC = 0.68 (0.65-0.71). The areas of higher mammographically dense regions are associated with almost 30% stronger breast cancer risk gradient, explain the risk association of the conventional measure and might be more aetiologically important. This has substantial implications for clinical translation and molecular, genetic and epidemiological research. © The Author 2016. Published by Oxford University Press on behalf of the International Epidemiological Association

Radiologists' preferences for digital mammographic display. The International Digital Mammography Development Group.

PubMed

Pisano, E D; Cole, E B; Major, S; Zong, S; Hemminger, B M; Muller, K E; Johnston, R E; Walsh, R; Conant, E; Fajardo, L L; Feig, S A; Nishikawa, R M; Yaffe, M J; Williams, M B; Aylward, S R

2000-09-01

To determine the preferences of radiologists among eight different image processing algorithms applied to digital mammograms obtained for screening and diagnostic imaging tasks. Twenty-eight images representing histologically proved masses or calcifications were obtained by using three clinically available digital mammographic units. Images were processed and printed on film by using manual intensity windowing, histogram-based intensity windowing, mixture model intensity windowing, peripheral equalization, multiscale image contrast amplification (MUSICA), contrast-limited adaptive histogram equalization, Trex processing, and unsharp masking. Twelve radiologists compared the processed digital images with screen-film mammograms obtained in the same patient for breast cancer screening and breast lesion diagnosis. For the screening task, screen-film mammograms were preferred to all digital presentations, but the acceptability of images processed with Trex and MUSICA algorithms were not significantly different. All printed digital images were preferred to screen-film radiographs in the diagnosis of masses; mammograms processed with unsharp masking were significantly preferred. For the diagnosis of calcifications, no processed digital mammogram was preferred to screen-film mammograms. When digital mammograms were preferred to screen-film mammograms, radiologists selected different digital processing algorithms for each of three mammographic reading tasks and for different lesion types. Soft-copy display will eventually allow radiologists to select among these options more easily.

Possible effects of insulin-like growth factor-I, IGF-binding protein-3 and IGF-1/IGFBP-3 molar ratio on mammographic density: a cross-sectional study.

PubMed

Meggiorini, M L; Cipolla, V; Borgoni, G; Nofroni, I; Pala, A; de Felice, C

2012-01-01

The purpose of this study was to examine the possible effects of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio on mammographic density and assess whether this relationship was similar in subgroups of pre- and postmenopausal women. A group of 341 Italian women of childbearing age or naturally postmenopausal who had performed mammographic examination at the section of radiology of our department a maximum three months prior to recruitment were enrolled. A blood sample was drawn for determination of IGF-1, IGFBP-3 levels and IGF-1/IGFBP-3 molar ratio was calculated. On the basis of recent mammograms the women were divided into two groups: dense breast (DB) and non-dense breast (NDB). To assess the association between mammographic density and IGF-1, IGFBP-3 and Molar ratio Student's t-test was employed before and after stratified by menopausal status. The analysis of the relationship between mammographic density and plasma levels of IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio showed that IGF-1 levels and molar ratio varied in the two groups resulting in higher mean values in the DB group whereas IGFBP-3 showed similar values in both groups (DB and NDB). After stratification of the study population by menopausal status, no association was found. Our study provides strong evidence of a crude association between breast density, and plasma levels of IGF-1 and molar ratio. IGF-1 and molar ratio might increase mammographic density and thus the risk of developing breast cancer.

The combined effect of mammographic texture and density on breast cancer risk: a cohort study.

PubMed

Wanders, Johanna O P; van Gils, Carla H; Karssemeijer, Nico; Holland, Katharina; Kallenberg, Michiel; Peeters, Petra H M; Nielsen, Mads; Lillholm, Martin

2018-05-02

Texture patterns have been shown to improve breast cancer risk segregation in addition to area-based mammographic density. The additional value of texture pattern scores on top of volumetric mammographic density measures in a large screening cohort has never been studied. Volumetric mammographic density and texture pattern scores were assessed automatically for the first available digital mammography (DM) screening examination of 51,400 women (50-75 years of age) participating in the Dutch biennial breast cancer screening program between 2003 and 2011. The texture assessment method was developed in a previous study and validated in the current study. Breast cancer information was obtained from the screening registration system and through linkage with the Netherlands Cancer Registry. All screen-detected breast cancers diagnosed at the first available digital screening examination were excluded. During a median follow-up period of 4.2 (interquartile range (IQR) 2.0-6.2) years, 301 women were diagnosed with breast cancer. The associations between texture pattern scores, volumetric breast density measures and breast cancer risk were determined using Cox proportional hazard analyses. Discriminatory performance was assessed using c-indices. The median age of the women at the time of the first available digital mammography examination was 56 years (IQR 51-63). Texture pattern scores were positively associated with breast cancer risk (hazard ratio (HR) 3.16 (95% CI 2.16-4.62) (p value for trend <0.001), for quartile (Q) 4 compared to Q1). The c-index of texture was 0.61 (95% CI 0.57-0.64). Dense volume and percentage dense volume showed positive associations with breast cancer risk (HR 1.85 (95% CI 1.32-2.59) (p value for trend <0.001) and HR 2.17 (95% CI 1.51-3.12) (p value for trend <0.001), respectively, for Q4 compared to Q1). When adding texture measures to models with dense volume or percentage dense volume, c-indices increased from 0.56 (95% CI 0.53-0.59) to 0

Features of a Health-Oriented Education Program during Daily Commutes: A Qualitative Study.

PubMed

Ramezankhani, Ali; Heydarabadi, Akbar Babaei; Ghaffari, Mohtasham; Mehrabi, Yadollah; Kazemi, Sadegh

2016-06-01

Today, despite scientific advances, many people spend more time and distance between home and their workplaces because of various economic and population reasons. The aim of this study was to identify features of an appropriate health education program during commutes for factory staff at Ardakan county (Yazd province, Iran). This qualitative study was conducted via the phenomenological method in 2014. The population of this study was members of the staff of Ardakan Steel Company. Nineteen specialists and 11 members of the factory's staff were invited to participate in the study, and data were collected using semi-structured interviews. The interviews took 20 to 40 minutes, and their content was analyzed using content analysis. Extraction of codes and themes and their placement in this study showed that an educational program during commutes should have nine features to have the desired effectiveness, i.e., the program must be audience-oriented, repeatable, participatory, technology-based, combinational, supportive, and motivational and interesting. Also, the program should have environmental and organizational support, and it must be evaluated for its effectiveness. Considering appropriate features of a health education program in educational situations, especially interventions related to daily commutes, is very important because the effectiveness of such health-oriented educational programs must be ensured.

Quantitative and qualitative features of heterologous virus-vector-induced antigen-specific CD8+ T cells against Trypanosoma cruzi infection.

PubMed

Takayama, Eiji; Ono, Takeshi; Carnero, Elena; Umemoto, Saori; Yamaguchi, Yoko; Kanayama, Atsuhiro; Oguma, Takemi; Takashima, Yasuhiro; Tadakuma, Takushi; García-Sastre, Adolfo; Miyahira, Yasushi

2010-11-01

We studied some aspects of the quantitative and qualitative features of heterologous recombinant (re) virus-vector-induced, antigen-specific CD8(+) T cells against Trypanosoma cruzi. We used three different, highly attenuated re-viruses, i.e., influenza virus, adenovirus and vaccinia virus, which all expressed a single, T. cruzi antigen-derived CD8(+) T-cell epitope. The use of two out of three vectors or the triple virus-vector vaccination regimen not only confirmed that the re-vaccinia virus, which was placed last in order for sequential immunisation, was an effective booster for the CD8(+) T-cell immunity in terms of the number of antigen-specific CD8(+) T cells, but also demonstrated that (i) the majority of cells exhibit the effector memory (T(EM)) phenotype, (ii) robustly secrete IFN-γ, (iii) express higher intensity of the CD122 molecule and (iv) present protective activity against T. cruzi infection. In contrast, placing the re-influenza virus last in sequential immunisation had a detrimental effect on the quantitative and qualitative features of CD8(+) T cells. The triple virus-vector vaccination was more effective at inducing a stronger CD8(+) T-cell immunity than using two re-viruses. The different quantitative and qualitative features of CD8(+) T cells induced by different immunisation regimens support the notion that the refinement of the best choice of multiple virus-vector combinations is indispensable for the induction of a maximum number of CD8(+) T cells of high quality. Copyright © 2010 Australian Society for Parasitology Inc. All rights reserved.

Prevalence of Mammographically Dense Breasts in the United States

PubMed Central

Gangnon, Ronald E.; Burt, Veronica; Trentham-Dietz, Amy; Hampton, John M.; Wellman, Robert D.; Kerlikowske, Karla; Miglioretti, Diana L.

2014-01-01

Background National legislation is under consideration that would require women with mammographically dense breasts to be informed of their breast density and encouraged to discuss supplemental breast cancer screening with their health care providers. The number of US women potentially affected by this legislation is unknown. Methods We determined the mammographic breast density distribution by age and body mass index (BMI) using data from 1518 599 mammograms conducted from 2007 through 2010 at mammography facilities in the Breast Cancer Surveillance Consortium (BCSC). We applied these breast density distributions to age- and BMI-specific counts of the US female population derived from the 2010 US Census and the National Health and Nutrition Examination Survey (NHANES) to estimate the number of US women with dense breasts. Results Overall, 43.3% (95% confidence interval [CI] = 43.1% to 43.4%) of women 40 to 74 years of age had heterogeneously or extremely dense breasts, and this proportion was inversely associated with age and BMI. Based on the age and BMI distribution of US women, we estimated that 27.6 million women (95% CI = 27.5 to 27.7 million) aged 40 to 74 years in the United States have heterogeneously or extremely dense breasts. Women aged 40 to 49 years (N = 12.3 million) accounted for 44.3% of this group. Conclusion The prevalence of dense breasts among US women of common breast cancer screening ages exceeds 25 million. Policymakers and healthcare providers should consider this large prevalence when debating breast density notification legislation and designing strategies to ensure that women who are notified have opportunities to evaluate breast cancer risk and discuss and pursue supplemental screening options if deemed appropriate. PMID:25217577

Formulating qualitative features using interactive visualization for analysis of multivariate spatiotemporal data

NASA Astrophysics Data System (ADS)

Porter, M.; Hill, M. C.; Pierce, S. A.; Gil, Y.; Pennington, D. D.

2017-12-01

DiscoverWater is a web-based visualization tool developed to enable the visual representation of data, and thus, aid scientific and societal understanding of hydrologic systems. Open data sources are coalesced to, for example, illustrate the impacts on streamflow of irrigation withdrawals. Scientists and stakeholders are informed through synchronized time-series data plots that correlate multiple spatiotemporal datasets and an interactive time-evolving map that provides a spatial analytical context. Together, these components elucidate trends so that the user can try to envision the relations between groundwater-surface water interactions, the impacts of pumping on these interactions, and the interplay of climate. Aligning data in this manner has the capacity for interdisciplinary knowledge discovery and motivates dialogue about system processes that we seek to enhance through qualitative features informed through quantitative models. DiscoverWater and its connection is demonstrated using two field cases. First, it is used to visualize data sets from the High Plains aquifer, where reservoir- and groundwater-supported irrigation has affected the Arkansas River in western Kansas. Second, data and model results from Barton Springs segment of the Edwards aquifer in Texas reveal the effects of regional pumping on this important urbanizing aquifer system. Identifying what is interesting about the data and the modeled system in the two different case studies is a step towards moving typically static visualization capabilities to an adaptive framework. Additionally, the dashboard interface incorporates both quantitative and qualitative information about distinctive case studies in a machine-readable form, such that a catalog of qualitative models can capture subject matter expertise alongside associated datasets. As the catalog is expanded to include other case studies, the collection has potential to establish a standard framework able to inform intelligent system

Identification of a novel percent mammographic density locus at 12q24.

PubMed

Stevens, Kristen N; Lindstrom, Sara; Scott, Christopher G; Thompson, Deborah; Sellers, Thomas A; Wang, Xianshu; Wang, Alice; Atkinson, Elizabeth; Rider, David N; Eckel-Passow, Jeanette E; Varghese, Jajini S; Audley, Tina; Brown, Judith; Leyland, Jean; Luben, Robert N; Warren, Ruth M L; Loos, Ruth J F; Wareham, Nicholas J; Li, Jingmei; Hall, Per; Liu, Jianjun; Eriksson, Louise; Czene, Kamila; Olson, Janet E; Pankratz, V Shane; Fredericksen, Zachary; Diasio, Robert B; Lee, Adam M; Heit, John A; DeAndrade, Mariza; Goode, Ellen L; Vierkant, Robert A; Cunningham, Julie M; Armasu, Sebastian M; Weinshilboum, Richard; Fridley, Brooke L; Batzler, Anthony; Ingle, James N; Boyd, Norman F; Paterson, Andrew D; Rommens, Johanna; Martin, Lisa J; Hopper, John L; Southey, Melissa C; Stone, Jennifer; Apicella, Carmel; Kraft, Peter; Hankinson, Susan E; Hazra, Aditi; Hunter, David J; Easton, Douglas F; Couch, Fergus J; Tamimi, Rulla M; Vachon, Celine M

2012-07-15

Percent mammographic density adjusted for age and body mass index (BMI) is one of the strongest risk factors for breast cancer and has a heritable component that remains largely unidentified. We performed a three-stage genome-wide association study (GWAS) of percent mammographic density to identify novel genetic loci associated with this trait. In stage 1, we combined three GWASs of percent density comprised of 1241 women from studies at the Mayo Clinic and identified the top 48 loci (99 single nucleotide polymorphisms). We attempted replication of these loci in 7018 women from seven additional studies (stage 2). The meta-analysis of stage 1 and 2 data identified a novel locus, rs1265507 on 12q24, associated with percent density, adjusting for age and BMI (P = 4.43 × 10(-8)). We refined the 12q24 locus with 459 additional variants (stage 3) in a combined analysis of all three stages (n = 10 377) and confirmed that rs1265507 has the strongest association in the 12q24 region (P = 1.03 × 10(-8)). Rs1265507 is located between the genes TBX5 and TBX3, which are members of the phylogenetically conserved T-box gene family and encode transcription factors involved in developmental regulation. Understanding the mechanism underlying this association will provide insight into the genetics of breast tissue composition.

Identification of a novel percent mammographic density locus at 12q24

PubMed Central

Stevens, Kristen N.; Lindstrom, Sara; Scott, Christopher G.; Thompson, Deborah; Sellers, Thomas A.; Wang, Xianshu; Wang, Alice; Atkinson, Elizabeth; Rider, David N.; Eckel-Passow, Jeanette E.; Varghese, Jajini S.; Audley, Tina; Brown, Judith; Leyland, Jean; Luben, Robert N.; Warren, Ruth M.L.; Loos, Ruth J.F.; Wareham, Nicholas J.; Li, Jingmei; Hall, Per; Liu, Jianjun; Eriksson, Louise; Czene, Kamila; Olson, Janet E.; Shane Pankratz, V.; Fredericksen, Zachary; Diasio, Robert B.; Lee, Adam M.; Heit, John A.; deAndrade, Mariza; Goode, Ellen L.; Vierkant, Robert A.; Cunningham, Julie M.; Armasu, Sebastian M.; Weinshilboum, Richard; Fridley, Brooke L.; Batzler, Anthony; Ingle, James N.; Boyd, Norman F.; Paterson, Andrew D.; Rommens, Johanna; Martin, Lisa J.; Hopper, John L.; Southey, Melissa C.; Stone, Jennifer; Apicella, Carmel; Kraft, Peter; Hankinson, Susan E.; Hazra, Aditi; Hunter, David J.; Easton, Douglas F.; Couch, Fergus J.; Tamimi, Rulla M.; Vachon, Celine M.

2012-01-01

Percent mammographic density adjusted for age and body mass index (BMI) is one of the strongest risk factors for breast cancer and has a heritable component that remains largely unidentified. We performed a three-stage genome-wide association study (GWAS) of percent mammographic density to identify novel genetic loci associated with this trait. In stage 1, we combined three GWASs of percent density comprised of 1241 women from studies at the Mayo Clinic and identified the top 48 loci (99 single nucleotide polymorphisms). We attempted replication of these loci in 7018 women from seven additional studies (stage 2). The meta-analysis of stage 1 and 2 data identified a novel locus, rs1265507 on 12q24, associated with percent density, adjusting for age and BMI (P = 4.43 × 10−8). We refined the 12q24 locus with 459 additional variants (stage 3) in a combined analysis of all three stages (n = 10 377) and confirmed that rs1265507 has the strongest association in the 12q24 region (P = 1.03 × 10−8). Rs1265507 is located between the genes TBX5 and TBX3, which are members of the phylogenetically conserved T-box gene family and encode transcription factors involved in developmental regulation. Understanding the mechanism underlying this association will provide insight into the genetics of breast tissue composition. PMID:22532574

Correlates of mammographic density in B-mode ultrasound and real time elastography.

PubMed

Jud, Sebastian Michael; Häberle, Lothar; Fasching, Peter A; Heusinger, Katharina; Hack, Carolin; Faschingbauer, Florian; Uder, Michael; Wittenberg, Thomas; Wagner, Florian; Meier-Meitinger, Martina; Schulz-Wendtland, Rüdiger; Beckmann, Matthias W; Adamietz, Boris R

2012-07-01

The aim of our study involved the assessment of B-mode imaging and elastography with regard to their ability to predict mammographic density (MD) without X-rays. Women, who underwent routine mammography, were prospectively examined with additional B-mode ultrasound and elastography. MD was assessed quantitatively with a computer-assisted method (Madena). The B-mode and elastography images were assessed by histograms with equally sized gray-level intervals. Regression models were built and cross validated to examine the ability to predict MD. The results of this study showed that B-mode imaging and elastography were able to predict MD. B-mode seemed to give a more accurate prediction. R for B-mode image and elastography were 0.67 and 0.44, respectively. Areas in the B-mode images that correlated with mammographic dense areas were either dark gray or of intermediate gray levels. Concerning elastography only the gray levels that represent extremely stiff tissue correlated positively with MD. In conclusion, ultrasound seems to be able to predict MD. Easy and cheap utilization of regular breast ultrasound machines encourages the use of ultrasound in larger case-control studies to validate this method as a breast cancer risk predictor. Furthermore, the application of ultrasound for breast tissue characterization could enable comprehensive research concerning breast cancer risk and breast density in young and pregnant women.

Mammographic Density Reduction as a Prognostic Marker for Postmenopausal Breast Cancer: Results Using a Joint Longitudinal-Survival Modeling Approach.

PubMed

Andersson, Therese M-L; Crowther, Michael J; Czene, Kamila; Hall, Per; Humphreys, Keith

2017-11-01

Previous studies have linked reductions in mammographic density after a breast cancer diagnosis to an improved prognosis. These studies focused on short-term change, using a 2-stage process, treating estimated change as a fixed covariate in a survival model. We propose the use of a joint longitudinal-survival model. This enables us to model long-term trends in density while accounting for dropout as well as for measurement error. We studied the change in mammographic density after a breast cancer diagnosis and its association with prognosis (measured by cause-specific mortality), overall and with respect to hormone replacement therapy and tamoxifen treatment. We included 1,740 women aged 50-74 years, diagnosed with breast cancer in Sweden during 1993-1995, with follow-up until 2008. They had a total of 6,317 mammographic density measures available from the first 5 years of follow-up, including baseline measures. We found that the impact of the withdrawal of hormone replacement therapy on density reduction was larger than that of tamoxifen treatment. Unlike previous studies, we found that there was an association between density reduction and survival, both for tamoxifen-treated women and women who were not treated with tamoxifen. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

Using tumor phenotype, histological tumor distribution, and mammographic appearance to explain the survival differences between screen-detected and clinically detected breast cancers.

PubMed

Chuang, Shu-Lin; Chen, Sam Li-Sheng; Yu, Cheng-Ping; Chang, King-Jen; Yen, Amy Ming-Fang; Chiu, Sherry Yueh-Hsia; Fann, Jean Ching-Yuan; Tabár, László; Stephen, Duffy W; Smith, Robert A; Chen, Hsiu-Hsi

2014-08-01

In the era of mass screening for breast cancer with mammography, it has been noted that conventional tumor attributes and mammographic appearance are insufficient to account for the better prognosis of screen-detected tumors. Such prognostication may require additional updated pathological information regarding tumor phenotype (e.g., basal status) and histological tumor distribution (focality). We investigated this hypothesis using a Bayesian approach to analyze breast cancer data from Dalarna County, Sweden. We used data for tumors diagnosed in the Swedish Two-County Trial and early service screening period, 1977-1995, and from the mature service screening period, 1996-1998. In the early period of mammographic screening (1977-1995), the crude hazard ratio (HR) of breast cancer death for screen-detected cases compared with symptomatic ones was 0.22 (95% CI: 0.17-0.29) compared with 0.53 (95% CI: 0.34-0.76) when adjusted for conventional tumor attributes only. Using the data from the mature service screening period, 1996-1998, the HR was 0.23 (95% CI: 0.08-0.44) unadjusted and 0.71 (95% CI: 0.26-1.47) after adjustment for tumor phenotype, mammographic appearance, histological tumor distribution, and conventional tumor attributes. The area under the ROC curve (AUC) for the prediction of breast cancer deaths using these variables without the detection mode was 0.82, only slightly less than that observed when additionally including the detection mode (AUC=0.83). Using Freedman statistics, conventional tumor attributes and mammographic appearances explained 58% (95% CI: 57.5-58.6%) of the difference of breast cancer survival between the screen-detected and the clinically detected breast cancers, whereas the corresponding figure was increased to 77% (95% CI: 75.6-77.6%) when adding the two information on tumor phenotype and histological tumor distribution. The results indicated that conventional tumor attributes and mammographic appearance are not sufficient to be

Combined effects of endogenous sex hormone levels and mammographic density on postmenopausal breast cancer risk: results from the Breakthrough Generations Study

PubMed Central

Schoemaker, M J; Folkerd, E J; Jones, M E; Rae, M; Allen, S; Ashworth, A; Dowsett, M; Swerdlow, A J

2014-01-01

Background: Mammographic density and sex hormone levels are strong risk factors for breast cancer, but it is unclear whether they represent the same aetiological entity or are independent risk factors. Methods: Within the Breakthrough Generations Study cohort, we conducted a case–control study of 265 postmenopausal breast cancer cases and 343 controls with prediagnostic mammograms and blood samples. Plasma was assayed for oestradiol, testosterone and sex hormone-binding globulin (SHBG) concentrations and mammographic density assessed by Cumulus. Results: Oestradiol and testosterone were negatively and SHBG positively associated with percentage density and absolute dense area, but after adjusting for body mass index the associations remained significant only for SHBG. Breast cancer risk was independently and significantly positively associated with percentage density (P=0.002), oestradiol (P=0.002) and testosterone (P=0.007) levels. Women in the highest tertile of both density and sex hormone level were at greatest risk, with an odds ratio of 7.81 (95% confidence interval (CI): 2.89–21.1) for oestradiol and 4.57 (95% CI: 1.75–11.9) for testosterone and high density compared with those who were in the lowest tertiles. The cumulative risk of breast cancer in the highest oestradiol and density tertiles, representing 8% of controls, was estimated as 12.8% at ages 50–69 years and 19.4% at ages 20–79 years, and in the lowest tertiles was 1.7% and 4.3%, respectively. Associations of breast cancer risk with tertiles of mammographic dense area were less strong than for percentage density. Conclusions: Endogenous sex hormone levels and mammographic density are independent risk factors for postmenopausal breast cancer, which in combination can identify women who might benefit from increased frequency of screening and chemoprophylaxis. PMID:24518596

Long-term effect of oncoplastic breast-conserving surgery using latissimus dorsi miniflaps on mammographic surveillance and the detection of local recurrence.

PubMed

Mele, S; Wright, D; Paramanathan, N; Laws, S; Peiris, L; Rainsbury, R

2017-09-01

Latissimus dorsi miniflap is a breast-conserving volume replacement technique for the reconstruction of large breast defects. While mammographic features of miniflap reconstruction have been described, little is known about the incidence, mode of presentation and size of local recurrence after this procedure. This study aimed to investigate the impact of latissimus dorsi miniflap reconstruction on the frequency, presentation and detection of local recurrence. Clinical, radiological and pathological data were reviewed in 261 patients. Complete records were available for 11 patients developing local recurrence, including mode, time of presentation and size of the recurrent tumours. All mammograms before and after local recurrence were assessed in relation to a range of specific characteristics including parenchymal density, flap visibility, architectural distortion, mass, calcifications, fat necrosis, skin thickening and breast oedema. Twenty-one patients developed local recurrence at 10.4 years following reconstruction (mean age 49 years, resection weight 182 g and tumour size 33 mm). Following radiotherapy, 0.5% of patients developed local recurrence each year, which increased five-fold when radiotherapy was omitted (HR 4.99). Local recurrences were diagnosed in five patients by mammography alone, in three by mammography and palpable lump, and in three by palpable lump alone. They were detected when small (15 mm) and were associated with new mammographic abnormalities in 10 patients. Long follow-up demonstrates that latissimus dorsi miniflap reconstruction allows oncologically safe breast conservation when combined with postoperative radiotherapy. Local recurrences are detected early, either by mammography, clinical examination or both, and detection is not compromised by the presence of a flap. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Introduction of an automated user-independent quantitative volumetric magnetic resonance imaging breast density measurement system using the Dixon sequence: comparison with mammographic breast density assessment.

PubMed

Wengert, Georg Johannes; Helbich, Thomas H; Vogl, Wolf-Dieter; Baltzer, Pascal; Langs, Georg; Weber, Michael; Bogner, Wolfgang; Gruber, Stephan; Trattnig, Siegfried; Pinker, Katja

2015-02-01

The purposes of this study were to introduce and assess an automated user-independent quantitative volumetric (AUQV) breast density (BD) measurement system on the basis of magnetic resonance imaging (MRI) using the Dixon technique as well as to compare it with qualitative and quantitative mammographic (MG) BD measurements. Forty-three women with normal mammogram results (Breast Imaging Reporting and Data System 1) were included in this institutional review board-approved prospective study. All participants were subjected to BD assessment with MRI using the following sequence with the Dixon technique (echo time/echo time, 6 milliseconds/2.45 milliseconds/2.67 milliseconds; 1-mm isotropic; 3 minutes 38 seconds). To test the reproducibility, a second MRI after patient repositioning was performed. The AUQV magnetic resonance (MR) BD measurement system automatically calculated percentage (%) BD. The qualitative BD assessment was performed using the American College of Radiology Breast Imaging Reporting and Data System BD categories. Quantitative BD was estimated semiautomatically using the thresholding technique Cumulus4. Appropriate statistical tests were used to assess the agreement between the AUQV MR measurements and to compare them with qualitative and quantitative MG BD estimations. The AUQV MR BD measurements were successfully performed in all 43 women. There was a nearly perfect agreement of AUQV MR BD measurements between the 2 MR examinations for % BD (P < 0.001; intraclass correlation coefficient, 0.998) with no significant differences (P = 0.384). The AUQV MR BD measurements were significantly lower than quantitative and qualitative MG BD assessment (P < 0.001). The AUQV MR BD measurement system allows a fully automated, user-independent, robust, reproducible, as well as radiation- and compression-free volumetric quantitative BD assessment through different levels of BD. The AUQV MR BD measurements were significantly lower than the currently used qualitative

Mammographic density and breast cancer risk by family history in women of white and Asian ancestry.

PubMed

Maskarinec, Gertraud; Nakamura, Kaylae L; Woolcott, Christy G; Conroy, Shannon M; Byrne, Celia; Nagata, Chisato; Ursin, Giske; Vachon, Celine M

2015-04-01

Mammographic density, i.e., the radiographic appearance of the breast, is a strong predictor of breast cancer risk. To determine whether the association of breast density with breast cancer is modified by a first-degree family history of breast cancer (FHBC) in women of white and Asian ancestry, we analyzed data from four case-control studies conducted in the USA and Japan. The study population included 1,699 breast cancer cases and 2,422 controls, of whom 45% reported white (N = 1,849) and 40% Asian (N = 1,633) ancestry. To standardize mammographic density assessment, a single observer re-read all mammograms using one type of interactive thresholding software. Logistic regression was applied to estimate odds ratios (OR) while adjusting for confounders. Overall, 496 (12%) of participants reported a FHBC, which was significantly associated with breast cancer risk in the adjusted model (OR 1.51; 95% CI 1.23-1.84). There was a statistically significant interaction on a multiplicative scale between FHBC and continuous percent density (per 10 % density: p = 0.03). The OR per 10% increase in percent density was higher among women with a FHBC (OR 1.30; 95% CI 1.13-1.49) than among those without a FHBC (OR 1.14; 1.09-1.20). This pattern was apparent in whites and Asians. The respective ORs were 1.45 (95% CI 1.17-1.80) versus 1.22 (95% CI 1.14-1.32) in whites, whereas the values in Asians were only 1.24 (95% CI 0.97-1.58) versus 1.09 (95% CI 1.00-1.19). These findings support the hypothesis that women with a FHBC appear to have a higher risk of breast cancer associated with percent mammographic density than women without a FHBC.

A comprehensive tool for measuring mammographic density changes over time.

PubMed

Eriksson, Mikael; Li, Jingmei; Leifland, Karin; Czene, Kamila; Hall, Per

2018-06-01

Mammographic density is a marker of breast cancer risk and diagnostics accuracy. Density change over time is a strong proxy for response to endocrine treatment and potentially a stronger predictor of breast cancer incidence. We developed STRATUS to analyse digital and analogue images and enable automated measurements of density changes over time. Raw and processed images from the same mammogram were randomly sampled from 41,353 healthy women. Measurements from raw images (using FDA approved software iCAD) were used as templates for STRATUS to measure density on processed images through machine learning. A similar two-step design was used to train density measures in analogue images. Relative risks of breast cancer were estimated in three unique datasets. An alignment protocol was developed using images from 11,409 women to reduce non-biological variability in density change. The protocol was evaluated in 55,073 women having two regular mammography screens. Differences and variances in densities were compared before and after image alignment. The average relative risk of breast cancer in the three datasets was 1.6 [95% confidence interval (CI) 1.3-1.8] per standard deviation of percent mammographic density. The discrimination was AUC 0.62 (CI 0.60-0.64). The type of image did not significantly influence the risk associations. Alignment decreased the non-biological variability in density change and re-estimated the yearly overall percent density decrease from 1.5 to 0.9%, p < 0.001. The quality of STRATUS density measures was not influenced by mammogram type. The alignment protocol reduced the non-biological variability between images over time. STRATUS has the potential to become a useful tool for epidemiological studies and clinical follow-up.

Combining semiquantitative measures of fibrosis and qualitative features of parenchymal remodelling to identify fibrosis regression in hepatitis C: a multiple biopsy study.

PubMed

Pattullo, Venessa; Thein, Hla-Hla; Heathcote, Elizabeth Jenny; Guindi, Maha

2012-09-01

A fall in hepatic fibrosis stage may be observed in patients with chronic hepatitis C (CHC); however, parenchymal architectural changes may also signify hepatic remodelling associated with fibrosis regression. The aim of this study was to utilize semiquantitative and qualitative methods to report the prevalence and factors associated with fibrosis regression in CHC. Paired liver biopsies were scored for fibrosis (Ishak), and for the presence of eight qualitative features of parenchymal remodelling, to derive a qualitative regression score (QR score). Combined fibrosis regression was defined as ≥2-stage fall in Ishak stage (Reg-I) or <2-stage fall in Ishak stage with a rise in QR score (Reg-Qual). Among 159 patients (biopsy interval 5.4 ± 3.1 years), Reg-I was observed in 12 (7.5%) and Reg-Qual in 26 (16.4%) patients. The combined diagnostic criteria increased the diagnosis rate for fibrosis regression (38 patients, 23.9%) compared with use of Reg-I alone (P < 0.001). Combined fibrosis regression was observed in nine patients (50%) who achieved sustained virological response (SVR), and in 29 of 141 (21%) patients despite persistent viraemia. SVR was the only clinical factor associated independently with combined fibrosis regression (odds ratio 3.05). The combination of semiquantitative measures and qualitative features aids the identification of fibrosis regression in CHC. © 2012 Blackwell Publishing Ltd.

The importance of service-users' perspectives: A systematic review of qualitative evidence reveals overlooked critical features of weight management programmes.

PubMed

Sutcliffe, Katy; Melendez-Torres, G J; Burchett, Helen E D; Richardson, Michelle; Rees, Rebecca; Thomas, James

2018-03-14

Extensive research effort shows that weight management programmes (WMPs) targeting both diet and exercise are broadly effective. However, the critical features of WMPs remain unclear. To develop a deeper understanding of WMPs critical features, we undertook a systematic review of qualitative evidence. We sought to understand from a service-user perspective how programmes are experienced, and may be effective, on the ground. We identified qualitative studies from existing reviews and updated the searches of one review. We included UK studies capturing the views of adult WMP users. Thematic analysis was used inductively to code and synthesize the evidence. Service users were emphatic that supportive relationships, with service providers or WMP peers, are the most critical aspect of WMPs. Supportive relationships were described as providing an extrinsic motivator or "hook" which helped to overcome barriers such as scepticism about dietary advice or a lack confidence to engage in physical activity. The evidence revealed that service-users' understandings of the critical features of WMPs differ from the focus of health promotion guidance or descriptions of evaluated programmes which largely emphasize educational or goal setting aspects of WMPs. Existing programme guidance may not therefore fully address the needs of service users. The study illustrates that the perspectives of service users can reveal unanticipated intervention mechanisms or underemphasized critical features and underscores the value of a holistic understanding about "what happens" in complex psychosocial interventions such as WMPs. © 2017 The Authors Health Expectations published by John Wiley & Sons Ltd.

Longitudinal study of mammographic density measures that predict breast cancer risk

PubMed Central

Krishnan, Kavitha; Baglietto, Laura; Stone, Jennifer; Simpson, Julie A; Severi, Gianluca; Evans, Christopher F; MacInnis, Robert J; Giles, Graham G; Apicella, Carmel; Hopper, John L

2016-01-01

Background After adjusting for age and body mass index (BMI), mammographic measures - dense area (DA), percent dense area (PDA) and non-dense area (NDA) - are associated with breast cancer risk. Our aim was to use longitudinal data to estimate the extent to which these risk-predicting measures track over time. Methods We collected 4,320 mammograms (age range, 24-83 years) from 970 women in the Melbourne Collaborative Cohort Study and the Australian Breast Cancer Family Registry. Women had on average 4.5 mammograms (range, 1-14). DA, PDA and NDA were measured using the Cumulus software and normalised using the Box-Cox method. Correlations in the normalised risk-predicting measures over time intervals of different lengths were estimated using nonlinear mixed-effects modelling of Gompertz curves. Results Mean normalised DA and PDA were constant with age to the early 40s, decreased over the next two decades, and were almost constant from the mid 60s onwards. Mean normalised NDA increased non-linearly with age. After adjusting for age and BMI, the within-woman correlation estimates for normalised DA were 0.94, 0.93, 0.91, 0.91 and 0.91 for mammograms taken 2, 4, 6, 8 and 10 years apart, respectively. Similar correlations were estimated for the age and BMI adjusted normalized PDA and NDA. Conclusion The mammographic measures that predict breast cancer risk are highly correlated over time. Impact This has implications for etiologic research and clinical management whereby women at increased risk could be identified at a young age (e.g. early 40s or even younger) and recommended appropriate screening and prevention strategies. PMID:28062399

[The effect of mammographic screening on tumor size, axillary node status and the degree of histologic anaplasia].

PubMed

Garami, Zoltán; Benkó, Klára; Kósa, Csaba; Fülöp, Balázs; Lukács, Géza

2006-10-01

Breast cancer is the most frequent malignant tumor in women in Hungary. Significant reduction of mortality has been brought about not only by the increasing efficiency of complex therapy but also by regular mammographic screening. Of the histopathological data of 633 patients operated with primary breast tumor at the 1st Surgical Clinic of the Debrecen Medical University between January 1st 2000 and December 31st 2004, the authors analyzed tumor diameter, axillary node status and the degree of histologic anaplasia and compared them with the data of mammographic screening. Of the "screened"patients, 70.7% were diagnosed with T1 size tumors, 28.5% with T2 size, and 0.8% with tumors bigger than that. In the "unscreened" patients, our findings were 44.3%, 45.9% and 9.8% respectively. Within T1 tumors, Tla tumors were found in 11%, TIb in 37.6% and T1c in 51.4% in the "screened" group of patients, while the "unscreened" group's results were 2.3%, 12.6% and 85% respectively. 72.7% of the "screened" patients and 56.2% of the "unscreened" patients were found to be axillary node-negative. A study of the degree of histologic anaplasia showed G-I tumors in 15.6%, G-IIs in 62.1% and G-IIIs in 22.3% of the "screened" patients. The corresponding values for the "unscreened" patients were 6.1%, 53.8% and 40.1%, respectively. The differences were highly significant (p < 0.001) in all the parameters investigated. The authors have found a significant increase in the proportion of node-negative patients and patients with smaller tumors even after the first round of mammographic screening and at less than 50% participation. It is to be hoped that a 20% reduction in mortality can be achieved by further increasing the rate of participation.

Predictive Modeling of Human Perception Subjectivity: Feasibility Study of Mammographic Lesion Similarity

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xu, Songhua; Tourassi, Georgia

2012-01-01

The majority of clinical content-based image retrieval (CBIR) studies disregard human perception subjectivity, aiming to duplicate the consensus expert assessment of the visual similarity on example cases. The purpose of our study is twofold: (i) discern better the extent of human perception subjectivity when assessing the visual similarity of two images with similar semantic content, and (ii) explore the feasibility of personalized predictive modeling of visual similarity. We conducted a human observer study in which five observers of various expertise were shown ninety-nine triplets of mammographic masses with similar BI-RADS descriptors and were asked to select the two masses withmore » the highest visual relevance. Pairwise agreement ranged between poor and fair among the five observers, as assessed by the kappa statistic. The observers' self-consistency rate was remarkably low, based on repeated questions where either the orientation or the presentation order of a mass was changed. Various machine learning algorithms were explored to determine whether they can predict each observer's personalized selection using textural features. Many algorithms performed with accuracy that exceeded each observer's self-consistency rate, as determined using a cross-validation scheme. This accuracy was statistically significantly higher than would be expected by chance alone (two-tailed p-value ranged between 0.001 and 0.01 for all five personalized models). The study confirmed that human perception subjectivity should be taken into account when developing CBIR-based medical applications.« less

Afimoxifene in Reducing the Risk of Breast Cancer in Women With Mammographically Dense Breast | Division of Cancer Prevention

Cancer.gov

This randomized phase II trial studies how well afimoxifene works in reducing the risk of breast cancer in women with mammographically dense breast. Estrogen can cause the growth of breast cancer cells. Hormone therapy using afimoxifene may fight breast cancer by blocking the use of estrogen by the tumor cells. |

Bismuth Sulfide Nanoflowers for Detection of X-rays in the Mammographic Energy Range

PubMed Central

Nambiar, Shruti; Osei, Ernest K.; Yeow, John T. W.

2015-01-01

The increased use of diagnostic x-rays, especially in the field of medical radiology, has necessitated a significant demand for high resolution, real-time radiation detectors. In this regard, the photoresponse of bismuth sulfide (Bi2S3), an n-type semiconducting metal chalcogenide, to low energy x-rays has been investigated in this study. In recent years, several types of nanomaterials of Bi2S3 have been widely studied for optoelectronic and thermoelectric applications. However, photoresponse of Bi2S3 nanomaterials for dosimetric applications has not yet been reported. The photosensitivity of Bi2S3 with nanoscale “flower-like” structures was characterized under x-ray tube-potentials typically used in mammographic procedures. Both dark current and photocurrent were measured under varying x-ray doses, field sizes, and bias voltages for each of the tube potentials – 20, 23, 26 and 30 kV. Results show that the Bi2S3 nanoflowers instantaneously responded to even minor changes in the dose delivered. The photoresponse was found to be relatively high (few nA) at bias voltage as low as +1 V, and fairly repeatable for both short and long exposures to mammographic x-rays with minimal or no loss in sensitivity. The overall dose-sensitivity of the Bi2S3 nanoflowers was found to be similar to that of a micro-ionization chamber. PMID:25801531

A population-based tissue probability map-driven level set method for fully automated mammographic density estimations.

PubMed

Kim, Youngwoo; Hong, Byung Woo; Kim, Seung Ja; Kim, Jong Hyo

2014-07-01

A major challenge when distinguishing glandular tissues on mammograms, especially for area-based estimations, lies in determining a boundary on a hazy transition zone from adipose to glandular tissues. This stems from the nature of mammography, which is a projection of superimposed tissues consisting of different structures. In this paper, the authors present a novel segmentation scheme which incorporates the learned prior knowledge of experts into a level set framework for fully automated mammographic density estimations. The authors modeled the learned knowledge as a population-based tissue probability map (PTPM) that was designed to capture the classification of experts' visual systems. The PTPM was constructed using an image database of a selected population consisting of 297 cases. Three mammogram experts extracted regions for dense and fatty tissues on digital mammograms, which was an independent subset used to create a tissue probability map for each ROI based on its local statistics. This tissue class probability was taken as a prior in the Bayesian formulation and was incorporated into a level set framework as an additional term to control the evolution and followed the energy surface designed to reflect experts' knowledge as well as the regional statistics inside and outside of the evolving contour. A subset of 100 digital mammograms, which was not used in constructing the PTPM, was used to validate the performance. The energy was minimized when the initial contour reached the boundary of the dense and fatty tissues, as defined by experts. The correlation coefficient between mammographic density measurements made by experts and measurements by the proposed method was 0.93, while that with the conventional level set was 0.47. The proposed method showed a marked improvement over the conventional level set method in terms of accuracy and reliability. This result suggests that the proposed method successfully incorporated the learned knowledge of the experts

Total Xenoestrogen Body Burden in Relation to Mammographic Density, a Marker of Breast Cancer Risk

DTIC Science & Technology

2008-10-01

average, how often do you eat a serving of meat, including beef , chicken, lamb, or pork? Never or less than once per month 1-3 servings per...has been obtained from the Susan Komen Foundation for an ancillary study of sex hormones and breast density. The Komen Foundation is providing funds...to analyze sex hormone levels in the blood samples obtained in this study. The relation between sex hormone levels and mammographic breast density

Are Mammographically Occult Additional Tumors Identified More Than 2 Cm Away From the Primary Breast Cancer on MRI Clinically Significant?

PubMed

Goodman, Sarah; Mango, Victoria; Friedlander, Lauren; Desperito, Elise; Wynn, Ralph; Ha, Richard

2018-06-08

To evaluate the clinical significance of mammographically occult additional tumors identified more than 2cm away from the primary breast cancer on preoperative magnetic resonance imaging (MRI). An Institutional Review Board approved review of consecutive preoperative breast MRIs performed from 1/1/08 to 12/31/14, yielded 667 patients with breast cancer. These patients underwent further assessment to identify biopsy proven mammographically occult breast tumors located more than 2cm away from the edge of the primary tumor. Additional MRI characteristics of the primary and secondary tumors and pathology were reviewed. Statistical analysis was performed using SPSS (v. 24). Of 667 patients with breast cancer, 129 patients had 150 additional ipsilateral mammographically occult tumors that were more than 2cm away from the edge of the primary tumor. One hundred twelve of 129 (86.8%) patients had one additional tumor and 17/129 (13.2%) had two or more additional tumors. In 71/129 (55.0%), additional tumors were located in a different quadrant and in 58/129 (45.0%) additional tumors were in the same quadrant but ≥2cm away. Overall, primary tumor size was significantly larger (mean 1.87± 1.25 cm) than the additional tumors (mean 0.79 ± 0.61cm, p < 0.001). However, in 20/129 (15.5%) the additional tumor was larger and in 26/129 (20.2%) the additional tumor was ≥1cm. The primary tumor was significantly more likely to be invasive (81.4%, 105/129) compared to additional tumors (70%, 105/150, p = 0.03). In 9/129 (7.0%) patients, additional tumors yielded unsuspected invasive cancer orhigher tumor grade. The additional tumor was more likely to be nonmass lesion type (37.3% vs 24% p = 0.02) and focus lesion type (10% vs 0.08%, p < 0.001) compared to primary tumor. Mammographically occult additional tumors identified more than 2cm away from the primary breast tumor on MRI are unlikely to be surgically treated if undiagnosed and may be clinically significant. Copyright �

Using Qualitative Metasummary to Synthesize Qualitative and Quantitative Descriptive Findings

PubMed Central

Sandelowski, Margarete; Barroso, Julie; Voils, Corrine I.

2008-01-01

The new imperative in the health disciplines to be more methodologically inclusive has generated a growing interest in mixed research synthesis, or the integration of qualitative and quantitative research findings. Qualitative metasummary is a quantitatively oriented aggregation of qualitative findings originally developed to accommodate the distinctive features of qualitative surveys. Yet these findings are similar in form and mode of production to the descriptive findings researchers often present in addition to the results of bivariate and multivariable analyses. Qualitative metasummary, which includes the extraction, grouping, and formatting of findings, and the calculation of frequency and intensity effect sizes, can be used to produce mixed research syntheses and to conduct a posteriori analyses of the relationship between reports and findings. PMID:17243111

Assessment of Interradiologist Agreement Regarding Mammographic Breast Density Classification Using the Fifth Edition of the BI-RADS Atlas.

PubMed

Ekpo, Ernest U; Ujong, Ujong Peter; Mello-Thoms, Claudia; McEntee, Mark F

2016-05-01

The objective of the present study was to assess interradiologist agreement regarding mammographic breast density assessment performed using the rating scale outlined in the fifth edition of the BI-RADS atlas of the American College of Radiology. Breast density assessments of 1000 cases were conducted by five radiologists from the same institution who together had recently undergone retraining in mammographic breast density classification based on the fifth edition of BI-RADS. The readers assigned breast density grades (A-D) on the basis of the BI-RADS classification scheme. Repeat assessment of 100 cases was performed by all readers 1 month after the initial assessment. A weighted kappa was used to calculate intrareader and interreader agreement. Intrareader agreement ranged from a kappa value of 0.86 (95% CI, 0.77-0.93) to 0.89 (95% CI, 0.81-0.95) on a four-category scale (categories A-D) and from 0.89 (95% CI, 0.86-0.92) to 0.94 (95% CI, 0.89-0.97) on a two-category scale (category A-B vs category C-D). Interreader agreement ranged from substantial (κ = 0.76; 95% CI, 0.73-0.78) to almost perfect (κ = 0.87; 95% CI, 0.86-0.89) on a four-category scale, and the overall weighted kappa value was substantial (0.79; 95% CI, 0.78-0.83). Interreader agreement on a two-category scale ranged from a kappa value of 0.85 (95% CI, 0.83-0.86) to 0.91 (95% CI, 0.90-0.92), and the overall weighted kappa was 0.88 (95% CI, 0.87-0.89). Overall, with regard to mammographic breast density classification, radiologists had substantial interreader agreement when a four-category scale was used and almost perfect interreader agreement when a dichotomous scale was used.

Construction of mammographic examination process ontology using bottom-up hierarchical task analysis.

PubMed

Yagahara, Ayako; Yokooka, Yuki; Jiang, Guoqian; Tsuji, Shintarou; Fukuda, Akihisa; Nishimoto, Naoki; Kurowarabi, Kunio; Ogasawara, Katsuhiko

2018-03-01

Describing complex mammography examination processes is important for improving the quality of mammograms. It is often difficult for experienced radiologic technologists to explain the process because their techniques depend on their experience and intuition. In our previous study, we analyzed the process using a new bottom-up hierarchical task analysis and identified key components of the process. Leveraging the results of the previous study, the purpose of this study was to construct a mammographic examination process ontology to formally describe the relationships between the process and image evaluation criteria to improve the quality of mammograms. First, we identified and created root classes: task, plan, and clinical image evaluation (CIE). Second, we described an "is-a" relation referring to the result of the previous study and the structure of the CIE. Third, the procedural steps in the ontology were described using the new properties: "isPerformedBefore," "isPerformedAfter," and "isPerformedAfterIfNecessary." Finally, the relationships between tasks and CIEs were described using the "isAffectedBy" property to represent the influence of the process on image quality. In total, there were 219 classes in the ontology. By introducing new properties related to the process flow, a sophisticated mammography examination process could be visualized. In relationships between tasks and CIEs, it became clear that the tasks affecting the evaluation criteria related to positioning were greater in number than those for image quality. We developed a mammographic examination process ontology that makes knowledge explicit for a comprehensive mammography process. Our research will support education and help promote knowledge sharing about mammography examination expertise.

Mammographic breast density in recent and longer-standing ethiopian immigrants to israel.

PubMed

Sklair-Levy, Miri; Segev, Anat; Sella, Tamar; Calderon-Margalit, Ronit; Zippel, Douglas

2018-04-23

High breast density is associated with an increased risk of breast cancer development. Little is known concerning ethnic variations in breast density and its relevant contributing factors. We aimed to study breast density among Ethiopian immigrants to Israel in comparison with Israeli-born women and to determine any effect on breast density of the length of residency in the immigrant population. Mammographic breast density using the BI-RADS system was estimated and compared between 77 women of Ethiopian origin who live in Israel and 177 Israeli-born controls. Logistic regression analysis was performed to estimate the odds ratios (OR) for high density (BI-RADS score ≥ 3) vs low density (BI-RADS score < 3) cases, comparing the 2 origin groups. Ethiopian-born women had a crude OR of 0.15 (95% CI: 0.08-0.26) for high breast density compared with Israeli-born women. Adjustments for various cofounders did not affect the results. Time since immigration to Israel seemed to modify the relationship, with a stronger association for women who immigrated within 2 years prior to mammography (OR:0.07, 95% CI: 0.03-0.17) as opposed to women with a longer residency stay in Israel (OR:0.23, 95% CI:0.10-0.50). Adjustments of various confounders did not alter these findings. Breast density in Ethiopian immigrants to Israel is significantly lower than that of Israeli-born controls. Our study suggests a positive association between time since immigration and breast density. Future studies are required to define the possible effects of dietary change on mammographic density following immigration. © 2018 Wiley Periodicals, Inc.

Correlative feature analysis on FFDM

PubMed Central

Yuan, Yading; Giger, Maryellen L.; Li, Hui; Sennett, Charlene

2008-01-01

Identifying the corresponding images of a lesion in different views is an essential step in improving the diagnostic ability of both radiologists and computer-aided diagnosis (CAD) systems. Because of the nonrigidity of the breasts and the 2D projective property of mammograms, this task is not trivial. In this pilot study, we present a computerized framework that differentiates between corresponding images of the same lesion in different views and noncorresponding images, i.e., images of different lesions. A dual-stage segmentation method, which employs an initial radial gradient index (RGI) based segmentation and an active contour model, is applied to extract mass lesions from the surrounding parenchyma. Then various lesion features are automatically extracted from each of the two views of each lesion to quantify the characteristics of density, size, texture and the neighborhood of the lesion, as well as its distance to the nipple. A two-step scheme is employed to estimate the probability that the two lesion images from different mammographic views are of the same physical lesion. In the first step, a correspondence metric for each pairwise feature is estimated by a Bayesian artificial neural network (BANN). Then, these pairwise correspondence metrics are combined using another BANN to yield an overall probability of correspondence. Receiver operating characteristic (ROC) analysis was used to evaluate the performance of the individual features and the selected feature subset in the task of distinguishing corresponding pairs from noncorresponding pairs. Using a FFDM database with 123 corresponding image pairs and 82 noncorresponding pairs, the distance feature yielded an area under the ROC curve (AUC) of 0.81±0.02 with leave-one-out (by physical lesion) evaluation, and the feature metric subset, which included distance, gradient texture, and ROI-based correlation, yielded an AUC of 0.87±0.02. The improvement by using multiple feature metrics was statistically

Direct measurement of clinical mammographic x-ray spectra using a CdTe spectrometer.

PubMed

Santos, Josilene C; Tomal, Alessandra; Furquim, Tânia A; Fausto, Agnes M F; Nogueira, Maria S; Costa, Paulo R

2017-07-01

To introduce and evaluate a method developed for the direct measurement of mammographic x-ray spectra using a CdTe spectrometer. The assembly of a positioning system and the design of a simple and customized alignment device for this application is described. A positioning system was developed to easily and accurately locate the CdTe detector in the x-ray beam. Additionally, an alignment device to line up the detector with the central axis of the radiation beam was designed. Direct x-ray spectra measurements were performed in two different clinical mammography units and the measured x-ray spectra were compared with computer-generated spectra. In addition, the spectrometer misalignment effect was evaluated by comparing the measured spectra when this device is aligned relatively to when it is misaligned. The positioning and alignment of the spectrometer have allowed the measurements of direct mammographic x-ray spectra in agreement with computer-generated spectra. The most accurate x-ray spectral shape, related with the minimal HVL value, and high photon fluence for measured spectra was found with the spectrometer aligned according to the proposed method. The HVL values derived from both simulated and measured x-ray spectra differ at most 1.3 and 4.5% for two mammography devices evaluated in this study. The experimental method developed in this work allows simple positioning and alignment of a spectrometer for x-ray spectra measurements given the geometrical constraints and maintenance of the original configurations of mammography machines. © 2017 American Association of Physicists in Medicine.

A genome-wide linkage study of mammographic density, a risk factor for breast cancer

PubMed Central

2011-01-01

Introduction Mammographic breast density is a highly heritable (h2 > 0.6) and strong risk factor for breast cancer. We conducted a genome-wide linkage study to identify loci influencing mammographic breast density (MD). Methods Epidemiological data were assembled on 1,415 families from the Australia, Northern California and Ontario sites of the Breast Cancer Family Registry, and additional families recruited in Australia and Ontario. Families consisted of sister pairs with age-matched mammograms and data on factors known to influence MD. Single nucleotide polymorphism (SNP) genotyping was performed on 3,952 individuals using the Illumina Infinium 6K linkage panel. Results Using a variance components method, genome-wide linkage analysis was performed using quantitative traits obtained by adjusting MD measurements for known covariates. Our primary trait was formed by fitting a linear model to the square root of the percentage of the breast area that was dense (PMD), adjusting for age at mammogram, number of live births, menopausal status, weight, height, weight squared, and menopausal hormone therapy. The maximum logarithm of odds (LOD) score from the genome-wide scan was on chromosome 7p14.1-p13 (LOD = 2.69; 63.5 cM) for covariate-adjusted PMD, with a 1-LOD interval spanning 8.6 cM. A similar signal was seen for the covariate adjusted area of the breast that was dense (DA) phenotype. Simulations showed that the complete sample had adequate power to detect LOD scores of 3 or 3.5 for a locus accounting for 20% of phenotypic variance. A modest peak initially seen on chromosome 7q32.3-q34 increased in strength when only the 513 families with at least two sisters below 50 years of age were included in the analysis (LOD 3.2; 140.7 cM, 1-LOD interval spanning 9.6 cM). In a subgroup analysis, we also found a LOD score of 3.3 for DA phenotype on chromosome 12.11.22-q13.11 (60.8 cM, 1-LOD interval spanning 9.3 cM), overlapping a region identified in a previous study

Automated assessment of bilateral breast volume asymmetry as a breast cancer biomarker during mammographic screening

NASA Astrophysics Data System (ADS)

Williams, Alex C.; Hitt, Austin; Voisin, Sophie; Tourassi, Georgia

2013-03-01

The biological concept of bilateral symmetry as a marker of developmental stability and good health is well established. Although most individuals deviate slightly from perfect symmetry, humans are essentially considered bilaterally symmetrical. Consequently, increased fluctuating asymmetry of paired structures could be an indicator of disease. There are several published studies linking bilateral breast size asymmetry with increased breast cancer risk. These studies were based on radiologists' manual measurements of breast size from mammographic images. We aim to develop a computerized technique to assess fluctuating breast volume asymmetry in screening mammograms and investigate whether it correlates with the presence of breast cancer. Using a large database of screening mammograms with known ground truth we applied automated breast region segmentation and automated breast size measurements in CC and MLO views using three well established methods. All three methods confirmed that indeed patients with breast cancer have statistically significantly higher fluctuating asymmetry of their breast volumes. However, statistically significant difference between patients with cancer and benign lesions was observed only for the MLO views. The study suggests that automated assessment of global bilateral asymmetry could serve as a breast cancer risk biomarker for women undergoing mammographic screening. Such biomarker could be used to alert radiologists or computer-assisted detection (CAD) systems to exercise increased vigilance if higher than normal cancer risk is suspected.

Computer-Aided Diagnosis of Breast Cancer: A Multi-Center Demonstrator

DTIC Science & Technology

1998-10-01

Artificial Neural Network (ANN) approach to computer aided diagnosis of breast cancer from mammographic findings. An ANN has been developed to provide support for the clinical decision to perform breast biopsy. The system is designed to aid in the decision to biopsy those patients who have suspicious mammographic findings. The decision to biopsy can be viewed as a two stage process: 1)the mammographer views the mammogram and determines the presence or absence of image features such as calcifications and masses, 2) the presence and description of these features

Mammographic screening in women with a family history of breast cancer: some results from the Swedish two-county trial.

PubMed

Nixon, R M; Pharoah, P; Tabar, L; Krusemo, U B; Duffy, S W; Prevost, T C; Chen, H H

2000-08-01

The objective of this study is to compare the effectiveness of mammographic screening in women with a family history of breast cancer to those without. In the invited arm of a randomised trial of breast cancer screening, data on family history of breast cancer were available on 29.179 women aged 40-74 attending for screening. Among those women, 358 were diagnosed with breast cancer during the trial. Those with and without a family history were compared with respect to mammographic parenchymal pattern, interval cancer rates, mean sojourn time and sensitivity of screening. In the 358 cancers, the effect of family history was estimated on survival, incidence of advanced cancers and their relationship to screen detection. A significantly higher proportion of high risk mammographic patterns was observed in association with family history among women aged 40-49. Interval cancer rates were higher in women with a family history, and in older women at least, mean sojourn time was shortened in women with a family history (1.89 years compared to 2.70). Survival was better (although not significantly so) in cancers in women with a family history (relative hazard=0.52) independently of detection mode and was significantly poorer in interval cancers then screen detected cancers (relative hazard=2.72) independently of family history. Similarly, interval cancers tended to be larger, and worse malignancy grade in those with and without a family history of breast cancer. These results suggest that the policy often adopted of annual screening for woman aged 40-49, with a family history of breast cancer, is a reasonable one, and that it may also be necessary to shorten the inter-screening interval to one year in women aged over 50 but with a positive family history.

Benign-malignant mass classification in mammogram using edge weighted local texture features

NASA Astrophysics Data System (ADS)

Rabidas, Rinku; Midya, Abhishek; Sadhu, Anup; Chakraborty, Jayasree

2016-03-01

This paper introduces novel Discriminative Robust Local Binary Pattern (DRLBP) and Discriminative Robust Local Ternary Pattern (DRLTP) for the classification of mammographic masses as benign or malignant. Mass is one of the common, however, challenging evidence of breast cancer in mammography and diagnosis of masses is a difficult task. Since DRLBP and DRLTP overcome the drawbacks of Local Binary Pattern (LBP) and Local Ternary Pattern (LTP) by discriminating a brighter object against the dark background and vice-versa, in addition to the preservation of the edge information along with the texture information, several edge-preserving texture features are extracted, in this study, from DRLBP and DRLTP. Finally, a Fisher Linear Discriminant Analysis method is incorporated with discriminating features, selected by stepwise logistic regression method, for the classification of benign and malignant masses. The performance characteristics of DRLBP and DRLTP features are evaluated using a ten-fold cross-validation technique with 58 masses from the mini-MIAS database, and the best result is observed with DRLBP having an area under the receiver operating characteristic curve of 0.982.

Natural enamel caries in polarized light microscopy: differences in histopathological features derived from a qualitative versus a quantitative approach to interpret enamel birefringence.

PubMed

De Medeiros, R C G; Soares, J D; De Sousa, F B

2012-05-01

Lesion area measurement of enamel caries using polarized light microscopy (PLM) is currently performed in a large number of studies, but measurements are based mainly on a mislead qualitative interpretation of enamel birefringence in a single immersion medium. Here, five natural enamel caries lesions are analysed by microradiography and in PLM, and the differences in their histopathological features derived from a qualitative versus a quantitative interpretation of enamel birefringence are described. Enamel birefringence in different immersion media (air, water and quinoline) is interpreted by both qualitative and quantitative approaches, the former leading to an underestimation of the depth of enamel caries mainly when the criterion of validating sound enamel as a negatively birefringent area in immersion in water is used (a current common practice in dental research). Procedures to avoid the shortcomings of a qualitative interpretation of enamel birefringence are presented and discussed. © 2012 The Authors Journal of Microscopy © 2012 Royal Microscopical Society.

Identification of two novel mammographic density loci at 6Q25.1.

PubMed

Brand, Judith S; Li, Jingmei; Humphreys, Keith; Karlsson, Robert; Eriksson, Mikael; Ivansson, Emma; Hall, Per; Czene, Kamila

2015-06-03

Mammographic density (MD) is a strong heritable and intermediate phenotype for breast cancer, but much of its genetic variation remains unexplained. We performed a large-scale genetic association study including 8,419 women of European ancestry to identify MD loci. Participants of three Swedish studies were genotyped on a custom Illumina iSelect genotyping array and percent and absolute mammographic density were ascertained using semiautomated and fully automated methods from film and digital mammograms. Linear regression analysis was used to test for SNP-MD associations, adjusting for age, body mass index, menopausal status and six principal components. Meta-analyses were performed by combining P values taking sample size, study-specific inflation factor and direction of effect into account. Genome-wide significant associations were observed for two previously identified loci: ZNF365 (rs10995194, P = 2.3 × 10(-8) for percent MD and P = 8.7 × 10(-9) for absolute MD) and AREG (rs10034692, P = 6.7 × 10(-9) for absolute MD). In addition, we found evidence of association for two variants at 6q25.1, both of which are known breast cancer susceptibility loci: rs9485370 in the TAB2 gene (P = 4.8 × 10(-9) for percent MD and P = 2.5 × 10(-8) for absolute MD) and rs60705924 in the CCDC170/ESR1 region (P = 2.2 × 10(-8) for absolute MD). Both regions have been implicated in estrogen receptor signaling with TAB2 being a potential regulator of tamoxifen response. We identified two novel MD loci at 6q25.1. These findings underscore the importance of 6q25.1 as a susceptibility region and provide more insight into the mechanisms through which MD influences breast cancer risk.

Detecting mammographically occult cancer in women with dense breasts using Radon Cumulative Distribution Transform: a preliminary analysis

NASA Astrophysics Data System (ADS)

Lee, Juhun; Nishikawa, Robert M.; Rohde, Gustavo K.

2018-02-01

We propose using novel imaging biomarkers for detecting mammographically-occult (MO) cancer in women with dense breast tissue. MO cancer indicates visually occluded, or very subtle, cancer that radiologists fail to recognize as a sign of cancer. We used the Radon Cumulative Distribution Transform (RCDT) as a novel image transformation to project the difference between left and right mammograms into a space, increasing the detectability of occult cancer. We used a dataset of 617 screening full-field digital mammograms (FFDMs) of 238 women with dense breast tissue. Among 238 women, 173 were normal with 2 - 4 consecutive screening mammograms, 552 normal mammograms in total, and the remaining 65 women had an MO cancer with a negative screening mammogram. We used Principal Component Analysis (PCA) to find representative patterns in normal mammograms in the RCDT space. We projected all mammograms to the space constructed by the first 30 eigenvectors of the RCDT of normal cases. Under 10-fold crossvalidation, we conducted quantitative feature analysis to classify normal mammograms and mammograms with MO cancer. We used receiver operating characteristic (ROC) analysis to evaluate the classifier's output using the area under the ROC curve (AUC) as the figure of merit. Four eigenvectors were selected via a feature selection method. The mean and standard deviation of the AUC of the trained classifier on the test set were 0.74 and 0.08, respectively. In conclusion, we utilized imaging biomarkers to highlight differences between left and right mammograms to detect MO cancer using novel imaging transformation.

Parenchymal texture analysis in digital mammography: robust texture feature identification and equivalence across devices.

PubMed

Keller, Brad M; Oustimov, Andrew; Wang, Yan; Chen, Jinbo; Acciavatti, Raymond J; Zheng, Yuanjie; Ray, Shonket; Gee, James C; Maidment, Andrew D A; Kontos, Despina

2015-04-01

An analytical framework is presented for evaluating the equivalence of parenchymal texture features across different full-field digital mammography (FFDM) systems using a physical breast phantom. Phantom images (FOR PROCESSING) are acquired from three FFDM systems using their automated exposure control setting. A panel of texture features, including gray-level histogram, co-occurrence, run length, and structural descriptors, are extracted. To identify features that are robust across imaging systems, a series of equivalence tests are performed on the feature distributions, in which the extent of their intersystem variation is compared to their intrasystem variation via the Hodges-Lehmann test statistic. Overall, histogram and structural features tend to be most robust across all systems, and certain features, such as edge enhancement, tend to be more robust to intergenerational differences between detectors of a single vendor than to intervendor differences. Texture features extracted from larger regions of interest (i.e., [Formula: see text]) and with a larger offset length (i.e., [Formula: see text]), when applicable, also appear to be more robust across imaging systems. This framework and observations from our experiments may benefit applications utilizing mammographic texture analysis on images acquired in multivendor settings, such as in multicenter studies of computer-aided detection and breast cancer risk assessment.

Qualitative dynamics semantics for SBGN process description.

PubMed

Rougny, Adrien; Froidevaux, Christine; Calzone, Laurence; Paulevé, Loïc

2016-06-16

Qualitative dynamics semantics provide a coarse-grain modeling of networks dynamics by abstracting away kinetic parameters. They allow to capture general features of systems dynamics, such as attractors or reachability properties, for which scalable analyses exist. The Systems Biology Graphical Notation Process Description language (SBGN-PD) has become a standard to represent reaction networks. However, no qualitative dynamics semantics taking into account all the main features available in SBGN-PD had been proposed so far. We propose two qualitative dynamics semantics for SBGN-PD reaction networks, namely the general semantics and the stories semantics, that we formalize using asynchronous automata networks. While the general semantics extends standard Boolean semantics of reaction networks by taking into account all the main features of SBGN-PD, the stories semantics allows to model several molecules of a network by a unique variable. The obtained qualitative models can be checked against dynamical properties and therefore validated with respect to biological knowledge. We apply our framework to reason on the qualitative dynamics of a large network (more than 200 nodes) modeling the regulation of the cell cycle by RB/E2F. The proposed semantics provide a direct formalization of SBGN-PD networks in dynamical qualitative models that can be further analyzed using standard tools for discrete models. The dynamics in stories semantics have a lower dimension than the general one and prune multiple behaviors (which can be considered as spurious) by enforcing the mutual exclusiveness between the activity of different nodes of a same story. Overall, the qualitative semantics for SBGN-PD allow to capture efficiently important dynamical features of reaction network models and can be exploited to further refine them.

Computing mammographic density from a multiple regression model constructed with image-acquisition parameters from a full-field digital mammographic unit

PubMed Central

Lu, Lee-Jane W.; Nishino, Thomas K.; Khamapirad, Tuenchit; Grady, James J; Leonard, Morton H.; Brunder, Donald G.

2009-01-01

Breast density (the percentage of fibroglandular tissue in the breast) has been suggested to be a useful surrogate marker for breast cancer risk. It is conventionally measured using screen-film mammographic images by a labor intensive histogram segmentation method (HSM). We have adapted and modified the HSM for measuring breast density from raw digital mammograms acquired by full-field digital mammography. Multiple regression model analyses showed that many of the instrument parameters for acquiring the screening mammograms (e.g. breast compression thickness, radiological thickness, radiation dose, compression force, etc) and image pixel intensity statistics of the imaged breasts were strong predictors of the observed threshold values (model R2=0.93) and %density (R2=0.84). The intra-class correlation coefficient of the %-density for duplicate images was estimated to be 0.80, using the regression model-derived threshold values, and 0.94 if estimated directly from the parameter estimates of the %-density prediction regression model. Therefore, with additional research, these mathematical models could be used to compute breast density objectively, automatically bypassing the HSM step, and could greatly facilitate breast cancer research studies. PMID:17671343

Birthweight, early life body size and adult mammographic density: a review of epidemiologic studies.

PubMed

Yochum, Laura; Tamimi, Rulla M; Hankinson, Susan E

2014-10-01

To evaluate the association between birth weight and early life body size with adult mammographic density in the peer-reviewed literature. A comprehensive literature search was conducted through January, 2014. English language articles that assessed adult mammographic density (MD) in relation to early life body size (≤18 years old), or birthweight were included. Nine studies reported results for early life body size and %MD. Both exposure and outcome were assessed at different ages using multiple methods. In premenopausal women, findings were inconsistent; two studies reported significant, inverse associations, one reported a non-significant, inverse association, and two observed no association. Reasons for these inconsistencies were not obvious. In postmenopausal women, four of five studies supported an inverse association. Two of three studies that adjusted for menopausal status found significant, inverse associations. Birthweight and %MD was evaluated in nine studies. No association was seen in premenopausal women and two of three studies reported positive associations in postmenopausal women. Three of four studies that adjusted for menopausal status found no association. Early life body size and birthweight appear unrelated to %MD in premenopausal women while an inverse association in postmenopausal women is more likely. Although based on limited data, birthweight and %MD appear positively associated in postmenopausal women. Given the small number of studies, the multiple methods of data collection and analysis, other methodologic issues, and lack of consistency in results, additional research is needed to clarify this complex association and develop a better understanding of the underlying biologic mechanisms.

Dose-dependent effect of mammographic breast density on the risk of contralateral breast cancer.

PubMed

Chowdhury, Marzana; Euhus, David; O'Donnell, Maureen; Onega, Tracy; Choudhary, Pankaj K; Biswas, Swati

2018-07-01

Increased mammographic breast density is a significant risk factor for breast cancer. It is not clear if it is also a risk factor for the development of contralateral breast cancer. The data were obtained from Breast Cancer Surveillance Consortium and included women diagnosed with invasive breast cancer or ductal carcinoma in situ between ages 18 and 88 and years 1995 and 2009. Each case of contralateral breast cancer was matched with three controls based on year of first breast cancer diagnosis, race, and length of follow-up. A total of 847 cases and 2541 controls were included. The risk factors included in the study were mammographic breast density, age of first breast cancer diagnosis, family history of breast cancer, anti-estrogen treatment, hormone replacement therapy, menopausal status, and estrogen receptor status, all from the time of first breast cancer diagnosis. Both univariate analysis and multivariate conditional logistic regression analysis were performed. In the final multivariate model, breast density, family history of breast cancer, and anti-estrogen treatment remained significant with p values less than 0.01. Increasing breast density had a dose-dependent effect on the risk of contralateral breast cancer. Relative to 'almost entirely fat' category of breast density, the adjusted odds ratios (and p values) in the multivariate analysis for 'scattered density,' 'heterogeneously dense,' and 'extremely dense' categories were 1.65 (0.036), 2.10 (0.002), and 2.32 (0.001), respectively. Breast density is an independent and significant risk factor for development of contralateral breast cancer. This risk factor should contribute to clinical decision making.

Mammographic Screening at Age 40 or 45? What Difference Does It Make? The Potential Impact of American Cancer Society Mammography Screening Guidelines.

PubMed

Fancher, Crystal E; Scott, Anthony; Allen, Ahkeel; Dale, Paul

2017-08-01

this is a 10-year retrospective chart review evaluating the potential impact of the most recent American Cancer Society mammography screening guidelines which excludes female patients aged 40 to 44 years from routine annual screening mammography. Instead they recommend screening mammography starting at age 45 with the option to begin screening earlier if the patient desires. The institutional cancer registry was systematically searched to identify all women aged 40 to 44 years treated for breast cancer over a 10-year period. These women were separated into two cohorts: screening mammography detected cancer (SMDC) and nonscreening mammography detected cancer (NSMDC). Statistical analysis of the cohorts was performed for lymph node status (SLN), five-year disease-free survival, and five-year overall survival. Women with SMDC had a significantly lower incidence of SLN positive cancer than the NSMDC group, 9 of 63 (14.3%) versus 36 of 81 (44 %; P < 0.001). The five-year disease-free survival for both groups was 84 per cent for SMDC and 80 per cent for NSMDC; this was not statistically significant. The five-year overall survival was statistically significant at 94 per cent for the SMDC group and 80 per cent for the NSMDC group (P < 0.05). This review demonstrates the significance of mammographic screening for early detection and treatment of breast cancer. Mammographic screening in women aged 40 to 44 detected tumors with fewer nodal metastases, resulting in improved survival and reaffirming the need for annual mammographic screening in this age group.

Association of infertility and fertility treatment with mammographic density in a large screening-based cohort of women: a cross-sectional study.

PubMed

Lundberg, Frida E; Johansson, Anna L V; Rodriguez-Wallberg, Kenny; Brand, Judith S; Czene, Kamila; Hall, Per; Iliadou, Anastasia N

2016-04-13

Ovarian stimulation drugs, in particular hormonal agents used for controlled ovarian stimulation (COS) required to perform in vitro fertilization, increase estrogen and progesterone levels and have therefore been suspected to influence breast cancer risk. This study aims to investigate whether infertility and hormonal fertility treatment influences mammographic density, a strong hormone-responsive risk factor for breast cancer. Cross-sectional study including 43,313 women recruited to the Karolinska Mammography Project between 2010 and 2013. Among women who reported having had infertility, 1576 had gone through COS, 1429 had had hormonal stimulation without COS and 5958 had not received any hormonal fertility treatment. Percent and absolute mammographic densities were obtained using the volumetric method Volpara™. Associations with mammographic density were assessed using multivariable generalized linear models, estimating mean differences (MD) with 95 % confidence intervals (CI). After multivariable adjustment, women with a history of infertility had 1.53 cm(3) higher absolute dense volume compared to non-infertile women (95 % CI: 0.70 to 2.35). Among infertile women, only those who had gone through COS treatment had a higher absolute dense volume than those who had not received any hormone treatment (adjusted MD 3.22, 95 % CI: 1.10 to 5.33). No clear associations were observed between infertility, fertility treatment and percent volumetric density. Overall, women reporting infertility had more dense tissue in the breast. The higher absolute dense volume in women treated with COS may indicate a treatment effect, although part of the association might also be due to the underlying infertility. Continued monitoring of cancer risk in infertile women, especially those who undergo COS, is warranted.

Sampling in Qualitative Research

PubMed Central

LUBORSKY, MARK R.; RUBINSTEIN, ROBERT L.

2011-01-01

In gerontology the most recognized and elaborate discourse about sampling is generally thought to be in quantitative research associated with survey research and medical research. But sampling has long been a central concern in the social and humanistic inquiry, albeit in a different guise suited to the different goals. There is a need for more explicit discussion of qualitative sampling issues. This article will outline the guiding principles and rationales, features, and practices of sampling in qualitative research. It then describes common questions about sampling in qualitative research. In conclusion it proposes the concept of qualitative clarity as a set of principles (analogous to statistical power) to guide assessments of qualitative sampling in a particular study or proposal. PMID:22058580

Granulomatous mastitis: changing clinical and imaging features with image-guided biopsy correlation.

PubMed

Handa, Priyanka; Leibman, A Jill; Sun, Derek; Abadi, Maria; Goldberg, Aryeh

2014-10-01

To review clinical presentation, revisit patient demographics and imaging findings in granulomatous mastitis and determine the optimal biopsy method for diagnosis. A retrospective study was performed to review the clinical presentation, imaging findings and biopsy methods in patients with granulomatous mastitis. Twenty-seven patients with pathology-proven granulomatous mastitis were included. The average age at presentation was 38.0 years (range, 21-73 years). Seven patients were between 48 and 73 years old. Twenty-four patients presented with symptoms and three patients were asymptomatic. Nineteen patients were imaged with mammography demonstrating mammographically occult lesions as the predominant finding. Twenty-six patients were imaged with ultrasound and the most common finding was a mass lesion. Pathological diagnosis was made by image-guided biopsy in 44 % of patients. The imaging features of granulomatous mastitis on mammography are infrequently described. Our study demonstrates that granulomatous mastitis can occur in postmenopausal or asymptomatic patients, although previously reported exclusively in young women with palpable findings. Presentation on mammography as calcifications requiring mammographically guided vacuum-assisted biopsy has not been previously described. The diagnosis of granulomatous mastitis can easily be made by image-guided biopsy and surgical excision should be reserved for definitive treatment. • Characterizes radiographic appearance of granulomatous mastitis in postmenopausal or asymptomatic patients. • Granulomatous mastitis can present exclusively as calcifications on mammography. • The diagnosis of granulomatous mastitis is made by image-guided biopsy techniques.

Matching mammographic regions in mediolateral oblique and cranio caudal views: a probabilistic approach

NASA Astrophysics Data System (ADS)

Samulski, Maurice; Karssemeijer, Nico

2008-03-01

Most of the current CAD systems detect suspicious mass regions independently in single views. In this paper we present a method to match corresponding regions in mediolateral oblique (MLO) and craniocaudal (CC) mammographic views of the breast. For every possible combination of mass regions in the MLO view and CC view, a number of features are computed, such as the difference in distance of a region to the nipple, a texture similarity measure, the gray scale correlation and the likelihood of malignancy of both regions computed by single-view analysis. In previous research, Linear Discriminant Analysis was used to discriminate between correct and incorrect links. In this paper we investigate if the performance can be improved by employing a statistical method in which four classes are distinguished. These four classes are defined by the combinations of view (MLO/CC) and pathology (TP/FP) labels. We use distance-weighted k-Nearest Neighbor density estimation to estimate the likelihood of a region combination. Next, a correspondence score is calculated as the likelihood that the region combination is a TP-TP link. The method was tested on 412 cases with a malignant lesion visible in at least one of the views. In 82.4% of the cases a correct link could be established between the TP detections in both views. In future work, we will use the framework presented here to develop a context dependent region matching scheme, which takes the number and likelihood of possible alternatives into account. It is expected that more accurate determination of matching probabilities will lead to improved CAD performance.

Improved visualization of breast cancer features in multifocal carcinoma using phase-contrast and dark-field mammography: an ex vivo study.

PubMed

Grandl, Susanne; Scherer, Kai; Sztrókay-Gaul, Anikó; Birnbacher, Lorenz; Willer, Konstantin; Chabior, Michael; Herzen, Julia; Mayr, Doris; Auweter, Sigrid D; Pfeiffer, Franz; Bamberg, Fabian; Hellerhoff, Karin

2015-12-01

Conventional X-ray attenuation-based contrast is inherently low for the soft-tissue components of the female breast. To overcome this limitation, we investigate the diagnostic merits arising from dark-field mammography by means of certain tumour structures enclosed within freshly dissected mastectomy samples. We performed grating-based absorption, absolute phase and dark-field mammography of three freshly dissected mastectomy samples containing bi- and multifocal carcinoma using a compact, laboratory Talbot-Lau interferometer. Preoperative in vivo imaging (digital mammography, ultrasound, MRI), postoperative histopathological analysis and ex vivo digital mammograms of all samples were acquired for the diagnostic verification of our results. In the diagnosis of multifocal tumour growth, dark-field mammography seems superior to standard breast imaging modalities, providing a better resolution of small, calcified tumour nodules, demarcation of tumour boundaries with desmoplastic stromal response and spiculated soft-tissue strands extending from an invasive ductal breast cancer. On the basis of selected cases, we demonstrate that dark-field mammography is capable of outperforming conventional mammographic imaging of tumour features in both calcified and non-calcified tumours. Presuming dose optimization, our results encourage further studies on larger patient cohorts to identify those patients that will benefit the most from this promising additional imaging modality. • X-ray dark-field mammography provides significantly improved visualization of tumour features • X-ray dark-field mammography is capable of outperforming conventional mammographic imaging • X-ray dark-field mammography provides imaging sensitivity towards highly dispersed calcium grains.

Enhanced visualization of abnormalities in digital-mammographic images

NASA Astrophysics Data System (ADS)

Young, Susan S.; Moore, William E.

2002-05-01

This paper describes two new presentation methods that are intended to improve the ability of radiologists to visualize abnormalities in mammograms by enhancing the appearance of the breast parenchyma pattern relative to the fatty-tissue surroundings. The first method, referred to as mountain- view, is obtained via multiscale edge decomposition through filter banks. The image is displayed in a multiscale edge domain that causes the image to have a topographic-like appearance. The second method displays the image in the intensity domain and is referred to as contrast-enhancement presentation. The input image is first passed through a decomposition filter bank to produce a filtered output (Id). The image at the lowest resolution is processed using a LUT (look-up table) to produce a tone scaled image (I'). The LUT is designed to optimally map the code value range corresponding to the parenchyma pattern in the mammographic image into the dynamic range of the output medium. The algorithm uses a contrast weight control mechanism to produce the desired weight factors to enhance the edge information corresponding to the parenchyma pattern. The output image is formed using a reconstruction filter bank through I' and enhanced Id.

Understanding Participatory Action Research: A Qualitative Research Methodology Option

ERIC Educational Resources Information Center

MacDonald, Cathy

2012-01-01

Participatory Action Research (PAR) is a qualitative research methodology option that requires further understanding and consideration. PAR is considered democratic, equitable, liberating, and life-enhancing qualitative inquiry that remains distinct from other qualitative methodologies (Kach & Kralik, 2006). Using PAR, qualitative features of an…

Cigarette smoking and mammographic density in the Danish Diet, Cancer and Health cohort.

PubMed

Jacobsen, Katja Kemp; Lynge, Elsebeth; Vejborg, Ilse; Tjønneland, Anne; von Euler-Chelpin, My; Andersen, Zorana J

2016-02-01

Smoking before first childbirth increases breast cancer risk, but the biological mechanism remains unknown and may involve mammographic density (MD), one of the strongest biomarkers of breast cancer risk. We aimed to examine whether active smoking and passive smoking were associated with MD. For the 5,356 women (4,489 postmenopausal) from the Danish Diet, Cancer and Health cohort (1993-1997) who attended mammographic screening in Copenhagen (1993-2001), we used MD (mixed/dense or fatty) assessed at the first screening after cohort entry. Active smoking (status, duration, and intensity) and passive smoking were assessed at cohort baseline (1993-1997) via questionnaire, together with other breast cancer risk factors. Logistic regression was used to estimate associations (odds ratios, 95 % confidence intervals) between smoking and MD, adjusting for confounders. Two thousand and twenty-six (56.5 %) women had mixed/dense MD, 2,214 (41.4 %) were current, and 1,175 (21.9 %) former smokers. Current smokers had significantly lower odds (0.86, 0.75-0.99) of having mixed/dense MD compared to never smokers, while former smoking was not associated with MD. Inverse association between smoking and MD was strongest in women who initiated smoking before age of 16 years (0.79, 0.64-0.96), smoked ≥15 cigarettes/day (0.83, 0.71-0.98), smoked ≥5 pack-years (0.62, 0.43-0.89), smoked >30 years (0.86, 0.75-0.99), and smoked ≥11 years before first childbirth (0.70, 0.51-0.96). Association between smoking and MD diminished after smoking cessation, with increased odds of having mixed/dense breasts in women who quit smoking >20 years ago as compared to current smokers (1.37, 1.01-1.67). There was no association between passive smoking and MD. We found an inverse association between active smoking and MD.

Screening Ultrasound as an Adjunct to Mammography in Women with Mammographically Dense Breasts

PubMed Central

Scheel, John R.; Lee, Janie M.; Sprague, Brian L.; Lee, Christoph I.; Lehman, Constance D.

2015-01-01

There is increasing interest in the potential benefits and harms of screening ultrasound to supplement mammographic screening of women with dense breast tissue. We review the current evidence regarding adjunctive screening breast ultrasound (US) and provide a summary for clinicians who counsel patients with dense breasts. We conducted a comprehensive literature review of published clinical trials and observational cohort studies assessing the efficacy of screening handheld US (HHUS) and automated breast US (ABUS) to supplement mammography among women with dense breasts. From a total of 189 peer-reviewed publications on the performance of screening US, 12 studies were relevant to our analysis. The reporting of breast cancer risk factors varied across studies; however, the study populations tended to be at greater than average risk for developing breast cancer. There is consistent evidence that adjunctive screening US detects more invasive cancers compared to mammography alone, but there is currently no evidence of associated long-term breast cancer mortality reduction. The studies also collectively found that US was associated with an additional 11.7–106.6 biopsies/1,000 examinations (Median 52.2), and detected an additional 0.3–7.7 cancers/1,000 examinations (Median 4.2). The associated number of unnecessary breast biopsies resulting from adjunct US screening exceeds that observed with screening mammography alone by approximately 5-fold. Adjunctive screening with ultrasound should also be considered in the context of screening mammography. It is important for clinicians to be aware that improvements in cancer detection in mammographically dense breasts have been achieved with the transition from film to digital mammography, reducing a limitation of film mammography. Clinicians should discuss breast density as one of several important breast cancer risk factors, consider the potential harms of adjunctive screening, and arrive at a shared decision consistent with

Hair product use, age at menarche and mammographic breast density in multiethnic urban women.

PubMed

McDonald, Jasmine A; Tehranifar, Parisa; Flom, Julie D; Terry, Mary Beth; James-Todd, Tamarra

2018-01-04

Select hair products contain endocrine disrupting chemicals (EDCs) that may affect breast cancer risk. We hypothesize that, if EDCs are related to breast cancer risk, then they may also affect two important breast cancer risk factors: age at menarche and mammographic breast density. In two urban female cohorts (N = 248): 1) the New York site of the National Collaborative Perinatal Project and 2) the New York City Multiethnic Breast Cancer Project, we measured childhood and adult use of hair oils, lotions, leave-in conditioners, root stimulators, perms/relaxers, and hair dyes using the same validated questionnaire. We used multivariable relative risk regression models to examine the association between childhood hair product use and early age at menarche (defined as <11 years of age) and multivariable linear regression models to examine the association between childhood and adult hair product use and adult mammographic breast density. Early menarche was associated with ever use of childhood hair products (RR 2.3, 95% CI 1.1, 4.8) and hair oil use (RR 2.5, 95% CI 1.2, 5.2); however, additional adjustment for race/ethnicity, attenuated associations (hair products RR 1.8, 95% CI 0.8, 4.1; hair oil use RR 2.3, 95% CI 1.0, 5.5). Breast density was not associated with adult or childhood hair product or hair oil use. If confirmed in larger prospective studies, these data suggest that exposure to EDCs through hair products in early life may affect breast cancer risk by altering timing of menarche, and may operate through a mechanism distinct from breast density.

Vitamin D and Mammographic Findings.

PubMed

Riedel, J; Straub, L; Wissing, J; Artmann, A; Schmidmayr, M; Kiechle, M; Seifert-Klauss, V R

2016-05-01

Introduction: Pleiotropic immune-modulatory and anti-proliferative effects of vitamin D and hopes to stop cancerogenesis have led to an increased interest in possible reduction of breast cancer with higher vitamin D levels. Mammographic density is an established risk factor for breast cancer risk, and its association with serum vitamin D is complex, as recent studies have shown. Patients and Methods: In this cross-sectional study, 1103 participants were recruited in the breast diagnostic unit of the Klinikum rechts der Isar, TU Munich. A standardised questionnaire and blood samples for 25-OH-vitamin D were taken on the day of mammography. Histologic results of biopsies in suspicious mammographies were documented. Results: In the 1090 data-sets analysed, vitamin D-deficiency was common among women under 40. Highest vitamin D values were observed in participants aged 60-69 years, but average values for all age cohorts were below 20 ng/ml of vitamin D. 15.6 % of all participants had very low vitamin D values (< 10 ng/ml), 51.3 % were vitamin D-deficient (10-19 ng/ml) and only 5.7 % were above 30 ng/ml, i.e. showed sufficient vitamin D. Patients with malignant results had vitamin D < 10 ng/ml more often (16.9 %; p = 0.61), and only 3.4 % in this group had sufficient vitamin D supply (> 30 ng/ml). There were no significant differences in vitamin D-levels between density groups according to the American College of Radiology (ACR) criteria. Conclusion: Vitamin D values were lower than in comparable US women. Up to now, there is no direct clinical evidence for a relationship between the risk for breast cancer and a specific vitamin D value.

Towards the use of computationally inserted lesions for mammographic CAD assessment

NASA Astrophysics Data System (ADS)

Ghanian, Zahra; Pezeshk, Aria; Petrick, Nicholas; Sahiner, Berkman

2018-03-01

Computer-aided detection (CADe) devices used for breast cancer detection on mammograms are typically first developed and assessed for a specific "original" acquisition system, e.g., a specific image detector. When CADe developers are ready to apply their CADe device to a new mammographic acquisition system, they typically assess the CADe device with images acquired using the new system. Collecting large repositories of clinical images containing verified cancer locations and acquired by the new image acquisition system is costly and time consuming. Our goal is to develop a methodology to reduce the clinical data burden in the assessment of a CADe device for use with a different image acquisition system. We are developing an image blending technique that allows users to seamlessly insert lesions imaged using an original acquisition system into normal images or regions acquired with a new system. In this study, we investigated the insertion of microcalcification clusters imaged using an original acquisition system into normal images acquired with that same system utilizing our previously-developed image blending technique. We first performed a reader study to assess whether experienced observers could distinguish between computationally inserted and native clusters. For this purpose, we applied our insertion technique to clinical cases taken from the University of South Florida Digital Database for Screening Mammography (DDSM) and the Breast Cancer Digital Repository (BCDR). Regions of interest containing microcalcification clusters from one breast of a patient were inserted into the contralateral breast of the same patient. The reader study included 55 native clusters and their 55 inserted counterparts. Analysis of the reader ratings using receiver operating characteristic (ROC) methodology indicated that inserted clusters cannot be reliably distinguished from native clusters (area under the ROC curve, AUC=0.58±0.04). Furthermore, CADe sensitivity was evaluated on

Using automated texture features to determine the probability for masking of a tumor on mammography, but not ultrasound.

PubMed

Häberle, Lothar; Hack, Carolin C; Heusinger, Katharina; Wagner, Florian; Jud, Sebastian M; Uder, Michael; Beckmann, Matthias W; Schulz-Wendtland, Rüdiger; Wittenberg, Thomas; Fasching, Peter A

2017-08-30

Tumors in radiologically dense breast were overlooked on mammograms more often than tumors in low-density breasts. A fast reproducible and automated method of assessing percentage mammographic density (PMD) would be desirable to support decisions whether ultrasonography should be provided for women in addition to mammography in diagnostic mammography units. PMD assessment has still not been included in clinical routine work, as there are issues of interobserver variability and the procedure is quite time consuming. This study investigated whether fully automatically generated texture features of mammograms can replace time-consuming semi-automatic PMD assessment to predict a patient's risk of having an invasive breast tumor that is visible on ultrasound but masked on mammography (mammography failure). This observational study included 1334 women with invasive breast cancer treated at a hospital-based diagnostic mammography unit. Ultrasound was available for the entire cohort as part of routine diagnosis. Computer-based threshold PMD assessments ("observed PMD") were carried out and 363 texture features were obtained from each mammogram. Several variable selection and regression techniques (univariate selection, lasso, boosting, random forest) were applied to predict PMD from the texture features. The predicted PMD values were each used as new predictor for masking in logistic regression models together with clinical predictors. These four logistic regression models with predicted PMD were compared among themselves and with a logistic regression model with observed PMD. The most accurate masking prediction was determined by cross-validation. About 120 of the 363 texture features were selected for predicting PMD. Density predictions with boosting were the best substitute for observed PMD to predict masking. Overall, the corresponding logistic regression model performed better (cross-validated AUC, 0.747) than one without mammographic density (0.734), but less well

Energy intake and dietary patterns in childhood and throughout adulthood and mammographic density: results from a British prospective cohort.

PubMed

Mishra, Gita D; dos Santos Silva, Isabel; McNaughton, Sarah A; Stephen, Alison; Kuh, Diana

2011-02-01

To examine the role of energy intake and dietary patterns in childhood and throughout adulthood on subsequent mammographic density. Prospective data were available from a cohort of 1161 British women followed up since their birth in 1946. Dietary intakes at age 4 years were determined by 24-hour recalls and during adulthood, average food consumed at ages 36 and 43 years by 5-day food records. Dietary patterns were determined by factor analysis. Associations between energy intake, dietary patterns, and percent breast density were investigated using regression analysis. During adulthood, energy intake was positively associated with percent breast density (adjusted regression coefficient [per SD) (95% CI): 0.12 (0.01, 0.23)]. The effect of the high fat and sugar dietary pattern remained similar when adjusted for total energy intake [0.06 (-0.01, 0.13)]. There was no evidence of an associations for the patterns low fat, high fiber pattern 0.03 (-0.04, 0.11); the alcohol and fish -0.02 (-0.13, 0.17); meat, potatoes, and vegetables -0.03 (-0.10, 0.04). No association was found for dietary pattern at age 4 and percent breast density. This study supports the hypothesis that overall energy intake during middle life is a determinant of subsequent mammographic breast density measured 15 years later.

Stiffness of the microenvironment upregulates ERBB2 expression in 3D cultures of MCF10A within the range of mammographic density.

PubMed

Cheng, Qingsu; Bilgin, Cemal Cagatay; Fontenay, Gerald; Chang, Hang; Henderson, Matthew; Han, Ju; Parvin, Bahram

2016-07-07

The effects of the stiffness of the microenvironment on the molecular response of 3D colony organization, at the maximum level of mammographic density (MD), are investigated. Phenotypic profiling reveals that 3D colony formation is heterogeneous and increased stiffness of the microenvironment, within the range of the MD, correlates with the increased frequency of aberrant 3D colony formation. Further integrative analysis of the genome-wide transcriptome and phenotypic profiling hypothesizes overexpression of ERBB2 in the premalignant MCF10A cell lines at a stiffness value that corresponds to the collagen component at high mammographic density. Subsequently, ERBB2 overexpression has been validated in the same cell line. Similar experiments with a more genetically stable cell line of 184A1 also revealed an increased frequency of aberrant colony formation with the increased stiffness; however, 184A1 did not demonstrate overexpression of ERBB2 at the same stiffness value of the high MD. These results suggest that stiffness exacerbates premalignant cell line of MCF10A.

Computer-aided diagnosis of breast cancer via Gabor wavelet bank and binary-class SVM in mammographic images

NASA Astrophysics Data System (ADS)

Torrents-Barrena, Jordina; Puig, Domenec; Melendez, Jaime; Valls, Aida

2016-03-01

Breast cancer is one of the most dangerous diseases that attack women in their 40s worldwide. Due to this fact, it is estimated that one in eight women will develop a malignant carcinoma during their life. In addition, the carelessness of performing regular screenings is an important reason for the increase of mortality. However, computer-aided diagnosis systems attempt to enhance the quality of mammograms as well as the detection of early signs related to the disease. In this paper we propose a bank of Gabor filters to calculate the mean, standard deviation, skewness and kurtosis features by four-sized evaluation windows. Therefore, an active strategy is used to select the most relevant pixels. Finally, a supervised classification stage using two-class support vector machines is utilised through an accurate estimation of kernel parameters. In order to show the development of our methodology based on mammographic image analysis, two main experiments are fulfilled: abnormal/normal breast tissue classification and the ability to detect the different breast cancer types. Moreover, the public screen-film mini-MIAS database is compared with a digitised breast cancer database to evaluate the method robustness. The area under the receiver operating characteristic curve is used to measure the performance of the method. Furthermore, both confusion matrix and accuracy are calculated to assess the results of the proposed algorithm.

Affinity proteomic profiling of plasma for proteins associated to area-based mammographic breast density.

PubMed

Byström, Sanna; Eklund, Martin; Hong, Mun-Gwan; Fredolini, Claudia; Eriksson, Mikael; Czene, Kamila; Hall, Per; Schwenk, Jochen M; Gabrielson, Marike

2018-02-14

Mammographic breast density is one of the strongest risk factors for breast cancer, but molecular understanding of how breast density relates to cancer risk is less complete. Studies of proteins in blood plasma, possibly associated with mammographic density, are well-suited as these allow large-scale analyses and might shed light on the association between breast cancer and breast density. Plasma samples from 1329 women in the Swedish KARMA project, without prior history of breast cancer, were profiled with antibody suspension bead array (SBA) assays. Two sample sets comprising 729 and 600 women were screened by two different SBAs targeting a total number of 357 proteins. Protein targets were selected through searching the literature, for either being related to breast cancer or for being linked to the extracellular matrix. Association between proteins and absolute area-based breast density (AD) was assessed by quantile regression, adjusting for age and body mass index (BMI). Plasma profiling revealed linear association between 20 proteins and AD, concordant in the two sets of samples (p < 0.05). Plasma levels of seven proteins were positively associated and 13 proteins negatively associated with AD. For eleven of these proteins evidence for gene expression in breast tissue existed. Among these, ABCC11, TNFRSF10D, F11R and ERRF were positively associated with AD, and SHC1, CFLAR, ACOX2, ITGB6, RASSF1, FANCD2 and IRX5 were negatively associated with AD. Screening proteins in plasma indicates associations between breast density and processes of tissue homeostasis, DNA repair, cancer development and/or progression in breast cancer. Further validation and follow-up studies of the shortlisted protein candidates in independent cohorts will be needed to infer their role in breast density and its progression in premenopausal and postmenopausal women.

Talking and Thinking about Qualitative Research

ERIC Educational Resources Information Center

Ellis, Carolyn; Bochner, Arthur; Denzin, Norman; Lincoln, Yvonna; Morse, Janice; Pelias, Ronald; Richardson, Laurel

2008-01-01

This script comes from an edited transcript of a session titled "Talking and Thinking About Qualitative Research," which was part of the 2006 International Congress of Qualitative Inquiry, held at the University of Illinois at Urbana-Champaign on May 4-6, 2006. This special session featured scholars informally responding to questions about their…

Study of quality perception in medical images based on comparison of contrast enhancement techniques in mammographic images

NASA Astrophysics Data System (ADS)

Matheus, B.; Verçosa, L. B.; Barufaldi, B.; Schiabel, H.

2014-03-01

With the absolute prevalence of digital images in mammography several new tools became available for radiologist; such as CAD schemes, digital zoom and contrast alteration. This work focuses in contrast variation and how the radiologist reacts to these changes when asked to evaluated image quality. Three contrast enhancing techniques were used in this study: conventional equalization, CCB Correction [1] - a digitization correction - and value subtraction. A set of 100 images was used in tests from some available online mammographic databases. The tests consisted of the presentation of all four versions of an image (original plus the three contrast enhanced images) to the specialist, requested to rank each one from the best up to worst quality for diagnosis. Analysis of results has demonstrated that CCB Correction [1] produced better images in almost all cases. Equalization, which mathematically produces a better contrast, was considered the worst for mammography image quality enhancement in the majority of cases (69.7%). The value subtraction procedure produced images considered better than the original in 84% of cases. Tests indicate that, for the radiologist's perception, it seems more important to guaranty full visualization of nuances than a high contrast image. Another result observed is that the "ideal" scanner curve does not yield the best result for a mammographic image. The important contrast range is the middle of the histogram, where nodules and masses need to be seen and clearly distinguished.

Mobile Versus Fixed Facility: Latinas' Attitudes and Preferences for Obtaining a Mammogram.

PubMed

Scheel, John R; Tillack, Allison A; Mercer, Lauren; Coronado, Gloria D; Beresford, Shirley A A; Molina, Yamile; Thompson, Beti

2018-01-01

Mobile mammographic services have been proposed as a way to reduce Latinas' disproportionate late-stage presentation compared with white women by increasing their access to mammography. The aims of this study were to assess why Latinas may not use mobile mammographic services and to explore their preferences after using these services. Using a mixed-methods approach, a secondary analysis was conducted of baseline survey data (n = 538) from a randomized controlled trial to improve screening mammography rates among Latinas in Washington. Descriptive statistics and bivariate regression were used to characterize mammography location preferences and to test for associations with sociodemographic indices, health care access, and perceived breast cancer risk and beliefs. On the basis of these findings, a qualitative study (n = 18) was used to explore changes in perceptions after using mobile mammographic services. More Latinas preferred obtaining a mammogram at a fixed facility (52.3% [n = 276]) compared with having no preference (46.3% [n = 249]) and preferring mobile mammographic services (1.7% [n = 9]). Concerns about privacy and comfort (15.6% [n = 84]) and about general quality (10.6% [n = 57]) were common reasons for preferring a fixed facility. Those with no history of mammography preferred a fixed facility (P < .05). In the qualitative study, Latinas expressed similar initial concerns but became positive toward the mobile mammographic services after obtaining a mammogram. Although most Latinas preferred obtaining a mammogram at a fixed facility, positive experiences with mobile mammography services changed their attitudes toward them. These findings highlight the need to include community education when using mobile mammographic service to increase screening mammography rates in underserved communities. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Use of MRI in Differentiation of Papillary Renal Cell Carcinoma Subtypes: Qualitative and Quantitative Analysis.

PubMed

Doshi, Ankur M; Ream, Justin M; Kierans, Andrea S; Bilbily, Matthew; Rusinek, Henry; Huang, William C; Chandarana, Hersh

2016-03-01

The purpose of this study was to determine whether qualitative and quantitative MRI feature analysis is useful for differentiating type 1 from type 2 papillary renal cell carcinoma (PRCC). This retrospective study included 21 type 1 and 17 type 2 PRCCs evaluated with preoperative MRI. Two radiologists independently evaluated various qualitative features, including signal intensity, heterogeneity, and margin. For the quantitative analysis, a radiology fellow and a medical student independently drew 3D volumes of interest over the entire tumor on T2-weighted HASTE images, apparent diffusion coefficient parametric maps, and nephrographic phase contrast-enhanced MR images to derive first-order texture metrics. Qualitative and quantitative features were compared between the groups. For both readers, qualitative features with greater frequency in type 2 PRCC included heterogeneous enhancement, indistinct margin, and T2 heterogeneity (all, p < 0.035). Indistinct margins and heterogeneous enhancement were independent predictors (AUC, 0.822). Quantitative analysis revealed that apparent diffusion coefficient, HASTE, and contrast-enhanced entropy were greater in type 2 PRCC (p < 0.05; AUC, 0.682-0.716). A combined quantitative and qualitative model had an AUC of 0.859. Qualitative features within the model had interreader concordance of 84-95%, and the quantitative data had intraclass coefficients of 0.873-0.961. Qualitative and quantitative features can help discriminate between type 1 and type 2 PRCC. Quantitative analysis may capture useful information that complements the qualitative appearance while benefiting from high interobserver agreement.

Modeling resident error-making patterns in detection of mammographic masses using computer-extracted image features: preliminary experiments

NASA Astrophysics Data System (ADS)

Mazurowski, Maciej A.; Zhang, Jing; Lo, Joseph Y.; Kuzmiak, Cherie M.; Ghate, Sujata V.; Yoon, Sora

2014-03-01

Providing high quality mammography education to radiology trainees is essential, as good interpretation skills potentially ensure the highest benefit of screening mammography for patients. We have previously proposed a computer-aided education system that utilizes trainee models, which relate human-assessed image characteristics to interpretation error. We proposed that these models be used to identify the most difficult and therefore the most educationally useful cases for each trainee. In this study, as a next step in our research, we propose to build trainee models that utilize features that are automatically extracted from images using computer vision algorithms. To predict error, we used a logistic regression which accepts imaging features as input and returns error as output. Reader data from 3 experts and 3 trainees were used. Receiver operating characteristic analysis was applied to evaluate the proposed trainee models. Our experiments showed that, for three trainees, our models were able to predict error better than chance. This is an important step in the development of adaptive computer-aided education systems since computer-extracted features will allow for faster and more extensive search of imaging databases in order to identify the most educationally beneficial cases.

In the Roiling Smoke: Qualitative Inquiry and Contested Fields

ERIC Educational Resources Information Center

Atkinson, Paul; Delamont, Sara

2006-01-01

Two British authors reflect on the current state of qualitative research, viewed as a battlefield through roiling smoke. From a UK perspective they reflect on the perceived crisis in qualitative research in the United States. They also suggest that there are four important features that good qualitative research should rely on: problematizing…

Mammographic breast density patterns in asymptomatic mexican women.

PubMed

Calderón-Garcidueñas, Ana Laura; Sanabria-Mondragón, Mónica; Hernández-Beltrán, Lourdes; López-Amador, Noé; Cerda-Flores, Ricardo M

2012-01-01

Breast density (BD) is a risk factor for breast cancer. Aims. To describe BD patterns in asymptomatic Mexican women and the pathological mammographic findings. Methods and Material. Prospective, descriptive, and comparative study. Women answered a questionnaire and their mammograms were analyzed according to BI-RADS. Univariate (χ(2)) and conditional logistic regression analyses were performed. Results. In 300 women studied the BD patterns were fat 56.7% (170), fibroglandular 29% (87), heterogeneously dense 5.7% (17), and dense pattern 8.6% (26). Prevalence of fat pattern was significantly different in women under 50 years (37.6%, 44/117) and older than 50 (68.8%, 126/183). Patterns of high breast density (BD) (dense + heterogeneously dense) were observed in 25.6% (30/117) of women ≤50 years and 7.1% (13/183) of women >50. Asymmetry in BD was observed in 22% (66/300). Compression cone ruled out underlying disease in 56 cases. In the remaining 10, biopsy revealed one fibroadenoma, one complex cyst, and 6 invasive and 2 intraductal carcinomas. 2.6% (8/300) of patients had non-palpable carcinomas. Benign lesions were observed in 63.3% (190/300) of cases, vascular calcification in 150 cases (78.9%), and fat necrosis in 38 cases (20%). Conclusions. Mexican women have a low percentage of high-density patterns.

How do the features of mindfulness-based cognitive therapy contribute to positive therapeutic change? A meta-synthesis of qualitative studies.

PubMed

Cairns, Victoria; Murray, Craig

2015-05-01

The exploration of Mindfulness-based Cognitive Therapy through qualitative investigation is a growing area of interest within current literature, providing valuable understanding of the process of change experienced by those engaging in this therapeutic approach. This meta-synthesis aims to gain a deeper understanding of how the features of Mindfulness-based Cognitive Therapy contribute to positive therapeutic change. Noblit and Hare's (1988) 7-step meta-ethnography method was conducted in order to synthesize the findings of seven qualitative studies. The process of reciprocal translation identified the following five major themes: i) Taking control through understanding, awareness and acceptance; ii) The impact of the group; (iii) Taking skills into everyday life; (iv) Feelings towards the self; (v) The role of expectations. The synthesis of translation identified the higher order concept of "The Mindfulness-based Cognitive Therapy Journey to Change", which depicts the complex interaction between the five themes in relation to how they contribute to positive therapeutic change. The findings are discussed in relation to previous research, theory and their implications for clinical practice.

Characteristics of quantitative perfusion parameters on dynamic contrast‐enhanced MRI in mammographically occult breast cancer

PubMed Central

Ryu, Jung Kyu; Rhee, Sun Jung; Song, Jeong Yoon; Cho, Soo Hyun

2016-01-01

The purpose of this study was to compare the characteristics of quantitative perfusion parameters obtained from dynamic contrast‐enhanced (DCE) magnetic resonance imaging (MRI) in patients with mammographically occult (MO) breast cancers and those with mammographically visible (MV) breast cancers. Quantitative parameters (AUC, Ktrans,kep,ve,vp, and wi) from 13 MO breast cancers and 16 MV breast cancers were mapped after the DCE‐MRI data were acquired. Various prognostic factors, including axillary nodal status, estrogen receptor (ER), progesterone receptor (PR), Ki‐67, p53, E‐cadherin, and human epidermal growth factor receptor 2 (HER2) were obtained in each group. Fisher's exact test was used to compare any differences of the various prognostic factors between the two groups. The Mann‐Whitney U test was applied to compare the quantitative parameters between these two groups. Finally, Spearman's correlation was used to investigate the relationships between perfusion indices and four factors — age, tumor size, Ki‐67, and p53 — for each group. Although age, tumor size, and the prognostic factors were not statistically different between the two groups, the mean values of the quantitative parameters, except wi in the MV group, were higher than those in the MO group without statistical significance (p=0.219). The kep value was significantly different between the two groups (p=0.048), but the other parameters were not. In the MO group, vp with size, ve with p53, and Ktrans and vp with Ki‐67 had significant correlations (p<0.05). However, in the MV group, only kep showed significant correlation with age. The kep value was only the perfusion parameter of statistical significance between MO and MV breast cancers. PACS number(s): 87.19.U‐, 87.61.‐c PMID:27685105

Using multiscale texture and density features for near-term breast cancer risk analysis

PubMed Central

Sun, Wenqing; Tseng, Tzu-Liang (Bill); Qian, Wei; Zhang, Jianying; Saltzstein, Edward C.; Zheng, Bin; Lure, Fleming; Yu, Hui; Zhou, Shi

2015-01-01

Purpose: To help improve efficacy of screening mammography by eventually establishing a new optimal personalized screening paradigm, the authors investigated the potential of using the quantitative multiscale texture and density feature analysis of digital mammograms to predict near-term breast cancer risk. Methods: The authors’ dataset includes digital mammograms acquired from 340 women. Among them, 141 were positive and 199 were negative/benign cases. The negative digital mammograms acquired from the “prior” screening examinations were used in the study. Based on the intensity value distributions, five subregions at different scales were extracted from each mammogram. Five groups of features, including density and texture features, were developed and calculated on every one of the subregions. Sequential forward floating selection was used to search for the effective combinations. Using the selected features, a support vector machine (SVM) was optimized using a tenfold validation method to predict the risk of each woman having image-detectable cancer in the next sequential mammography screening. The area under the receiver operating characteristic curve (AUC) was used as the performance assessment index. Results: From a total number of 765 features computed from multiscale subregions, an optimal feature set of 12 features was selected. Applying this feature set, a SVM classifier yielded performance of AUC = 0.729 ± 0.021. The positive predictive value was 0.657 (92 of 140) and the negative predictive value was 0.755 (151 of 200). Conclusions: The study results demonstrated a moderately high positive association between risk prediction scores generated by the quantitative multiscale mammographic image feature analysis and the actual risk of a woman having an image-detectable breast cancer in the next subsequent examinations. PMID:26127038

Selective magnetic resonance imaging (MRI) in invasive lobular breast cancer based on mammographic density: does it lead to an appropriate change in surgical treatment?

PubMed

Bansal, Gaurav J; Santosh, Divya; Davies, Eleri L

2016-01-01

The purpose of this study was to evaluate whether high mammographic density can be used as one of the selection criteria for MRI in invasive lobular breast cancer (ILC). In our institute, high breast density has been used as one of the indications for performing MRI scan in patients with ILC. We divided the patients in two groups, one with MRI performed pre-operatively and other without MRI. We compared their surgical procedures and analyzed whether surgical plan was altered after MRI. In case of alteration of plan, we analyzed whether the change was adequate by comparing post-operative histological findings. Between 2011 and 2015, there were a total of 1601 breast cancers with 97 lobular cancers, out of which 36 had pre-operative MRI and 61 had no MRI scan. 12 (33.3%) had mastectomy following MRI, out of which 9 (25%) had change in surgical plan from conservation to mastectomy following MRI. There were no unnecessary mastectomies in the MRI group. However, utilization of MRI in this cohort of patients did not reduce reoperation rate (19.3%). Lobular carcinoma in situ (LCIS) was identified in 60% of reoperations on post-surgical histology. Patients in the "No MRI" group had higher mastectomy rate 26 (42.6%), which was again appropriate. High mammographic density is a useful risk stratification criterion for selective MRI in ILC within a multidisciplinary team meeting setting. Provided additional lesions identified on MRI are confirmed with biopsy, pre-operative MRI does not cause unnecessary mastectomies. Used in this selective manner, reoperation rates were not eliminated, albeit reduced when compared to literature. High mammographic breast density can be used as one of the selection criteria for pre-operative MRI in ILC without an increase in inappropriate mastectomies with potential time and cost savings. In this cohort, re-excisions were not reduced markedly with pre-operative MRI.

Phantom evaluation of the effect of film processing on mammographic screen-film combinations.

PubMed

McLean, D; Rickard, M T

1994-08-01

Mammographic image quality should be optimal for diagnosis, and the film contrast can be manipulated by altering development parameters. In this study phantom test objects were radiographed and processed for a given range of developer temperatures and times for four film-screen systems. Radiologists scored the phantom test objects on the resultant films to evaluate the effect on diagnosis of varying image contrast. While for three film-screen systems processing led to appreciable contrast differences, for only one film system did maximum contrast correspond with optimal phantom test object scoring. The inability to show an effect on diagnosis in all cases is possibly due to the variation in radiologist responses found in this study and in normal clinical circumstances. Other technical factors such as changes in film fog, grain and mottle may contribute to the study findings.

Assessment of global and local region-based bilateral mammographic feature asymmetry to predict short-term breast cancer risk

NASA Astrophysics Data System (ADS)

Li, Yane; Fan, Ming; Cheng, Hu; Zhang, Peng; Zheng, Bin; Li, Lihua

2018-01-01

This study aims to develop and test a new imaging marker-based short-term breast cancer risk prediction model. An age-matched dataset of 566 screening mammography cases was used. All ‘prior’ images acquired in the two screening series were negative, while in the ‘current’ screening images, 283 cases were positive for cancer and 283 cases remained negative. For each case, two bilateral cranio-caudal view mammograms acquired from the ‘prior’ negative screenings were selected and processed by a computer-aided image processing scheme, which segmented the entire breast area into nine strip-based local regions, extracted the element regions using difference of Gaussian filters, and computed both global- and local-based bilateral asymmetrical image features. An initial feature pool included 190 features related to the spatial distribution and structural similarity of grayscale values, as well as of the magnitude and phase responses of multidirectional Gabor filters. Next, a short-term breast cancer risk prediction model based on a generalized linear model was built using an embedded stepwise regression analysis method to select features and a leave-one-case-out cross-validation method to predict the likelihood of each woman having image-detectable cancer in the next sequential mammography screening. The area under the receiver operating characteristic curve (AUC) values significantly increased from 0.5863  ±  0.0237 to 0.6870  ±  0.0220 when the model trained by the image features extracted from the global regions and by the features extracted from both the global and the matched local regions (p  =  0.0001). The odds ratio values monotonically increased from 1.00-8.11 with a significantly increasing trend in slope (p  =  0.0028) as the model-generated risk score increased. In addition, the AUC values were 0.6555  ±  0.0437, 0.6958  ±  0.0290, and 0.7054  ±  0.0529 for the three age groups of 37

Certain performance values arising from mammographic test set readings correlate well with clinical audit.

PubMed

Soh, BaoLin Pauline; Lee, Warwick Bruce; Mello-Thoms, Claudia; Tapia, Kriscia; Ryan, John; Hung, Wai Tak; Thompson, Graham; Heard, Rob; Brennan, Patrick

2015-08-01

Test sets have been increasingly utilised to augment clinical audit in breast screening programmes; however, their relationship has never been satisfactorily understood. This study examined the relationship between mammographic test set performance and clinical audit data. Clinical audit data over a 2-year period was generated for each of 20 radiologists. Sixty mammographic examinations, consisting of 40 normal and 20 cancer cases, formed the test set. Readers located any identifiable cancer, and levels of confidence were scored from 2 to 5, where a score of 3 and above is considered a recall rating. Jackknifing free response operating characteristic (JAFROC) figure-of-merit (FOM), location sensitivity and specificity were calculated for individual readers and then compared with clinical audit values using Spearman's rho. JAFROC FOM showed significant correlations to: recall rate at a first round of screening (r = 0.51; P = 0.02); rate of small invasive cancers per 10 000 reads (r = 0.5; P = 0.02); percentage of all cancers read that were not recalled (r = -0.51; P = 0.02); and sensitivity (r = 0.51; P = 0.02). Location sensitivity demonstrated significant correlations with: rate of small invasive cancers per 10 000 reads (r = 0.46; P = 0.04); rate of DCIS (ductal carcinoma in situ) per 10 000 reads (r = 0.44; P = 0.05); detection rate of all invasive cancers and DCIS per 10 000 reads (r = 0.54; P = 0.01); percentage of all cancers read that were not recalled (r = -0.57; P = 0.009); and sensitivity (r = 0.57; P = 0.009). No other significant relationships were noted. Performance indicators from test set demonstrate significant correlations with specific aspects of clinical performance, although caution needs to be exercised when generalising test set specificity to the clinical situation. © 2015 The Royal Australian and New Zealand College of Radiologists.

Deep learning of symmetrical discrepancies for computer-aided detection of mammographic masses

NASA Astrophysics Data System (ADS)

Kooi, Thijs; Karssemeijer, Nico

2017-03-01

When humans identify objects in images, context is an important cue; a cheetah is more likely to be a domestic cat when a television set is recognised in the background. Similar principles apply to the analysis of medical images. The detection of diseases that manifest unilaterally in symmetrical organs or organ pairs can in part be facilitated by a search for symmetrical discrepancies in or between the organs in question. During a mammographic exam, images are recorded of each breast and absence of a certain structure around the same location in the contralateral image will render the area under scrutiny more suspicious and conversely, the presence of similar tissue less so. In this paper, we present a fusion scheme for a deep Convolutional Neural Network (CNN) architecture with the goal to optimally capture such asymmetries. The method is applied to the domain of mammography CAD, but can be relevant to other medical image analysis tasks where symmetry is important such as lung, prostate or brain images.

Effect of poor control of film processors on mammographic image quality.

PubMed

Kimme-Smith, C; Sun, H; Bassett, L W; Gold, R H

1992-11-01

With the increasingly stringent standards of image quality in mammography, film processor quality control is especially important. Current methods are not sufficient for ensuring good processing. The authors used a sensitometer and densitometer system to evaluate the performance of 22 processors at 16 mammographic facilities. Standard sensitometric values of two films were established, and processor performance was assessed for variations from these standards. Developer chemistry of each processor was analyzed and correlated with its sensitometric values. Ten processors were retested, and nine were found to be out of calibration. The developer components of hydroquinone, sulfites, bromide, and alkalinity varied the most, and low concentrations of hydroquinone were associated with lower average gradients at two facilities. Use of the sensitometer and densitometer system helps identify out-of-calibration processors, but further study is needed to correlate sensitometric values with developer component values. The authors believe that present quality control would be improved if sensitometric or other tests could be used to identify developer components that are out of calibration.

Extraction of Qualitative Features from Sensor Data Using Windowed Fourier Transform

NASA Technical Reports Server (NTRS)

Amini, Abolfazl M.; Figueroa, Fenando

2003-01-01

In this paper, we use Matlab to model the health monitoring of a system through the information gathered from sensors. This implies assessment of the condition of the system components. Once a normal mode of operation is established any deviation from the normal behavior indicates a change. This change may be due to a malfunction of an element, a qualitative change, or a change due to a problem with another element in the network. For example, if one sensor indicates that the temperature in the tank has experienced a step change then a pressure sensor associated with the process in the tank should also experience a step change. The step up and step down as well as sensor disturbances are assumed to be exponential. An RC network is used to model the main process, which is step-up (charging), drift, and step-down (discharging). The sensor disturbances and spike are added while the system is in drift. The system is allowed to run for a period equal to three time constant of the main process before changes occur. Then each point of the signal is selected with a trailing data collected previously. Two trailing lengths of data are selected, one equal to two time constants of the main process and the other equal to two time constants of the sensor disturbance. Next, the DC is removed from each set of data and then the data are passed through a window followed by calculation of spectra for each set. In order to extract features the signal power, peak, and spectrum are plotted vs time. The results indicate distinct shapes corresponding to each process. The study is also carried out for a number of Gaussian distributed noisy cases.

Evaluating Thin Compression Paddles for Mammographically Compatible Ultrasound

PubMed Central

Booi, Rebecca C.; Krücker, Jochen F.; Goodsitt, Mitchell M.; O’Donnell, Matthew; Kapur, Ajay; LeCarpentier, Gerald L.; Roubidoux, Marilyn A.; Fowlkes, J. Brian; Carson, Paul L.

2007-01-01

We are developing a combined digital mammography/3D ultrasound system to improve detection and/or characterization of breast lesions. Ultrasound scanning through a mammographic paddle could significantly reduce signal level, degrade beam focusing, and create reverberations. Thus, appropriate paddle choice is essential for accurate sonographic lesion detection and assessment with this system. In this study, we characterized ultrasound image quality through paddles of varying materials (lexan, polyurethane, TPX, mylar) and thicknesses (0.25–2.5 mm). Analytical experiments focused on lexan and TPX, which preliminary results demonstrated were most competitive. Spatial and contrast resolution, sidelobe and range lobe levels, contrast and signal strength were compared with no-paddle images. When the beamforming of the system was corrected to account for imaging through the paddle, the TPX 2.5 mm paddle performed the best. Test objects imaged through this paddle demonstrated ≤ 15% reduction in spatial resolution, ≤ 7.5 dB signal loss, ≤ 3 dB contrast loss, and range lobe levels ≥ 35 dB below signal maximum over 4 cm. TPX paddles < 2.5 mm could also be used with this system, depending on imaging goals. In 10 human subjects with cysts, small CNR losses were observed but were determined to be statistically insignificant. Radiologists concluded that 75% of cysts in through-paddle scans were at least as detectable as in their corresponding direct-contact scans. (Email: rbooi@umich.edu) PMID:17280765

Maternal Anthropometry and Mammographic Density in Adult Daughters.

PubMed

Michels, Karin B; Cohn, Barbara A; Goldberg, Mandy; Flom, Julie D; Dougan, Marcelle; Terry, Mary Beth

2016-11-01

We examined the relation between maternal anthropometry and mammographic density in the adult daughter using prospectively collected data. Our study included a total of 700 mother-daughter dyads participating in an adult follow-up of women born in 2 US birth cohorts: the Child Health and Development Study and the Boston, Massachusetts, and Providence, Rhode Island sites of the National Collaborative Perinatal Project. We observed an increased percent breast density at a mean age of 43.1 years in the daughters of mothers who gained 5 kg or less during pregnancy compared with mother-daughter pairs in which the mother gained 5 to 10 kg (β = 4.8, 95% confidence interval: 1.0 to 8.6). The daughters of mothers who were overweight at the time of conception (prepregnancy BMI ≥25) and who gained >5 kg during pregnancy had a lower percent density (β = -3.2, 95% confidence interval: -6.2 to -0.2) compared with mothers with a BMI <25 at conception who gained >5 kg. We did not find any strong and consistent patterns between maternal anthropometry and the daughter's breast density, a strong predictor of breast cancer risk. A modest association between low gestational weight gain and increased breast density 40 years later in the daughter was observed, even after accounting for adult body size, and if confirmed, possible mechanisms need to be further elucidated. Copyright © 2016 by the American Academy of Pediatrics.

Analysis of confidence level scores from an ROC study: comparison of three mammographic systems for detection of simulated calcifications

NASA Astrophysics Data System (ADS)

Lai, Chao-Jen; Shaw, Chris C.; Whitman, Gary J.; Yang, Wei T.; Dempsey, Peter J.

2005-04-01

The purpose of this study is to compare the detection performance of three different mammography systems: screen/film (SF) combination, a-Si/CsI flat-panel (FP-), and charge-coupled device (CCD-) based systems. A 5-cm thick 50% adipose/50% glandular breast tissue equivalent slab phantom was used to provide an uniform background. Calcium carbonate grains of three different size groups were used to simulate microcalcifications (MCs): 112-125, 125-140, and 140-150 μm overlapping with the uniform background. Calcification images were acquired with the three mammography systems. Digital images were printed on hardcopy films. All film images were displayed on a mammographic viewer and reviewed by 5 mammographers. The visibility of the MC was rated with a 5-point confidence rating scale for each detection task, including the negative controls. Scores were averaged over all readers for various detectors and size groups. Receiver operating characteristic (ROC) analysis was performed and the areas under the ROC curves (Az"s) were computed for various imaging conditions. The results shows that (1) the FP-based system performed significantly better than the SF and CCD-based systems for individual size groups using ROC analysis (2) the FP-based system also performed significantly better than the SF and CCD-based systems for individual size groups using averaged confidence scale, and (3) the results obtained from the Az"s were largely correlated with these from confidence level scores. However, the correlation varied slightly among different imaging conditions.

Autobiographical Planning and the Brain: Activation and Its Modulation by Qualitative Features.

PubMed

Spreng, R Nathan; Gerlach, Kathy D; Turner, Gary R; Schacter, Daniel L

2015-11-01

To engage in purposeful behavior, it is important to make plans, which organize subsequent actions. Most studies of planning involve "look-ahead" puzzle tasks that are unrelated to personal goals. We developed a task to assess autobiographical planning, which involves the formulation of personal plans in response to real-world goals, and examined autobiographical planning in 63 adults during fMRI scanning. Autobiographical planning was found to engage the default network, including medial-temporal lobe and midline structures, and executive control regions in lateral pFC and parietal cortex and caudate. To examine how specific qualitative features of autobiographical plans modulate neural activity, we performed parametric modulation analyses. Ratings of plan detail, novelty, temporal distance, ease of plan formulation, difficulty in goal completion, and confidence in goal accomplishment were used as covariates in six hierarchical linear regression models. This modeling procedure removed shared variance among the ratings, allowing us to determine the independent relationship between ratings of interest and trial-wise BOLD signal. We found that specific autobiographical planning, describing a detailed, achievable, and actionable planning process for attaining a clearly envisioned future, recruited both default and frontoparietal brain regions. In contrast, abstract autobiographical planning, plans that were constructed from more generalized semantic or affective representations of a less tangible and distant future, involved interactions among default, sensory perceptual, and limbic brain structures. Specific qualities of autobiographical plans are important predictors of default and frontoparietal control network engagement during plan formation and reflect the contribution of mnemonic and executive control processes to autobiographical planning.

Qualitative and Quantitative Features of Music Reported to Support Peak Mystical Experiences during Psychedelic Therapy Sessions

PubMed Central

Barrett, Frederick S.; Robbins, Hollis; Smooke, David; Brown, Jenine L.; Griffiths, Roland R.

2017-01-01

Psilocybin is a classic (serotonergic) hallucinogen (“psychedelic” drug) that may occasion mystical experiences (characterized by a profound feeling of oneness or unity) during acute effects. Such experiences may have therapeutic value. Research and clinical applications of psychedelics usually include music listening during acute drug effects, based on the expectation that music will provide psychological support during the acute effects of psychedelic drugs, and may even facilitate the occurrence of mystical experiences. However, the features of music chosen to support the different phases of drug effects are not well-specified. As a result, there is currently neither real guidance for the selection of music nor standardization of the music used to support clinical trials with psychedelic drugs across various research groups or therapists. A description of the features of music found to be supportive of mystical experience will allow for the standardization and optimization of the delivery of psychedelic drugs in both research trials and therapeutic contexts. To this end, we conducted an anonymous survey of individuals with extensive experience administering psilocybin or psilocybin-containing mushrooms under research or therapeutic conditions, in order to identify the features of commonly used musical selections that have been found by therapists and research staff to be supportive of mystical experiences within a psilocybin session. Ten respondents yielded 24 unique recommendations of musical stimuli supportive of peak effects with psilocybin, and 24 unique recommendations of musical stimuli supportive of the period leading up to a peak experience. Qualitative analysis (expert rating of musical and music-theoretic features of the recommended stimuli) and quantitative analysis (using signal processing and music-information retrieval methods) of 22 of these stimuli yielded a description of peak period music that was characterized by regular, predictable

Qualitative and Quantitative Features of Music Reported to Support Peak Mystical Experiences during Psychedelic Therapy Sessions.

PubMed

Barrett, Frederick S; Robbins, Hollis; Smooke, David; Brown, Jenine L; Griffiths, Roland R

2017-01-01

Psilocybin is a classic (serotonergic) hallucinogen ("psychedelic" drug) that may occasion mystical experiences (characterized by a profound feeling of oneness or unity) during acute effects. Such experiences may have therapeutic value. Research and clinical applications of psychedelics usually include music listening during acute drug effects, based on the expectation that music will provide psychological support during the acute effects of psychedelic drugs, and may even facilitate the occurrence of mystical experiences. However, the features of music chosen to support the different phases of drug effects are not well-specified. As a result, there is currently neither real guidance for the selection of music nor standardization of the music used to support clinical trials with psychedelic drugs across various research groups or therapists. A description of the features of music found to be supportive of mystical experience will allow for the standardization and optimization of the delivery of psychedelic drugs in both research trials and therapeutic contexts. To this end, we conducted an anonymous survey of individuals with extensive experience administering psilocybin or psilocybin-containing mushrooms under research or therapeutic conditions, in order to identify the features of commonly used musical selections that have been found by therapists and research staff to be supportive of mystical experiences within a psilocybin session. Ten respondents yielded 24 unique recommendations of musical stimuli supportive of peak effects with psilocybin, and 24 unique recommendations of musical stimuli supportive of the period leading up to a peak experience. Qualitative analysis (expert rating of musical and music-theoretic features of the recommended stimuli) and quantitative analysis (using signal processing and music-information retrieval methods) of 22 of these stimuli yielded a description of peak period music that was characterized by regular, predictable

A deep learning method for classifying mammographic breast density categories.

PubMed

Mohamed, Aly A; Berg, Wendie A; Peng, Hong; Luo, Yahong; Jankowitz, Rachel C; Wu, Shandong

2018-01-01

Mammographic breast density is an established risk marker for breast cancer and is visually assessed by radiologists in routine mammogram image reading, using four qualitative Breast Imaging and Reporting Data System (BI-RADS) breast density categories. It is particularly difficult for radiologists to consistently distinguish the two most common and most variably assigned BI-RADS categories, i.e., "scattered density" and "heterogeneously dense". The aim of this work was to investigate a deep learning-based breast density classifier to consistently distinguish these two categories, aiming at providing a potential computerized tool to assist radiologists in assigning a BI-RADS category in current clinical workflow. In this study, we constructed a convolutional neural network (CNN)-based model coupled with a large (i.e., 22,000 images) digital mammogram imaging dataset to evaluate the classification performance between the two aforementioned breast density categories. All images were collected from a cohort of 1,427 women who underwent standard digital mammography screening from 2005 to 2016 at our institution. The truths of the density categories were based on standard clinical assessment made by board-certified breast imaging radiologists. Effects of direct training from scratch solely using digital mammogram images and transfer learning of a pretrained model on a large nonmedical imaging dataset were evaluated for the specific task of breast density classification. In order to measure the classification performance, the CNN classifier was also tested on a refined version of the mammogram image dataset by removing some potentially inaccurately labeled images. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were used to measure the accuracy of the classifier. The AUC was 0.9421 when the CNN-model was trained from scratch on our own mammogram images, and the accuracy increased gradually along with an increased size of training samples

Towards a nanoscale mammographic contrast agent: development of a modular pre-clinical dual optical/x-ray agent

NASA Astrophysics Data System (ADS)

Hill, Melissa L.; Gorelikov, Ivan; Niroui, Farnaz; Levitin, Ronald B.; Mainprize, James G.; Yaffe, Martin J.; Rowlands, J. A.; Matsuura, Naomi

2013-08-01

Contrast-enhanced digital mammography (CEDM) can provide improved breast cancer detection and characterization compared to conventional mammography by imaging the effects of tumour angiogenesis. Current small-molecule contrast agents used for CEDM are limited by a short plasma half-life and rapid extravasation into tissue interstitial space. To address these limitations, nanoscale agents that can remain intravascular except at sites of tumour angiogenesis can be used. For CEDM, this agent must be both biocompatible and strongly attenuate mammographic energy x-rays. Nanoscale perfluorooctylbromide (PFOB) droplets have good x-ray attenuation and have been used in patients for other applications. However, the macroscopic scale of x-ray imaging (50-100 µm) is inadequate for direct verification that PFOB droplets localize at sites of breast tumour angiogenesis. For efficient pre-clinical optimization for CEDM, we integrated an optical marker into PFOB droplets for microscopic assessment (≪50 µm). To develop PFOB droplets as a new nanoscale mammographic contrast agent, PFOB droplets were labelled with fluorescent quantum dots (QDs). The droplets had mean diameters of 160 nm, fluoresced at 635 nm and attenuated x-ray spectra at 30.5 keV mean energy with a relative attenuation of 5.6 ± 0.3 Hounsfield units (HU) mg-1 mL-1 QD-PFOB. With the agent loaded into tissue phantoms, good correlation between x-ray attenuation and optical fluorescence was found (R2 = 0.96), confirming co-localization of the QDs with PFOB for quantitative assessment using x-ray or optical methods. Furthermore, the QDs can be removed from the PFOB agent without affecting its x-ray attenuation or structural properties for expedited translation of optimized PFOB droplet formulations into patients.

Breast imaging using an amorphous silicon-based full-field digital mammographic system: stability of a clinical prototype.

PubMed

Vedantham, S; Karellas, A; Suryanarayanan, S; D'Orsi, C J; Hendrick, R E

2000-11-01

An amorphous silicon-based full-breast imager for digital mammography was evaluated for detector stability over a period of 1 year. This imager uses a structured CsI:TI scintillator coupled to an amorphous silicon layer with a 100-micron pixel pitch and read out by special purpose electronics. The stability of the system was characterized using the following quantifiable metrics: conversion factor (mean number of electrons generated per incident x-ray), presampling modulation transfer function (MTF), detector linearity and sensitivity, detector signal-to-noise ratio (SNR), and American College of Radiology (ACR) accreditation phantom scores. Qualitative metrics such as flat field uniformity, geometric distortion, and Society of Motion Picture and Television Engineers (SMPTE) test pattern image quality were also used to study the stability of the system. Observations made over this 1-year period indicated that the maximum variation from the average of the measurements were less than 0.5% for conversion factor, 3% for presampling MTF over all spatial frequencies, 5% for signal response, linearity and sensitivity, 12% for SNR over seven locations for all 3 target-filter combinations, and 0% for ACR accreditation phantom scores. ACR mammographic accreditation phantom images indicated the ability to resolve 5 fibers, 4 speck groups, and 5 masses at a mean glandular dose of 1.23 mGy. The SMPTE pattern image quality test for the display monitors used for image viewing indicated ability to discern all contrast steps and ability to distinguish line-pair images at the center and corners of the image. No bleeding effects were observed in the image. Flat field uniformity for all 3 target-filter combinations displayed no artifacts such as gridlines, bad detector rows or columns, horizontal or vertical streaks, or bad pixels. Wire mesh screen images indicated uniform resolution and no geometric distortion.

Idiopathic bile acid malabsorption: qualitative and quantitative clinical features and response to cholestyramine.

PubMed

Sinha, L; Liston, R; Testa, H J; Moriarty, K J

1998-09-01

Idiopathic bile acid malabsorption is a poorly recognized cause of chronic diarrhoea. The SeHCAT (75Selenium HomotauroCholic Acid Test) can accurately diagnose this condition. To identify patients with idiopathic bile acid malabsorption, to describe their clinical features, both qualitatively and quantitatively, and to assess the response to cholestyramine. Idiopathic bile acid malabsorption was considered in all patients complaining of chronic diarrhoea. They were included in the study if their SeHCATs were positive (< 15% retention) and secondary causes of bile acid malabsorption were excluded. The response to therapy with cholestyramine was assessed. Nine patients were diagnosed with idiopathic bile acid malabsorption (median SeHCAT retention 8%, range 3-12.6). Their median daily faecal weight was 285 g (range 85-676) and median faecal fat output was 17 mmol/24 h (range 8.3-38.8). Six patients had an immediate response to cholestyramine. There was a marked reduction in stool frequency (median stool frequency pre-treatment 5/day vs. 2/day post-treatment, P = 0.03). Five patients had large volume diarrhoea (faecal weight > 200 g/day) and three had steatorrhoea. Idiopathic bile acid malabsorption, once suspected, especially by documenting true 'large volume' watery diarrhoea or steatorrhoea, is easily diagnosed and response to therapy is often very good. There is often a previous history of gastrointestinal infection and this condition should be considered in patients with chronic diarrhoea of undetermined origin, especially before they are labelled as having irritable bowel syndrome.

Temporal assessment of radiomic features on clinical mammography in a high-risk population

NASA Astrophysics Data System (ADS)

Mendel, Kayla R.; Li, Hui; Lan, Li; Chan, Chun-Wai; King, Lauren M.; Tayob, Nabihah; Whitman, Gary; El-Zein, Randa; Bedrosian, Isabelle; Giger, Maryellen L.

2018-02-01

Extraction of high-dimensional quantitative data from medical images has become necessary in disease risk assessment, diagnostics and prognostics. Radiomic workflows for mammography typically involve a single medical image for each patient although medical images may exist for multiple imaging exams, especially in screening protocols. Our study takes advantage of the availability of mammograms acquired over multiple years for the prediction of cancer onset. This study included 841 images from 328 patients who developed subsequent mammographic abnormalities, which were confirmed as either cancer (n=173) or non-cancer (n=155) through diagnostic core needle biopsy. Quantitative radiomic analysis was conducted on antecedent FFDMs acquired a year or more prior to diagnostic biopsy. Analysis was limited to the breast contralateral to that in which the abnormality arose. Novel metrics were used to identify robust radiomic features. The most robust features were evaluated in the task of predicting future malignancies on a subset of 72 subjects (23 cancer cases and 49 non-cancer controls) with mammograms over multiple years. Using linear discriminant analysis, the robust radiomic features were merged into predictive signatures by: (i) using features from only the most recent contralateral mammogram, (ii) change in feature values between mammograms, and (iii) ratio of feature values over time, yielding AUCs of 0.57 (SE=0.07), 0.63 (SE=0.06), and 0.66 (SE=0.06), respectively. The AUCs for temporal radiomics (ratio) statistically differed from chance, suggesting that changes in radiomics over time may be critical for risk assessment. Overall, we found that our two-stage process of robustness assessment followed by performance evaluation served well in our investigation on the role of temporal radiomics in risk assessment.

Mammographic density and risk of breast cancer according to tumor characteristics and mode of detection: a Spanish population-based case-control study

PubMed Central

2013-01-01

Introduction It is not clear whether high mammographic density (MD) is equally associated with all subtypes of breast cancer (BC). We investigated the association between MD and subsequent BC, considering invasiveness, means of detection, pathologic subtype, and the time elapsed since mammographic exploration and BC diagnosis. Methods BC cases occurring in the population of women who attended screening from 1997 through 2004 in Navarre, a Spanish region with a fully consolidated screening program, were identified via record linkage with the Navarre Cancer Registry (n = 1,172). Information was extracted from the records of their first attendance at screening in that period. For each case, we randomly selected four controls, matched by screening round, year of birth, and place of residence. Cases were classified according to invasiveness (ductal carcinoma in situ (DCIS) versus invasive tumors), pathologic subtype (considering hormonal receptors and HER2), and type of diagnosis (screen-detected versus interval cases). MD was evaluated by a single, experienced radiologist by using a semiquantitative scale. Data on BC risk factors were obtained by the screening program in the corresponding round. The association between MD and tumor subtype was assessed by using conditional logistic regression. Results MD was clearly associated with subsequent BC. The odds ratio (OR) for the highest MD category (MD >75%) compared with the reference category (MD <10%) was similar for DCIS (OR = 3.47; 95% CI = 1.46 to 8.27) and invasive tumors (OR = 2.95; 95% CI = 2.01 to 4.35). The excess risk was particularly high for interval cases (OR = 7.72; 95% CI = 4.02 to 14.81) in comparison with screened detected tumors (OR = 2.17; 95% CI = 1.40 to 3.36). Sensitivity analyses excluding interval cases diagnosed in the first year after MD assessment or immediately after an early recall to screening yielded similar results. No differences were seen regarding pathologic subtypes. The excess risk

Increased COX-2 expression in epithelial and stromal cells of high mammographic density tissues and in a xenograft model of mammographic density.

PubMed

Chew, G L; Huo, C W; Huang, D; Hill, P; Cawson, J; Frazer, H; Hopper, J L; Haviv, I; Henderson, M A; Britt, K; Thompson, E W

2015-08-01

Mammographic density (MD) adjusted for age and body mass index is one of the strongest known risk factors for breast cancer. Given the high attributable risk of MD for breast cancer, chemoprevention with a safe and available agent that reduces MD and breast cancer risk would be beneficial. Cox-2 has been implicated in MD-related breast cancer risk, and was increased in stromal cells in high MD tissues in one study. Our study assessed differential Cox-2 expression in epithelial and stromal cells in paired samples of high and low MD human breast tissue, and in a validated xenograft biochamber model of MD. We also examined the effects of endocrine treatment upon Cox-2 expression in high and low MD tissues in the MD xenograft model. Paired high and low MD human breast tissue samples were immunostained for Cox-2, then assessed for differential expression and staining intensity in epithelial and stromal cells. High and low MD human breast tissues were separately maintained in biochambers in mice treated with Tamoxifen, oestrogen or placebo implants, then assessed for percentage Cox-2 staining in epithelial and stromal cells. Percentage Cox-2 staining was greater for both epithelial (p = 0.01) and stromal cells (p < 0.0001) of high compared with low MD breast tissues. In high MD biochamber tissues, percentage Cox-2 staining was greater in stromal cells of oestrogen-treated versus placebo-treated tissues (p = 0.05).

Longitudinal Association of Anthropometry with Mammographic Breast Density in the Study of Women's Health Across the Nation (Swan)

PubMed Central

Reeves, Katherine W.; Stone, Roslyn A.; Modugno, Francesmary; Ness, Roberta B.; Vogel, Victor G.; Weissfeld, Joel L.; Habel, Laurel A.; Sternfeld, Barbara; Cauley, Jane A.

2009-01-01

High percent mammographic breast density is strongly associated with increased breast cancer risk. Though body mass index (BMI) is positively associated with risk of postmenopausal breast cancer, BMI is negatively associated with percent breast density in cross-sectional studies. Few longitudinal studies have evaluated associations between BMI and weight and mammographic breast density. We studied the longitudinal relationships between anthropometry and breast density in a prospective cohort of 834 pre- and perimenopausal women enrolled in an ancillary study to the Study of Women's Health Across the Nation (SWAN). Routine screening mammograms were collected and read for breast density. Random intercept regression models were used to evaluate whether annual BMI change was associated with changes over time in dense breast area and percent density. The study population was 7.4% African American, 48.8% Caucasian, 21.8% Chinese, and 21.9% Japanese. Mean follow-up was 4.8 years. Mean annual weight change was +0.32 kg/year, mean change in dense area was -0.77 cm2/year, and mean change in percent density was -1.14%/year. In fully adjusted models, annual change in BMI was not significantly associated with changes in dense breast area (-0.17 cm2, 95% CI -0.64, 0.29). Borderline significant negative associations were observed between annual BMI change and annual percent density change, with percent density decreasing 0.36% (95% CI -0.74, 0.02) for a one unit increase in BMI over a year. This longitudinal study provides modest evidence that changes in BMI are not associated with changes in dense area, yet may be negatively associated with percent density. PMID:19065651

Evolution of mammographic image quality in the state of Rio de Janeiro*

PubMed Central

Villar, Vanessa Cristina Felippe Lopes; Seta, Marismary Horsth De; de Andrade, Carla Lourenço Tavares; Delamarque, Elizabete Vianna; de Azevedo, Ana Cecília Pedrosa

2015-01-01

Objective To evaluate the evolution of mammographic image quality in the state of Rio de Janeiro on the basis of parameters measured and analyzed during health surveillance inspections in the period from 2006 to 2011. Materials and Methods Descriptive study analyzing parameters connected with imaging quality of 52 mammography apparatuses inspected at least twice with a one-year interval. Results Amongst the 16 analyzed parameters, 7 presented more than 70% of conformity, namely: compression paddle pressure intensity (85.1%), films development (72.7%), film response (72.7%), low contrast fine detail (92.2%), tumor mass visualization (76.5%), absence of image artifacts (94.1%), mammography-specific developers availability (88.2%). On the other hand, relevant parameters were below 50% conformity, namely: monthly image quality control testing (28.8%) and high contrast details with respect to microcalcifications visualization (47.1%). Conclusion The analysis revealed critical situations in terms of compliance with the health surveillance standards. Priority should be given to those mammography apparatuses that remained non-compliant at the second inspection performed within the one-year interval. PMID:25987749

Coding of visual object features and feature conjunctions in the human brain.

PubMed

Martinovic, Jasna; Gruber, Thomas; Müller, Matthias M

2008-01-01

Object recognition is achieved through neural mechanisms reliant on the activity of distributed coordinated neural assemblies. In the initial steps of this process, an object's features are thought to be coded very rapidly in distinct neural assemblies. These features play different functional roles in the recognition process--while colour facilitates recognition, additional contours and edges delay it. Here, we selectively varied the amount and role of object features in an entry-level categorization paradigm and related them to the electrical activity of the human brain. We found that early synchronizations (approx. 100 ms) increased quantitatively when more image features had to be coded, without reflecting their qualitative contribution to the recognition process. Later activity (approx. 200-400 ms) was modulated by the representational role of object features. These findings demonstrate that although early synchronizations may be sufficient for relatively crude discrimination of objects in visual scenes, they cannot support entry-level categorization. This was subserved by later processes of object model selection, which utilized the representational value of object features such as colour or edges to select the appropriate model and achieve identification.

Mammographic x-ray unit kilovoltage test tool based on k-edge absorption effect.

PubMed

Napolitano, Mary E; Trueblood, Jon H; Hertel, Nolan E; David, George

2002-09-01

A simple tool to determine the peak kilovoltage (kVp) of a mammographic x-ray unit has been designed. Tool design is based on comparing the effect of k-edge discontinuity of the attenuation coefficient for a series of element filters. Compatibility with the mammography accreditation phantom (MAP) to obtain a single quality control film is a second design objective. When the attenuation of a series of sequential elements is studied simultaneously, differences in the absorption characteristics due to the k-edge discontinuities are more evident. Specifically, when the incident photon energy is higher than the k-edge energy of a number of the elements and lower than the remainder, an inflection may be seen in the resulting attenuation data. The maximum energy of the incident photon spectra may be determined based on this inflection point for a series of element filters. Monte Carlo photon transport analysis was used to estimate the photon transmission probabilities for each of the sequential k-edge filter elements. The photon transmission corresponds directly to optical density recorded on mammographic x-ray film. To observe the inflection, the element filters chosen must have k-edge energies that span a range greater than the expected range of the end point energies to be determined. For the design, incident x-ray spectra ranging from 25 to 40 kVp were assumed to be from a molybdenum target. Over this range, the k-edge energy changes by approximately 1.5 keV between sequential elements. For this design 21 elements spanning an energy range from 20 to 50 keV were chosen. Optimum filter element thicknesses were calculated to maximize attenuation differences at the k-edge while maintaining optical densities between 0.10 and 3.00. Calculated relative transmission data show that the kVp could be determined to within +/-1 kV. To obtain experimental data, a phantom was constructed containing 21 different elements placed in an acrylic holder. MAP images were used to determine

When fear of cancer recurrence becomes a clinical issue: a qualitative analysis of features associated with clinical fear of cancer recurrence.

PubMed

Mutsaers, Brittany; Jones, Georden; Rutkowski, Nicole; Tomei, Christina; Séguin Leclair, Caroline; Petricone-Westwood, Danielle; Simard, Sébastien; Lebel, Sophie

2016-10-01

Fear of cancer recurrence (FCR) is a common experience for cancer survivors. However, it remains unclear what characteristics differentiate non-clinical from clinical levels of FCR. The goal of this study was to investigate the potential hallmarks of clinical FCR. A convenience sample of 40 participants (n = 19 female) was drawn from another study (Lebel et al. in Qual Life Res 25:311-321. doi: 10.1007/s11136-015-1088-2 , 2016). The semi-structured interview for fear of cancer recurrence (Simard and Savard in J Cancer Surviv 9:481-491. doi: 10.1007/s11764-015-0424-4 , 2015) was used to identify participants with non-clinical and clinical FCR and qualitative analysis of these interviews was performed. Individuals with clinical FCR reported the following features: death-related thoughts, feeling alone, belief that the cancer would return, experiencing intolerance of uncertainty, having cancer-related thoughts and imagery that were difficult to control, daily and recurrent, lasted 30 minutes or more, increased over time, caused distress and impacted their daily life. Triggers of FCR and coping strategies did not appear to be features of clinical FCR as they were reported by participants with a range of FCR scores. While features of clinical FCR found in this analysis such as intrusive thoughts, distress and impact on functioning confirmed previous FCR research, other features spontaneously emerged from the interviews including "death-related thoughts," "feeling alone," and "belief that the cancer will return." The participants' descriptions of cancer-specific fear and worry suggest that FCR is a distinct phenomenon related to cancer survivorship, despite similarities with psychological disorders (e.g., Anxiety Disorders). Future research investigating the construct of FCR, and the distinguishing features of clinical FCR across a range of cancer types and gender is required.

Time-frequency analysis of functional optical mammographic images

NASA Astrophysics Data System (ADS)

Barbour, Randall L.; Graber, Harry L.; Schmitz, Christoph H.; Tarantini, Frank; Khoury, Georges; Naar, David J.; Panetta, Thomas F.; Lewis, Theophilus; Pei, Yaling

2003-07-01

We have introduced working technology that provides for time-series imaging of the hemoglobin signal in large tissue structures. In this study we have explored our ability to detect aberrant time-frequency responses of breast vasculature for subjects with Stage II breast cancer at rest and in response to simple provocations. The hypothesis being explored is that time-series imaging will be sensitive to the known structural and functional malformations of the tumor vasculature. Mammographic studies were conducted using an adjustable hemisheric measuring head containing 21 source and 21 detector locations (441 source-detector pairs). Simultaneous dual-wavelength studies were performed at 760 and 830 nm at a framing rate of ~2.7 Hz. Optical measures were performed on women lying prone with the breast hanging in a pendant position. Two class of measures were performed: (1) 20- minute baseline measure wherein the subject was at rest; (2) provocation studies wherein the subject was asked to perform some simple breathing maneuvers. Collected data were analyzed to identify the time-frequency structure and central tendencies of the detector responses and those of the image time series. Imaging data were generated using the Normalized Difference Method (Pei et al., Appl. Opt. 40, 5755-5769, 2001). Results obtained clearly document three classes of anomalies when compared to the normal contralateral breast. 1) Breast tumors exhibit altered oxygen supply/demand imbalance in response to an oxidative challenge (breath hold). 2) The vasomotor response of the tumor vasculature is mainly depressed and exhibits an altered modulation. 3) The affected area of the breast wherein the altered vasomotor signature is seen extends well beyond the limits of the tumor itself.

Use of volumetric features for temporal comparison of mass lesions in full field digital mammograms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bozek, Jelena, E-mail: jelena.bozek@fer.hr; Grgic, Mislav; Kallenberg, Michiel

2014-02-15

Purpose: Temporal comparison of lesions might improve classification between benign and malignant lesions in full-field digital mammograms (FFDM). The authors compare the use of volumetric features for lesion classification, which are computed from dense tissue thickness maps, to the use of mammographic lesion area. Use of dense tissue thickness maps for lesion characterization is advantageous, since it results in lesion features that are invariant to acquisition parameters. Methods: The dataset used in the analysis consisted of 60 temporal mammogram pairs comprising 120 mediolateral oblique or craniocaudal views with a total of 65 lesions, of which 41 were benign and 24more » malignant. The authors analyzed the performance of four volumetric features, area, and four other commonly used features obtained from temporal mammogram pairs, current mammograms, and prior mammograms. The authors evaluated the individual performance of all features and of different feature sets. The authors used linear discriminant analysis with leave-one-out cross validation to classify different feature sets. Results: Volumetric features from temporal mammogram pairs achieved the best individual performance, as measured by the area under the receiver operating characteristic curve (A{sub z} value). Volume change (A{sub z} = 0.88) achieved higher A{sub z} value than projected lesion area change (A{sub z} = 0.78) in the temporal comparison of lesions. Best performance was achieved with a set that consisted of a set of features extracted from the current exam combined with four volumetric features representing changes with respect to the prior mammogram (A{sub z} = 0.90). This was significantly better (p = 0.005) than the performance obtained using features from the current exam only (A{sub z} = 0.77). Conclusions: Volumetric features from temporal mammogram pairs combined with features from the single exam significantly improve discrimination of benign and malignant lesions in FFDM

Sleep patterns, sleep disorders and mammographic density in spanish women: The DDM-Spain/Var-DDM study.

PubMed

Pedraza-Flechas, Ana María; Lope, Virginia; Moreo, Pilar; Ascunce, Nieves; Miranda-García, Josefa; Vidal, Carmen; Sánchez-Contador, Carmen; Santamariña, Carmen; Pedraz-Pingarrón, Carmen; Llobet, Rafael; Aragonés, Nuria; Salas-Trejo, Dolores; Pollán, Marina; Pérez-Gómez, Beatriz

2017-05-01

We explored the relationship between sleep patterns and sleep disorders and mammographic density (MD), a marker of breast cancer risk. Participants in the DDM-Spain/var-DDM study, which included 2878 middle-aged Spanish women, were interviewed via telephone and asked questions on sleep characteristics. Two radiologists assessed MD in their left craneo-caudal mammogram, assisted by a validated semiautomatic-computer tool (DM-scan). We used log-transformed percentage MD as the dependent variable and fitted mixed linear regression models, including known confounding variables. Our results showed that neither sleeping patterns nor sleep disorders were associated with MD. However, women with frequent changes in their bedtime due to anxiety or depression had higher MD (e β :1.53;95%CI:1.04-2.26). Copyright © 2017 Elsevier B.V. All rights reserved.

Does the prediction of breast cancer improve using a combination of mammographic density measures compared to individual measures alone?

NASA Astrophysics Data System (ADS)

Wong Sik Hee, Joseph Ryan; Harkness, Elaine F.; Gadde, Soujanya; Lim, Yit Y.; Maxwell, Anthony J.; Evans, D. Gareth; Howell, Anthony; Astley, Susan M.

2017-03-01

High mammographic density is associated with an increased risk of breast cancer, however whether the association is stronger when there is agreement across measures is unclear. This study investigates whether a combination of density measures is a better predictor of breast cancer risk than individual methods alone. Women recruited to the Predicting Risk of Cancer At Screening (PROCAS) study and with mammographic density assessed using three different methods were included (n=33,304). Density was assessed visually using Visual Analogue Scales (VAS) and by two fully automated methods, Quantra and Volpara. Percentage breast density was divided into (high, medium and low) and combinations of measures were used to further categorise individuals (e.g. `all high'). A total of 667 breast cancers were identified and logistic regression was used to determine the relationship between breast density and breast cancer risk. In total, 44% of individuals were in the same tertile for all three measures, 8.6% were in non-adjacent (high and low) or mixed categories (high, medium and low). For individual methods the strongest association with breast cancer risk was for medium and high tertiles of VAS with odds ratios (OR) adjusted for age and BMI of 1.63 (95% CI 1.31-2.03) and 2.33 (1.87-2.90) respectively. For the combination of density methods the strongest association was for `all high' (OR 2.42, 1.77-3.31) followed by "two high" (OR 1.90, 1.35-3.31) and "two medium" (OR 1.88, 1.40-2.52). Combining density measures did not affect the magnitude of risk compared to using individual methods.

[Quality control and assessment of qualitative interview in health care research].

PubMed

Xie, Yan-ming; Liao, Xing

2008-07-01

It is not finally concluded how to standardize the use of qualitative research in the world. Qualitative researchers disagree with each other about this issue. As we know, there have been a large number of articles written in different ways about qualitative research due to the "flexibility", one of its features. Qualitative research is quite different from quantitative research which is easy to control its quality and quality assessment. A series of criteria has been set up for quantitative research. However qualitative research needs to be improved in these aspects, in which qualitative interviews are mostly used at home and abroad at present. Hence, it becomes an important and urgent issue for qualitative researchers to standardly control and assess the quality of qualitative interview.

Computer-aided classification of breast microcalcification clusters: merging of features from image processing and radiologists

NASA Astrophysics Data System (ADS)

Lo, Joseph Y.; Gavrielides, Marios A.; Markey, Mia K.; Jesneck, Jonathan L.

2003-05-01

We developed an ensemble classifier for the task of computer-aided diagnosis of breast microcalcification clusters,which are very challenging to characterize for radiologists and computer models alike. The purpose of this study is to help radiologists identify whether suspicious calcification clusters are benign vs. malignant, such that they may potentially recommend fewer unnecessary biopsies for actually benign lesions. The data consists of mammographic features extracted by automated image processing algorithms as well as manually interpreted by radiologists according to a standardized lexicon. We used 292 cases from a publicly available mammography database. From each cases, we extracted 22 image processing features pertaining to lesion morphology, 5 radiologist features also pertaining to morphology, and the patient age. Linear discriminant analysis (LDA) models were designed using each of the three data types. Each local model performed poorly; the best was one based upon image processing features which yielded ROC area index AZ of 0.59 +/- 0.03 and partial AZ above 90% sensitivity of 0.08 +/- 0.03. We then developed ensemble models using different combinations of those data types, and these models all improved performance compared to the local models. The final ensemble model was based upon 5 features selected by stepwise LDA from all 28 available features. This ensemble performed with AZ of 0.69 +/- 0.03 and partial AZ of 0.21 +/- 0.04, which was statistically significantly better than the model based on the image processing features alone (p<0.001 and p=0.01 for full and partial AZ respectively). This demonstrated the value of the radiologist-extracted features as a source of information for this task. It also suggested there is potential for improved performance using this ensemble classifier approach to combine different sources of currently available data.

Qualitative and Quantitative Analysis for Facial Complexion in Traditional Chinese Medicine

PubMed Central

Zhao, Changbo; Li, Guo-zheng; Li, Fufeng; Wang, Zhi; Liu, Chang

2014-01-01

Facial diagnosis is an important and very intuitive diagnostic method in Traditional Chinese Medicine (TCM). However, due to its qualitative and experience-based subjective property, traditional facial diagnosis has a certain limitation in clinical medicine. The computerized inspection method provides classification models to recognize facial complexion (including color and gloss). However, the previous works only study the classification problems of facial complexion, which is considered as qualitative analysis in our perspective. For quantitative analysis expectation, the severity or degree of facial complexion has not been reported yet. This paper aims to make both qualitative and quantitative analysis for facial complexion. We propose a novel feature representation of facial complexion from the whole face of patients. The features are established with four chromaticity bases splitting up by luminance distribution on CIELAB color space. Chromaticity bases are constructed from facial dominant color using two-level clustering; the optimal luminance distribution is simply implemented with experimental comparisons. The features are proved to be more distinctive than the previous facial complexion feature representation. Complexion recognition proceeds by training an SVM classifier with the optimal model parameters. In addition, further improved features are more developed by the weighted fusion of five local regions. Extensive experimental results show that the proposed features achieve highest facial color recognition performance with a total accuracy of 86.89%. And, furthermore, the proposed recognition framework could analyze both color and gloss degrees of facial complexion by learning a ranking function. PMID:24967342

Handbook of Qualitative Research. Second Edition.

ERIC Educational Resources Information Center

Denzin, Norman K., Ed.; Lincoln, Yvonna S., Ed.

This handbook's second edition represents the state of the art for the theory and practice of qualitative inquiry. It features eight new topics, including autoethnography, critical race theory, applied ethnography, queer theory, and "testimonio"every chapter in the handbook has been thoroughly revised and updated. The book…

Series: Practical guidance to qualitative research. Part 1: Introduction.

PubMed

Moser, Albine; Korstjens, Irene

2017-12-01

In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called Frequently Asked Questions. This journal series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By 'novice' we mean Master's students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of papers reporting on qualitative research. This first article describes the key features of qualitative research, provides publications for further learning and reading, and gives an outline of the series.

Correlative Feature Analysis for Multimodality Breast CAD

DTIC Science & Technology

2009-09-01

Imaging 20, 1275–1284 2001. 22V. Caselles, R . Kimmel, and G. Sapiro, “Geodesic active contours,” Int. J. Comput. Vis. 22, 61–79 1997. 23R. Malladi , J...A. R . Jamieson, C. A. Sennett, and S. A. Jensen, “Evaluation of computer-aided diagnosis on a large clinical full-field digital mammographic dataset...Academic Radiology, 15, 1437-1445 (2008). Conference Proceeding Papers [1] Y. Yuan, M. L. Giger, K. Suzuki, H. Li, and A. R . Jamieson, “A

Applying a machine learning model using a locally preserving projection based feature regeneration algorithm to predict breast cancer risk

NASA Astrophysics Data System (ADS)

Heidari, Morteza; Zargari Khuzani, Abolfazl; Danala, Gopichandh; Mirniaharikandehei, Seyedehnafiseh; Qian, Wei; Zheng, Bin

2018-03-01

Both conventional and deep machine learning has been used to develop decision-support tools applied in medical imaging informatics. In order to take advantages of both conventional and deep learning approach, this study aims to investigate feasibility of applying a locally preserving projection (LPP) based feature regeneration algorithm to build a new machine learning classifier model to predict short-term breast cancer risk. First, a computer-aided image processing scheme was used to segment and quantify breast fibro-glandular tissue volume. Next, initially computed 44 image features related to the bilateral mammographic tissue density asymmetry were extracted. Then, an LLP-based feature combination method was applied to regenerate a new operational feature vector using a maximal variance approach. Last, a k-nearest neighborhood (KNN) algorithm based machine learning classifier using the LPP-generated new feature vectors was developed to predict breast cancer risk. A testing dataset involving negative mammograms acquired from 500 women was used. Among them, 250 were positive and 250 remained negative in the next subsequent mammography screening. Applying to this dataset, LLP-generated feature vector reduced the number of features from 44 to 4. Using a leave-onecase-out validation method, area under ROC curve produced by the KNN classifier significantly increased from 0.62 to 0.68 (p < 0.05) and odds ratio was 4.60 with a 95% confidence interval of [3.16, 6.70]. Study demonstrated that this new LPP-based feature regeneration approach enabled to produce an optimal feature vector and yield improved performance in assisting to predict risk of women having breast cancer detected in the next subsequent mammography screening.

Neurofibromatosis and breast cancer: Do we need to revise the mammographic screening schedule in patients of neurofibromatosis?

PubMed

Pradhan, Dinesh; Kaur, Neeraj; Gami, Ashmita; Hura, Kanwaljeet S; Garg, Garima; Mohanty, Sambit K

2017-01-01

Neurofibromatosis type 1 (NF-1) is a neurocutaneous syndrome with autosomal dominant mode of inheritance and has a high propensity to develop benign and malignant nervous system tumors. Although uncommon, case reports describing the association of NF-1 and breast cancer are available in the literature. We illustrate one such case of NF-1, with no family history of the disorder and presenting with multifocal invasive carcinoma of the right breast, in an attempt to describe the association between these two entities. We also attempt to extensively review the current literature on the subject. Since patients with NF-1 are at an increased risk of developing breast cancer, we recommend strict adherence to careful clinical breast examination and annual screening mammographic examination starting at 40 years of age in all patients of NF-1.

Intensity variation study of the radiation field in a mammographic system using thermoluminescent dosimeters TLD-900 (CaSO4:Dy)

NASA Astrophysics Data System (ADS)

Corrêa, E. L.; Silva, J. O.; Vivolo, V.; Potiens, M. P. A.; Daros, K. A. C.; Medeiros, R. B.

2014-02-01

This study presents the results of the intensity variation of the radiation field in a mammographic system using the thermoluminescent dosimeter TLD-900 (CaSO4:Dy). These TLDs were calibrated and characterized in an industrial X-ray system used for instruments calibration, in the energy range used in mammography. They were distributed in a matrix of 19 lines and five columns, covering an area of 18 cm×8 cm in the center of the radiation field on the clinical equipment. The results showed a variation of the intensity probably explained by the non-uniformity of the field due to the heel effect.

Method and apparatus for detecting a desired behavior in digital image data

DOEpatents

Kegelmeyer, Jr., W. Philip

1997-01-01

A method for detecting stellate lesions in digitized mammographic image data includes the steps of prestoring a plurality of reference images, calculating a plurality of features for each of the pixels of the reference images, and creating a binary decision tree from features of randomly sampled pixels from each of the reference images. Once the binary decision tree has been created, a plurality of features, preferably including an ALOE feature (analysis of local oriented edges), are calculated for each of the pixels of the digitized mammographic data. Each of these plurality of features of each pixel are input into the binary decision tree and a probability is determined, for each of the pixels, corresponding to the likelihood of the presence of a stellate lesion, to create a probability image. Finally, the probability image is spatially filtered to enforce local consensus among neighboring pixels and the spatially filtered image is output.

Method and apparatus for detecting a desired behavior in digital image data

DOEpatents

Kegelmeyer, Jr., W. Philip

1997-01-01

A method for detecting stellate lesions in digitized mammographic image data includes the steps of prestoring a plurality of reference images, calculating a plurality of features for each of the pixels of the reference images, and creating a binary decision tree from features of randomly sampled pixels from each of the reference images. Once the binary decision tree has been created, a plurality of features, preferably including an ALOE feature (analysis of local oriented edges), are calculated for each of the pixels of the digitized mammographic data. Each of these plurality of features of each pixel are input into the binary decision tree and a probability is determined, for each of the pixels, corresponding to the likelihood of the presence of a stellate lesion, to create a probability image. Finally, the probability image is spacially filtered to enforce local consensus among neighboring pixels and the spacially filtered image is output.

External validation of a publicly available computer assisted diagnostic tool for mammographic mass lesions with two high prevalence research datasets.

PubMed

Benndorf, Matthias; Burnside, Elizabeth S; Herda, Christoph; Langer, Mathias; Kotter, Elmar

2015-08-01

Lesions detected at mammography are described with a highly standardized terminology: the breast imaging-reporting and data system (BI-RADS) lexicon. Up to now, no validated semantic computer assisted classification algorithm exists to interactively link combinations of morphological descriptors from the lexicon to a probabilistic risk estimate of malignancy. The authors therefore aim at the external validation of the mammographic mass diagnosis (MMassDx) algorithm. A classification algorithm like MMassDx must perform well in a variety of clinical circumstances and in datasets that were not used to generate the algorithm in order to ultimately become accepted in clinical routine. The MMassDx algorithm uses a naïve Bayes network and calculates post-test probabilities of malignancy based on two distinct sets of variables, (a) BI-RADS descriptors and age ("descriptor model") and (b) BI-RADS descriptors, age, and BI-RADS assessment categories ("inclusive model"). The authors evaluate both the MMassDx (descriptor) and MMassDx (inclusive) models using two large publicly available datasets of mammographic mass lesions: the digital database for screening mammography (DDSM) dataset, which contains two subsets from the same examinations-a medio-lateral oblique (MLO) view and cranio-caudal (CC) view dataset-and the mammographic mass (MM) dataset. The DDSM contains 1220 mass lesions and the MM dataset contains 961 mass lesions. The authors evaluate discriminative performance using area under the receiver-operating-characteristic curve (AUC) and compare this to the BI-RADS assessment categories alone (i.e., the clinical performance) using the DeLong method. The authors also evaluate whether assigned probabilistic risk estimates reflect the lesions' true risk of malignancy using calibration curves. The authors demonstrate that the MMassDx algorithms show good discriminatory performance. AUC for the MMassDx (descriptor) model in the DDSM data is 0.876/0.895 (MLO/CC view) and AUC

Mammographic density and ageing: A collaborative pooled analysis of cross-sectional data from 22 countries worldwide

PubMed Central

Maskarinec, Gertraud; Perez-Gomez, Beatriz; Vachon, Celine; Miao, Hui; Lajous, Martín; López-Ridaura, Ruy; Rice, Megan; Pereira, Ana; Garmendia, Maria Luisa; Tamimi, Rulla M.; Bertrand, Kimberly; Kwong, Ava; Ursin, Giske; Lee, Eunjung; Qureshi, Samera A.; Ma, Huiyan; Moss, Sue; Allen, Steve; Ndumia, Rose; Vinayak, Sudhir; Teo, Soo-Hwang; Mariapun, Shivaani; Fadzli, Farhana; Bukowska, Agnieszka; Nagata, Chisato; Stone, Jennifer; Ozmen, Vahit; Aribal, Mustafa Erkin; Schüz, Joachim; Wanders, Johanna O. P.; Sirous, Reza; Sirous, Mehri; Kim, Jisun; Lee, Jong Won; Dickens, Caroline; Hartman, Mikael; Chia, Kee-Seng; Chiarelli, Anna M.; Linton, Linda; Pollan, Marina; Flugelman, Anath Arzee; Salem, Dorria; Kamal, Rasha; Boyd, Norman; dos-Santos-Silva, Isabel; McCormack, Valerie

2017-01-01

Background Mammographic density (MD) is one of the strongest breast cancer risk factors. Its age-related characteristics have been studied in women in western countries, but whether these associations apply to women worldwide is not known. Methods and findings We examined cross-sectional differences in MD by age and menopausal status in over 11,000 breast-cancer-free women aged 35–85 years, from 40 ethnicity- and location-specific population groups across 22 countries in the International Consortium on Mammographic Density (ICMD). MD was read centrally using a quantitative method (Cumulus) and its square-root metrics were analysed using meta-analysis of group-level estimates and linear regression models of pooled data, adjusted for body mass index, reproductive factors, mammogram view, image type, and reader. In all, 4,534 women were premenopausal, and 6,481 postmenopausal, at the time of mammography. A large age-adjusted difference in percent MD (PD) between post- and premenopausal women was apparent (–0.46 cm [95% CI: −0.53, −0.39]) and appeared greater in women with lower breast cancer risk profiles; variation across population groups due to heterogeneity (I2) was 16.5%. Among premenopausal women, the √PD difference per 10-year increase in age was −0.24 cm (95% CI: −0.34, −0.14; I2 = 30%), reflecting a compositional change (lower dense area and higher non-dense area, with no difference in breast area). In postmenopausal women, the corresponding difference in √PD (−0.38 cm [95% CI: −0.44, −0.33]; I2 = 30%) was additionally driven by increasing breast area. The study is limited by different mammography systems and its cross-sectional rather than longitudinal nature. Conclusions Declines in MD with increasing age are present premenopausally, continue postmenopausally, and are most pronounced over the menopausal transition. These effects were highly consistent across diverse groups of women worldwide, suggesting that they result from an

Learning better deep features for the prediction of occult invasive disease in ductal carcinoma in situ through transfer learning

NASA Astrophysics Data System (ADS)

Shi, Bibo; Hou, Rui; Mazurowski, Maciej A.; Grimm, Lars J.; Ren, Yinhao; Marks, Jeffrey R.; King, Lorraine M.; Maley, Carlo C.; Hwang, E. Shelley; Lo, Joseph Y.

2018-02-01

Purpose: To determine whether domain transfer learning can improve the performance of deep features extracted from digital mammograms using a pre-trained deep convolutional neural network (CNN) in the prediction of occult invasive disease for patients with ductal carcinoma in situ (DCIS) on core needle biopsy. Method: In this study, we collected digital mammography magnification views for 140 patients with DCIS at biopsy, 35 of which were subsequently upstaged to invasive cancer. We utilized a deep CNN model that was pre-trained on two natural image data sets (ImageNet and DTD) and one mammographic data set (INbreast) as the feature extractor, hypothesizing that these data sets are increasingly more similar to our target task and will lead to better representations of deep features to describe DCIS lesions. Through a statistical pooling strategy, three sets of deep features were extracted using the CNNs at different levels of convolutional layers from the lesion areas. A logistic regression classifier was then trained to predict which tumors contain occult invasive disease. The generalization performance was assessed and compared using repeated random sub-sampling validation and receiver operating characteristic (ROC) curve analysis. Result: The best performance of deep features was from CNN model pre-trained on INbreast, and the proposed classifier using this set of deep features was able to achieve a median classification performance of ROC-AUC equal to 0.75, which is significantly better (p<=0.05) than the performance of deep features extracted using ImageNet data set (ROCAUC = 0.68). Conclusion: Transfer learning is helpful for learning a better representation of deep features, and improves the prediction of occult invasive disease in DCIS.

The role of communication in breast cancer screening: a qualitative study with Australian experts.

PubMed

Parker, Lisa M; Rychetnik, Lucie; Carter, Stacy M

2015-10-19

One well-accepted strategy for optimising outcomes in mammographic breast cancer screening is to improve communication with women about screening. It is not always clear, however, what it is that communication should be expected to achieve, and why or how this is so. We investigated Australian experts' opinions on breast screening communication. Our research questions were: 1 What are the views of Australian experts about communicating with consumers on breast screening? 2 How do experts reason about this topic? We used a qualitative methodology, interviewing 33 breast screening experts across Australia with recognisable influence in the Australian mammographic breast cancer screening setting. We used purposive and theoretical sampling to identify experts from different professional roles (including clinicians, program managers, policy makers, advocates and researchers) with a range of opinions about communication in breast screening. Experts discussed the topic of communication with consumers by focusing on two main questions: how strongly to guide consumers' breast cancer screening choices, and what to communicate about overdiagnosis. Each expert adopted one of three approaches to consumer communication depending on their views about these topics. We labelled these approaches: Be screened; Be screened and here's why; Screening is available please consider whether it's right for you. There was a similar level of support for all three approaches. Experts' reasoning was grounded in how they conceived of and prioritised their underlying values including: delivering benefits, avoiding harms, delivering more benefits than harms, respecting autonomy and transparency. There is disagreement between experts regarding communication with breast screening consumers. Our study provides some insights into this persisting lack of consensus, highlighting the different meanings that experts give to values, and different ways that values are prioritised. We suggest that explicit

Automated mammographic breast density estimation using a fully convolutional network.

PubMed

Lee, Juhun; Nishikawa, Robert M

2018-03-01

The purpose of this study was to develop a fully automated algorithm for mammographic breast density estimation using deep learning. Our algorithm used a fully convolutional network, which is a deep learning framework for image segmentation, to segment both the breast and the dense fibroglandular areas on mammographic images. Using the segmented breast and dense areas, our algorithm computed the breast percent density (PD), which is the faction of dense area in a breast. Our dataset included full-field digital screening mammograms of 604 women, which included 1208 mediolateral oblique (MLO) and 1208 craniocaudal (CC) views. We allocated 455, 58, and 91 of 604 women and their exams into training, testing, and validation datasets, respectively. We established ground truth for the breast and the dense fibroglandular areas via manual segmentation and segmentation using a simple thresholding based on BI-RADS density assessments by radiologists, respectively. Using the mammograms and ground truth, we fine-tuned a pretrained deep learning network to train the network to segment both the breast and the fibroglandular areas. Using the validation dataset, we evaluated the performance of the proposed algorithm against radiologists' BI-RADS density assessments. Specifically, we conducted a correlation analysis between a BI-RADS density assessment of a given breast and its corresponding PD estimate by the proposed algorithm. In addition, we evaluated our algorithm in terms of its ability to classify the BI-RADS density using PD estimates, and its ability to provide consistent PD estimates for the left and the right breast and the MLO and CC views of the same women. To show the effectiveness of our algorithm, we compared the performance of our algorithm against a state of the art algorithm, laboratory for individualized breast radiodensity assessment (LIBRA). The PD estimated by our algorithm correlated well with BI-RADS density ratings by radiologists. Pearson's rho values of

New method for generating breast models featuring glandular tissue spatial distribution

NASA Astrophysics Data System (ADS)

Paixão, L.; Oliveira, B. B.; Oliveira, M. A.; Teixeira, M. H. A.; Fonseca, T. C. F.; Nogueira, M. S.

2016-02-01

Mammography is the main radiographic technique used for breast imaging. A major concern with mammographic imaging is the risk of radiation-induced breast cancer due to the high sensitivity of breast tissue. The mean glandular dose (DG) is the dosimetric quantity widely accepted to characterize the risk of radiation induced cancer. Previous studies have concluded that DG depends not only on the breast glandular content but also on the spatial distribution of glandular tissue within the breast. In this work, a new method for generating computational breast models featuring skin composition and glandular tissue distribution from patients undergoing digital mammography is proposed. Such models allow a more accurate way of calculating individualized breast glandular doses taking into consideration the glandular tissue fraction. Sixteen breast models of four patients with different glandularity breasts were simulated and the results were compared with those obtained from recommended DG conversion factors. The results show that the internationally recommended conversion factors may be overestimating the mean glandular dose to less dense breasts and underestimating the mean glandular dose for denser breasts. The methodology described in this work constitutes a powerful tool for breast dosimetry, especially for risk studies.

Mobile apps for mood tracking: an analysis of features and user reviews.

PubMed

Caldeira, Clara; Chen, Yu; Chan, Lesley; Pham, Vivian; Chen, Yunan; Zheng, Kai

2017-01-01

Many mood tracking apps are available on smartphone app stores, but little is known about their features and their users' experiences. To investigate commercially available mood tracking apps, we conducted an in-depth feature analysis of 32 apps, and performed a qualitative analysis of a set of user reviews. Informed by a widely adopted personal informatics framework, we conducted a feature analysis to investigate how these apps support four stages of selftracking: preparation, collection, reflection, and action; and found that mood tracking apps offer many features for the collection and reflection stages, but lack adequate support for the preparation and action stages. Through the qualitative analysis of user reviews, we found that users utilize mood tracking to learn about their mood patterns, improve their mood, and self-manage their mental illnesses. In this paper, we present our findings and discuss implications for mobile apps designed to enhance emotional wellness.

Clinical application of qualitative assessment for breast masses in shear-wave elastography.

PubMed

Gweon, Hye Mi; Youk, Ji Hyun; Son, Eun Ju; Kim, Jeong-Ah

2013-11-01

To evaluate the interobserver agreement and the diagnostic performance of various qualitative features in shear-wave elastography (SWE) for breast masses. A total of 153 breast lesions in 152 women who underwent B-mode ultrasound and SWE before biopsy were included. Qualitative analysis in SWE was performed using two different classifications: E values (Ecol; 6-point color score, Ehomo; homogeneity score and Esha; shape score) and a four-color pattern classification. Two radiologists reviewed five data sets: B-mode ultrasound, SWE, and combination of both for E values and four-color pattern. The BI-RADS categories were assessed B-mode and combined sets. Interobserver agreement was assessed using weighted κ statistics. Areas under the receiver operating characteristic curve (AUC), sensitivity, and specificity were analyzed. Interobserver agreement was substantial for Ecol (κ=0.79), Ehomo (κ=0.77) and four-color pattern (κ=0.64), and moderate for Esha (κ=0.56). Better-performing qualitative features were Ecol and four-color pattern (AUCs, 0.932 and 0.925) compared with Ehomo and Esha (AUCs, 0.857 and 0.864; P<0.05). The diagnostic performance of B-mode ultrasound (AUC, 0.950) was not significantly different from combined sets with E value and with four color pattern (AUCs, 0.962 and 0.954). When all qualitative values were negative, leading to downgrade the BI-RADS category, the specificity increased significantly from 16.5% to 56.1% (E value) and 57.0% (four-color pattern) (P<0.001) without improvement in sensitivity. The qualitative SWE features were highly reproducible and showed good diagnostic performance in suspicious breast masses. Adding qualitative SWE to B-mode ultrasound increased specificity in decision making for biopsy recommendation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

The ethics in qualitative health research: special considerations.

PubMed

Peter, Elizabeth

2015-09-01

A sound knowledge of the nature of qualitative research, along with an appreciation of some special ethical considerations, is needed for rigorous reviews to be conducted. The overall character of qualitative research is described with an emphasis on the tendency of qualitative researchers to explore sensitive topics using theoretically informed methods. A number of specific features of qualitative that require additional ethical attention and awareness are also examined including the following: 1) participants are frequently quite vulnerable and require protection because the data collection methods, such as in-depth interviews, can delve into personally and politically charged matters; 2) naturalistic observation can raise concerns regarding privacy and consent; 3) the potential for the identifiability of the results of this research may require extra efforts to maintain confidentiality. Ultimately, Reseach Ethics Committee members must be knowledgeable about qualitative approaches to be able to assess the potential harms and benefits in a protocol carefully. Without this knowledge gaining ethics approval can be overly difficult for researchers and the best practices for protecting human participants can be overlooked.

What features do Dutch university students prefer in a smartphone application for promotion of physical activity? A qualitative approach.

PubMed

Middelweerd, Anouk; van der Laan, Danielle M; van Stralen, Maartje M; Mollee, Julia S; Stuij, Mirjam; te Velde, Saskia J; Brug, Johannes

2015-03-01

The transition from adolescence to early adulthood is a critical period in which there is a decline in physical activity (PA). College and university students make up a large segment of this age group. Smartphones may be used to promote and support PA. The purpose of this qualitative study was to explore Dutch students' preferences regarding a PA application (PA app) for smartphones. Thirty Dutch students (aged 18-25 years) used a PA app for three weeks and subsequently attended a focus group discussion (k = 5). To streamline the discussion, a discussion guide was developed covering seven main topics, including general app usage, usage and appreciation of the PA app, appreciation of and preferences for its features and the sharing of PA accomplishments through social media. The discussions were audio and video recorded, transcribed and analysed according to conventional content analysis. The participants, aged 21 ± 2 years, were primarily female (67%). Several themes emerged: app usage, technical aspects, PA assessment, coaching aspects and sharing through social media. Participants most often used social networking apps (e.g., Facebook or Twitter), communication apps (e.g., WhatsApp) and content apps (e.g., news reports or weather forecasts). They preferred a simple and structured layout without unnecessary features. Ideally, the PA app should enable users to tailor it to their personal preferences by including the ability to hide features. Participants preferred a companion website for detailed information about their accomplishments and progress, and they liked tracking their workout using GPS. They preferred PA apps that coached and motivated them and provided tailored feedback toward personally set goals. They appreciated PA apps that enabled competition with friends by ranking or earning rewards, but only if the reward system was transparent. They were not willing to share their regular PA accomplishments through social media unless they were

Occupational exposures and mammographic density in Spanish women.

PubMed

Lope, Virginia; García-Pérez, Javier; Pérez-Gómez, Beatriz; Pedraza-Flechas, Ana María; Alguacil, Juan; González-Galarzo, Mª Carmen; Alba, Miguel Angel; van der Haar, Rudolf; Cortés-Barragán, Rosa Ana; Pedraz-Pingarrón, Carmen; Moreo, Pilar; Santamariña, Carmen; Ederra, María; Vidal, Carmen; Salas-Trejo, Dolores; Sánchez-Contador, Carmen; Llobet, Rafael; Pollán, Marina

2018-02-01

The association between occupational exposures and mammographic density (MD), a marker of breast cancer risk, has not been previously explored. Our objective was to investigate the influence of occupational exposure to chemical, physical and microbiological agents on MD in adult women. This is a population-based cross-sectional study based on 1476 female workers aged 45-65 years from seven Spanish breast cancer screening programmes. Occupational history was surveyed by trained staff. Exposure to occupational agents was assessed using the Spanish job-exposure matrix MatEmESp. Percentage of MD was measured by two radiologists using a semiautomatic computer tool. The association was estimated using mixed log-linear regression models adjusting for age, education, body mass index, menopausal status, parity, smoking, alcohol intake, type of mammography, family history of breast cancer and hormonal therapy use, and including screening centre and professional reader as random effects terms. Although no association was found with most of the agents, women occupationally exposed to perchloroethylene (e β =1.51; 95% CI 1.04 to 2.19), ionising radiation (e β =1.23; 95% CI 0.99 to 1.52) and mould spores (e β =1.44; 95% CI 1.01 to 2.04) tended to have higher MD. The percentage of density increased 12% for every 5 years exposure to perchloroethylene or mould spores, 11% for every 5 years exposure to aliphatic/alicyclic hydrocarbon solvents and 3% for each 5 years exposure to ionising radiation. Exposure to perchloroethylene, ionising radiation, mould spores or aliphatic/alicyclic hydrocarbon solvents in occupational settings could be associated with higher MD. Further studies are needed to clarify the accuracy and the reasons for these findings. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Bone mineral density and mammographic density in Mexican women.

PubMed

Moseson, Heidi; Rice, Megan S; López-Ridaura, Ruy; Bertrand, Kimberly A; Torres, Gabriela; Blanco, Margarita; Tamayo-Orozco, Juan Alfredo; Lajous, Martin; Romieu, Isabelle

2016-01-01

Bone mineral density (BMD) is a putative marker for lifetime exposure to estrogen. Studies that have explored whether BMD is a determinant of mammographic density (MD) have observed inconsistent results. Therefore,we examined this potential association in a sample of women (n = 1,516) from the clinical sub-cohort in the Mexican teachers’ cohort (n = 115,315). We used multivariable linear regression to assess the association between quartiles of BMD and percent MD, as well as total dense and non-dense area of the breast, stratified by menopausal status. We also examined the associations by body mass index (BMI) (< 30 kg/m(2), ≥ 30 kg/m(2)). Overall, there was no association between BMD and MD among premenopausal women. However, when we stratified by BMI, there was a modest inverse association between BMD and percent MD (difference between extreme quartiles = -2.8, 95 % CI -5.9, 0.27, p trend = 0.04) among women with BMI < 30 kg/m(2), but a positive association among obese women (comparable difference = 5.1, 95 % CI 0.02, 10.1, p trend = 0.03;p interaction < 0.01). Among postmenopausal women, BMD and percent MD were positively associated after adjustment for BMI (p trend < 0.01). Postmenopausal women in the highest two quartiles of BMD had 4–5 % point higher percent MD compared to women in the lowest quartile. The association did not differ by BMI in postmenopausal women (p interaction = 0.76). Among obese premenopausal women as well as postmenopausal women, BMD was positively associated with percent MD. Among leaner premenopausal women, BMD and percent MD were modestly inversely associated. These findings support the hypothesis that cumulative exposure to estrogen (as measured by BMD) may influence MD.

Bone mineral density and mammographic density in Mexican women

PubMed Central

Moseson, Heidi; Rice, Megan S.; López-Ridaura, Ruy; Bertrand, Kimberly A.; Torres, Gabriela; Blanco, Margarita; Tamayo-Orozco, Juan Alfredo; Lajous, Martin; Romieu, Isabelle

2016-01-01

Background Bone mineral density (BMD) is a putative marker for lifetime exposure to estrogen. Studies that have explored whether BMD is a determinant of mammographic density (MD) have observed inconsistent results. Therefore, we examined this potential association in a sample of women (N=1,516) from the clinical sub-cohort in the Mexican Teachers’ Cohort (N=115,315). Methods We used multivariable linear regression to assess the association between quartiles of BMD and percent MD, as well as total dense and non-dense area of the breast, stratified by menopausal status. We also examined the associations by body mass index (BMI) (<30kg/m2,, ≥30kg/m2). Results Overall, there was no association between BMD and MD among premenopausal women. However, when we stratified by BMI, there was a modest inverse association between BMD and percent MD (difference between extreme quartiles= −2.8, 95%CI: −5.9, 0.27, p-trend=0.04) among women with BMI <30 kg/m2, but a positive association among obese women (comparable difference=5.1, 95%CI: 0.02, 10.1, p-trend=0.03; p-interaction<0.01). Among postmenopausal women, BMD and percent MD were positively associated after adjustment for BMI (p-trend<0.01). Postmenopausal women in the highest two quartiles of BMD had 4–5 percentage point higher percent MD compared to women in the lowest quartile. The association did not differ by BMI in postmenopausal women (p-interaction=0.76). Conclusion Among obese premenopausal women as well as postmenopausal women, BMD was positively associated with percent MD. Among leaner premenopausal women, BMD and percent MD were modestly inversely associated. These findings support the hypothesis that cumulative exposure to estrogen (as measured by BMD) may influence MD. PMID:26463740

Exploring the Relevance of Qualitative Research Synthesis to Higher Education Research and Practice

ERIC Educational Resources Information Center

Major, Claire; Savin-Baden, Maggi

2010-01-01

This paper proposes the importance of qualitative research synthesis to the field of higher education. It examines seven key texts that undertake synthesis in this field and compares essential features and elements across studies. The authors indicate strengths of the approaches and highlight ways forward for using qualitative research synthesis…

Aging, selective attention, and feature integration.

PubMed

Plude, D J; Doussard-Roosevelt, J A

1989-03-01

This study used feature-integration theory as a means of determining the point in processing at which selective attention deficits originate. The theory posits an initial stage of processing in which features are registered in parallel and then a serial process in which features are conjoined to form complex stimuli. Performance of young and older adults on feature versus conjunction search is compared. Analyses of reaction times and error rates suggest that elderly adults in addition to young adults, can capitalize on the early parallel processing stage of visual information processing, and that age decrements in visual search arise as a result of the later, serial stage of processing. Analyses of a third, unconfounded, conjunction search condition reveal qualitatively similar modes of conjunction search in young and older adults. The contribution of age-related data limitations is found to be secondary to the contribution of age decrements in selective attention.

Expression levels of uridine 5'-diphospho-glucuronosyltransferase genes in breast tissue from healthy women are associated with mammographic density.

PubMed

Haakensen, Vilde D; Biong, Margarethe; Lingjærde, Ole Christian; Holmen, Marit Muri; Frantzen, Jan Ole; Chen, Ying; Navjord, Dina; Romundstad, Linda; Lüders, Torben; Bukholm, Ida K; Solvang, Hiroko K; Kristensen, Vessela N; Ursin, Giske; Børresen-Dale, Anne-Lise; Helland, Aslaug

2010-01-01

Mammographic density (MD), as assessed from film screen mammograms, is determined by the relative content of adipose, connective and epithelial tissue in the female breast. In epidemiological studies, a high percentage of MD confers a four to six fold risk elevation of developing breast cancer, even after adjustment for other known breast cancer risk factors. However, the biologic correlates of density are little known. Gene expression analysis using whole genome arrays was performed on breast biopsies from 143 women; 79 women with no malignancy (healthy women) and 64 newly diagnosed breast cancer patients, both included from mammographic centres. Percent MD was determined using a previously validated, computerized method on scanned mammograms. Significance analysis of microarrays (SAM) was performed to identify genes influencing MD and a linear regression model was used to assess the independent contribution from different variables to MD. SAM-analysis identified 24 genes differentially expressed between samples from breasts with high and low MD. These genes included three uridine 5'-diphospho-glucuronosyltransferase (UGT) genes and the oestrogen receptor gene (ESR1). These genes were down-regulated in samples with high MD compared to those with low MD. The UGT gene products, which are known to inactivate oestrogen metabolites, were also down-regulated in tumour samples compared to samples from healthy individuals. Several single nucleotide polymorphisms (SNPs) in the UGT genes associated with the expression of UGT and other genes in their vicinity were identified. Three UGT enzymes were lower expressed both in breast tissue biopsies from healthy women with high MD and in biopsies from newly diagnosed breast cancers. The association was strongest amongst young women and women using hormonal therapy. UGT2B10 predicts MD independently of age, hormone therapy and parity. Our results indicate that down-regulation of UGT genes in women exposed to female sex hormones is

Expression levels of uridine 5'-diphospho-glucuronosyltransferase genes in breast tissue from healthy women are associated with mammographic density

PubMed Central

2010-01-01

Introduction Mammographic density (MD), as assessed from film screen mammograms, is determined by the relative content of adipose, connective and epithelial tissue in the female breast. In epidemiological studies, a high percentage of MD confers a four to six fold risk elevation of developing breast cancer, even after adjustment for other known breast cancer risk factors. However, the biologic correlates of density are little known. Methods Gene expression analysis using whole genome arrays was performed on breast biopsies from 143 women; 79 women with no malignancy (healthy women) and 64 newly diagnosed breast cancer patients, both included from mammographic centres. Percent MD was determined using a previously validated, computerized method on scanned mammograms. Significance analysis of microarrays (SAM) was performed to identify genes influencing MD and a linear regression model was used to assess the independent contribution from different variables to MD. Results SAM-analysis identified 24 genes differentially expressed between samples from breasts with high and low MD. These genes included three uridine 5'-diphospho-glucuronosyltransferase (UGT) genes and the oestrogen receptor gene (ESR1). These genes were down-regulated in samples with high MD compared to those with low MD. The UGT gene products, which are known to inactivate oestrogen metabolites, were also down-regulated in tumour samples compared to samples from healthy individuals. Several single nucleotide polymorphisms (SNPs) in the UGT genes associated with the expression of UGT and other genes in their vicinity were identified. Conclusions Three UGT enzymes were lower expressed both in breast tissue biopsies from healthy women with high MD and in biopsies from newly diagnosed breast cancers. The association was strongest amongst young women and women using hormonal therapy. UGT2B10 predicts MD independently of age, hormone therapy and parity. Our results indicate that down-regulation of UGT genes

Exploring KM Features of High-Performance Companies

NASA Astrophysics Data System (ADS)

Wu, Wei-Wen

2007-12-01

For reacting to an increasingly rival business environment, many companies emphasize the importance of knowledge management (KM). It is a favorable way to explore and learn KM features of high-performance companies. However, finding out the critical KM features of high-performance companies is a qualitative analysis problem. To handle this kind of problem, the rough set approach is suitable because it is based on data-mining techniques to discover knowledge without rigorous statistical assumptions. Thus, this paper explored KM features of high-performance companies by using the rough set approach. The results show that high-performance companies stress the importance on both tacit and explicit knowledge, and consider that incentives and evaluations are the essentials to implementing KM.

A Qualitative Metasynthesis of Consultation Process Research: What We Know and Where to Go

ERIC Educational Resources Information Center

Newman, Daniel S.; McKenney, Elizabeth L. W.; Silva, Arlene E.; Clare, Mary; Salmon, Diane; Jackson, Safiyah

2017-01-01

Qualitative metasynthesis (QM) is a research methodology that permits the meaningful integration and interpretation of qualitative research. This study applies a QM approach combined with constructivist grounded theory methods, bolstered by several features of research credibility, to examine the state of consultee-centered consultation (CCC) and…

Inter-observer variability within BI-RADS and RANZCR mammographic density assessment schemes

NASA Astrophysics Data System (ADS)

Damases, Christine N.; Mello-Thoms, Claudia; McEntee, Mark F.

2016-03-01

This study compares variability associated with two visual mammographic density (MD) assessment methods using two separate samples of radiologists. The image test-set comprised of images obtained from 20 women (age 42-89 years). The images were assessed for their MD by twenty American Board of Radiology (ABR) examiners and twenty-six radiologists registered with the Royal Australian and New Zealand College of Radiologists (RANZCR). Images were assessed using the same technology and conditions, however the ABR radiologists used the BI-RADS and the RANZCR radiologists used the RANZCR breast density synoptic. Both scales use a 4-point assessment. The images were then grouped as low- and high-density; low including BIRADS 1 and 2 or RANZCR 1 and 2 and high including BI-RADS 3 and 4 or RANZCR 3 and 4. Four-point BI-RADS and RANZCR showed no or negligible correlation (ρ=-0.029 p<0.859). The average inter-observer agreement on the BI-RADS scale had a Kappa of 0.565; [95% CI = 0.519 - 0.610], and ranged between 0.328-0.669 while the inter-observer agreement using the RANZCR scale had a Kappa of 0.360; [95% CI = 0.308 - 0.412] and a range of 0.078-0.499. Our findings show a wider range of inter-observer variability among RANZCR registered radiologists than the ABR examiners.

HIV is Now a Manageable Long-Term Condition, But What Makes it Unique? A Qualitative Study Exploring Views About Distinguishing Features from Multi-Professional HIV Specialists in North West England.

PubMed

Jelliman, Pauline; Porcellato, Lorna

HIV is evolving from a life-threatening infection to a long-term, manageable condition because of medical advances, radical changes in health and social care policy, and the impact of an aging population. However, HIV remains complex, presenting unique characteristics distinguishing it from other long-term conditions (LTCs). Our aim in this qualitative descriptive study was to identify and explore these features in the context of LTCs. A focus group (FG) method was used to gather the views and experiences of multi-professional HIV specialists who worked in North West England. Twenty-four staff participated in FGs (n = 3), which were audio recorded, manually transcribed, and thematically analyzed. We found four main themes: (a) stigma, (b) challenges faced by HIV specialists, (c) lack HIV-related knowledge, and (d) unique features, termed "stand alone." We concluded that these distinguishing features hindered full recognition and acceptance of HIV as an LTC. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

Breast Cancer Risk and Mammographic Density Assessed with Semiautomated and Fully Automated Methods and BI-RADS.

PubMed

Jeffers, Abra M; Sieh, Weiva; Lipson, Jafi A; Rothstein, Joseph H; McGuire, Valerie; Whittemore, Alice S; Rubin, Daniel L

2017-02-01

Purpose To compare three metrics of breast density on full-field digital mammographic (FFDM) images as predictors of future breast cancer risk. Materials and Methods This institutional review board-approved study included 125 women with invasive breast cancer and 274 age- and race-matched control subjects who underwent screening FFDM during 2004-2013 and provided informed consent. The percentage of density and dense area were assessed semiautomatically with software (Cumulus 4.0; University of Toronto, Toronto, Canada), and volumetric percentage of density and dense volume were assessed automatically with software (Volpara; Volpara Solutions, Wellington, New Zealand). Clinical Breast Imaging Reporting and Data System (BI-RADS) classifications of breast density were extracted from mammography reports. Odds ratios and 95% confidence intervals (CIs) were estimated by using conditional logistic regression stratified according to age and race and adjusted for body mass index, parity, and menopausal status, and the area under the receiver operating characteristic curve (AUC) was computed. Results The adjusted odds ratios and 95% CIs for each standard deviation increment of the percentage of density, dense area, volumetric percentage of density, and dense volume were 1.61 (95% CI: 1.19, 2.19), 1.49 (95% CI: 1.15, 1.92), 1.54 (95% CI: 1.12, 2.10), and 1.41 (95% CI: 1.11, 1.80), respectively. Odds ratios for women with extremely dense breasts compared with those with scattered areas of fibroglandular density were 2.06 (95% CI: 0.85, 4.97) and 2.05 (95% CI: 0.90, 4.64) for BI-RADS and Volpara density classifications, respectively. Clinical BI-RADS was more accurate (AUC, 0.68; 95% CI: 0.63, 0.74) than Volpara (AUC, 0.64; 95% CI: 0.58, 0.70) and continuous measures of percentage of density (AUC, 0.66; 95% CI: 0.60, 0.72), dense area (AUC, 0.66; 95% CI: 0.60, 0.72), volumetric percentage of density (AUC, 0.64; 95% CI: 0.58, 0.70), and density volume (AUC, 0.65; 95% CI: 0.59, 0

A case-control study to assess the impact of mammographic density on breast cancer risk in women aged 40-49 at intermediate familial risk.

PubMed

Assi, Valentina; Massat, Nathalie J; Thomas, Susan; MacKay, James; Warwick, Jane; Kataoka, Masako; Warsi, Iqbal; Brentnall, Adam; Warren, Ruth; Duffy, Stephen W

2015-05-15

Mammographic density is a strong risk factor for breast cancer, but its potential application in risk management is not clear, partly due to uncertainties about its interaction with other breast cancer risk factors. We aimed to quantify the impact of mammographic density on breast cancer risk in women aged 40-49 at intermediate familial risk of breast cancer (average lifetime risk of 23%), in particular in premenopausal women, and to investigate its relationship with other breast cancer risk factors in this population. We present the results from a case-control study nested with the FH01 cohort study of 6,710 women mostly aged 40-49 at intermediate familial risk of breast cancer. One hundred and three cases of breast cancer were age-matched to one or two controls. Density was measured by semiautomated interactive thresholding. Absolute density, but not percent density, was a significant risk factor for breast cancer in this population after adjusting for area of nondense tissue (OR per 10 cm(2) = 1.07, 95% CI 1.00-1.15, p = 0.04). The effect was stronger in premenopausal women, who made up the majority of the study population. Absolute density remained a significant predictor of breast cancer risk after adjusting for age at menarche, age at first live birth, parity, past or present hormone replacement therapy, and the Tyrer-Cuzick 10-year relative risk estimate of breast cancer. Absolute density can improve breast cancer risk stratification and delineation of high-risk groups alongside the Tyrer-Cuzick 10-year relative risk estimate. © 2014 UICC.

Assessment of mammographic film processor performance in a hospital and mobile screening unit.

PubMed

Murray, J G; Dowsett, D J; Laird, O; Ennis, J T

1992-12-01

In contrast to the majority of mammographic breast screening programmes, film processing at this centre occurs on site in both hospital and mobile trailer units. Initial (1989) quality control (QC) sensitometric tests revealed a large variation in film processor performance in the mobile unit. The clinical significance of these variations was assessed and acceptance limits for processor performance determined. Abnormal mammograms were used as reference material and copied using high definition 35 mm film over a range of exposure settings. The copies were than matched with QC film density variation from the mobile unit. All films were subsequently ranked for spatial and contrast resolution. Optimal values for processing time of 2 min (equivalent to film transit time 3 min and developer time 46 s) and temperature of 36 degrees C were obtained. The widespread anomaly of reporting film transit time as processing time is highlighted. Use of mammogram copies as a means of measuring the influence of film processor variation is advocated. Careful monitoring of the mobile unit film processor performance has produced stable quality comparable with the hospital based unit. The advantages of on site film processing are outlined. The addition of a sensitometric step wedge to all mammography film stock as a means of assessing image quality is recommended.

AI/OR computational model for integrating qualitative and quantitative design methods

NASA Technical Reports Server (NTRS)

Agogino, Alice M.; Bradley, Stephen R.; Cagan, Jonathan; Jain, Pramod; Michelena, Nestor

1990-01-01

A theoretical framework for integrating qualitative and numerical computational methods for optimally-directed design is described. The theory is presented as a computational model and features of implementations are summarized where appropriate. To demonstrate the versatility of the methodology we focus on four seemingly disparate aspects of the design process and their interaction: (1) conceptual design, (2) qualitative optimal design, (3) design innovation, and (4) numerical global optimization.

Mammographic screening for breast cancer in a resource-restricted environment.

PubMed

Apffelstaedt, S P; Dalmayer, L; Baatjes, K

2014-04-01

Mammographic screening is carried out at public sector hospitals as part of clinical practice. We report the experience of such screening at Tygerberg Academic Hospital (TBAH), a tertiary referral hospital in the Western Cape Province, South Africa. All mammograms performed between 2003 and 2012 at TBAH were analysed regarding patient demographics, clinical data, indication and outcome according to the American College of Radiology Breast Imaging Reporting and Data System (BIRADS). Screening mammography was offered to patients > 40 years of age and mammograms were read by experienced breast surgeons. Patients with BIRADS 3 and 4 lesions were recalled for short-term follow-up, further imaging or tissue acquisition. Patients with BIRADS 5 lesions were recalled for tissue acquisition. Further imaging, method of tissue acquisition, histology results and use of neo-adjuvant therapy were also recorded. Of 16 105 mammograms, 3 774 (23.4%) were carried out for screening purposes. The median age of patients undergoing screening was 54 years. Of 407 women with mammograms that were reported as BIRADS 3 - 5 (10.8% of screening mammograms), 187 (46% of recalled women) went on to have further imaging only. Tissue was acquired in 175 patients (43% of recalled women), comprising a biopsy rate of 4.6% of the total series. The malignancy rate in cases in which tissue acquisition was done was 25%. Forty-three breast cancers were diagnosed (11.4/1 000 examinations). Of the cancers, nine (31%) were ductal carcinomas in situ. Of 20 invasive cancers, nine (45%) were < 10 mm in size. Of the invasive cancers, 40% were node-positive. The cancer diagnosis rate indicates a high breast cancer load in an urbanised population.

Vision 20/20: Mammographic breast density and its clinical applications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ng, Kwan-Hoong, E-mail: ngkh@ummc.edu.my; Lau, Susie

2015-12-15

Breast density is a strong predictor of the failure of mammography screening to detect breast cancer and is a strong predictor of the risk of developing breast cancer. The many imaging options that are now available for imaging dense breasts show great promise, but there is still the question of determining which women are “dense” and what imaging modality is suitable for individual women. To date, mammographic breast density has been classified according to the Breast Imaging-Reporting and Data System (BI-RADS) categories from visual assessment, but this is known to be very subjective. Despite many research reports, the authors believemore » there has been a lack of physics-led and evidence-based arguments about what breast density actually is, how it should be measured, and how it should be used. In this paper, the authors attempt to start correcting this situation by reviewing the history of breast density research and the debates generated by the advocacy movement. The authors review the development of breast density estimation from pattern analysis to area-based analysis, and the current automated volumetric breast density (VBD) analysis. This is followed by a discussion on seeking the ground truth of VBD and mapping volumetric methods to BI-RADS density categories. The authors expect great improvement in VBD measurements that will satisfy the needs of radiologists, epidemiologists, surgeons, and physicists. The authors believe that they are now witnessing a paradigm shift toward personalized breast screening, which is going to see many more cancers being detected early, with the use of automated density measurement tools as an important component.« less

Critically appraising qualitative research: a guide for clinicians more familiar with quantitative techniques.

PubMed

Kisely, Stephen; Kendall, Elizabeth

2011-08-01

Papers using qualitative methods are increasingly common in psychiatric journals. This overview is an introduction to critically appraising a qualitative paper for clinicians who are more familiar with quantitative methods. Qualitative research uses data from interviews (semi-structured or unstructured), focus groups, observations or written materials. Data analysis is inductive, allowing meaning to emerge from the data, rather than the more deductive, hypothesis centred approach of quantitative research. This overview compares and contrasts quantitative and qualitative research methods. Quantitative concepts such as reliability, validity, statistical power, bias and generalisability have qualitative equivalents. These include triangulation, trustworthiness, saturation, reflexivity and applicability. Reflexivity also shares features of transference. Qualitative approaches include: ethnography, action-assessment, grounded theory, case studies and mixed methods. Qualitative research can complement quantitative approaches. An understanding of both is useful in critically appraising the psychiatric literature.

So you want to do research? 3. An introduction to qualitative methods.

PubMed

Meadows, Keith A

2003-10-01

This article describes some of the key issues in the use of qualitative research methods. Starting with a description of what qualitative research is and outlining some of the distinguishing features between quantitative and qualitative research, examples of the type of setting where qualitative research can be applied are provided. Methods of collecting information through in-depth interviews and group discussions are discussed in some detail, including issues around sampling and recruitment, the use of topic guides and techniques to encourage participants to talk openly. An overview on the analysis of qualitative data discusses aspects on data reduction, display and drawing conclusions from the data. Approaches to ensuring rigour in the collection, analysis and reporting of qualitative research are discussed and the concepts of credibility, transferability, dependability and confirmability are described. Finally, guidelines for the reporting of qualitative research are outlined and the need to write for a particular audience is discussed.

Feature extraction applied to agricultural crops as seen by LANDSAT

NASA Technical Reports Server (NTRS)

Kauth, R. J.; Lambeck, P. F.; Richardson, W.; Thomas, G. S.; Pentland, A. P. (Principal Investigator)

1979-01-01

The physical interpretation of the spectral-temporal structure of LANDSAT data can be conveniently described in terms of a graphic descriptive model called the Tassled Cap. This model has been a source of development not only in crop-related feature extraction, but also for data screening and for haze effects correction. Following its qualitative description and an indication of its applications, the model is used to analyze several feature extraction algorithms.

Fractal dimension and lacunarity analysis of mammographic patterns in assessing breast cancer risk related to HRT treated population: a longitudinal and cross-sectional study

NASA Astrophysics Data System (ADS)

Karemore, Gopal; Nielsen, Mads

2009-02-01

Structural texture measures are used to address the aspect of breast cancer risk assessment in screening mammograms. The current study investigates whether texture properties characterized by local Fractal Dimension (FD) and Lacunarity contribute to asses breast cancer risk. FD represents the complexity while the Lacunarity characterize the gappiness of a fractal. Our cross-sectional case-control study includes mammograms of 50 patients diagnosed with breast cancer in the subsequent 2-4 years and 50 matched controls. The longitudinal double blind placebo controlled HRT study includes 39 placebo and 36 HRT treated volunteers for two years. ROIs with same dimension (250*150 pixels) were created behind the nipple region on these radiographs. Box counting method was used to calculate the fractal dimension (FD) and the Lacunarity. Paired t-test and Pearson correlation coefficient were calculated. It was found that there were no differences between cancer and control group for FD (P=0.8) and Lacunarity (P=0.8) in crosssectional study whereas earlier published heterogeneity examination of radiographs (BC-HER) breast cancer risk score separated groups (p=0.002). In the longitudinal study, FD decreased significantly (P<0.05) in the HRT treated population while Lacunarity remained insignificant (P=0.2). FD is negatively correlated to Lacunarity (-0.74, P<0.001), BIRADS (-0.34, P<0.001) and Percentage Density (-0.41, P<0.001). FD is invariant to the mammographic texture change from control to cancer population but marginally varying in HRT treated population. This study yields no evidence that lacunarity or FD are suitable surrogate markers of mammographic heterogeneity as they neither pick up breast cancer risk, nor show good sensitivity to HRT.

A new approach to develop computer-aided detection schemes of digital mammograms

NASA Astrophysics Data System (ADS)

Tan, Maxine; Qian, Wei; Pu, Jiantao; Liu, Hong; Zheng, Bin

2015-06-01

The purpose of this study is to develop a new global mammographic image feature analysis based computer-aided detection (CAD) scheme and evaluate its performance in detecting positive screening mammography examinations. A dataset that includes images acquired from 1896 full-field digital mammography (FFDM) screening examinations was used in this study. Among them, 812 cases were positive for cancer and 1084 were negative or benign. After segmenting the breast area, a computerized scheme was applied to compute 92 global mammographic tissue density based features on each of four mammograms of the craniocaudal (CC) and mediolateral oblique (MLO) views. After adding three existing popular risk factors (woman’s age, subjectively rated mammographic density, and family breast cancer history) into the initial feature pool, we applied a sequential forward floating selection feature selection algorithm to select relevant features from the bilateral CC and MLO view images separately. The selected CC and MLO view image features were used to train two artificial neural networks (ANNs). The results were then fused by a third ANN to build a two-stage classifier to predict the likelihood of the FFDM screening examination being positive. CAD performance was tested using a ten-fold cross-validation method. The computed area under the receiver operating characteristic curve was AUC = 0.779   ±   0.025 and the odds ratio monotonically increased from 1 to 31.55 as CAD-generated detection scores increased. The study demonstrated that this new global image feature based CAD scheme had a relatively higher discriminatory power to cue the FFDM examinations with high risk of being positive, which may provide a new CAD-cueing method to assist radiologists in reading and interpreting screening mammograms.

Partial dependence of breast tumor malignancy on ultrasound image features derived from boosted trees

NASA Astrophysics Data System (ADS)

Yang, Wei; Zhang, Su; Li, Wenying; Chen, Yaqing; Lu, Hongtao; Chen, Wufan; Chen, Yazhu

2010-04-01

Various computerized features extracted from breast ultrasound images are useful in assessing the malignancy of breast tumors. However, the underlying relationship between the computerized features and tumor malignancy may not be linear in nature. We use the decision tree ensemble trained by the cost-sensitive boosting algorithm to approximate the target function for malignancy assessment and to reflect this relationship qualitatively. Partial dependence plots are employed to explore and visualize the effect of features on the output of the decision tree ensemble. In the experiments, 31 image features are extracted to quantify the sonographic characteristics of breast tumors. Patient age is used as an external feature because of its high clinical importance. The area under the receiver-operating characteristic curve of the tree ensembles can reach 0.95 with sensitivity of 0.95 (61/64) at the associated specificity 0.74 (77/104). The partial dependence plots of the four most important features are demonstrated to show the influence of the features on malignancy, and they are in accord with the empirical observations. The results can provide visual and qualitative references on the computerized image features for physicians, and can be useful for enhancing the interpretability of computer-aided diagnosis systems for breast ultrasound.

Qualitative Features Extraction from Sensor Data using Short-time Fourier Transform

NASA Technical Reports Server (NTRS)

Amini, Abolfazl M.; Figueroa, Fernando

2004-01-01

The information gathered from sensors is used to determine the health of a sensor. Once a normal mode of operation is established any deviation from the normal behavior indicates a change. This change may be due to a malfunction of the sensor(s) or the system (or process). The step-up and step-down features, as well as sensor disturbances are assumed to be exponential. An RC network is used to model the main process, which is defined by a step-up (charging), drift, and step-down (discharging). The sensor disturbances and spike are added while the system is in drift. The system runs for a period of at least three time-constants of the main process every time a process feature occurs (e.g. step change). The Short-Time Fourier Transform of the Signal is taken using the Hamming window. Three window widths are used. The DC value is removed from the windowed data prior to taking the FFT. The resulting three dimensional spectral plots provide good time frequency resolution. The results indicate distinct shapes corresponding to each process.

Basic physics and doubts about relationship between mammographically determined tissue density and breast cancer risk.

PubMed

Kopans, Daniel B

2008-02-01

Numerous studies have suggested a link between breast tissue patterns, as defined with mammography, and risk for breast cancer. There may be a relationship, but the author believes all of these studies have methodological flaws. It is impossible, with the parameters used in these studies, to accurately measure the percentage of tissues by volume when two-dimensional x-ray mammographic images are used. Without exposure values, half-value layer information, and knowledge of the compressed thickness of the breast, an accurate volume of tissue cannot be calculated. The great variability in positioning the breast for a mammogram is also an uncontrollable factor in measuring tissue density. Computerized segmentation algorithms can accurately assess the percentage of the x-ray image that is "dense," but this does not accurately measure the true volume of tissue. Since the percentage of dense tissue is ultimately measured in relation to the complete volume of the breast, defining the true boundaries of the breast is also a problem. Studies that purport to show small percentage differences between groups are likely inaccurate. Future investigations need to use three-dimensional information. (c) RSNA, 2008.

Risk factors for breast cancer in a cohort of mammographic screening program: a nested case-control study within the FRiCaM study.

PubMed

Bravi, Francesca; Decarli, Adriano; Russo, Antonio Giampiero

2018-05-01

Breast cancer is the most common cancer diagnosis and the leading cause of cancer death among women in the world, and differences across populations indicate a role of hormonal, reproductive and lifestyle factors. This study is based on a cohort of 78,050 women invited to undergo a mammogram by Local Health Authority of Milan, between 2003 and 2007. We carried out a nested case-control study including all the 3303 incident breast cancer cases diagnosed up to 2015, and 9909 controls matched by age and year of enrollment. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using logistic regression models. The ORs were 0.88 (95% CI: 0.78-0.98) for an age at menarche ≥14 years and 1.39 (95% CI: 1.07-1.81) for an age of 30 years or older at first pregnancy. Body mass index (BMI) was positively associated with breast cancer risk in women older than 50 years (OR = 1.89, 95% CI: 1.54-2.31, for BMI≥30 vs. <20), while the association tended to be inverse in younger women. A high mammographic density increased breast cancer risk (OR = 2.61, 95% CI: 2.02-3.38 for density >75% vs. adipose tissue). The ORs were 1.67 (95% CI: 1.47-1.89) and 2.04 (95% CI: 1.38-3.00) for one first-degree relative and two or more relatives affected by breast cancer, respectively. Our study confirms the role of major recognized risk factors for breast cancer in our population and provides the basis for a stratification of the participants in the mammographic screening according to different levels of risk. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Failure analysis of ceramic clinical cases using qualitative fractography.

PubMed

Scherrer, Susanne S; Quinn, Janet B; Quinn, George D; Kelly, J Robert

2006-01-01

To educate dental academic staff and clinicians on the application of descriptive (qualitative) fractography for analyses of clinical and laboratory failures of brittle materials such as glass and ceramic. The fracture surface topography of failed glass, glass fiber-reinforced composite, and ceramic restorations (Procera, Cerestore, In-Ceram, porcelain-fused-to-metal) was examined utilizing a scanning electron microscope. Replicas and original failed parts were scrutinized for classic fractographic features such as hackle, wake hackle, twist hackle, arrest lines, and mirrors. Failed surfaces of the veneering porcelain of ceramic and porcelain-fused-to-metal crowns exhibited hackle, wake hackle, twist hackle, arrest lines, and compression curl, which were produced by the interaction of the advancing crack with the microstructure of the material. Fracture surfaces of glass and glass fiber-reinforced composite showed additional features, such as velocity hackle and mirrors. The observed features were good indicators of the local direction of crack propagation and were used to trace the crack back to an initial starting area (the origin). Examples of failure analysis in this study are intended to guide the researcher in using qualitative (descriptive) fractography as a tool for understanding the failure process in brittle restorative materials and also for assessing possible design inadequacies.

Parenchymal texture analysis in digital mammography: A fully automated pipeline for breast cancer risk assessment.

PubMed

Zheng, Yuanjie; Keller, Brad M; Ray, Shonket; Wang, Yan; Conant, Emily F; Gee, James C; Kontos, Despina

2015-07-01

Mammographic percent density (PD%) is known to be a strong risk factor for breast cancer. Recent studies also suggest that parenchymal texture features, which are more granular descriptors of the parenchymal pattern, can provide additional information about breast cancer risk. To date, most studies have measured mammographic texture within selected regions of interest (ROIs) in the breast, which cannot adequately capture the complexity of the parenchymal pattern throughout the whole breast. To better characterize patterns of the parenchymal tissue, the authors have developed a fully automated software pipeline based on a novel lattice-based strategy to extract a range of parenchymal texture features from the entire breast region. Digital mammograms from 106 cases with 318 age-matched controls were retrospectively analyzed. The lattice-based approach is based on a regular grid virtually overlaid on each mammographic image. Texture features are computed from the intersection (i.e., lattice) points of the grid lines within the breast, using a local window centered at each lattice point. Using this strategy, a range of statistical (gray-level histogram, co-occurrence, and run-length) and structural (edge-enhancing, local binary pattern, and fractal dimension) features are extracted. To cover the entire breast, the size of the local window for feature extraction is set equal to the lattice grid spacing and optimized experimentally by evaluating different windows sizes. The association between their lattice-based texture features and breast cancer was evaluated using logistic regression with leave-one-out cross validation and further compared to that of breast PD% and commonly used single-ROI texture features extracted from the retroareolar or the central breast region. Classification performance was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC). DeLong's test was used to compare the different ROCs in terms of AUC

Neighborhood Structural Similarity Mapping for the Classification of Masses in Mammograms.

PubMed

Rabidas, Rinku; Midya, Abhishek; Chakraborty, Jayasree

2018-05-01

In this paper, two novel feature extraction methods, using neighborhood structural similarity (NSS), are proposed for the characterization of mammographic masses as benign or malignant. Since gray-level distribution of pixels is different in benign and malignant masses, more regular and homogeneous patterns are visible in benign masses compared to malignant masses; the proposed method exploits the similarity between neighboring regions of masses by designing two new features, namely, NSS-I and NSS-II, which capture global similarity at different scales. Complementary to these global features, uniform local binary patterns are computed to enhance the classification efficiency by combining with the proposed features. The performance of the features are evaluated using the images from the mini-mammographic image analysis society (mini-MIAS) and digital database for screening mammography (DDSM) databases, where a tenfold cross-validation technique is incorporated with Fisher linear discriminant analysis, after selecting the optimal set of features using stepwise logistic regression method. The best area under the receiver operating characteristic curve of 0.98 with an accuracy of is achieved with the mini-MIAS database, while the same for the DDSM database is 0.93 with accuracy .

The association between mammographic calcifications and breast cancer prognostic factors in a population-based registry cohort.

PubMed

Nyante, Sarah J; Lee, Sheila S; Benefield, Thad S; Hoots, Tiffany N; Henderson, Louise M

2017-01-01

Mammographic calcifications can be a marker of malignancy, but their association with prognosis is less well established. In the current study, the authors examined the relationship between calcifications and breast cancer prognostic factors in the population-based Carolina Mammography Registry. The current study included 8472 invasive breast cancers diagnosed in the Carolina Mammography Registry between 1996 and 2011 for which information regarding calcifications occurring within 2 years of diagnosis was reported. Calcification-specific Breast Imaging Reporting and Data System (BI-RADS) assessments were reported prospectively by a radiologist. Tumor characteristic data were obtained from the North Carolina Central Cancer Registry and/or pathology reports. Multivariable-adjusted associations between the presence of calcifications in the breast affected by cancer and tumor characteristics were estimated using logistic regression. Statistical tests were 2-sided. The presence of calcifications was found to be positively associated with tumors that were high grade (vs low grade: odds ratio [OR], 1.43; 95% confidence interval [95% CI], 1.10-1.88) or had an in situ component (vs without: OR, 2.15; 95% CI, 1.81-2.55). Calcifications were found to be inversely associated with hormone receptor-negative status (vs positive status: OR, 0.73; 95% CI, 0.57-0.93), size >35 mm (vs ≤8 mm: OR, 0.47; 95% CI, 0.37-0.61), and lobular tumors (vs ductal: OR, 0.39; 95% CI, 0.22-0.69). The association between the presence of calcifications and an in situ component was limited to BI-RADS category 4 and 5 calcifications and was absent for BI-RADS category 2 or 3 calcifications (P for heterogeneity <.01). The association with tumor size was found to be strongest for BI-RADS categories 3 and 4 (P for heterogeneity <.01). Calcifications were found to be associated with both unfavorable (high grade) and favorable (small size, hormone receptor positivity) prognostic factors

Predicting radiologists' true and false positive decisions in reading mammograms by using gaze parameters and image-based features

NASA Astrophysics Data System (ADS)

Gandomkar, Ziba; Tay, Kevin; Ryder, Will; Brennan, Patrick C.; Mello-Thoms, Claudia

2016-03-01

Radiologists' gaze-related parameters combined with image-based features were utilized to classify suspicious mammographic areas ultimately scored as True Positives (TP) and False Positives (FP). Eight breast radiologists read 120 two-view digital mammograms of which 59 had biopsy proven cancer. Eye tracking data was collected and nearby fixations were clustered together. Suspicious areas on mammograms were independently identified based on thresholding an intensity saliency map followed by automatic segmentation and pruning steps. For each radiologist reported area, radiologist's fixation clusters in the area, as well as neighboring suspicious areas within 2.5° of the center of fixation, were found. A 45-dimensional feature vector containing gaze parameters of the corresponding cluster along with image-based characteristics was constructed. Gaze parameters included total number of fixations in the cluster, dwell time, time to hit the cluster for the first time, maximum number of consecutive fixations, and saccade magnitude of the first fixation in the cluster. Image-based features consisted of intensity, shape, and texture descriptors extracted from the region around the suspicious area, its surrounding tissue, and the entire breast. For each radiologist, a userspecific Support Vector Machine (SVM) model was built to classify the reported areas as TPs or FPs. Leave-one-out cross validation was utilized to avoid over-fitting. A feature selection step was embedded in the SVM training procedure by allowing radial basis function kernels to have 45 scaling factors. The proposed method was compared with the radiologists' performance using the jackknife alternative free-response receiver operating characteristic (JAFROC). The JAFROC figure of merit increased significantly for six radiologists.

Developing a clinical utility framework to evaluate prediction models in radiogenomics

NASA Astrophysics Data System (ADS)

Wu, Yirong; Liu, Jie; Munoz del Rio, Alejandro; Page, David C.; Alagoz, Oguzhan; Peissig, Peggy; Onitilo, Adedayo A.; Burnside, Elizabeth S.

2015-03-01

Combining imaging and genetic information to predict disease presence and behavior is being codified into an emerging discipline called "radiogenomics." Optimal evaluation methodologies for radiogenomics techniques have not been established. We aim to develop a clinical decision framework based on utility analysis to assess prediction models for breast cancer. Our data comes from a retrospective case-control study, collecting Gail model risk factors, genetic variants (single nucleotide polymorphisms-SNPs), and mammographic features in Breast Imaging Reporting and Data System (BI-RADS) lexicon. We first constructed three logistic regression models built on different sets of predictive features: (1) Gail, (2) Gail+SNP, and (3) Gail+SNP+BI-RADS. Then, we generated ROC curves for three models. After we assigned utility values for each category of findings (true negative, false positive, false negative and true positive), we pursued optimal operating points on ROC curves to achieve maximum expected utility (MEU) of breast cancer diagnosis. We used McNemar's test to compare the predictive performance of the three models. We found that SNPs and BI-RADS features augmented the baseline Gail model in terms of the area under ROC curve (AUC) and MEU. SNPs improved sensitivity of the Gail model (0.276 vs. 0.147) and reduced specificity (0.855 vs. 0.912). When additional mammographic features were added, sensitivity increased to 0.457 and specificity to 0.872. SNPs and mammographic features played a significant role in breast cancer risk estimation (p-value < 0.001). Our decision framework comprising utility analysis and McNemar's test provides a novel framework to evaluate prediction models in the realm of radiogenomics.

The Utility of Template Analysis in Qualitative Psychology Research.

PubMed

Brooks, Joanna; McCluskey, Serena; Turley, Emma; King, Nigel

2015-04-03

Thematic analysis is widely used in qualitative psychology research, and in this article, we present a particular style of thematic analysis known as Template Analysis. We outline the technique and consider its epistemological position, then describe three case studies of research projects which employed Template Analysis to illustrate the diverse ways it can be used. Our first case study illustrates how the technique was employed in data analysis undertaken by a team of researchers in a large-scale qualitative research project. Our second example demonstrates how a qualitative study that set out to build on mainstream theory made use of the a priori themes (themes determined in advance of coding) permitted in Template Analysis. Our final case study shows how Template Analysis can be used from an interpretative phenomenological stance. We highlight the distinctive features of this style of thematic analysis, discuss the kind of research where it may be particularly appropriate, and consider possible limitations of the technique. We conclude that Template Analysis is a flexible form of thematic analysis with real utility in qualitative psychology research.

Generating One Biometric Feature from Another: Faces from Fingerprints

PubMed Central

Ozkaya, Necla; Sagiroglu, Seref

2010-01-01

This study presents a new approach based on artificial neural networks for generating one biometric feature (faces) from another (only fingerprints). An automatic and intelligent system was designed and developed to analyze the relationships among fingerprints and faces and also to model and to improve the existence of the relationships. The new proposed system is the first study that generates all parts of the face including eyebrows, eyes, nose, mouth, ears and face border from only fingerprints. It is also unique and different from similar studies recently presented in the literature with some superior features. The parameter settings of the system were achieved with the help of Taguchi experimental design technique. The performance and accuracy of the system have been evaluated with 10-fold cross validation technique using qualitative evaluation metrics in addition to the expanded quantitative evaluation metrics. Consequently, the results were presented on the basis of the combination of these objective and subjective metrics for illustrating the qualitative properties of the proposed methods as well as a quantitative evaluation of their performances. Experimental results have shown that one biometric feature can be determined from another. These results have once more indicated that there is a strong relationship between fingerprints and faces. PMID:22399877

Theoretical Coalescence: A Method to Develop Qualitative Theory

PubMed Central

Morse, Janice M.

2018-01-01

Background Qualitative research is frequently context bound, lacks generalizability, and is limited in scope. Objectives The purpose of this article was to describe a method, theoretical coalescence, that provides a strategy for analyzing complex, high-level concepts and for developing generalizable theory. Theoretical coalescence is a method of theoretical expansion, inductive inquiry, of theory development, that uses data (rather than themes, categories, and published extracts of data) as the primary source for analysis. Here, using the development of the lay concept of enduring as an example, I explore the scientific development of the concept in multiple settings over many projects and link it within the Praxis Theory of Suffering. Methods As comprehension emerges when conducting theoretical coalescence, it is essential that raw data from various different situations be available for reinterpretation/reanalysis and comparison to identify the essential features of the concept. The concept is then reconstructed, with additional inquiry that builds description, and evidence is conducted and conceptualized to create a more expansive concept and theory. Results By utilizing apparently diverse data sets from different contexts that are linked by certain characteristics, the essential features of the concept emerge. Such inquiry is divergent and less bound by context yet purposeful, logical, and with significant pragmatic implications for practice in nursing and beyond our discipline. Conclusion Theoretical coalescence is a means by which qualitative inquiry is broadened to make an impact, to accommodate new theoretical shifts and concepts, and to make qualitative research applied and accessible in new ways. PMID:29360688

Development of an online, publicly accessible naive Bayesian decision support tool for mammographic mass lesions based on the American College of Radiology (ACR) BI-RADS lexicon.

PubMed

Benndorf, Matthias; Kotter, Elmar; Langer, Mathias; Herda, Christoph; Wu, Yirong; Burnside, Elizabeth S

2015-06-01

To develop and validate a decision support tool for mammographic mass lesions based on a standardized descriptor terminology (BI-RADS lexicon) to reduce variability of practice. We used separate training data (1,276 lesions, 138 malignant) and validation data (1,177 lesions, 175 malignant). We created naïve Bayes (NB) classifiers from the training data with tenfold cross-validation. Our "inclusive model" comprised BI-RADS categories, BI-RADS descriptors, and age as predictive variables; our "descriptor model" comprised BI-RADS descriptors and age. The resulting NB classifiers were applied to the validation data. We evaluated and compared classifier performance with ROC-analysis. In the training data, the inclusive model yields an AUC of 0.959; the descriptor model yields an AUC of 0.910 (P < 0.001). The inclusive model is superior to the clinical performance (BI-RADS categories alone, P < 0.001); the descriptor model performs similarly. When applied to the validation data, the inclusive model yields an AUC of 0.935; the descriptor model yields an AUC of 0.876 (P < 0.001). Again, the inclusive model is superior to the clinical performance (P < 0.001); the descriptor model performs similarly. We consider our classifier a step towards a more uniform interpretation of combinations of BI-RADS descriptors. We provide our classifier at www.ebm-radiology.com/nbmm/index.html . • We provide a decision support tool for mammographic masses at www.ebm-radiology.com/nbmm/index.html . • Our tool may reduce variability of practice in BI-RADS category assignment. • A formal analysis of BI-RADS descriptors may enhance radiologists' diagnostic performance.

Metabolic syndrome and mammographic density: The Study of Women’s Health Across the Nation (SWAN)

PubMed Central

Conroy, Shannon M.; Butler, Lesley M.; Harvey, Danielle; Gold, Ellen B.; Sternfeld, Barbara; Greendale, Gail A.; Habel, Laurel A.

2013-01-01

The metabolic syndrome (MetS) is associated with an increase in breast cancer risk. In this study, we evaluated whether the MetS was associated with an increase in percent mammographic density (MD), a breast cancer risk factor. We used linear regression and mixed models to examine the cross-sectional and longitudinal associations of the MetS and components of the MetS to percent MD in 790 pre- and early perimenopausal women enrolled in the Study of Women’s Health Across the Nation (SWAN). In cross-sectional analyses adjusted for body mass index (BMI), modest inverse associations were observed between percent MD and the MetS (β = −2.5, SE = 1.9, p = 0.19), abdominal adiposity (β = −4.8, SE = 1.9, p = 0.01) and raised glucose (β = −3.7, SE = 2.4, p = 0.12). In longitudinal models adjusted for covariates including age and BMI, abdominal adiposity (β = 0.34, SE = 0.17, p = 0.05) was significantly positively associated with slower annual decline in percent MD with time. In conclusion, our results do not support the hypothesis that the MetS increases breast cancer risk via a mechanism reflected by an increase in percent MD. PMID:21105041

QML-AiNet: An immune network approach to learning qualitative differential equation models

PubMed Central

Pang, Wei; Coghill, George M.

2015-01-01

In this paper, we explore the application of Opt-AiNet, an immune network approach for search and optimisation problems, to learning qualitative models in the form of qualitative differential equations. The Opt-AiNet algorithm is adapted to qualitative model learning problems, resulting in the proposed system QML-AiNet. The potential of QML-AiNet to address the scalability and multimodal search space issues of qualitative model learning has been investigated. More importantly, to further improve the efficiency of QML-AiNet, we also modify the mutation operator according to the features of discrete qualitative model space. Experimental results show that the performance of QML-AiNet is comparable to QML-CLONALG, a QML system using the clonal selection algorithm (CLONALG). More importantly, QML-AiNet with the modified mutation operator can significantly improve the scalability of QML and is much more efficient than QML-CLONALG. PMID:25648212

QML-AiNet: An immune network approach to learning qualitative differential equation models.

PubMed

Pang, Wei; Coghill, George M

2015-02-01

In this paper, we explore the application of Opt-AiNet, an immune network approach for search and optimisation problems, to learning qualitative models in the form of qualitative differential equations. The Opt-AiNet algorithm is adapted to qualitative model learning problems, resulting in the proposed system QML-AiNet. The potential of QML-AiNet to address the scalability and multimodal search space issues of qualitative model learning has been investigated. More importantly, to further improve the efficiency of QML-AiNet, we also modify the mutation operator according to the features of discrete qualitative model space. Experimental results show that the performance of QML-AiNet is comparable to QML-CLONALG, a QML system using the clonal selection algorithm (CLONALG). More importantly, QML-AiNet with the modified mutation operator can significantly improve the scalability of QML and is much more efficient than QML-CLONALG.

A feasibility study of X-ray phase-contrast mammographic tomography at the Imaging and Medical beamline of the Australian Synchrotron.

PubMed

Nesterets, Yakov I; Gureyev, Timur E; Mayo, Sheridan C; Stevenson, Andrew W; Thompson, Darren; Brown, Jeremy M C; Kitchen, Marcus J; Pavlov, Konstantin M; Lockie, Darren; Brun, Francesco; Tromba, Giuliana

2015-11-01

Results are presented of a recent experiment at the Imaging and Medical beamline of the Australian Synchrotron intended to contribute to the implementation of low-dose high-sensitivity three-dimensional mammographic phase-contrast imaging, initially at synchrotrons and subsequently in hospitals and medical imaging clinics. The effect of such imaging parameters as X-ray energy, source size, detector resolution, sample-to-detector distance, scanning and data processing strategies in the case of propagation-based phase-contrast computed tomography (CT) have been tested, quantified, evaluated and optimized using a plastic phantom simulating relevant breast-tissue characteristics. Analysis of the data collected using a Hamamatsu CMOS Flat Panel Sensor, with a pixel size of 100 µm, revealed the presence of propagation-based phase contrast and demonstrated significant improvement of the quality of phase-contrast CT imaging compared with conventional (absorption-based) CT, at medically acceptable radiation doses.

Common genetic variation and novel loci associated with volumetric mammographic density.

PubMed

Brand, Judith S; Humphreys, Keith; Li, Jingmei; Karlsson, Robert; Hall, Per; Czene, Kamila

2018-04-17

Mammographic density (MD) is a strong and heritable intermediate phenotype of breast cancer, but much of its genetic variation remains unexplained. We conducted a genetic association study of volumetric MD in a Swedish mammography screening cohort (n = 9498) to identify novel MD loci. Associations with volumetric MD phenotypes (percent dense volume, absolute dense volume, and absolute nondense volume) were estimated using linear regression adjusting for age, body mass index, menopausal status, and six principal components. We also estimated the proportion of MD variance explained by additive contributions from single-nucleotide polymorphisms (SNP-based heritability [h 2 SNP ]) in 4948 participants of the cohort. In total, three novel MD loci were identified (at P < 5 × 10 - 8 ): one for percent dense volume (HABP2) and two for the absolute dense volume (INHBB, LINC01483). INHBB is an established locus for ER-negative breast cancer, and HABP2 and LINC01483 represent putative new breast cancer susceptibility loci, because both loci were associated with breast cancer in available meta-analysis data including 122,977 breast cancer cases and 105,974 control subjects (P < 0.05). h 2 SNP (SE) estimates for percent dense, absolute dense, and nondense volume were 0.29 (0.07), 0.31 (0.07), and 0.25 (0.07), respectively. Corresponding ratios of h 2 SNP to previously observed narrow-sense h 2 estimates in the same cohort were 0.46, 0.72, and 0.41, respectively. These findings provide new insights into the genetic basis of MD and biological mechanisms linking MD to breast cancer risk. Apart from identifying three novel loci, we demonstrate that at least 25% of the MD variance is explained by common genetic variation with h 2 SNP /h 2 ratios varying between dense and nondense MD components.

Mammographic Density Phenotypes and Risk of Breast Cancer: A Meta-analysis

PubMed Central

Graff, Rebecca E.; Ursin, Giske; dos Santos Silva, Isabel; McCormack, Valerie; Baglietto, Laura; Vachon, Celine; Bakker, Marije F.; Giles, Graham G.; Chia, Kee Seng; Czene, Kamila; Eriksson, Louise; Hall, Per; Hartman, Mikael; Warren, Ruth M. L.; Hislop, Greg; Chiarelli, Anna M.; Hopper, John L.; Krishnan, Kavitha; Li, Jingmei; Li, Qing; Pagano, Ian; Rosner, Bernard A.; Wong, Chia Siong; Scott, Christopher; Stone, Jennifer; Maskarinec, Gertraud; Boyd, Norman F.; van Gils, Carla H.

2014-01-01

Background Fibroglandular breast tissue appears dense on mammogram, whereas fat appears nondense. It is unclear whether absolute or percentage dense area more strongly predicts breast cancer risk and whether absolute nondense area is independently associated with risk. Methods We conducted a meta-analysis of 13 case–control studies providing results from logistic regressions for associations between one standard deviation (SD) increments in mammographic density phenotypes and breast cancer risk. We used random-effects models to calculate pooled odds ratios and 95% confidence intervals (CIs). All tests were two-sided with P less than .05 considered to be statistically significant. Results Among premenopausal women (n = 1776 case patients; n = 2834 control subjects), summary odds ratios were 1.37 (95% CI = 1.29 to 1.47) for absolute dense area, 0.78 (95% CI = 0.71 to 0.86) for absolute nondense area, and 1.52 (95% CI = 1.39 to 1.66) for percentage dense area when pooling estimates adjusted for age, body mass index, and parity. Corresponding odds ratios among postmenopausal women (n = 6643 case patients; n = 11187 control subjects) were 1.38 (95% CI = 1.31 to 1.44), 0.79 (95% CI = 0.73 to 0.85), and 1.53 (95% CI = 1.44 to 1.64). After additional adjustment for absolute dense area, associations between absolute nondense area and breast cancer became attenuated or null in several studies and summary odds ratios became 0.82 (95% CI = 0.71 to 0.94; P heterogeneity = .02) for premenopausal and 0.85 (95% CI = 0.75 to 0.96; P heterogeneity < .01) for postmenopausal women. Conclusions The results suggest that percentage dense area is a stronger breast cancer risk factor than absolute dense area. Absolute nondense area was inversely associated with breast cancer risk, but it is unclear whether the association is independent of absolute dense area. PMID:24816206

Comparison of subjective and fully automated methods for measuring mammographic density.

PubMed

Moshina, Nataliia; Roman, Marta; Sebuødegård, Sofie; Waade, Gunvor G; Ursin, Giske; Hofvind, Solveig

2018-02-01

Background Breast radiologists of the Norwegian Breast Cancer Screening Program subjectively classified mammographic density using a three-point scale between 1996 and 2012 and changed into the fourth edition of the BI-RADS classification since 2013. In 2015, an automated volumetric breast density assessment software was installed at two screening units. Purpose To compare volumetric breast density measurements from the automated method with two subjective methods: the three-point scale and the BI-RADS density classification. Material and Methods Information on subjective and automated density assessment was obtained from screening examinations of 3635 women recalled for further assessment due to positive screening mammography between 2007 and 2015. The score of the three-point scale (I = fatty; II = medium dense; III = dense) was available for 2310 women. The BI-RADS density score was provided for 1325 women. Mean volumetric breast density was estimated for each category of the subjective classifications. The automated software assigned volumetric breast density to four categories. The agreement between BI-RADS and volumetric breast density categories was assessed using weighted kappa (k w ). Results Mean volumetric breast density was 4.5%, 7.5%, and 13.4% for categories I, II, and III of the three-point scale, respectively, and 4.4%, 7.5%, 9.9%, and 13.9% for the BI-RADS density categories, respectively ( P for trend < 0.001 for both subjective classifications). The agreement between BI-RADS and volumetric breast density categories was k w  = 0.5 (95% CI = 0.47-0.53; P < 0.001). Conclusion Mean values of volumetric breast density increased with increasing density category of the subjective classifications. The agreement between BI-RADS and volumetric breast density categories was moderate.

A Meta-analysis Method to Advance Design of Technology-Based Learning Tool: Combining Qualitative and Quantitative Research to Understand Learning in Relation to Different Technology Features

NASA Astrophysics Data System (ADS)

Zhang, Lin

2014-02-01

Educators design and create various technology tools to scaffold students' learning. As more and more technology designs are incorporated into learning, growing attention has been paid to the study of technology-based learning tool. This paper discusses the emerging issues, such as how can learning effectiveness be understood in relation to different technology features? And how can pieces of qualitative and quantitative results be integrated to achieve a broader understanding of technology designs? To address these issues, this paper proposes a meta-analysis method. Detailed explanations about the structure of the methodology and its scientific mechanism are provided for discussions and suggestions. This paper ends with an in-depth discussion on the concerns and questions that educational researchers might raise, such as how this methodology takes care of learning contexts.

The website-based eaTracker® 'My Goals' feature: a qualitative evaluation.

PubMed

Lieffers, Jessica Rl; Haresign, Helen; Mehling, Christine; Arocha, Jose F; Hanning, Rhona M

2017-04-01

In 2011, Dietitians of Canada added 'My Goals' to its website-based nutrition/activity tracking program (eaTracker®, http://www.eaTracker.ca/); this feature allows users to choose 'ready-made' or 'write-your-own' goals and to self-report progress. The purpose of the present study was to document experiences and perceptions of goal setting and My Goals, and report users' feedback on what is needed in future website-based goal setting/tracking tools. One-on-one semi-structured interviews were conducted with (i) My Goals users and (ii) dietitians providing a public information support service, EatRight Ontario (ERO). My Goals users from Ontario and Alberta, Canada were recruited via an eaTracker website pop-up box; ERO dietitians working in Ontario, Canada were recruited via ERO. My Goals users (n 23; age 19-70 years; 91 % female; n 5 from Alberta/n 18 from Ontario) and ERO dietitians (n 5). Dietitians and users felt goal setting for nutrition (and activity) behaviour change was both a beneficial and a challenging process. Dietitians were concerned about users setting poor-quality goals and users felt it was difficult to stick to their goals. Both users and dietitians were enthusiastic about the My Goals concept, but felt the current feature had limitations that affected use. Dietitians and users provided suggestions to improve My Goals (e.g. more prominent presence of My Goals in eaTracker; assistance with goal setting; automated personalized feedback). Dietitians and users shared similar perspectives on the My Goals feature and both felt goal use was challenging. Several suggestions were provided to enhance My Goals that are relevant to website-based goal setting/tracking tool design in general.

Comparison of volumetric breast density estimations from mammography and thorax CT

NASA Astrophysics Data System (ADS)

Geeraert, N.; Klausz, R.; Cockmartin, L.; Muller, S.; Bosmans, H.; Bloch, I.

2014-08-01

Breast density has become an important issue in current breast cancer screening, both as a recognized risk factor for breast cancer and by decreasing screening efficiency by the masking effect. Different qualitative and quantitative methods have been proposed to evaluate area-based breast density and volumetric breast density (VBD). We propose a validation method comparing the computation of VBD obtained from digital mammographic images (VBDMX) with the computation of VBD from thorax CT images (VBDCT). We computed VBDMX by applying a conversion function to the pixel values in the mammographic images, based on models determined from images of breast equivalent material. VBDCT is computed from the average Hounsfield Unit (HU) over the manually delineated breast volume in the CT images. This average HU is then compared to the HU of adipose and fibroglandular tissues from patient images. The VBDMX method was applied to 663 mammographic patient images taken on two Siemens Inspiration (hospL) and one GE Senographe Essential (hospJ). For the comparison study, we collected images from patients who had a thorax CT and a mammography screening exam within the same year. In total, thorax CT images corresponding to 40 breasts (hospL) and 47 breasts (hospJ) were retrieved. Averaged over the 663 mammographic images the median VBDMX was 14.7% . The density distribution and the inverse correlation between VBDMX and breast thickness were found as expected. The average difference between VBDMX and VBDCT is smaller for hospJ (4%) than for hospL (10%). This study shows the possibility to compare VBDMX with the VBD from thorax CT exams, without additional examinations. In spite of the limitations caused by poorly defined breast limits, the calibration of mammographic images to local VBD provides opportunities for further quantitative evaluations.

Building qualitative study design using nursing's disciplinary epistemology.

PubMed

Thorne, Sally; Stephens, Jennifer; Truant, Tracy

2016-02-01

To discuss the implications of drawing on core nursing knowledge as theoretical scaffolding for qualitative nursing enquiry. Although nurse scholars have been using qualitative methods for decades, much of their methodological direction derives from conventional approaches developed for answering questions in the social sciences. The quality of available knowledge to inform practice can be enhanced through the selection of study design options informed by an appreciation for the nature of nursing knowledge. Discussion paper. Drawing on the body of extant literature dealing with nursing's theoretical and qualitative research traditions, we consider contextual factors that have shaped the application of qualitative research approaches in nursing, including prior attempts to align method with the structure and form of disciplinary knowledge. On this basis, we critically reflect on design considerations that would follow logically from core features associated with a nursing epistemology. The substantive knowledge used by nurses to inform their practice includes both aspects developed at the level of the general and also that which pertains to application in the unique context of the particular. It must be contextually relevant to a fluid and dynamic healthcare environment and adaptable to distinctive patient conditions. Finally, it must align with nursing's moral mandate and action imperative. Qualitative research design components informed by nursing's disciplinary epistemology will help ensure a logical line of reasoning in our enquiries that remains true to the nature and structure of practice knowledge. © 2015 John Wiley & Sons Ltd.

The Influence of Universities' Organizational Features on Professorial Intellectual Leadership

ERIC Educational Resources Information Center

Uslu, Baris; Welch, Anthony

2018-01-01

This research examines the intellectual leadership behaviours of senior academics at professoriate level, and the influences of institutional support practices, climate and communication in universities as main organizational features on these behaviours. To explore relations among research variables, qualitative data were collected by interviews…

Shapelet analysis of pupil dilation for modeling visuo-cognitive behavior in screening mammography

NASA Astrophysics Data System (ADS)

Alamudun, Folami; Yoon, Hong-Jun; Hammond, Tracy; Hudson, Kathy; Morin-Ducote, Garnetta; Tourassi, Georgia

2016-03-01

Our objective is to improve understanding of visuo-cognitive behavior in screening mammography under clinically equivalent experimental conditions. To this end, we examined pupillometric data, acquired using a head-mounted eye-tracking device, from 10 image readers (three breast-imaging radiologists and seven Radiology residents), and their corresponding diagnostic decisions for 100 screening mammograms. The corpus of mammograms comprised cases of varied pathology and breast parenchymal density. We investigated the relationship between pupillometric fluctuations, experienced by an image reader during mammographic screening, indicative of changes in mental workload, the pathological characteristics of a mammographic case, and the image readers' diagnostic decision and overall task performance. To answer these questions, we extract features from pupillometric data, and additionally applied time series shapelet analysis to extract discriminative patterns in changes in pupil dilation. Our results show that pupillometric measures are adequate predictors of mammographic case pathology, and image readers' diagnostic decision and performance with an average accuracy of 80%.

When Assessment Data Are Words: Validity Evidence for Qualitative Educational Assessments.

PubMed

Cook, David A; Kuper, Ayelet; Hatala, Rose; Ginsburg, Shiphra

2016-10-01

Quantitative scores fail to capture all important features of learner performance. This awareness has led to increased use of qualitative data when assessing health professionals. Yet the use of qualitative assessments is hampered by incomplete understanding of their role in forming judgments, and lack of consensus in how to appraise the rigor of judgments therein derived. The authors articulate the role of qualitative assessment as part of a comprehensive program of assessment, and translate the concept of validity to apply to judgments arising from qualitative assessments. They first identify standards for rigor in qualitative research, and then use two contemporary assessment validity frameworks to reorganize these standards for application to qualitative assessment.Standards for rigor in qualitative research include responsiveness, reflexivity, purposive sampling, thick description, triangulation, transparency, and transferability. These standards can be reframed using Messick's five sources of validity evidence (content, response process, internal structure, relationships with other variables, and consequences) and Kane's four inferences in validation (scoring, generalization, extrapolation, and implications). Evidence can be collected and evaluated for each evidence source or inference. The authors illustrate this approach using published research on learning portfolios.The authors advocate a "methods-neutral" approach to assessment, in which a clearly stated purpose determines the nature of and approach to data collection and analysis. Increased use of qualitative assessments will necessitate more rigorous judgments of the defensibility (validity) of inferences and decisions. Evidence should be strategically sought to inform a coherent validity argument.

Mammographic breast density and breast cancer: evidence of a shared genetic basis.

PubMed

Varghese, Jajini S; Thompson, Deborah J; Michailidou, Kyriaki; Lindström, Sara; Turnbull, Clare; Brown, Judith; Leyland, Jean; Warren, Ruth M L; Luben, Robert N; Loos, Ruth J; Wareham, Nicholas J; Rommens, Johanna; Paterson, Andrew D; Martin, Lisa J; Vachon, Celine M; Scott, Christopher G; Atkinson, Elizabeth J; Couch, Fergus J; Apicella, Carmel; Southey, Melissa C; Stone, Jennifer; Li, Jingmei; Eriksson, Louise; Czene, Kamila; Boyd, Norman F; Hall, Per; Hopper, John L; Tamimi, Rulla M; Rahman, Nazneen; Easton, Douglas F

2012-03-15

Percent mammographic breast density (PMD) is a strong heritable risk factor for breast cancer. However, the pathways through which this risk is mediated are still unclear. To explore whether PMD and breast cancer have a shared genetic basis, we identified genetic variants most strongly associated with PMD in a published meta-analysis of five genome-wide association studies (GWAS) and used these to construct risk scores for 3,628 breast cancer cases and 5,190 controls from the UK2 GWAS of breast cancer. The signed per-allele effect estimates of single-nucleotide polymorphisms (SNP) were multiplied with the respective allele counts in the individual and summed over all SNPs to derive the risk score for an individual. These scores were included as the exposure variable in a logistic regression model with breast cancer case-control status as the outcome. This analysis was repeated using 10 different cutoff points for the most significant density SNPs (1%-10% representing 5,222-50,899 SNPs). Permutation analysis was also conducted across all 10 cutoff points. The association between risk score and breast cancer was significant for all cutoff points from 3% to 10% of top density SNPs, being most significant for the 6% (2-sided P = 0.002) to 10% (P = 0.001) cutoff points (overall permutation P = 0.003). Women in the top 10% of the risk score distribution had a 31% increased risk of breast cancer [OR = 1.31; 95% confidence interval (CI), 1.08-1.59] compared with women in the bottom 10%. Together, our results show that PMD and breast cancer have a shared genetic basis that is mediated through a large number of common variants.

Mammographic breast density and breast cancer: evidence of a shared genetic basis

PubMed Central

Varghese, Jajini S; Thompson, Deborah J; Michailidou, Kyriaki; Lindström, Sara; Turnbull, Clare; Brown, Judith; Leyland, Jean; Warren, Ruth ML; Luben, Robert N; Loos, Ruth J; Wareham, Nicholas J; Rommens, Johanna; Paterson, Andrew D; Martin, Lisa J; Vachon, Celine M; Scott, Christopher G; Atkinson, Elizabeth J; Couch, Fergus J; Apicella, Carmel; Southey, Melissa C; Stone, Jennifer; Li, Jingmei; Eriksson, Louise; Czene, Kamila; Boyd, Norman F; Hall, Per; Hopper, John L; Tamimi, Rulla M; Rahman, Nazneen; Easton, Douglas F

2012-01-01

Percent mammographic breast density (PMD) is a strong heritable risk factor for breast cancer. However, the pathways through which this risk is mediated are still unclear. To explore whether PMD and breast cancer have a shared genetic basis, we identified genetic variants most strongly associated with PMD in a published meta-analysis of five genome-wide association studies (GWAS) and used these to construct risk scores for 3628 breast cancer cases and 5190 controls from the UK2 GWAS of breast cancer. The signed per-allele effect estimates of SNPs were multiplied with the respective allele counts in the individual and summed over all SNPs to derive the risk score for an individual. These scores were included as the exposure variable in a logistic regression model with breast cancer case-control status as the outcome. This analysis was repeated using ten different cut-offs for the most significant density SNPs (1-10% representing 5,222-50,899 SNPs). Permutation analysis was also performed across all 10 cut-offs. The association between risk score and breast cancer was significant for all cut-offs from 3-10% of top density SNPs, being most significant for the 6% (2-sided P=0.002) to 10% (P=0.001) cut-offs (overall permutation P=0.003). Women in the top 10% of the risk score distribution had a 31% increased risk of breast cancer [OR= 1.31 (95%CI 1.08-1.59)] compared to women in the bottom 10%. Together, our results demonstrate that PMD and breast cancer have a shared genetic basis that is mediated through a large number of common variants. PMID:22266113

Qualitative evaluation of pretreatment patient concerns in orthodontics.

PubMed

Twigge, Eugene; Roberts, Rachel M; Jamieson, Lisa; Dreyer, Craig W; Sampson, Wayne J

2016-07-01

A discrepancy exists between objective and subjective measures of orthodontic treatment need, highlighting the importance of patients' perceptions. Limited qualitative information is available regarding patients' perceptions and orthodontic concerns. For the first time, patient facial images and qualitative methodology were used to assess patients' orthodontic concerns, which are incorporated into and are important in treatment planning and consent. An interview-based, cross-sectional study of adolescent patients eligible to receive orthodontic treatment in a public dental hospital was conducted with 105 adolescents (42 boys, 63 girls) aged between 12 and 17 years. Each patient's face was video recorded, and 3 images were selected from each recording to assess the patient's orthodontic concerns. The initial chief concerns were compared with concerns articulated after the patients assessed their facial images. In addition, patient concerns were compared with occlusal features visible on smiling using the Dental Aesthetic Index and patient study casts. For 37% of the adolescent patients, smiling images helped to identify additional concerns. For 87%, their smiling images helped them to describe their concerns in more detail. In addition, a few patients did not articulate any concern about features measurable on the Dental Aesthetic Index that were visible on smiling. Showing adolescent patients images of their face and smile helped them to identify and better describe their concerns. Adolescents are not always overly concerned about visible and quantifiable malocclusion features. This might influence orthodontic treatment planning and consent. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Modern and Fossil Raindrop Impressions as a Lesson in Interpretation of Ancient Sedimentary Features.

ERIC Educational Resources Information Center

Pardi, Richard R.; Brickner, Dorene

1990-01-01

Procedures for duplicating fossil raindrop impressions are presented. The use of modern and fossil imprints as the basis for qualitative and quantitative lessons in the interpretation of ancient sedimentary features is discussed. (CW)

Mammographic film-processor temperature, development time, and chemistry: effect on dose, contrast, and noise.

PubMed

Kimme-Smith, C; Rothschild, P A; Bassett, L W; Gold, R H; Moler, C

1989-01-01

Six different combinations of film-processor temperature (33.3 degrees C, 35 degrees C), development time (22 sec, 44 sec), and chemistry (Du Pont medium contrast developer [MCD] and Kodak rapid process [RP] developer) were each evaluated by separate analyses with Hurter and Driffield curves, test images of plastic step wedges, noise variance analysis, and phantom images; each combination also was evaluated clinically. Du Pont MCD chemistry produced greater contrast than did Kodak RP chemistry. A change in temperature from 33.3 degrees C (92 degrees F) to 35 degrees C (95 degrees F) had the least effect on dose and image contrast. Temperatures of 36.7 degrees C (98 degrees F) and 38.3 degrees C (101 degrees F) also were tested with extended processing. The speed increased for 36.7 degrees C but decreased at 38.3 degrees C. Base plus fog increased, but contrast decreased for these higher temperatures. Increasing development time had the greatest effect on decreasing the dose required for equivalent film darkening when imaging BR12 breast equivalent test objects; ion chamber measurements showed a 32% reduction in dose when the development time was increased from 22 to 44 sec. Although noise variance doubled in images processed with the extended development time, diagnostic capability was not compromised. Extending the processing time for mammographic films was an effective method of dose reduction, whereas varying the processing temperature and chemicals had less effect on contrast and dose.

Mammographic findings after reshaping with autoprosthesis in women undergoing contralateral breast reconstruction and mastectomy.

PubMed

Scaperrotta, Gianfranco; Capalbo, Emanuela; Ferranti, Claudio; Falco, Giuseppe; Nava, Maurizio B; Di Leo, Gianni; Marchesini, Monica; Suman, Laura; Panizza, Pietro

2016-01-01

Breast reduction and mastopexy combined with inferior dermo-lipo-glandular flap (autoprosthesis) gives good breast shape, long-term projection, and upper pole fullness. We assess the impact on breast oncologic surveillance compared to other techniques. A total of 105 patients who underwent mastectomy and reconstruction were divided into 3 groups of 35 patients each: groups 1 and 2 include patients with contralateral breast symmetrization performed with and without autoprosthesis technique, respectively. Group 3 is a control group without contralateral breast reshaping. On mammography, edema, skin thickening, architectural distortion, and calcifications were recorded, as well as further diagnostic examinations, biopsies, and surgical treatments required. Statistically significant differences (p<0.001) in the first follow-up mammography between groups 1 and 2 were stromal edema (6% vs 51%) and architectural distortion (74% vs 63%). The latest findings meant architectural distortion also have significant difference (p<0.001) in the last mammography (79% vs 66%). Microcalcification has statistically significant difference (p<0.001) in the latest postsurgical mammography, increased in group 1. Skin thickening had a similar course in either group. Mammography follow-up was not impaired in most cases notwithstanding the parenchyma distortion as compared with mammography after breast-conserving surgery. Four core biopsies were performed in both groups: 3 new breast cancers and 1 benign epithelial hyperplasia were found. No difficulties were found impairing mammographic evaluation in patients treated with autoprosthesis as compared to other techniques.

Increased vitamin D and calcium intake associated with reduced mammographic breast density among premenopausal women

PubMed Central

Fair, Alecia Malin; Lewis, Toni J.; Sanderson, Maureen; Dupont, William D.; Fletcher, Sarah; Egan, Kathleen M.; Disher, Anthony C.

2015-01-01

Vitamin D has been identified as a weak protective factor for postmenopausal breast cancer (relative risk [RR]~0.9), while high breast density has been identified as a strong risk factor (RR~4–6). To test the hypothesis that there is an association between vitamin D intake, but not circulating vitamin D levels, and mammographic breast density among women in our study we conducted a cross-sectional study of 165 screening mammography patients at Nashville General Hospital’s Breast Health Center (NGH-BHC), a public facility serving medically indigent and underserved women. Dietary and total (dietary plus supplements) vitamin D, calcium intakes were estimated by the AAFQ and blood samples were analyzed for 25-Hydroxyvitamin D [25(OH)D3]. Average percent breast density for the left and right breasts combined was estimated from digitized films using an interactive-thresholding method available through Cumulus software. After statistical adjustment for age, race and body mass index, the results revealed there were significant trends of decreasing breast density with increasing vitamin D and calcium intake among premenopausal, but not among postmenopausal women. There was no association between serum vitamin D and breast density in pre- or postmenopausal women. Confirmation of our findings in larger studies may assist in clarifying the role of vitamin D in breast density. PMID:26321093

Deep convolutional neural network for mammographic density segmentation

NASA Astrophysics Data System (ADS)

Wei, Jun; Li, Songfeng; Chan, Heang-Ping; Helvie, Mark A.; Roubidoux, Marilyn A.; Lu, Yao; Zhou, Chuan; Hadjiiski, Lubomir; Samala, Ravi K.

2018-02-01

Breast density is one of the most significant factors for cancer risk. In this study, we proposed a supervised deep learning approach for automated estimation of percentage density (PD) on digital mammography (DM). The deep convolutional neural network (DCNN) was trained to estimate a probability map of breast density (PMD). PD was calculated as the ratio of the dense area to the breast area based on the probability of each pixel belonging to dense region or fatty region at a decision threshold of 0.5. The DCNN estimate was compared to a feature-based statistical learning approach, in which gray level, texture and morphological features were extracted from each ROI and the least absolute shrinkage and selection operator (LASSO) was used to select and combine the useful features to generate the PMD. The reference PD of each image was provided by two experienced MQSA radiologists. With IRB approval, we retrospectively collected 347 DMs from patient files at our institution. The 10-fold cross-validation results showed a strong correlation r=0.96 between the DCNN estimation and interactive segmentation by radiologists while that of the feature-based statistical learning approach vs radiologists' segmentation had a correlation r=0.78. The difference between the segmentation by DCNN and by radiologists was significantly smaller than that between the feature-based learning approach and radiologists (p < 0.0001) by two-tailed paired t-test. This study demonstrated that the DCNN approach has the potential to replace radiologists' interactive thresholding in PD estimation on DMs.

Investigation of mammographic breast density as a risk factor for ovarian cancer.

PubMed

Wernli, Karen J; O'Meara, Ellen S; Kerlikowske, Karla; Miglioretti, Diana L; Muller, Carolyn Y; Onega, Tracy; Sprague, Brian L; Henderson, Louise M; Buist, Diana S M

2014-01-01

Endogenous hormones and growth factors that increase mammographic breast density could increase ovarian cancer risk. We examined whether high breast density is associated with ovarian cancer risk. We conducted a cohort study of 724,603 women aged 40 to 79 years with 2,506,732 mammograms participating in the Breast Cancer Surveillance Consortium from 1995 to 2009. Incident epithelial ovarian cancer was diagnosed in 1373 women. We used partly conditional Cox regression to estimate the association between breast density and 5-year risk of incident epithelial ovarian cancer overall and stratified by 10-year age group. All statistical tests were two-sided. Compared with women with scattered fibroglandular densities, women with heterogeneously dense and extremely dense breast tissue had 20% and 18% increased 5-year risk of incident epithelial ovarian cancer (hazard ratio [HR] = 1.20, 95% confidence interval [CI] = 1.06 to 1.36; HR = 1.18, 95% CI = 0.93 to 1.50, respectively; P(trend) = .01). Among women aged 50 to 59 years, we observed a trend in elevated risk associated with increased breast density (P(trend) = .02); women with heterogeneously and extremely dense breast tissue had 30% (HR = 1.30; 95% CI = 1.03 to 1.64) and 65% (HR = 1.65; 95% CI = 1.12 to 2.44) increased risk, respectively, compared with women with scattered fibroglandular densities. The pattern was similar but not statistically significant at age 40 to 49 years. There were no consistent patterns of breast density and ovarian cancer risk at age 60 to 79 years. Dense breast tissue was associated with a modest increase in 5-year ovarian cancer risk in women aged 50 to 59 years but was not associated with ovarian cancer at ages 40 to 49 or 60 to 79 years.

Impact of Breast Reader Assessment Strategy on mammographic radiologists' test reading performance.

PubMed

Suleiman, Wasfi I; Rawashdeh, Mohammad A; Lewis, Sarah J; McEntee, Mark F; Lee, Warwick; Tapia, Kriscia; Brennan, Patrick C

2016-06-01

The detection of breast cancer is somewhat limited by human factors, and thus there is a need to improve reader performance. This study assesses whether radiologists who regularly undertake the education in the form of the Breast Reader Assessment Strategy (BREAST) demonstrate any changes in mammography interpretation performance over time. In 2011, 2012 and 2013, 14 radiologists independently assessed a year-specific BREAST mammographic test-set. Radiologists read a different single test-set once each year, with each comprising 60 digital mammogram cases. Radiologists marked the location of suspected lesions without computer-aided diagnosis (CAD) and assigned a confidence rating of 2 for benign and 3-5 for malignant lesions. The mean sensitivity, specificity, location sensitivity, JAFROC FOM and ROC AUC were calculated. A Kruskal-Wallis test was used to compare the readings for the 14 radiologists across the 3 years. Wilcoxon signed rank test was used to assess comparison between pairs of years. Relationships between changes in performance and radiologist characteristics were examined using a Spearman's test. Significant increases were noted in mean sensitivity (P = 0.01), specificity (P = 0.01), location sensitivity (P = 0.001) and JAFROC FOM (P = 0.001) between 2011 and 2012. Between 2012 and 2013, significant improvements were noted in mean sensitivity (P = 0.003), specificity (P = 0.002), location sensitivity (P = 0.02), JAFROC FOM (P = 0.005) and ROC AUC (P = 0.008). No statistically significant correlations were shown between the levels of improvement and radiologists' characteristics. Radiologists' who undertake the BREAST programme demonstrate significant improvements in test-set performance during a 3-year period, highlighting the value of ongoing education through the use of test-set. © 2016 The Royal Australian and New Zealand College of Radiologists.

Qualitative Analysis of Information Communication Technology Use on Teaching-Learning Process.

ERIC Educational Resources Information Center

Akahori, Kanji

This paper describes some of the features of Information Communication Technology (ICT) and its uses in the teaching-learning process in elementary schools. In most schools, it is difficult for ICT to be used effectively in the teaching-learning process. The author observed many classes using ICT in elementary schools. Qualitative data, such as…

Using listener-based perceptual features as intermediate representations in music information retrieval.

PubMed

Friberg, Anders; Schoonderwaldt, Erwin; Hedblad, Anton; Fabiani, Marco; Elowsson, Anders

2014-10-01

The notion of perceptual features is introduced for describing general music properties based on human perception. This is an attempt at rethinking the concept of features, aiming to approach the underlying human perception mechanisms. Instead of using concepts from music theory such as tones, pitches, and chords, a set of nine features describing overall properties of the music was selected. They were chosen from qualitative measures used in psychology studies and motivated from an ecological approach. The perceptual features were rated in two listening experiments using two different data sets. They were modeled both from symbolic and audio data using different sets of computational features. Ratings of emotional expression were predicted using the perceptual features. The results indicate that (1) at least some of the perceptual features are reliable estimates; (2) emotion ratings could be predicted by a small combination of perceptual features with an explained variance from 75% to 93% for the emotional dimensions activity and valence; (3) the perceptual features could only to a limited extent be modeled using existing audio features. Results clearly indicated that a small number of dedicated features were superior to a "brute force" model using a large number of general audio features.

Radiographic features of the limbs of juvenile and subadult loggerhead sea turtles (Caretta caretta)

PubMed Central

Valente, Ana Luisa; Marco, Ignasi; Zamora, Maria Angeles; Parga, Maria Luz; Lavín, Santiago; Alegre, Ferran; Cuenca, Rafaela

2007-01-01

This study aimed to provide the normal radiographic anatomic appearance of the limbs of the loggerhead sea turtle, Caretta caretta. Dorsopalmar and dorsoplantar radiographs were taken of the forelimbs and hindlimbs of 15 juvenile and 15 subadult loggerhead sea turtles, 17 alive and 13 dead. For comparison, computed tomographic, gross anatomic, osteologic, and histologic studies were performed on the limbs of 5 of the sea turtles. Bones from the distal part of the fore and hind flippers were seen in detail with a mammographic film–screen combination. The pectoral and pelvic girdles, superimposed by the carapace, were better seen on standard radiographs with the use of rare-earth intensifying screens. Mammographic radiographs of the manus of 5 small juvenile turtles showed active growth zones. Visualization of bone contours in the distal part of the limbs was clearer than in mammals owing to the very few superimpositions. The presence of a substantial amount of cartilage in the epiphyses produced better visibility of limb ends. We conclude that use of a mammography film–screen combination is the best way to evaluate the bony and joint structures of the limbs of sea turtles. Radiography provides reliable images for clinical purposes. Considering the low cost and logistics of this technique, it is a practical ancillary test for marine animal rehabilitation centers to use. PMID:17955906

Associations of coffee consumption and caffeine intake with mammographic breast density.

PubMed

Yaghjyan, Lusine; Colditz, Graham; Rosner, Bernard; Gasparova, Aleksandra; Tamimi, Rulla M

2018-05-01

Previous studies suggest that coffee and caffeine intake may be associated with reduced breast cancer risk. We investigated the association of coffee and caffeine intake with mammographic breast density by woman's menopausal status and, in postmenopausal women, by hormone therapy (HT). This study included 4130 cancer-free women within the Nurses' Health Study and Nurses' Health Study II cohorts. Percent breast density (PD) was measured from digitized film mammograms using a computer-assisted thresholding technique and square root-transformed for the analysis. Average cumulative coffee/caffeine consumption was calculated using data from all food frequency questionnaires preceding the mammogram date. Information regarding breast cancer risk factors was obtained from questionnaires closest to the mammogram date. We used generalized linear regression to quantify associations of regular, decaffeinated, and total coffee, and energy-adjusted caffeine intake with percent density. In multivariable analyses, decaffeinated coffee was positively associated with PD in premenopausal women (2+ cups/day: β = 0.23, p trend = 0.03). In postmenopausal women, decaffeinated and total coffee were inversely associated with PD (decaffeinated 2+ cups/day: β = - 0.24, p trend = 0.04; total 4+ cups/day: β = - 0.16, p trend = 0.02). Interaction of decaffeinated coffee with menopausal status was significant (p-interaction < 0.001). Among current HT users, regular coffee and caffeine were inversely associated with PD (regular coffee 4+ cups/day: β = - 0.29, p trend = 0.01; caffeine 4th vs. 1st quartile: β = - 0.32, p trend = 0.01). Among past users, decaffeinated coffee was inversely associated with PD (2+ cups/day β = - 0.70, p trend = 0.02). Associations of decaffeinated coffee with percent density differ by woman's menopausal status. Associations of regular coffee and caffeine with percent density may differ by HT status.

Aspirin use is associated with lower mammographic density in a large screening cohort.

PubMed

Wood, Marie E; Sprague, Brian L; Oustimov, Andrew; Synnstvedt, Marie B; Cuke, Melissa; Conant, Emily F; Kontos, Despina

2017-04-01

Observational and biologic studies suggest that aspirin is a promising prevention therapy for breast cancer. However, clinical trials to date have not corroborated this evidence, potentially due to study design. We evaluated the effect of aspirin on mammographic density (MD), an established modifiable risk factor for breast cancer. Electronic medical records from the University of Pennsylvania were evaluated for women who underwent screening mammography, saw their primary care provider, and had a confirmed list of medications during 2012-2013. Logistic regression was performed to test for associations between clinically recorded MD and aspirin use, after adjusting for age, body mass index (BMI), and ethnicity. We identified 26,000 eligible women. Mean age was 57.3, mean BMI was 28.9 kg/m 2 , 41% were African American, and 19.7% reported current aspirin use. Aspirin users were significantly older and had higher BMI. There was an independent, inverse association between aspirin use and MD (P trend  < 0.001). Women with extremely dense breasts were less likely to be aspirin users than women with scattered fibroglandular density (OR 0.73; 95% CI 0.57-0.93). This association was stronger for younger women (P = 0.0002) and for African Americans (P = 0.011). The likelihood of having dense breasts decreased with aspirin dose (P trend  = 0.007), suggesting a dose response. We demonstrate an independent association between aspirin use and lower MD in a large, diverse screening cohort. This association was stronger for younger and African American women: two groups at greater risk for ER- breast cancer. These results contribute to the importance of investigating aspirin for breast cancer prevention.

Convolutional neural network features based change detection in satellite images

NASA Astrophysics Data System (ADS)

Mohammed El Amin, Arabi; Liu, Qingjie; Wang, Yunhong

2016-07-01

With the popular use of high resolution remote sensing (HRRS) satellite images, a huge research efforts have been placed on change detection (CD) problem. An effective feature selection method can significantly boost the final result. While hand-designed features have proven difficulties to design features that effectively capture high and mid-level representations, the recent developments in machine learning (Deep Learning) omit this problem by learning hierarchical representation in an unsupervised manner directly from data without human intervention. In this letter, we propose approaching the change detection problem from a feature learning perspective. A novel deep Convolutional Neural Networks (CNN) features based HR satellite images change detection method is proposed. The main guideline is to produce a change detection map directly from two images using a pretrained CNN. This method can omit the limited performance of hand-crafted features. Firstly, CNN features are extracted through different convolutional layers. Then, a concatenation step is evaluated after an normalization step, resulting in a unique higher dimensional feature map. Finally, a change map was computed using pixel-wise Euclidean distance. Our method has been validated on real bitemporal HRRS satellite images according to qualitative and quantitative analyses. The results obtained confirm the interest of the proposed method.

Qualitative research.

PubMed

Gelling, Leslie

2015-03-25

Qualitative research has an important role in helping nurses and other healthcare professionals understand patient experiences of health and illness. Qualitative researchers have a large number of methodological options and therefore should take care in planning and conducting their research. This article offers a brief overview of some of the key issues qualitative researchers should consider.

Wavelet processing techniques for digital mammography

NASA Astrophysics Data System (ADS)

Laine, Andrew F.; Song, Shuwu

1992-09-01

This paper introduces a novel approach for accomplishing mammographic feature analysis through multiresolution representations. We show that efficient (nonredundant) representations may be identified from digital mammography and used to enhance specific mammographic features within a continuum of scale space. The multiresolution decomposition of wavelet transforms provides a natural hierarchy in which to embed an interactive paradigm for accomplishing scale space feature analysis. Similar to traditional coarse to fine matching strategies, the radiologist may first choose to look for coarse features (e.g., dominant mass) within low frequency levels of a wavelet transform and later examine finer features (e.g., microcalcifications) at higher frequency levels. In addition, features may be extracted by applying geometric constraints within each level of the transform. Choosing wavelets (or analyzing functions) that are simultaneously localized in both space and frequency, results in a powerful methodology for image analysis. Multiresolution and orientation selectivity, known biological mechanisms in primate vision, are ingrained in wavelet representations and inspire the techniques presented in this paper. Our approach includes local analysis of complete multiscale representations. Mammograms are reconstructed from wavelet representations, enhanced by linear, exponential and constant weight functions through scale space. By improving the visualization of breast pathology we can improve the chances of early detection of breast cancers (improve quality) while requiring less time to evaluate mammograms for most patients (lower costs).

Correlation of mammographic density and serum calcium levels in patients with primary breast cancer.

PubMed

Hack, Carolin C; Stoll, Martin J; Jud, Sebastian M; Heusinger, Katharina; Adler, Werner; Haeberle, Lothar; Ganslandt, Thomas; Heindl, Felix; Schulz-Wendtland, Rüdiger; Cavallaro, Alexander; Uder, Michael; Beckmann, Matthias W; Fasching, Peter A; Bayer, Christian M

2017-06-01

Percentage mammographic breast density (PMD) is one of the most important risk factors for breast cancer (BC). Calcium, vitamin D, bisphosphonates, and denosumab have been considered and partly confirmed as factors potentially influencing the risk of BC. This retrospective observational study investigated the association between serum calcium level and PMD. A total of 982 BC patients identified in the research database at the University Breast Center for Franconia with unilateral BC, calcium and albumin values, and mammogram at the time of first diagnosis were included. PMD was assessed, using a semiautomated method by two readers. Linear regression analyses were conducted to investigate the impact on PMD of the parameters of serum calcium level adjusted for albumin level, and well-known clinical predictors such as age, body mass index (BMI), menopausal status and confounder for serum calcium like season in which the BC was diagnosed. Increased calcium levels were associated with reduced PMD (P = 0.024). Furthermore, PMD was inversely associated with BMI (P < 0.001) and age (P < 0.001). There was also an association between PMD and menopausal status (P < 0.001). The goodness-of-fit of the regression model was moderate. This is the first study assessing the association between serum calcium level and PMD. An inverse association with adjusted serum calcium levels was observed. These findings add to previously published data relating to vitamin D, bisphosphonates, denosumab, and the RANK/RANKL signaling pathway in breast cancer risk and prevention. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Role of ultrasonography in detecting mammographically occult breast carcinoma in women with dense breasts.

PubMed

Corsetti, V; Ferrari, A; Ghirardi, M; Bergonzini, R; Bellarosa, S; Angelini, O; Bani, C; Ciatto, S

2006-04-01

The purpose of this study was to assess the usefulness of routine ultrasonography in women with negative mammography and dense breasts [Breast Imaging Reporting and Data System (BIRADS D3-4)]. We applied a protocol involving routine ultrasonography in a consecutive series of subjects with negative mammography and dense breasts. After evaluation by internal and external reviewers of cancers detected by ultrasonography performed to confirm negative mammography, we determined the additional cancer detection rate of ultrasonography and the cost of the protocol. Out of 17,883 total mammographies, 167 cancers were diagnosed (detection rate: 0.93%). Out of 257 suspicious mammographies, 138 cancers were detected. Out of 17,626 negative mammographies, 6,449 (36.5%) were classified as "dense breast" and underwent ultrasonography: 29 cancers were detected (detection rate: 0.44%, or 17.3% of total cancers). Out of 25 cancer cases reviewed, negative mammography and asymptomatic status was confirmed in 15 (detection rate 0.23%, or 8.9% of total cancers). The cancer detection rate was 0.11%, 0.22%, 0.32% and 0.14% for age groups <40, 40-49, 50-59 and >59, respectively. The cost per additional carcinoma detected by ultrasonography alone was euro 25,847.85 whereas that per examined woman was euro 21.68. The study confirms the possibility that ultrasonography can detect mammographically occult breast carcinoma in dense breasts. The evidence is insufficient to recommend this policy in routine screening practice but suggests that, at least in current clinical practice, adding ultrasonography in dense breasts may be useful despite the substantial costs.

Vaccination Persuasion Online: A Qualitative Study of Two Provaccine and Two Vaccine-Skeptical Websites

PubMed Central

Hausman, Bernice L; Cashion, Margaret; Lucchesi, Nicholas; Patel, Kelsey; Roberts, Jonathan

2015-01-01

Background Current concerns about vaccination resistance often cite the Internet as a source of vaccine controversy. Most academic studies of vaccine resistance online use quantitative methods to describe misinformation on vaccine-skeptical websites. Findings from these studies are useful for categorizing the generic features of these websites, but they do not provide insights into why these websites successfully persuade their viewers. To date, there have been few attempts to understand, qualitatively, the persuasive features of provaccine or vaccine-skeptical websites. Objective The purpose of this research was to examine the persuasive features of provaccine and vaccine-skeptical websites. The qualitative analysis was conducted to generate hypotheses concerning what features of these websites are persuasive to people seeking information about vaccination and vaccine-related practices. Methods This study employed a fully qualitative case study methodology that used the anthropological method of thick description to detail and carefully review the rhetorical features of 1 provaccine government website, 1 provaccine hospital website, 1 vaccine-skeptical information website focused on general vaccine safety, and 1 vaccine-skeptical website focused on a specific vaccine. The data gathered were organized into 5 domains: website ownership, visual and textual content, user experience, hyperlinking, and social interactivity. Results The study found that the 2 provaccine websites analyzed functioned as encyclopedias of vaccine information. Both of the websites had relatively small digital ecologies because they only linked to government websites or websites that endorsed vaccination and evidence-based medicine. Neither of these websites offered visitors interactive features or made extensive use of the affordances of Web 2.0. The study also found that the 2 vaccine-skeptical websites had larger digital ecologies because they linked to a variety of vaccine-related websites

Vaccination persuasion online: a qualitative study of two provaccine and two vaccine-skeptical websites.

PubMed

Grant, Lenny; Hausman, Bernice L; Cashion, Margaret; Lucchesi, Nicholas; Patel, Kelsey; Roberts, Jonathan

2015-05-29

Current concerns about vaccination resistance often cite the Internet as a source of vaccine controversy. Most academic studies of vaccine resistance online use quantitative methods to describe misinformation on vaccine-skeptical websites. Findings from these studies are useful for categorizing the generic features of these websites, but they do not provide insights into why these websites successfully persuade their viewers. To date, there have been few attempts to understand, qualitatively, the persuasive features of provaccine or vaccine-skeptical websites. The purpose of this research was to examine the persuasive features of provaccine and vaccine-skeptical websites. The qualitative analysis was conducted to generate hypotheses concerning what features of these websites are persuasive to people seeking information about vaccination and vaccine-related practices. This study employed a fully qualitative case study methodology that used the anthropological method of thick description to detail and carefully review the rhetorical features of 1 provaccine government website, 1 provaccine hospital website, 1 vaccine-skeptical information website focused on general vaccine safety, and 1 vaccine-skeptical website focused on a specific vaccine. The data gathered were organized into 5 domains: website ownership, visual and textual content, user experience, hyperlinking, and social interactivity. The study found that the 2 provaccine websites analyzed functioned as encyclopedias of vaccine information. Both of the websites had relatively small digital ecologies because they only linked to government websites or websites that endorsed vaccination and evidence-based medicine. Neither of these websites offered visitors interactive features or made extensive use of the affordances of Web 2.0. The study also found that the 2 vaccine-skeptical websites had larger digital ecologies because they linked to a variety of vaccine-related websites, including government websites. They

Qualitative Assessment of Ultrasound Biomicroscopic Images Using Standard Photographs: The Liwan Eye Study

PubMed Central

Jiang, Yuzhen; Huang, Wenyong; Huang, Qunxiao; Zhang, Jian; Foster, Paul J.

2010-01-01

Objective. To classify anatomic features related to anterior chamber angles by a qualitative assessment system based on ultrasound biomicroscopy (UBM) images. Methods. Cases of primary angle-closure suspect (PACS), defined by pigmented trabecular meshwork that is not visible in two or more quadrants on static gonioscopy (cases) and systematically selected subjects (1 of every 10) who did not meet this criterion (controls) were enrolled during a population-based survey in Guangzhou, China. All subjects underwent UBM examination. A set of standard UBM images was used to qualitatively classify anatomic features related to the angle configuration, including iris thickness, iris convexity, iris angulation, ciliary body size, and ciliary process position. All analysis was conducted on right eye images. Results. Based on the qualitative grades, the difference in overall iris thickness between gonioscopically narrow eyes (n = 117) and control eyes (n = 57) was not statistically significant. The peripheral one third of the iris tended to be thicker in all quadrants of the PACS eyes, although the difference was statistically significant only in the superior quadrant (P = 0.008). No significant differences were found in the qualitative classifications of iris insertion, iris angulation, ciliary body size, and ciliary process position. The findings were similar when compared with the control group of eyes with wide angles in all quadrants. Conclusions. Basal iris thickness seems to be more relevant to narrow angle configuration than to overall iris thickness. Otherwise, the anterior rotation and size of the ciliary body, the iris insertion, and the overall iris thickness are comparable in narrow- and wide-angle eyes. PMID:19834039

An image-processing methodology for extracting bloodstain pattern features.

PubMed

Arthur, Ravishka M; Humburg, Philomena J; Hoogenboom, Jerry; Baiker, Martin; Taylor, Michael C; de Bruin, Karla G

2017-08-01

There is a growing trend in forensic science to develop methods to make forensic pattern comparison tasks more objective. This has generally involved the application of suitable image-processing methods to provide numerical data for identification or comparison. This paper outlines a unique image-processing methodology that can be utilised by analysts to generate reliable pattern data that will assist them in forming objective conclusions about a pattern. A range of features were defined and extracted from a laboratory-generated impact spatter pattern. These features were based in part on bloodstain properties commonly used in the analysis of spatter bloodstain patterns. The values of these features were consistent with properties reported qualitatively for such patterns. The image-processing method developed shows considerable promise as a way to establish measurable discriminating pattern criteria that are lacking in current bloodstain pattern taxonomies. Copyright © 2017 Elsevier B.V. All rights reserved.

Series: Practical guidance to qualitative research. Part 2: Context, research questions and designs.

PubMed

Korstjens, Irene; Moser, Albine

2017-12-01

In the course of our supervisory work over the years, we have noticed that qualitative research tends to evoke a lot of questions and worries, so-called frequently asked questions (FAQs). This series of four articles intends to provide novice researchers with practical guidance for conducting high-quality qualitative research in primary care. By 'novice' we mean Master's students and junior researchers, as well as experienced quantitative researchers who are engaging in qualitative research for the first time. This series addresses their questions and provides researchers, readers, reviewers and editors with references to criteria and tools for judging the quality of qualitative research papers. This second article addresses FAQs about context, research questions and designs. Qualitative research takes into account the natural contexts in which individuals or groups function to provide an in-depth understanding of real-world problems. The research questions are generally broad and open to unexpected findings. The choice of a qualitative design primarily depends on the nature of the research problem, the research question(s) and the scientific knowledge one seeks. Ethnography, phenomenology and grounded theory are considered to represent the 'big three' qualitative approaches. Theory guides the researcher through the research process by providing a 'lens' to look at the phenomenon under study. Since qualitative researchers and the participants of their studies interact in a social process, researchers influence the research process. The first article described the key features of qualitative research, the third article will focus on sampling, data collection and analysis, while the last article focuses on trustworthiness and publishing.

Qualitative features of semantic fluency performance in mesial and lateral frontal patients.

PubMed

Reverberi, Carlo; Laiacona, Marcella; Capitani, Erminio

2006-01-01

Semantic verbal fluency is widely used in clinical and experimental studies. This task is highly sensitive to the presence of brain pathology and is frequently impaired after frontal lesions. Besides the total number of words generated, a qualitative analysis of their sequence can add valuable information about the impaired cognitive components. Thirty-four frontal patients and a group of matched controls were examined. Besides the number of words and subcategories retrieved by each group, we analysed two distinct aspects of the word sequence: the search strategy through a semantically organised store and the ability to switch from one subcategory to another. We checked whether the pattern of impairment changed according to the lesion site within the frontal lobe. Overall, patients produced fewer words than controls. However, only lateral frontal patients presented a reduced semantic relatedness between contiguously produced words and a specifically increased proportion of switches to different subcategories. The performance of lateral frontal patients was in line with the hypothesis of a search strategy impairment and cannot be attributed to a switching deficit. The performance of mesial frontal patients could be ascribed to a general deficit of activation.

Shear-wave elastographic features of breast cancers: comparison with mechanical elasticity and histopathologic characteristics.

PubMed

Lee, Su Hyun; Moon, Woo Kyung; Cho, Nariya; Chang, Jung Min; Moon, Hyeong-Gon; Han, Wonshik; Noh, Dong-Young; Lee, Jung Chan; Kim, Hee Chan; Lee, Kyoung-Bun; Park, In-Ae

2014-03-01

The objective of this study was to compare the quantitative and qualitative shear-wave elastographic (SWE) features of breast cancers with mechanical elasticity and histopathologic characteristics. This prospective study was conducted with institutional review board approval, and written informed consent was obtained. Shear-wave elastography was performed for 30 invasive breast cancers in 30 women before surgery. The mechanical elasticity of a fresh breast tissue section, correlated with the ultrasound image, was measured using an indentation system. Quantitative (maximum, mean, minimum, and standard deviation of elasticity in kilopascals) and qualitative (color heterogeneity and presence of signal void areas in the mass) SWE features were compared with mechanical elasticity and histopathologic characteristics using the Pearson correlation coefficient and the Wilcoxon signed rank test. Maximum SWE values showed a moderate correlation with maximum mechanical elasticity (r = 0.530, P = 0.003). There were no significant differences between SWE values and mechanical elasticity in histologic grade I or II cancers (P = 0.268). However, SWE values were significantly higher than mechanical elasticity in histologic grade III cancers (P < 0.001), which have low amounts of fibrosis, high tumor cellularity, and intratumoral necrosis. In addition, color heterogeneity was correlated with intratumoral heterogeneity of mechanical elasticity (r = 0.469, P = 0.009). Signal void areas in the masses were present in 43% of breast cancers (13 of 30) and were correlated with dense collagen depositions (n = 11) or intratumoral necrosis (n = 2). Quantitative and qualitative SWE features reflect both the mechanical elasticity and histopathologic characteristics of breast cancers.

Sensing qualitative events to control manipulation

NASA Astrophysics Data System (ADS)

Pook, Polly K.; Ballard, Dana H.

1992-11-01

Dexterous robotic hands have numerous sensors distributed over a flexible high-degree-of- freedom framework. Control of these hands often relies on a detailed task description that is either specified a priori or computed on-line from sensory feedback. Such controllers are complex and may use unnecessary precision. In contrast, one can incorporate plan cues that provide a contextual backdrop in order to simplify the control task. To demonstrate, a Utah/MIT dexterous hand mounted on a Puma 760 arm flips a plastic egg, using the finger tendon tensions as the sole control signal. The completion of each subtask, such as picking up the spatula, finding the pan, and sliding the spatula under the egg, is detected by sensing tension states. The strategy depends on the task context but does not require precise positioning knowledge. We term this qualitative manipulation to draw a parallel with qualitative vision strategies. The approach is to design closed-loop programs that detect significant events to control manipulation but ignore inessential details. The strategy is generalized by analyzing the robot state dynamics during teleoperated hand actions to reveal the essential features that control each action.

Interactions of alcohol and postmenopausal hormone use in regards to mammographic breast density.

PubMed

Yaghjyan, Lusine; Colditz, Graham; Eliassen, Heather; Rosner, Bernard; Gasparova, Aleksandra; Tamimi, Rulla M

2018-06-25

We investigated the association of alcohol intake with mammographic breast density in postmenopausal women by their hormone therapy (HT) status. This study included 2,100 cancer-free postmenopausal women within the Nurses' Health Study and Nurses' Health Study II cohorts. Percent breast density (PD), absolute dense (DA), and non-dense areas (NDA) were measured from digitized film mammograms using a computer-assisted thresholding technique; all measures were square root transformed. Alcohol consumption was assessed with a food frequency questionnaire (0, < 5, and ≥ 5 g/day). Information regarding breast cancer risk factors was obtained from baseline or biennial questionnaires closest to the mammogram date. We used generalized linear regression to examine associations between alcohol and breast density measures in women with no HT history, current, and past HT users. In multivariable analyses, we found no associations of alcohol consumption with PD (p trend = 0.32) and DA (p trend = 0.53) and an inverse association with NDA (β = - 0.41, 95% CI - 0.73, - 0.09 for ≥ 5 g/day, p trend < 0.01). In the stratified analysis by HT status, alcohol was not associated with PD in any of the strata. We found a significant inverse association of alcohol with NDA among past HT users (β = - 0.79, 95% CI - 1.51, - 0.07 for ≥ 5 g/day, p trend = 0.02). There were no significant interactions between alcohol and HT in relation to PD, DA, and NDA (p interaction = 0.19, 0.42, and 0.43, respectively). Our findings suggest that associations of alcohol with breast density do not vary by HT status.

The Systems Biology Markup Language (SBML) Level 3 Package: Qualitative Models, Version 1, Release 1.

PubMed

Chaouiya, Claudine; Keating, Sarah M; Berenguier, Duncan; Naldi, Aurélien; Thieffry, Denis; van Iersel, Martijn P; Le Novère, Nicolas; Helikar, Tomáš

2015-09-04

Quantitative methods for modelling biological networks require an in-depth knowledge of the biochemical reactions and their stoichiometric and kinetic parameters. In many practical cases, this knowledge is missing. This has led to the development of several qualitative modelling methods using information such as, for example, gene expression data coming from functional genomic experiments. The SBML Level 3 Version 1 Core specification does not provide a mechanism for explicitly encoding qualitative models, but it does provide a mechanism for SBML packages to extend the Core specification and add additional syntactical constructs. The SBML Qualitative Models package for SBML Level 3 adds features so that qualitative models can be directly and explicitly encoded. The approach taken in this package is essentially based on the definition of regulatory or influence graphs. The SBML Qualitative Models package defines the structure and syntax necessary to describe qualitative models that associate discrete levels of activities with entity pools and the transitions between states that describe the processes involved. This is particularly suited to logical models (Boolean or multi-valued) and some classes of Petri net models can be encoded with the approach.

Theoretical Coalescence: A Method to Develop Qualitative Theory: The Example of Enduring.

PubMed

Morse, Janice M

Qualitative research is frequently context bound, lacks generalizability, and is limited in scope. The purpose of this article was to describe a method, theoretical coalescence, that provides a strategy for analyzing complex, high-level concepts and for developing generalizable theory. Theoretical coalescence is a method of theoretical expansion, inductive inquiry, of theory development, that uses data (rather than themes, categories, and published extracts of data) as the primary source for analysis. Here, using the development of the lay concept of enduring as an example, I explore the scientific development of the concept in multiple settings over many projects and link it within the Praxis Theory of Suffering. As comprehension emerges when conducting theoretical coalescence, it is essential that raw data from various different situations be available for reinterpretation/reanalysis and comparison to identify the essential features of the concept. The concept is then reconstructed, with additional inquiry that builds description, and evidence is conducted and conceptualized to create a more expansive concept and theory. By utilizing apparently diverse data sets from different contexts that are linked by certain characteristics, the essential features of the concept emerge. Such inquiry is divergent and less bound by context yet purposeful, logical, and with significant pragmatic implications for practice in nursing and beyond our discipline. Theoretical coalescence is a means by which qualitative inquiry is broadened to make an impact, to accommodate new theoretical shifts and concepts, and to make qualitative research applied and accessible in new ways.

Qualitative "trial-sibling" studies and "unrelated" qualitative studies contributed to complex intervention reviews.

PubMed

Noyes, Jane; Hendry, Margaret; Lewin, Simon; Glenton, Claire; Chandler, Jackie; Rashidian, Arash

2016-06-01

To compare the contribution of "trial-sibling" and "unrelated" qualitative studies in complex intervention reviews. Researchers are using qualitative "trial-sibling" studies undertaken alongside trials to provide explanations to understand complex interventions. In the absence of qualitative "trial-sibling" studies, it is not known if qualitative studies "unrelated" to trials are helpful. Trials, "trial-sibling," and "unrelated" qualitative studies looking at three health system interventions were identified. We looked for similarities and differences between the two types of qualitative studies, such as participants, intervention delivery, context, study quality and reporting, and contribution to understanding trial results. Reporting was generally poor in both qualitative study types. We detected no substantial differences in participant characteristics. Interventions in qualitative "trial-sibling" studies were delivered using standardized protocols, whereas interventions in "unrelated" qualitative studies were delivered in routine care. Qualitative "trial-sibling" studies alone provided insufficient data to develop meaningful transferrable explanations beyond the trial context, and their limited focus on immediate implementation did not address all phenomena of interest. Together, "trial-sibling" and "unrelated" qualitative studies provided larger, richer data sets across contexts to better understand the phenomena of interest. Findings support inclusion of "trial-sibling" and "unrelated" qualitative studies to explore complexity in complex intervention reviews. Copyright © 2016 Elsevier Inc. All rights reserved.

Exploring How Different Features of Animations of Sodium Chloride Dissolution Affect Students' Explanations

ERIC Educational Resources Information Center

Kelly, Resa M.; Jones, Loretta L.

2007-01-01

Animations of molecular structure and dynamics are often used to help students understand the abstract ideas of chemistry. This qualitative study investigated how the features of two different styles of molecular-level animation affected students' explanations of how sodium chloride dissolves in water. In small group sessions 18 college-level…

Assessing the impact of representational and contextual problem features on student use of right-hand rules

NASA Astrophysics Data System (ADS)

Kustusch, Mary Bridget

2016-06-01

Students in introductory physics struggle with vector algebra and these challenges are often associated with contextual and representational features of the problems. Performance on problems about cross product direction is particularly poor and some research suggests that this may be primarily due to misapplied right-hand rules. However, few studies have had the resolution to explore student use of right-hand rules in detail. This study reviews literature in several disciplines, including spatial cognition, to identify ten contextual and representational problem features that are most likely to influence performance on problems requiring a right-hand rule. Two quantitative measures of performance (correctness and response time) and two qualitative measures (methods used and type of errors made) were used to explore the impact of these problem features on student performance. Quantitative results are consistent with expectations from the literature, but reveal that some features (such as the type of reasoning required and the physical awkwardness of using a right-hand rule) have a greater impact than others (such as whether the vectors are placed together or separate). Additional insight is gained by the qualitative analysis, including identifying sources of difficulty not previously discussed in the literature and revealing that the use of supplemental methods, such as physically rotating the paper, can mitigate errors associated with certain features.

Application of texture analysis method for mammogram density classification

NASA Astrophysics Data System (ADS)

Nithya, R.; Santhi, B.

2017-07-01

Mammographic density is considered a major risk factor for developing breast cancer. This paper proposes an automated approach to classify breast tissue types in digital mammogram. The main objective of the proposed Computer-Aided Diagnosis (CAD) system is to investigate various feature extraction methods and classifiers to improve the diagnostic accuracy in mammogram density classification. Texture analysis methods are used to extract the features from the mammogram. Texture features are extracted by using histogram, Gray Level Co-Occurrence Matrix (GLCM), Gray Level Run Length Matrix (GLRLM), Gray Level Difference Matrix (GLDM), Local Binary Pattern (LBP), Entropy, Discrete Wavelet Transform (DWT), Wavelet Packet Transform (WPT), Gabor transform and trace transform. These extracted features are selected using Analysis of Variance (ANOVA). The features selected by ANOVA are fed into the classifiers to characterize the mammogram into two-class (fatty/dense) and three-class (fatty/glandular/dense) breast density classification. This work has been carried out by using the mini-Mammographic Image Analysis Society (MIAS) database. Five classifiers are employed namely, Artificial Neural Network (ANN), Linear Discriminant Analysis (LDA), Naive Bayes (NB), K-Nearest Neighbor (KNN), and Support Vector Machine (SVM). Experimental results show that ANN provides better performance than LDA, NB, KNN and SVM classifiers. The proposed methodology has achieved 97.5% accuracy for three-class and 99.37% for two-class density classification.

Interaction of mammographic breast density with menopausal status and postmenopausal hormone use in relation to the risk of aggressive breast cancer subtypes.

PubMed

Yaghjyan, Lusine; Tamimi, Rulla M; Bertrand, Kimberly A; Scott, Christopher G; Jensen, Matthew R; Pankratz, V Shane; Brandt, Kathy; Visscher, Daniel; Norman, Aaron; Couch, Fergus; Shepherd, John; Fan, Bo; Chen, Yunn-Yi; Ma, Lin; Beck, Andrew H; Cummings, Steven R; Kerlikowske, Karla; Vachon, Celine M

2017-09-01

We examined the associations of mammographic breast density with breast cancer risk by tumor aggressiveness and by menopausal status and current postmenopausal hormone therapy. This study included 2596 invasive breast cancer cases and 4059 controls selected from participants of four nested case-control studies within four established cohorts: the Mayo Mammography Health Study, the Nurses' Health Study, Nurses' Health Study II, and San Francisco Mammography Registry. Percent breast density (PD), absolute dense (DA), and non-dense areas (NDA) were assessed from digitized film-screen mammograms using a computer-assisted threshold technique and standardized across studies. We used polytomous logistic regression to quantify the associations of breast density with breast cancer risk by tumor aggressiveness (defined as presence of at least two of the following tumor characteristics: size ≥2 cm, grade 2/3, ER-negative status, or positive nodes), stratified by menopausal status and current hormone therapy. Overall, the positive association of PD and borderline inverse association of NDA with breast cancer risk was stronger in aggressive vs. non-aggressive tumors (≥51 vs. 11-25% OR 2.50, 95% CI 1.94-3.22 vs. OR 2.03, 95% CI 1.70-2.43, p-heterogeneity = 0.03; NDA 4th vs. 2nd quartile OR 0.54, 95% CI 0.41-0.70 vs. OR 0.71, 95% CI 0.59-0.85, p-heterogeneity = 0.07). However, there were no differences in the association of DA with breast cancer by aggressive status. In the stratified analysis, there was also evidence of a stronger association of PD and NDA with aggressive tumors among postmenopausal women and, in particular, current estrogen+progesterone users (≥51 vs. 11-25% OR 3.24, 95% CI 1.75-6.00 vs. OR 1.93, 95% CI 1.25-2.98, p-heterogeneity = 0.01; NDA 4th vs. 2nd quartile OR 0.43, 95% CI 0.21-0.85 vs. OR 0.56, 95% CI 0.35-0.89, p-heterogeneity = 0.01), even though the interaction was not significant. Our findings suggest that associations of mammographic

The effect of change in body mass index on volumetric measures of mammographic density

PubMed Central

Hart, Vicki; Reeves, Katherine W.; Sturgeon, Susan R.; Reich, Nicholas G.; Sievert, Lynnette Leidy; Kerlikowske, Karla; Ma, Lin; Shepherd, John; Tice, Jeffrey A.; Mahmoudzadeh, Amir Pasha; Malkov, Serghei; Sprague, Brian L.

2015-01-01

Background Understanding how changes in body mass index (BMI) relate to changes in mammographic density is necessary to evaluate adjustment for BMI gain/loss in studies of change in density and breast cancer risk. Increase in BMI has been associated with a decrease in percent density, but the effect on change in absolute dense area or volume is unclear. Methods We examined the association between change in BMI and change in volumetric breast density among 24,556 women in the San Francisco Mammography Registry from 2007-2013. Height and weight were self-reported at the time of mammography. Breast density was assessed using single x-ray absorptiometry measurements. Cross-sectional and longitudinal associations between BMI and dense volume (DV), non-dense volume (NDV) and percent dense volume (PDV) were assessed using multivariable linear regression models, adjusted for demographics, risk factors, and reproductive history. Results In cross-sectional analysis, BMI was positively associated with DV (β=2.95 cm3, 95% CI 2.69, 3.21) and inversely associated with PDV (β=-2.03%, 95% CI -2.09, -1.98). In contrast, increasing BMI was longitudinally associated with a decrease in both DV (β=-1.01 cm3, 95% CI -1.59, -0.42) and PDV (β=-1.17%, 95% CI -1.31, -1.04). These findings were consistent for both pre- and postmenopausal women. Conclusion Our findings support an inverse association between change in BMI and change in PDV. The association between increasing BMI and decreasing DV requires confirmation. Impact Longitudinal studies of PDV and breast cancer risk, or those using PDV as an indicator of breast cancer risk, should evaluate adjustment for change in BMI. PMID:26315554

A model of primary and scattered photon fluence for mammographic x-ray image quantification

NASA Astrophysics Data System (ADS)

Tromans, Christopher E.; Cocker, Mary R.; Brady, Michael, Sir

2012-10-01

We present an efficient method to calculate the primary and scattered x-ray photon fluence component of a mammographic image. This can be used for a range of clinically important purposes, including estimation of breast density, personalized image display, and quantitative mammogram analysis. The method is based on models of: the x-ray tube; the digital detector; and a novel ray tracer which models the diverging beam emanating from the focal spot. The tube model includes consideration of the anode heel effect, and empirical corrections for wear and manufacturing tolerances. The detector model is empirical, being based on a family of transfer functions that cover the range of beam qualities and compressed breast thicknesses which are encountered clinically. The scatter estimation utilizes optimal information sampling and interpolation (to yield a clinical usable computation time) of scatter calculated using fundamental physics relations. A scatter kernel arising around each primary ray is calculated, and these are summed by superposition to form the scatter image. Beam quality, spatial position in the field (in particular that arising at the air-boundary due to the depletion of scatter contribution from the surroundings), and the possible presence of a grid, are considered, as is tissue composition using an iterative refinement procedure. We present numerous validation results that use a purpose designed tissue equivalent step wedge phantom. The average differences between actual acquisitions and modelled pixel intensities observed across the adipose to fibroglandular attenuation range vary between 5% and 7%, depending on beam quality and, for a single beam quality are 2.09% and 3.36% respectively with and without a grid.

Print advertisements for Alzheimer's disease drugs: informational and transformational features.

PubMed

Gooblar, Jonathan; Carpenter, Brian D

2013-06-01

We examined print advertisements for Alzheimer's disease drugs published in journals and magazines between January 2008 and February 2012, using an informational versus transformational theoretical framework to identify objective and persuasive features. In 29 unique advertisements, we used qualitative methods to code and interpret identifying information, charts, benefit and side effect language, and persuasive appeals embedded in graphics and narratives. Most elements contained a mixture of informational and transformational features. Charts were used infrequently, but when they did appear the accompanying text often exaggerated the data. Benefit statements covered an array of symptoms, drug properties, and caregiver issues. Side effect statements often used positive persuasive appeals. Graphics and narrative features emphasized positive emotions and outcomes. We found subtle and sophisticated attempts both to educate and to persuade readers. It is important for consumers and prescribing physicians to read print advertisements critically so that they can make informed treatment choices.

Features of primary health care teams associated with successful quality improvement of diabetes care: a qualitative study.

PubMed

Stevenson, K; Baker, R; Farooqi, A; Sorrie, R; Khunti, K

2001-02-01

In quality improvement activities such as audit, some general practices succeed in improving care and some do not. With audit of care likely to be one of the major tools in clinical governance, it would be helpful to establish what features of primary health care teams are associated with successful audit in general practice. The aim of the present study was to identify those features of primary health care teams that were associated with successful quality improvement during systematic audit of diabetes care. Semi-structured tape-recorded interviews were carried out with lead GPs and practice nurses in 18 general practices in Leicestershire that had the opportunity to improve their care and had completed two data collections in a multipractice audit of diabetes care. The interviewees were asked to describe their practice's approach to audit and the transcripts were coded for common features and judged for strength of feeling by blinded independent raters. Features common to practices that had, and those that had not, managed to improve diabetes care were identified. Six features were identified reliably in the transcripts by blinded independent raters. Four were significantly associated with the successful improvement of care. Success was more likely in teams in which: the GP or nurse felt personally involved in the audit; they perceived their teamwork as good; they had recognized the need for systematic plans to address obstacles to quality improvement; and their teams had a positive attitude to continued monitoring of care. A positive attitude to audit and a personal interest in the disease were not associated with improvement in care. Success in improving diabetes care is associated with certain organizational features of primary health care teams. Experimental studies are required to determine whether the development of teamwork enables practice teams to identify and overcome systematically the obstacles to improved quality of patient care that face them.

Mammographic density is the main correlate of tumors detected on ultrasound but not on mammography.

PubMed

Häberle, Lothar; Fasching, Peter A; Brehm, Barbara; Heusinger, Katharina; Jud, Sebastian M; Loehberg, Christian R; Hack, Carolin C; Preuss, Caroline; Lux, Michael P; Hartmann, Arndt; Vachon, Celine M; Meier-Meitinger, Martina; Uder, Michael; Beckmann, Matthias W; Schulz-Wendtland, Rüdiger

2016-11-01

Although mammography screening programs do not include ultrasound examinations, some diagnostic units do provide women with both mammography and ultrasonography. This article is concerned with estimating the risk of a breast cancer patient diagnosed in a hospital-based mammography unit having a tumor that is visible on ultrasound but not on mammography. A total of 1,399 women with invasive breast cancer from a hospital-based diagnostic mammography unit were included in this retrospective study. For inclusion, mammograms from the time of the primary diagnosis had to be available for computer-assisted assessment of percentage mammographic density (PMD), as well as Breast Imaging Reporting and Data System (BIRADS) assessment of mammography. In addition, ultrasound findings were available for the complete cohort as part of routine diagnostic procedures, regardless of any patient or imaging characteristics. Logistic regression analyses were conducted to identify predictors of mammography failure, defined as BIRADS assessment 1 or 2. The probability that the visibility of a tumor might be masked at diagnosis was estimated using a regression model with the identified predictors. Tumors were only visible on ultrasound in 107 cases (7.6%). PMD was the strongest predictor for mammography failure, but age, body mass index and previous breast surgery also influenced the risk, independently of the PMD. Risk probabilities ranged from 1% for a defined low-risk group up to 40% for a high-risk group. These findings might help identify women who should be offered ultrasound examinations in addition to mammography. © 2016 UICC.

Qualitative-Based Methodology to Teaching Qualitative Methodology in Higher Education

ERIC Educational Resources Information Center

Katz, Sara

2015-01-01

There is no defined theory for teaching Qualitative Inquiry, and very few studies have focused on the topic. This study is a qualitative case study focused on the Qualitative Methods course that I teach at a college of education in Israel. The aim of the study is to explore and describe the course, to provide a true picture of my pedagogy, and to…

A novel ultrasonic method for measuring breast density and breast cancer risk

NASA Astrophysics Data System (ADS)

Glide-Hurst, Carri K.; Duric, Neb; Littrup, Peter J.

2008-03-01

Women with high mammographic breast density are at 4- to 6-fold increased risk of developing breast cancer compared to women with fatty breasts. However, current breast density estimations rely on mammography, which cannot provide accurate volumetric breast representation. Therefore, we explored two techniques of breast density evaluation via ultrasound tomography. A sample of 93 patients was imaged with our clinical prototype; each dataset contained 45-75 tomograms ranging from near the chest wall through the nipple. Whole breast acoustic velocity was determined by creating image stacks and evaluating the sound speed frequency distribution. Ultrasound percent density (USPD) was determined by segmenting high sound speed areas from each tomogram using k-means clustering, integrating over the entire breast, and dividing by total breast area. Both techniques were independently evaluated using two mammographic density measures: (1) qualitative, determined by a radiologist's visual assessment using BI-RADS Categories, and (2) quantitative, via semi-automatic segmentation to calculate mammographic percent density (MPD) for craniocaudal and medio-lateral oblique mammograms. ~140 m/s difference in acoustic velocity was observed between fatty and dense BI-RADS Categories. Increased sound speed was found with increased BI-RADS Category and quantitative MPD. Furthermore, strong positive associations between USPD, BI-RADS Category, and calculated MPD were observed. These results confirm that utilizing sound speed, both for whole-breast evaluation and segmenting locally, can be implemented to evaluate breast density.

Association of BRCA Mutation Types, Imaging Features, and Pathologic Findings in Patients With Breast Cancer With BRCA1 and BRCA2 Mutations.

PubMed

Ha, Su Min; Chae, Eun Young; Cha, Joo Hee; Kim, Hak Hee; Shin, Hee Jung; Choi, Woo Jung

2017-10-01

The purpose of this study is to retrospectively evaluate the relationships between the BRCA mutation types, imaging features, and pathologic findings of breast cancers in BRCA1 and BRCA2 mutation carriers. We identified patients with breast cancer with BRCA gene mutations from January 2000 to December 2014. After excluding patients who underwent lesion excision before MRI, 99 BRCA1 and 103 BRCA2 lesions in 187 women (mean age, 39.7 and 40.4 years, respectively) were enrolled. Mammographic, sonographic, and MRI scans were reviewed according to the BI-RADS lexicon (5th edition). Pathologic data were reviewed, including the immunohistochemistry findings. The relationships between the BRCA mutations and both imaging and pathologic findings were analyzed. The distribution of molecular subtypes of tumors significantly differed by the mutation type. BRCA1 tumors were associated with the triple-negative subtype, whereas BRCA2 tumors were associated with the luminal B subtype (p = 0.002). At MRI, breast cancers with BRCA1 mutations exhibited a circumscribed margin (p = 0.032) and rim enhancement (p = 0.013). No significant differences in mass shape or kinetic features were observed at MRI. Cancers in BRCA1 mutation carriers tended to develop in the posterior location in the breast (p = 0.034). At mammography, no significant difference in the prevalence of calcifications was observed according to the mutation type. At sonography, BRCA1 lesions were found to be associated with posterior acoustic enhancement (p < 0.0001). Breast cancers with BRCA1 mutations tend to exhibit benign morphologic features at MRI, mammography, and sonography, compared with BRCA2 mutations. Lesion location may represent another difference on imaging among various genetic phenotypes.

Elementary Teachers' Perceptions about the Effective Features of Explicit-Reflective Nature of Science Instruction

ERIC Educational Resources Information Center

Adibelli-Sahin, Elif; Deniz, Hasan

2017-01-01

This qualitative study explored elementary teachers' perceptions about the effective features of explicit-reflective nature of science (NOS) instruction. Our participants were four elementary teachers from a public charter school located in the Southwestern U.S.A. The four elementary teachers participated in an academic year-long professional…

Qualitative Student Models.

ERIC Educational Resources Information Center

Clancey, William J.

The concept of a qualitative model is used as the focus of this review of qualitative student models in order to compare alternative computational models and to contrast domain requirements. The report is divided into eight sections: (1) Origins and Goals (adaptive instruction, qualitative models of processes, components of an artificial…

Critiquing qualitative research.

PubMed

Beck, Cheryl Tatano

2009-10-01

The ability to critique research is a valuable skill that is fundamental to a perioperative nurse's ability to base his or her clinical practice on evidence derived from research. Criteria differ for critiquing a quantitative versus a qualitative study (ie, statistics are evaluated in a quantitative study, but not in a qualitative study). This article provides on guidelines for assessing qualitative research. Excerpts from a published qualitative research report are summarized and then critiqued. Questions are provided that help evaluate different sections of a research study (eg, sample, data collection methods, data analysis).

The qualitative research proposal.

PubMed

Klopper, H

2008-12-01

Qualitative research in the health sciences has had to overcome many prejudices and a number of misunderstandings, but today qualitative research is as acceptable as quantitative research designs and is widely funded and published. Writing the proposal of a qualitative study, however, can be a challenging feat, due to the emergent nature of the qualitative research design and the description of the methodology as a process. Even today, many sub-standard proposals at post-graduate evaluation committees and application proposals to be considered for funding are still seen. This problem has led the researcher to develop a framework to guide the qualitative researcher in writing the proposal of a qualitative study based on the following research questions: (i) What is the process of writing a qualitative research proposal? and (ii) What does the structure and layout of a qualitative proposal look like? The purpose of this article is to discuss the process of writing the qualitative research proposal, as well as describe the structure and layout of a qualitative research proposal. The process of writing a qualitative research proposal is discussed with regards to the most important questions that need to be answered in your research proposal with consideration of the guidelines of being practical, being persuasive, making broader links, aiming for crystal clarity and planning before you write. While the structure of the qualitative research proposal is discussed with regards to the key sections of the proposal, namely the cover page, abstract, introduction, review of the literature, research problem and research questions, research purpose and objectives, research paradigm, research design, research method, ethical considerations, dissemination plan, budget and appendices.

Textural kinetics: a novel dynamic contrast-enhanced (DCE)-MRI feature for breast lesion classification.

PubMed

Agner, Shannon C; Soman, Salil; Libfeld, Edward; McDonald, Margie; Thomas, Kathleen; Englander, Sarah; Rosen, Mark A; Chin, Deanna; Nosher, John; Madabhushi, Anant

2011-06-01

Dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) of the breast has emerged as an adjunct imaging tool to conventional X-ray mammography due to its high detection sensitivity. Despite the increasing use of breast DCE-MRI, specificity in distinguishing malignant from benign breast lesions is low, and interobserver variability in lesion classification is high. The novel contribution of this paper is in the definition of a new DCE-MRI descriptor that we call textural kinetics, which attempts to capture spatiotemporal changes in breast lesion texture in order to distinguish malignant from benign lesions. We qualitatively and quantitatively demonstrated on 41 breast DCE-MRI studies that textural kinetic features outperform signal intensity kinetics and lesion morphology features in distinguishing benign from malignant lesions. A probabilistic boosting tree (PBT) classifier in conjunction with textural kinetic descriptors yielded an accuracy of 90%, sensitivity of 95%, specificity of 82%, and an area under the curve (AUC) of 0.92. Graph embedding, used for qualitative visualization of a low-dimensional representation of the data, showed the best separation between benign and malignant lesions when using textural kinetic features. The PBT classifier results and trends were also corroborated via a support vector machine classifier which showed that textural kinetic features outperformed the morphological, static texture, and signal intensity kinetics descriptors. When textural kinetic attributes were combined with morphologic descriptors, the resulting PBT classifier yielded 89% accuracy, 99% sensitivity, 76% specificity, and an AUC of 0.91.

Qualitative spatial logic descriptors from 3D indoor scenes to generate explanations in natural language.

PubMed

Falomir, Zoe; Kluth, Thomas

2017-06-24

The challenge of describing 3D real scenes is tackled in this paper using qualitative spatial descriptors. A key point to study is which qualitative descriptors to use and how these qualitative descriptors must be organized to produce a suitable cognitive explanation. In order to find answers, a survey test was carried out with human participants which openly described a scene containing some pieces of furniture. The data obtained in this survey are analysed, and taking this into account, the QSn3D computational approach was developed which uses a XBox 360 Kinect to obtain 3D data from a real indoor scene. Object features are computed on these 3D data to identify objects in indoor scenes. The object orientation is computed, and qualitative spatial relations between the objects are extracted. These qualitative spatial relations are the input to a grammar which applies saliency rules obtained from the survey study and generates cognitive natural language descriptions of scenes. Moreover, these qualitative descriptors can be expressed as first-order logical facts in Prolog for further reasoning. Finally, a validation study is carried out to test whether the descriptions provided by QSn3D approach are human readable. The obtained results show that their acceptability is higher than 82%.

Evaluating public awareness of new currency design features

NASA Astrophysics Data System (ADS)

DiNunzio, Lisa; Church, Sara E.

2002-04-01

One of the goals of the 1996 series design was to integrate highly recognizable features that enable the general public to more easily distinguish counterfeit from genuine notes, thereby reducing the chance of counterfeit notes being passed. The purpose of this study is to evaluate how knowledgeable the public is concerning the new currency, to identify the channels through which the public learns about new currency design, and to assess the usefulness of the new currency's authentication features. Also, the study will serve as a baseline measurement for future design studies and in comparative analysis with other countries. The results of the qualitative research will be described in the following sections of this paper. The quantitative research is scheduled to begin in February 2002, at the same time as the Netherlands' opinion poll of the Euro and NLG-notes in an effort to compare results.

Feature saltation and the evolution of mimicry.

PubMed

Gamberale-Stille, Gabriella; Balogh, Alexandra C V; Tullberg, Birgitta S; Leimar, Olof

2012-03-01

In Batesian mimicry, a harmless prey species imitates the warning coloration of an unpalatable model species. A traditional suggestion is that mimicry evolves in a two-step process, in which a large mutation first achieves approximate similarity to the model, after which smaller changes improve the likeness. However, it is not known which aspects of predator psychology cause the initial mutant to be perceived by predators as being similar to the model, leaving open the question of how the crucial first step of mimicry evolution occurs. Using theoretical evolutionary simulations and reconstruction of examples of mimicry evolution, we show that the evolution of Batesian mimicry can be initiated by a mutation that causes prey to acquire a trait that is used by predators as a feature to categorize potential prey as unsuitable. The theory that species gain entry to mimicry through feature saltation allows us to formulate scenarios of the sequence of events during mimicry evolution and to reconstruct an initial mimetic appearance for important examples of Batesian mimicry. Because feature-based categorization by predators entails a qualitative distinction between nonmimics and passable mimics, the theory can explain the occurrence of imperfect mimicry. © 2011 The Author(s). Evolution© 2011 The Society for the Study of Evolution.

Comparison of synthetic mammography, reconstructed from digital breast tomosynthesis, and digital mammography: evaluation of lesion conspicuity and BI-RADS assessment categories.

PubMed

Mariscotti, Giovanna; Durando, Manuela; Houssami, Nehmat; Fasciano, Mirella; Tagliafico, Alberto; Bosco, Davide; Casella, Cristina; Bogetti, Camilla; Bergamasco, Laura; Fonio, Paolo; Gandini, Giovanni

2017-12-01

To compare the interpretive performance of synthetic mammography (SM), reconstructed from digital breast tomosynthesis (DBT), and full-field digital mammography (FFDM) in a diagnostic setting, covering different conditions of breast density and mammographic signs. A retrospective analysis was conducted on 231 patients, who underwent FFDM and DBT (from which SM images were reconstructed) between September 2014-September 2015. The study included 250 suspicious breast lesions, all biopsy proven: 148 (59.2%) malignant and 13 (5.2%) high-risk lesions were confirmed by surgery, 89 (35.6%) benign lesions had radiological follow-up. Two breast radiologists, blinded to histology, independently reviewed all cases. Readings were performed with SM alone, then with FFDM, collecting data on: probability of malignancy for each finding, lesion conspicuity, mammographic features and dimensions of detected lesions. Agreement between readers was good for BI-RADS classification (Cohen's k-coefficient = 0.93 ± 0.02) and for lesion dimension (Wilcoxon's p = 0.76). Visibility scores assigned to SM and FFDM for each lesion were similar for non-dense and dense breasts, however, there were significant differences (p = 0.0009) in distribution of mammographic features subgroups. SM and FFDM had similar sensitivities in non-dense (respectively 94 vs. 91%) and dense breasts (88 vs. 80%) and for all mammographic signs (93 vs. 87% for asymmetric densities, 96 vs. 75% for distortion, 92 vs. 85% for microcalcifications, and both 94% for masses). Based on all data, there was a significant difference in sensitivity for SM (92%) vs. FFDM (87%), p = 0.02, whereas the two modalities yielded similar results for specificity (SM: 60%, FFDM: 62%, p = 0.21). SM alone showed similar interpretive performance to FFDM, confirming its potential role as an alternative to FFDM in women having tomosynthesis, with the added advantage of halving the patient's dose exposure.

A Qualitative Inquiry into the Complex Features of Strained Interactions: Analysis and Implications for Health Care Personnel.

PubMed

Thunborg, Charlotta; Salzmann-Erikson, Martin

2017-01-01

Communication skills are vital for successful relationships between patients and health care professionals. Failure to communicate may lead to a lack of understanding and may result in strained interactions. Our theoretical point of departure was to make use of chaos and complexity theories. To examine the features of strained interactions and to discuss their relevance for health care settings. A netnography study design was applied. Data were purposefully sampled, and video clips (122 minutes from 30 video clips) from public online venues were used. The results are presented in four categories: 1) unpredictability, 2) sensitivity dependence, 3) resistibility, and 4) iteration. They are all features of strained interactions. Strained interactions are a complex phenomenon that exists in health care settings. The findings provide health care professionals guidance to understand the complexity and the features of strained interactions.

Automated breast tissue density assessment using high order regional texture descriptors in mammography

NASA Astrophysics Data System (ADS)

Law, Yan Nei; Lieng, Monica Keiko; Li, Jingmei; Khoo, David Aik-Aun

2014-03-01

Breast cancer is the most common cancer and second leading cause of cancer death among women in the US. The relative survival rate is lower among women with a more advanced stage at diagnosis. Early detection through screening is vital. Mammography is the most widely used and only proven screening method for reliably and effectively detecting abnormal breast tissues. In particular, mammographic density is one of the strongest breast cancer risk factors, after age and gender, and can be used to assess the future risk of disease before individuals become symptomatic. A reliable method for automatic density assessment would be beneficial and could assist radiologists in the evaluation of mammograms. To address this problem, we propose a density classification method which uses statistical features from different parts of the breast. Our method is composed of three parts: breast region identification, feature extraction and building ensemble classifiers for density assessment. It explores the potential of the features extracted from second and higher order statistical information for mammographic density classification. We further investigate the registration of bilateral pairs and time-series of mammograms. The experimental results on 322 mammograms demonstrate that (1) a classifier using features from dense regions has higher discriminative power than a classifier using only features from the whole breast region; (2) these high-order features can be effectively combined to boost the classification accuracy; (3) a classifier using these statistical features from dense regions achieves 75% accuracy, which is a significant improvement from 70% accuracy obtained by the existing approaches.

Multi-scale textural feature extraction and particle swarm optimization based model selection for false positive reduction in mammography.

PubMed

Zyout, Imad; Czajkowska, Joanna; Grzegorzek, Marcin

2015-12-01

The high number of false positives and the resulting number of avoidable breast biopsies are the major problems faced by current mammography Computer Aided Detection (CAD) systems. False positive reduction is not only a requirement for mass but also for calcification CAD systems which are currently deployed for clinical use. This paper tackles two problems related to reducing the number of false positives in the detection of all lesions and masses, respectively. Firstly, textural patterns of breast tissue have been analyzed using several multi-scale textural descriptors based on wavelet and gray level co-occurrence matrix. The second problem addressed in this paper is the parameter selection and performance optimization. For this, we adopt a model selection procedure based on Particle Swarm Optimization (PSO) for selecting the most discriminative textural features and for strengthening the generalization capacity of the supervised learning stage based on a Support Vector Machine (SVM) classifier. For evaluating the proposed methods, two sets of suspicious mammogram regions have been used. The first one, obtained from Digital Database for Screening Mammography (DDSM), contains 1494 regions (1000 normal and 494 abnormal samples). The second set of suspicious regions was obtained from database of Mammographic Image Analysis Society (mini-MIAS) and contains 315 (207 normal and 108 abnormal) samples. Results from both datasets demonstrate the efficiency of using PSO based model selection for optimizing both classifier hyper-parameters and parameters, respectively. Furthermore, the obtained results indicate the promising performance of the proposed textural features and more specifically, those based on co-occurrence matrix of wavelet image representation technique. Copyright © 2015 Elsevier Ltd. All rights reserved.

Two-layer contractive encodings for learning stable nonlinear features.

PubMed

Schulz, Hannes; Cho, Kyunghyun; Raiko, Tapani; Behnke, Sven

2015-04-01

Unsupervised learning of feature hierarchies is often a good strategy to initialize deep architectures for supervised learning. Most existing deep learning methods build these feature hierarchies layer by layer in a greedy fashion using either auto-encoders or restricted Boltzmann machines. Both yield encoders which compute linear projections of input followed by a smooth thresholding function. In this work, we demonstrate that these encoders fail to find stable features when the required computation is in the exclusive-or class. To overcome this limitation, we propose a two-layer encoder which is less restricted in the type of features it can learn. The proposed encoder is regularized by an extension of previous work on contractive regularization. This proposed two-layer contractive encoder potentially poses a more difficult optimization problem, and we further propose to linearly transform hidden neurons of the encoder to make learning easier. We demonstrate the advantages of the two-layer encoders qualitatively on artificially constructed datasets as well as commonly used benchmark datasets. We also conduct experiments on a semi-supervised learning task and show the benefits of the proposed two-layer encoders trained with the linear transformation of perceptrons. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mammographic and Ultrasonographic Findings of Oxidized Regenerated Cellulose in Breast Cancer Surgery: A 5-Year Experience.

PubMed

Giuliani, Michela; Fubelli, Rita; Patrolecco, Federica; Rella, Rossella; Borelli, Cristina; Buccheri, Chiara; Di Giovanni, Silvia Eleonora; Belli, Paolo; Romani, Maurizio; Rinaldi, Pierluigi; Bufi, Enida; Franceschini, Gianluca; Bonomo, Lorenzo

2015-10-01

The purpose of this study was to describe the ultrasonographic (US) and mammographic (MX) findings in patients who underwent breast-conserving surgery followed by oxidized regenerated cellulose (ORC) implantation in the surgical cavity and their size variations in follow-up. We retrospectively reviewed 417 MX and 743 US images performed between January 2009 and January 2014 for 262 women who underwent breast-conserving surgery. All patients underwent US, only 203 women underwent MX examination. In 170 of 262 patients, US examinations showed abnormal findings. Three main US patterns were identified: (1) complex masses: well-encapsulated ipoisoechoic lesions with circumscribed margins with internal hyperechoic nodules (56%); (2) hypoanechoic lesions without internal hyperechoic nodules (24%); and (3) completely anechoic collections (20%). Moreover, Doppler ultrasound examination was performed on all of the patients. In 95 of 203 patients, MX examinations showed abnormalities. Four main MX patterns were identified: (1) round or oval opacity with circumscribed margins (58%); (2) round or oval opacity with indistinct or ill-defined margins (17%); (3) irregular opacity with indistinct or spiculated margins (9%); and (4) architectural distortion or focal asymmetry (15%). Most of the lesions showed a decrease in size at US and MX follow-up examination and the decrease was statistically significant (P < .01). When applied to the surgical residual cavity, ORC aids to control local hemorrhage and reduce the risk of postoperative infections, but can lead to alterations in surgical scar. Thus, knowledge of the radiological findings might allow avoidance of misdiagnosis of tumor recurrence or unnecessary diagnostic examinations. Copyright © 2015 Elsevier Inc. All rights reserved.

Online feature selection with streaming features.

PubMed

Wu, Xindong; Yu, Kui; Ding, Wei; Wang, Hao; Zhu, Xingquan

2013-05-01

We propose a new online feature selection framework for applications with streaming features where the knowledge of the full feature space is unknown in advance. We define streaming features as features that flow in one by one over time whereas the number of training examples remains fixed. This is in contrast with traditional online learning methods that only deal with sequentially added observations, with little attention being paid to streaming features. The critical challenges for Online Streaming Feature Selection (OSFS) include 1) the continuous growth of feature volumes over time, 2) a large feature space, possibly of unknown or infinite size, and 3) the unavailability of the entire feature set before learning starts. In the paper, we present a novel Online Streaming Feature Selection method to select strongly relevant and nonredundant features on the fly. An efficient Fast-OSFS algorithm is proposed to improve feature selection performance. The proposed algorithms are evaluated extensively on high-dimensional datasets and also with a real-world case study on impact crater detection. Experimental results demonstrate that the algorithms achieve better compactness and higher prediction accuracy than existing streaming feature selection algorithms.

High Mammographic Density in Long-Term Night-Shift Workers: DDM-Spain/Var-DDM.

PubMed

Pedraza-Flechas, Ana María; Lope, Virginia; Sánchez-Contador, Carmen; Santamariña, Carmen; Pedraz-Pingarrón, Carmen; Moreo, Pilar; Ederra, María; Miranda-García, Josefa; Vidal, Carmen; Llobet, Rafael; Aragonés, Nuria; Salas-Trejo, Dolores; Pollán, Marina; Pérez-Gómez, Beatriz

2017-06-01

Background: Night-shift work (NSW) has been suggested as a possible cause of breast cancer, and its association with mammographic density (MD), one of the strongest risk factors for breast cancer, has been scarcely addressed. This study examined NSW and MD in Spanish women. Methods: The study covered 2,752 women aged 45-68 years recruited in 2007-2008 in 7 population-based public breast cancer screening centers, which included 243 women who had performed NSW for at least one year. Occupational data and information on potential confounders were collected by personal interview. Two trained radiologist estimated the percentage of MD assisted by a validated semiautomatic computer tool (DM-scan). Multivariable mixed linear regression models with random screening center-specific intercepts were fitted using log-transformed percentage of MD as the dependent variable and adjusting by known confounding variables. Results: Having ever worked in NSW was not associated with MD [Formula: see text]:0.96; 95% confidence interval (CI), 0.86-1.06]. However, the adjusted geometric mean of the percentage of MD in women with NSW for more than 15 years was 25% higher than that of those without NSW history (MD >15 years :20.7% vs. MD never :16.5%;[Formula: see text]:1.25; 95% CI,1.01-1.54). This association was mainly observed in postmenopausal participants ([Formula: see text]:1.28; 95% CI, 1.00-1.64). Among NSW-exposed women, those with ≤2 night-shifts per week had higher MD than those with 5 to 7 nightshifts per week ([Formula: see text]:1.42; 95% CI, 1.10-1.84). Conclusions: Performing NSW was associated with higher MD only in women with more than 15 years of cumulated exposure. These findings warrant replication in futures studies. Impact: Our findings suggest that MD could play a role in the pathway between long-term NSW and breast cancer. Cancer Epidemiol Biomarkers Prev; 26(6); 905-13. ©2017 AACR . ©2017 American Association for Cancer Research.

Magnetic resonance imaging features of dogs with incomplete recovery after acute, severe spinal cord injury

PubMed Central

Lewis, Melissa J.; Cohen, Eli B.; Olby, Natasha J.

2017-01-01

Study Design Retrospective case series Objectives Describe the magnetic resonance imaging (MRI) features of dogs chronically impaired after severe spinal cord injury (SCI) and investigate associations between imaging variables and residual motor function. Setting United States of America Methods Thoracolumbar MRI from dogs with incomplete recovery months to years after clinically complete (paralysis with loss of pain perception) thoracolumbar SCI were reviewed. Lesion features were described and quantified. Gait was quantified using an ordinal, open field scale (OFS). Associations between imaging features and gait scores, duration of injury (DOI) or SCI treatment were determined. Results 35 dogs were included. Median OFS was 2 (0–6), median DOI was 13 months (3–83) and intervertebral disc herniation was the most common diagnosis (n=27). Myelomalacia was the most common qualitative feature followed by cystic change; syringomyelia and fibrosis were uncommon. Lesion length corrected to L2 length (LL:L2) was variable (median LL:L2=3.5 (1.34–11.54)). Twenty-nine dogs had 100% maximum cross-sectional spinal cord compromise (MSCC) at the lesion epicenter and the length of 100% compromised area varied widely (median length 100% MSCC:L2=1.29 (0.39–7.64). Length 100% MSCC:L2 was associated with OFS (p=0.012). OFS was not associated with any qualitative features. DOI or treatment type were not associated with imaging features or lesion quantification. Conclusions Lesion characteristics on MRI in dogs with incomplete recovery after severe SCI were established. Length of 100% MSCC was associated with hind limb motor function. Findings demonstrate a spectrum of injury severity on MRI amongst severely affected dogs which is related to functional status. PMID:29057987

Nurses' shift reports: a systematic literature search and critical review of qualitative field studies.

PubMed

Buus, Niels; Hoeck, Bente; Hamilton, Bridget Elizabeth

2017-10-01

To identify reporting practices that feature in studies of nurses' shift reports across diverse nursing specialities. The objectives were to perform an exhaustive systematic literature search and to critically review the quality and findings of qualitative field studies of nurses' shift reports. Nurses' shift reports are routine occurrences in healthcare organisations that are viewed as crucial for patient outcomes, patient safety and continuity of care. Studies of communication between nurses attend primarily to 1:1 communication and analyse the adequacy and accuracy of patient information and feature handovers at the bedside. Still, verbal reports between groups of nurses about patients are commonplace. Shift reports are obvious sites for studying the situated accomplishment of professional nursing at the group level. This review is focused exclusively on qualitative field research for nuanced and contextualised insights into nurses' everyday shift reporting practices. The study is a systematic literature search and critical review of qualitative field analyses of nurses' shift reports. We searched in the databases CIHAHL, PubMed and PsycINFO and identified and reviewed 19 articles published 1992-2014. Data were systematically extracted using criteria for the evaluation of qualitative research reports. The studies described shift report practices and identified several factors contributing to distribution of clinical knowledge. Shift report practices were described as highly conventionalised and locally situated, but with occasional opportunities for improvisation and negotiation between nurses. Finally, shift reports were described as multifunctional meetings, with individual and social effects for nurses and teams. Innovations in between-shift communications can benefit from this analysis, by providing for the many functions of handovers that are revealed in field studies. Leaders and practising nurses may consider what are the best opportunities for nurses to

TU-CD-BRB-04: Automated Radiomic Features Complement the Prognostic Value of VASARI in the TCGA-GBM Dataset

DOE Office of Scientific and Technical Information (OSTI.GOV)

Velazquez, E Rios; Narayan, V; Grossmann, P

2015-06-15

Purpose: To compare the complementary prognostic value of automated Radiomic features to that of radiologist-annotated VASARI features in TCGA-GBM MRI dataset. Methods: For 96 GBM patients, pre-operative MRI images were obtained from The Cancer Imaging Archive. The abnormal tumor bulks were manually defined on post-contrast T1w images. The contrast-enhancing and necrotic regions were segmented using FAST. From these sub-volumes and the total abnormal tumor bulk, a set of Radiomic features quantifying phenotypic differences based on the tumor intensity, shape and texture, were extracted from the post-contrast T1w images. Minimum-redundancy-maximum-relevance (MRMR) was used to identify the most informative Radiomic, VASARI andmore » combined Radiomic-VASARI features in 70% of the dataset (training-set). Multivariate Cox-proportional hazards models were evaluated in 30% of the dataset (validation-set) using the C-index for OS. A bootstrap procedure was used to assess significance while comparing the C-Indices of the different models. Results: Overall, the Radiomic features showed a moderate correlation with the radiologist-annotated VASARI features (r = −0.37 – 0.49); however that correlation was stronger for the Tumor Diameter and Proportion of Necrosis VASARI features (r = −0.71 – 0.69). After MRMR feature selection, the best-performing Radiomic, VASARI, and Radiomic-VASARI Cox-PH models showed a validation C-index of 0.56 (p = NS), 0.58 (p = NS) and 0.65 (p = 0.01), respectively. The combined Radiomic-VASARI model C-index was significantly higher than that obtained from either the Radiomic or VASARI model alone (p = <0.001). Conclusion: Quantitative volumetric and textural Radiomic features complement the qualitative and semi-quantitative annotated VASARI feature set. The prognostic value of informative qualitative VASARI features such as Eloquent Brain and Multifocality is increased with the addition of quantitative volumetric and textural features from

A qualitative evidence synthesis on the management of male obesity

PubMed Central

Archibald, Daryll; Douglas, Flora; Hoddinott, Pat; van Teijlingen, Edwin; Stewart, Fiona; Robertson, Clare; Boyers, Dwayne; Avenell, Alison

2015-01-01

Objectives To investigate what weight management interventions work for men, with which men, and under what circumstances. Design Realist synthesis of qualitative studies. Data sources Sensitive searches of 11 electronic databases from 1990 to 2012 supplemented by grey literature searches. Study selection Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m2 in all settings. Results 22 studies were identified, including 5 qualitative studies linked to randomised controlled trials of weight maintenance interventions and 8 qualitative studies linked to non-randomised intervention studies, and 9 relevant UK-based qualitative studies not linked to any intervention. Health concerns and the perception that certain programmes had ‘worked’ for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematising their weight until labelled ‘obese’; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design. Conclusions Men's perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention

A qualitative evidence synthesis on the management of male obesity.

PubMed

Archibald, Daryll; Douglas, Flora; Hoddinott, Pat; van Teijlingen, Edwin; Stewart, Fiona; Robertson, Clare; Boyers, Dwayne; Avenell, Alison

2015-10-12

To investigate what weight management interventions work for men, with which men, and under what circumstances. Realist synthesis of qualitative studies. Sensitive searches of 11 electronic databases from 1990 to 2012 supplemented by grey literature searches. Studies published between 1990 and 2012 reporting qualitative research with obese men, or obese men in contrast to obese women and lifestyle or drug weight management were included. The studies included men aged 16 years or over, with no upper age limit, with a mean or median body mass index of 30 kg/m(2) in all settings. 22 studies were identified, including 5 qualitative studies linked to randomised controlled trials of weight maintenance interventions and 8 qualitative studies linked to non-randomised intervention studies, and 9 relevant UK-based qualitative studies not linked to any intervention. Health concerns and the perception that certain programmes had 'worked' for other men were the key factors that motivated men to engage with weight management programmes. Barriers to engagement and adherence with programmes included: men not problematising their weight until labelled 'obese'; a lack of support for new food choices by friends and family, and reluctance to undertake extreme dieting. Retaining some autonomy over what is eaten; flexibility about treats and alcohol, and a focus on physical activity were attractive features of programmes. Group interventions, humour and social support facilitated attendance and adherence. Men were motivated to attend programmes in settings that were convenient, non-threatening and congruent with their masculine identities, but men were seldom involved in programme design. Men's perspectives and preferences within the wider context of family, work and pleasure should be sought when designing weight management services. Qualitative research is needed with men to inform all aspects of intervention design, including the setting, optimal recruitment processes and

Desired features of smartphone applications promoting physical activity.

PubMed

Rabin, Carolyn; Bock, Beth

2011-12-01

Approximately one-third of adults in the United States are physically inactive. This is a significant public health concern as physical activity (PA) can influence the risk of cardiovascular disease, diabetes, and certain forms of cancer. To minimize these health risks, effective PA interventions must be developed and disseminated to the vast number of individuals who remain sedentary. Smartphone technology presents an exciting opportunity for delivering PA interventions remotely. Although a number of PA applications are currently available for smartphones, these "apps" are not based on established theories of health behavior change and most do not include evidence-based features (e.g., reinforcement and goal setting). Our aim was to collect formative data to develop a smartphone PA app that is empirically and theoretically-based and incorporates user preferences. We recruited 15 sedentary adults to test three currently available PA smartphone apps and provide qualitative and quantitative feedback. Findings indicate that users have a number of specific preferences with regard to PA app features, including that apps provide automatic tracking of PA (e.g., steps taken and calories burned), track progress toward PA goals, and integrate a music feature. Participants also preferred that PA apps be flexible enough to be used with several types of PA, and have well-documented features and user-friendly interfaces (e.g., a one-click main page). When queried by the researcher, most participants endorsed including goal-setting and problem-solving features. These findings provide a blue print for developing a smartphone PA app that incorporates evidence-based components and user preferences.

Getting added value from using qualitative research with randomized controlled trials: a qualitative interview study

PubMed Central

2014-01-01

Background Qualitative research is undertaken with randomized controlled trials of health interventions. Our aim was to explore the perceptions of researchers with experience of this endeavour to understand the added value of qualitative research to the trial in practice. Methods A telephone semi-structured interview study with 18 researchers with experience of undertaking the trial and/or the qualitative research. Results Interviewees described the added value of qualitative research for the trial, explaining how it solved problems at the pretrial stage, explained findings, and helped to increase the utility of the evidence generated by the trial. From the interviews, we identified three models of relationship of the qualitative research to the trial. In ‘the peripheral’ model, the trial was an opportunity to undertake qualitative research, with no intention that it would add value to the trial. In ‘the add-on’ model, the qualitative researcher understood the potential value of the qualitative research but it was viewed as a separate and complementary endeavour by the trial lead investigator and wider team. Interviewees described how this could limit the value of the qualitative research to the trial. Finally ‘the integral’ model played out in two ways. In ‘integral-in-theory’ studies, the lead investigator viewed the qualitative research as essential to the trial. However, in practice the qualitative research was under-resourced relative to the trial, potentially limiting its ability to add value to the trial. In ‘integral-in-practice’ studies, interviewees described how the qualitative research was planned from the beginning of the study, senior qualitative expertise was on the team from beginning to end, and staff and time were dedicated to the qualitative research. In these studies interviewees described the qualitative research adding value to the trial although this value was not necessarily visible beyond the original research team due

Getting added value from using qualitative research with randomized controlled trials: a qualitative interview study.

PubMed

O'Cathain, Alicia; Goode, Jackie; Drabble, Sarah J; Thomas, Kate J; Rudolph, Anne; Hewison, Jenny

2014-06-09

Qualitative research is undertaken with randomized controlled trials of health interventions. Our aim was to explore the perceptions of researchers with experience of this endeavour to understand the added value of qualitative research to the trial in practice. A telephone semi-structured interview study with 18 researchers with experience of undertaking the trial and/or the qualitative research. Interviewees described the added value of qualitative research for the trial, explaining how it solved problems at the pretrial stage, explained findings, and helped to increase the utility of the evidence generated by the trial. From the interviews, we identified three models of relationship of the qualitative research to the trial. In 'the peripheral' model, the trial was an opportunity to undertake qualitative research, with no intention that it would add value to the trial. In 'the add-on' model, the qualitative researcher understood the potential value of the qualitative research but it was viewed as a separate and complementary endeavour by the trial lead investigator and wider team. Interviewees described how this could limit the value of the qualitative research to the trial. Finally 'the integral' model played out in two ways. In 'integral-in-theory' studies, the lead investigator viewed the qualitative research as essential to the trial. However, in practice the qualitative research was under-resourced relative to the trial, potentially limiting its ability to add value to the trial. In 'integral-in-practice' studies, interviewees described how the qualitative research was planned from the beginning of the study, senior qualitative expertise was on the team from beginning to end, and staff and time were dedicated to the qualitative research. In these studies interviewees described the qualitative research adding value to the trial although this value was not necessarily visible beyond the original research team due to the challenges of publishing this research

Association between mammogram density and background parenchymal enhancement of breast MRI

NASA Astrophysics Data System (ADS)

Aghaei, Faranak; Danala, Gopichandh; Wang, Yunzhi; Zarafshani, Ali; Qian, Wei; Liu, Hong; Zheng, Bin

2018-02-01

Breast density has been widely considered as an important risk factor for breast cancer. The purpose of this study is to examine the association between mammogram density results and background parenchymal enhancement (BPE) of breast MRI. A dataset involving breast MR images was acquired from 65 high-risk women. Based on mammography density (BIRADS) results, the dataset was divided into two groups of low and high breast density cases. The Low-Density group has 15 cases with mammographic density (BIRADS 1 and 2), while the High-density group includes 50 cases, which were rated by radiologists as mammographic density BIRADS 3 and 4. A computer-aided detection (CAD) scheme was applied to segment and register breast regions depicted on sequential images of breast MRI scans. CAD scheme computed 20 global BPE features from the entire two breast regions, separately from the left and right breast region, as well as from the bilateral difference between left and right breast regions. An image feature selection method namely, CFS method, was applied to remove the most redundant features and select optimal features from the initial feature pool. Then, a logistic regression classifier was built using the optimal features to predict the mammogram density from the BPE features. Using a leave-one-case-out validation method, the classifier yields the accuracy of 82% and area under ROC curve, AUC=0.81+/-0.09. Also, the box-plot based analysis shows a negative association between mammogram density results and BPE features in the MRI images. This study demonstrated a negative association between mammogram density and BPE of breast MRI images.

Visual Aggregate Analysis of Eligibility Features of Clinical Trials

PubMed Central

He, Zhe; Carini, Simona; Sim, Ida; Weng, Chunhua

2015-01-01

Objective To develop a method for profiling the collective populations targeted for recruitment by multiple clinical studies addressing the same medical condition using one eligibility feature each time. Methods Using a previously published database COMPACT as the backend, we designed a scalable method for visual aggregate analysis of clinical trial eligibility features. This method consists of four modules for eligibility feature frequency analysis, query builder, distribution analysis, and visualization, respectively. This method is capable of analyzing (1) frequently used qualitative and quantitative features for recruiting subjects for a selected medical condition, (2) distribution of study enrollment on consecutive value points or value intervals of each quantitative feature, and (3) distribution of studies on the boundary values, permissible value ranges, and value range widths of each feature. All analysis results were visualized using Google Charts API. Five recruited potential users assessed the usefulness of this method for identifying common patterns in any selected eligibility feature for clinical trial participant selection. Results We implemented this method as a Web-based analytical system called VITTA (Visual Analysis Tool of Clinical Study Target Populations). We illustrated the functionality of VITTA using two sample queries involving quantitative features BMI and HbA1c for conditions “hypertension” and “Type 2 diabetes”, respectively. The recruited potential users rated the user-perceived usefulness of VITTA with an average score of 86.4/100. Conclusions We contributed a novel aggregate analysis method to enable the interrogation of common patterns in quantitative eligibility criteria and the collective target populations of multiple related clinical studies. A larger-scale study is warranted to formally assess the usefulness of VITTA among clinical investigators and sponsors in various therapeutic areas. PMID:25615940

Visual aggregate analysis of eligibility features of clinical trials.

PubMed

He, Zhe; Carini, Simona; Sim, Ida; Weng, Chunhua

2015-04-01

To develop a method for profiling the collective populations targeted for recruitment by multiple clinical studies addressing the same medical condition using one eligibility feature each time. Using a previously published database COMPACT as the backend, we designed a scalable method for visual aggregate analysis of clinical trial eligibility features. This method consists of four modules for eligibility feature frequency analysis, query builder, distribution analysis, and visualization, respectively. This method is capable of analyzing (1) frequently used qualitative and quantitative features for recruiting subjects for a selected medical condition, (2) distribution of study enrollment on consecutive value points or value intervals of each quantitative feature, and (3) distribution of studies on the boundary values, permissible value ranges, and value range widths of each feature. All analysis results were visualized using Google Charts API. Five recruited potential users assessed the usefulness of this method for identifying common patterns in any selected eligibility feature for clinical trial participant selection. We implemented this method as a Web-based analytical system called VITTA (Visual Analysis Tool of Clinical Study Target Populations). We illustrated the functionality of VITTA using two sample queries involving quantitative features BMI and HbA1c for conditions "hypertension" and "Type 2 diabetes", respectively. The recruited potential users rated the user-perceived usefulness of VITTA with an average score of 86.4/100. We contributed a novel aggregate analysis method to enable the interrogation of common patterns in quantitative eligibility criteria and the collective target populations of multiple related clinical studies. A larger-scale study is warranted to formally assess the usefulness of VITTA among clinical investigators and sponsors in various therapeutic areas. Copyright © 2015 Elsevier Inc. All rights reserved.

Accounts of bullying on Twitter in relation to dentofacial features and orthodontic treatment.

PubMed

Chan, A; Antoun, J S; Morgaine, K C; Farella, M

2017-04-01

Social media offers an accessible resource for gaining valuable insights into the social culture of bullying. The purpose of this study was to qualitatively analyse Twitter posts for common themes relating to dentofacial features, braces and bullying. Twitter's database was searched from 2010 to 2014 using keywords relevant to bullying, teeth and orthodontics. Two investigators assessed the Twitter posts, and selected those that conveyed the experiences or opinions of bullying victims. The posts were qualitatively analysed using thematic analysis. Of the 548 posts screened, 321 were included in the final sample. Four primary categories relating to 'dental-related bullying' were identified: (i) morphological features, (ii) psychological and psychosocial impact, (iii) coping mechanisms and (iv) the role of family. Bullied individuals reported a diverse range of psychological impacts and coping mechanisms. Secondary categories were also identified. Family members, for example, were found to play both a contributory and mediatory role in bullying. In summary, social media can provide new and valuable information about the causal factors and social issues associated with oral health-related bullying. Importantly, some coping mechanisms may mitigate the negative effects of bullying. © 2017 John Wiley & Sons Ltd.

Print Advertisements for Alzheimer’s Disease Drugs: Informational and Transformational Features

PubMed Central

Gooblar, Jonathan; Carpenter, Brian D.

2014-01-01

Purpose We examined print advertisements for Alzheimer’s disease drugs published in journals and magazines between January 2008 and February 2012, using an informational versus transformational theoretical framework to identify objective and persuasive features. Methods In 29 unique advertisements, we used qualitative methods to code and interpret identifying information, charts, benefit and side effect language, and persuasive appeals embedded in graphics and narratives. Results Most elements contained a mixture of informational and transformational features. Charts were used infrequently, but when they did appear the accompanying text often exaggerated the data. Benefit statements covered an array of symptoms, drug properties, and caregiver issues. Side effect statements often used positive persuasive appeals. Graphics and narrative features emphasized positive emotions and outcomes. Implications We found subtle and sophisticated attempts both to educate and to persuade readers. It is important for consumers and prescribing physicians to read print advertisements critically so that they can make informed treatment choices. PMID:23687184

A Symbolic Approach Using Feature Construction Capable of Acquiring Information/Knowledge for Building Expert Systems.

ERIC Educational Resources Information Center

Major, Raymond L.

1998-01-01

Presents a technique for developing a knowledge-base of information to use in an expert system. Proposed approach employs a popular machine-learning algorithm along with a method for forming a finite number of features or conjuncts of at most n primitive attributes. Illustrates this procedure by examining qualitative information represented in a…

Parenchymal Texture Analysis in Digital Breast Tomosynthesis for Breast Cancer Risk Estimation: A Preliminary Study

PubMed Central

Kontos, Despina; Bakic, Predrag R.; Carton, Ann-Katherine; Troxel, Andrea B.; Conant, Emily F.; Maidment, Andrew D.A.

2009-01-01

Rationale and Objectives Studies have demonstrated a relationship between mammographic parenchymal texture and breast cancer risk. Although promising, texture analysis in mammograms is limited by tissue superimposition. Digital breast tomosynthesis (DBT) is a novel tomographic x-ray breast imaging modality that alleviates the effect of tissue superimposition, offering superior parenchymal texture visualization compared to mammography. Our study investigates the potential advantages of DBT parenchymal texture analysis for breast cancer risk estimation. Materials and Methods DBT and digital mammography (DM) images of 39 women were analyzed. Texture features, shown in studies with mammograms to correlate with cancer risk, were computed from the retroareolar breast region. We compared the relative performance of DBT and DM texture features in correlating with two measures of breast cancer risk: (i) the Gail and Claus risk estimates, and (ii) mammographic breast density. Linear regression was performed to model the association between texture features and increasing levels of risk. Results No significant correlation was detected between parenchymal texture and the Gail and Claus risk estimates. Significant correlations were observed between texture features and breast density. Overall, the DBT texture features demonstrated stronger correlations with breast percent density (PD) than DM (p ≤0.05). When dividing our study population in groups of increasing breast PD, the DBT texture features appeared to be more discriminative, having regression lines with overall lower p-values, steeper slopes, and higher R2 estimates. Conclusion Although preliminary, our results suggest that DBT parenchymal texture analysis could provide more accurate characterization of breast density patterns, which could ultimately improve breast cancer risk estimation. PMID:19201357

Instructional Quality Features in Videotaped Biology Lessons: Content-Independent Description of Characteristics

NASA Astrophysics Data System (ADS)

Dorfner, Tobias; Förtsch, Christian; Boone, William; Neuhaus, Birgit J.

2017-09-01

A number of studies on single instructional quality features have been reported for mathematics and science instruction. For summarizing single instructional quality features, researchers have created a model of three basic dimensions (classroom management, supportive climate, and cognitive activation) of instructional quality mainly through observing mathematics instruction. Considering this model as valid for all subjects and as usable for describing instruction, we used it in this study which aimed to analyze characteristics of instructional quality in biology lessons of high-achieving and low-achieving classes, independently of content. Therefore, we used the data of three different previous video studies of biology instruction conducted in Germany. From each video study, we selected three high-achieving and three low-achieving classes (N = 18 teachers; 35 videos) for our multiple-case study, in which conspicuous characteristics of instructional quality features were qualitatively identified and qualitatively analyzed. The amount of these characteristics was counted in a quantitative way in all the videos. The characteristics we found could be categorized using the model of three basic dimensions of instructional quality despite some subject-specific differences for biology instruction. Our results revealed that many more characteristics were observable in high-achieving classes than in low-achieving classes. Thus, we believe that this model could be used to describe biology instruction independently of the content. We also make the claims about the qualities for biology instruction—working with concentration in a content-structured environment, getting challenged in higher order thinking, and getting praised for performance—that could have positive influence on students' achievement.

Design-Based Comparison of Spine Surgery Simulators: Optimizing Educational Features of Surgical Simulators.

PubMed

Ryu, Won Hyung A; Mostafa, Ahmed E; Dharampal, Navjit; Sharlin, Ehud; Kopp, Gail; Jacobs, W Bradley; Hurlbert, R John; Chan, Sonny; Sutherland, Garnette R

2017-10-01

Simulation-based education has made its entry into surgical residency training, particularly as an adjunct to hands-on clinical experience. However, one of the ongoing challenges to wide adoption is the capacity of simulators to incorporate educational features required for effective learning. The aim of this study was to identify strengths and limitations of spine simulators to characterize design elements that are essential in enhancing resident education. We performed a mixed qualitative and quantitative cohort study with a focused survey and interviews of stakeholders in spine surgery pertaining to their experiences on 3 spine simulators. Ten participants were recruited spanning all levels of training and expertise until qualitative analysis reached saturation of themes. Participants were asked to perform lumbar pedicle screw insertion on 3 simulators. Afterward, a 10-item survey was administrated and a focused interview was conducted to explore topics pertaining to the design features of the simulators. Overall impressions of the simulators were positive with regards to their educational benefit, but our qualitative analysis revealed differing strengths and limitations. Main design strengths of the computer-based simulators were incorporation of procedural guidance and provision of performance feedback. The synthetic model excelled in achieving more realistic haptic feedback and incorporating use of actual surgical tools. Stakeholders from trainees to experts acknowledge the growing role of simulation-based education in spine surgery. However, different simulation modalities have varying design elements that augment learning in distinct ways. Characterization of these design characteristics will allow for standardization of simulation curricula in spinal surgery, optimizing educational benefit. Copyright © 2017 Elsevier Inc. All rights reserved.

Exact analysis of intrinsic qualitative features of phosphorelays using mathematical models.

PubMed

Knudsen, Michael; Feliu, Elisenda; Wiuf, Carsten

2012-05-07

Phosphorelays are a class of signaling mechanisms used by cells to respond to changes in their environment. Phosphorelays (of which two-component systems constitute a special case) are particularly abundant in prokaryotes and have been shown to be involved in many fundamental processes such as stress response, osmotic regulation, virulence, and chemotaxis. We develop a general model of phosphorelays extending existing models of phosphorelays and two-component systems. We analyze the model analytically under the assumption of mass-action kinetics and prove that a phosphorelay has a unique stable steady-state. Furthermore, we derive explicit functions relating stimulus to the response in any layer of a phosphorelay and show that a limited degree of ultrasensitivity in the bottom layer of a phosphorelay is an intrinsic feature which does not depend on any reaction rates or substrate amounts. On the other hand, we show how adjusting reaction rates and substrate amounts may lead to higher degrees of ultrasensitivity in intermediate layers. The explicit formulas also enable us to prove how the response changes with alterations in stimulus, kinetic parameters, and substrate amounts. Aside from providing biological insight, the formulas may also be used to replace the time-consuming simulations in numerical analyses. Copyright © 2012 Elsevier Ltd. All rights reserved.

Work environments and HIV prevention: a qualitative review and meta-synthesis of sex worker narratives.

PubMed

Goldenberg, Shira M; Duff, Putu; Krusi, Andrea

2015-12-16

Sex workers (SWs) experience a disproportionately high burden of HIV, with evidence indicating that complex and dynamic factors within work environments play a critical role in mitigating or producing HIV risks in sex work. In light of sweeping policy efforts to further criminalize sex work globally, coupled with emerging calls for structural responses situated in labour and human-rights frameworks, this meta-synthesis of the qualitative and ethnographic literature sought to examine SWs' narratives to elucidate the ways in which physical, social and policy features of diverse work environments influence SWs' agency to engage in HIV prevention. We conducted a meta-synthesis of qualitative and ethnographic studies published from 2008 to 2014 to elucidate SWs' narratives and lived experiences of the complex and nuanced ways in which physical, social, and policy features of indoor and outdoor work environments shape HIV prevention in the sex industry. Twenty-four qualitative and/or ethnographic studies were included in this meta-synthesis. SWs' narratives revealed the nuanced ways that physical, social, and policy features of work environments shaped HIV risk and interacted with macrostructural constraints (e.g., criminalization, stigma) and community determinants (e.g., sex worker empowerment initiatives) to shape SWs' agency in negotiating condom use. SWs' narratives revealed the ways in which the existence of occupational health and safety standards in indoor establishments, as well as protective practices of third parties (e.g., condom promotion) and other SWs/peers were critical ways of enhancing safety and sexual risk negotiation within indoor work environments. Additionally, working in settings where negative interactions with law enforcement were minimized (e.g., working in decriminalized contexts or environments in which peers/managers successfully deterred unjust policing practices) was critical for supporting SWs' agency to negotiate HIV prevention. Policy

Maternal perception of fetal movements in the third trimester: A qualitative description.

PubMed

Bradford, Billie; Maude, Robyn

2017-12-26

Decreased fetal movements is a common reason for unscheduled antenatal assessment and is associated with adverse pregnancy outcome. Fetal movement counting has not been proven to reduce stillbirths in high-quality studies. The aim was to explore a qualitative account of fetal movements in the third trimester as perceived by pregnant women themselves. Using qualitative descriptive methodology, interviews were conducted with 19 women experiencing an uncomplicated first pregnancy, at two timepoints in their third trimester. Interview transcripts were later analysed using qualitative content analysis. Pregnant women described a sustained increase in strength, frequency and variation in types of fetal movements from quickening until 28-32 weeks. Patterns of fetal movement were consistently described as involving increased movement later in the day and as having an inverse relationship to the women's own activity and rest. At term, the most notable feature was increased strength. Kicking and jolting movements decreased whilst pushing and rolling movements increased. Maternal descriptions of fetal activity in this study were consistent with other qualitative studies and with ultrasound studies of fetal development. Pregnant women observe a complex range of fetal movement patterns, actions and responses that are likely to be consistent with normal development. Maternal perception of a qualitative change in fetal movements may be clinically important and should take precedence over any numeric definition of decreased fetal movement. Midwives may inform women that it is normal to perceive more fetal movement in the evening and increasingly strong movements as pregnancy advances. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Theory and interpretation in qualitative studies from general practice: Why and how?

PubMed

Malterud, Kirsti

2016-03-01

In this article, I want to promote theoretical awareness and commitment among qualitative researchers in general practice and suggest adequate and feasible theoretical approaches. I discuss different theoretical aspects of qualitative research and present the basic foundations of the interpretative paradigm. Associations between paradigms, philosophies, methodologies and methods are examined and different strategies for theoretical commitment presented. Finally, I discuss the impact of theory for interpretation and the development of general practice knowledge. A scientific theory is a consistent and soundly based set of assumptions about a specific aspect of the world, predicting or explaining a phenomenon. Qualitative research is situated in an interpretative paradigm where notions about particular human experiences in context are recognized from different subject positions. Basic theoretical features from the philosophy of science explain why and how this is different from positivism. Reflexivity, including theoretical awareness and consistency, demonstrates interpretative assumptions, accounting for situated knowledge. Different types of theoretical commitment in qualitative analysis are presented, emphasizing substantive theories to sharpen the interpretative focus. Such approaches are clearly within reach for a general practice researcher contributing to clinical practice by doing more than summarizing what the participants talked about, without trying to become a philosopher. Qualitative studies from general practice deserve stronger theoretical awareness and commitment than what is currently established. Persistent attention to and respect for the distinctive domain of knowledge and practice where the research deliveries are targeted is necessary to choose adequate theoretical endeavours. © 2015 the Nordic Societies of Public Health.

Is Qualitative Research Second Class Science? A Quantitative Longitudinal Examination of Qualitative Research in Medical Journals

PubMed Central

Shuval, Kerem; Harker, Karen; Roudsari, Bahman; Groce, Nora E.; Mills, Britain; Siddiqi, Zoveen; Shachak, Aviv

2011-01-01

Background Qualitative research appears to be gaining acceptability in medical journals. Yet, little is actually known about the proportion of qualitative research and factors affecting its publication. This study describes the proportion of qualitative research over a 10 year period and correlates associated with its publication. Design A quantitative longitudinal examination of the proportion of original qualitative research in 67 journals of general medicine during a 10 year period (1998–2007). The proportion of qualitative research was determined by dividing original qualitative studies published (numerator) by all original research articles published (denominator). We used a generalized estimating equations approach to assess the longitudinal association between the proportion of qualitative studies and independent variables (i.e. journals' country of publication and impact factor; editorial/methodological papers discussing qualitative research; and specific journal guidelines pertaining to qualitative research). Findings A 2.9% absolute increase and 3.4-fold relative increase in qualitative research publications occurred over a 10 year period (1.2% in 1998 vs. 4.1% in 2007). The proportion of original qualitative research was independently and significantly associated with the publication of editorial/methodological papers in the journal (b = 3.688, P = 0.012); and with qualitative research specifically mentioned in guidelines for authors (b = 6.847, P<0.001). Additionally, a higher proportion of qualitative research was associated only with journals published in the UK in comparison to other countries, yet with borderline statistical significance (b = 1.776, P = 0.075). The journals' impact factor was not associated with the publication of qualitative research. Conclusions Despite an increase in the proportion of qualitative research in medical journals over a 10 year period, the proportion remains low. Journals' policies pertaining to

How is depression experienced around the world? A systematic review of qualitative literature

PubMed Central

Haroz, E.E.; Ritchey, M.; Bass, J.K.; Kohrt, B.A.; Augustinavicius, J.; Michalopoulos, L.; Burkey, M.D.; Bolton, P.

2017-01-01

To date global research on depression has used assessment tools based on research and clinical experience drawn from Western populations (i.e., in North American, European and Australian). There may be features of depression in non-Western populations which are not captured in current diagnostic criteria or measurement tools, as well as criteria for depression that are not relevant in other regions. We investigated this possibility through a systematic review of qualitative studies of depression worldwide. Nine online databases were searched for records that used qualitative methods to study depression. Initial searches were conducted between August 2012 and December 2012; an updated search was repeated in June of 2015 to include relevant literature published between December 30, 2012 and May 30, 2015. No date limits were set for inclusion of articles. A total of 16,130 records were identified and 138 met full inclusion criteria. Included studies were published between 1976 and 2015. These 138 studies represented data on 170 different study populations (some reported on multiple samples) and 77 different nationalities/ethnicities. Variation in results by geographical region, gender, and study context were examined to determine the consistency of descriptions across populations. Fisher’s exact tests were used to compare frequencies of features across region, gender and context. Seven of the 15 features with the highest relative frequency form part of the DSM-5 diagnosis of Major Depressive Disorder (MDD). However, many of the other features with relatively high frequencies across the studies are associated features in the DSM, but are not prioritized as diagnostic criteria and therefore not included in standard instruments. The DSM-5 diagnostic criteria of problems with concentration and psychomotor agitation or slowing were infrequently mentioned. This research suggests that the DSM model and standard instruments currently based on the DSM may not adequately

How is depression experienced around the world? A systematic review of qualitative literature.

PubMed

Haroz, E E; Ritchey, M; Bass, J K; Kohrt, B A; Augustinavicius, J; Michalopoulos, L; Burkey, M D; Bolton, P

2017-06-01

To date global research on depression has used assessment tools based on research and clinical experience drawn from Western populations (i.e., in North American, European and Australian). There may be features of depression in non-Western populations which are not captured in current diagnostic criteria or measurement tools, as well as criteria for depression that are not relevant in other regions. We investigated this possibility through a systematic review of qualitative studies of depression worldwide. Nine online databases were searched for records that used qualitative methods to study depression. Initial searches were conducted between August 2012 and December 2012; an updated search was repeated in June of 2015 to include relevant literature published between December 30, 2012 and May 30, 2015. No date limits were set for inclusion of articles. A total of 16,130 records were identified and 138 met full inclusion criteria. Included studies were published between 1976 and 2015. These 138 studies represented data on 170 different study populations (some reported on multiple samples) and 77 different nationalities/ethnicities. Variation in results by geographical region, gender, and study context were examined to determine the consistency of descriptions across populations. Fisher's exact tests were used to compare frequencies of features across region, gender and context. Seven of the 15 features with the highest relative frequency form part of the DSM-5 diagnosis of Major Depressive Disorder (MDD). However, many of the other features with relatively high frequencies across the studies are associated features in the DSM, but are not prioritized as diagnostic criteria and therefore not included in standard instruments. The DSM-5 diagnostic criteria of problems with concentration and psychomotor agitation or slowing were infrequently mentioned. This research suggests that the DSM model and standard instruments currently based on the DSM may not adequately

Cost-effectiveness of annual versus biennial screening mammography for women with high mammographic breast density.

PubMed

Pataky, Reka; Ismail, Zahra; Coldman, Andrew J; Elwood, Mark; Gelmon, Karen; Hedden, Lindsay; Hislop, Greg; Kan, Lisa; McCoy, Bonnie; Olivotto, Ivo A; Peacock, Stuart

2014-12-01

The sensitivity of screening mammography is much lower among women who have dense breast tissue, compared with women who have largely fatty breasts, and they are also at much higher risk of developing the disease. Increasing mammography screening frequency from biennially to annually has been suggested as a policy option to address the elevated risk in this population. The purpose of this study was to assess the cost-effectiveness of annual versus biennial screening mammography among women aged 50-79 with dense breast tissue. A Markov model was constructed based on screening, diagnostic, and treatment pathways for the population-based screening and cancer care programme in British Columbia, Canada. Model probabilities and screening costs were calculated from screening programme data. Costs for breast cancer treatment were calculated from treatment data, and utility values were obtained from the literature. Incremental cost-effectiveness was expressed as cost per quality adjusted life year (QALY), and probabilistic sensitivity analysis was conducted. Compared with biennial screening, annual screening generated an additional 0.0014 QALYs (95% CI: -0.0480-0.0359) at a cost of $819 ($ = Canadian dollars) per patient (95% CI: 506-1185), resulting in an incremental cost effectiveness ratio of $565,912/QALY. Annual screening had a 37.5% probability of being cost-effective at a willingness-to-pay threshold of $100,000/QALY. There is considerable uncertainty about the incremental cost-effectiveness of annual mammography. Further research on the comparative effectiveness of screening strategies for women with high mammographic breast density is warranted, particularly as digital mammography and density measurement become more widespread, before cost-effectiveness can be reevaluated. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Qualitative Methods in Higher Education Research: A Team Approach to Multiple Site Investigation. ASHE Annual Meeting Paper.

ERIC Educational Resources Information Center

Whitt, Elizabeth J.; Kuh, George D.

A team approach to the use of qualitative methods in a study of high quality out-of-class experiences for undergraduate students at 14 institutions of higher education is described. Four research questions examined: the physical and organizational features characterizing the institutions; the nature of institutional policies related to…

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed Central

Gadd, C. S.; Baskaran, P.; Lobach, D. F.

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings. Images Figure 1 PMID:9929188

Identification of design features to enhance utilization and acceptance of systems for Internet-based decision support at the point of care.

PubMed

Gadd, C S; Baskaran, P; Lobach, D F

1998-01-01

Extensive utilization of point-of-care decision support systems will be largely dependent on the development of user interaction capabilities that make them effective clinical tools in patient care settings. This research identified critical design features of point-of-care decision support systems that are preferred by physicians, through a multi-method formative evaluation of an evolving prototype of an Internet-based clinical decision support system. Clinicians used four versions of the system--each highlighting a different functionality. Surveys and qualitative evaluation methodologies assessed clinicians' perceptions regarding system usability and usefulness. Our analyses identified features that improve perceived usability, such as telegraphic representations of guideline-related information, facile navigation, and a forgiving, flexible interface. Users also preferred features that enhance usefulness and motivate use, such as an encounter documentation tool and the availability of physician instruction and patient education materials. In addition to identifying design features that are relevant to efforts to develop clinical systems for point-of-care decision support, this study demonstrates the value of combining quantitative and qualitative methods of formative evaluation with an iterative system development strategy to implement new information technology in complex clinical settings.

Comparison of naïve Bayes and logistic regression for computer-aided diagnosis of breast masses using ultrasound imaging

NASA Astrophysics Data System (ADS)

Cary, Theodore W.; Cwanger, Alyssa; Venkatesh, Santosh S.; Conant, Emily F.; Sehgal, Chandra M.

2012-03-01

This study compares the performance of two proven but very different machine learners, Naïve Bayes and logistic regression, for differentiating malignant and benign breast masses using ultrasound imaging. Ultrasound images of 266 masses were analyzed quantitatively for shape, echogenicity, margin characteristics, and texture features. These features along with patient age, race, and mammographic BI-RADS category were used to train Naïve Bayes and logistic regression classifiers to diagnose lesions as malignant or benign. ROC analysis was performed using all of the features and using only a subset that maximized information gain. Performance was determined by the area under the ROC curve, Az, obtained from leave-one-out cross validation. Naïve Bayes showed significant variation (Az 0.733 +/- 0.035 to 0.840 +/- 0.029, P < 0.002) with the choice of features, but the performance of logistic regression was relatively unchanged under feature selection (Az 0.839 +/- 0.029 to 0.859 +/- 0.028, P = 0.605). Out of 34 features, a subset of 6 gave the highest information gain: brightness difference, margin sharpness, depth-to-width, mammographic BI-RADs, age, and race. The probabilities of malignancy determined by Naïve Bayes and logistic regression after feature selection showed significant correlation (R2= 0.87, P < 0.0001). The diagnostic performance of Naïve Bayes and logistic regression can be comparable, but logistic regression is more robust. Since probability of malignancy cannot be measured directly, high correlation between the probabilities derived from two basic but dissimilar models increases confidence in the predictive power of machine learning models for characterizing solid breast masses on ultrasound.

No relationship between circulating levels of sex steroids and mammographic breast density: the Prospect-EPIC cohort

PubMed Central

Verheus, Martijn; Peeters, Petra HM; van Noord, Paulus AH; van der Schouw, Yvonne T; Grobbee, Diederick E; van Gils, Carla H

2007-01-01

Background High breast density is associated with increased breast cancer risk. Epidemiologic studies have shown an increase in breast cancer risk in postmenopausal women with high levels of sex steroids. Hence, sex steroids may increase postmenopausal breast cancer risk via an increase of breast density. The objective of the present study was to study the relation between circulating oestrogens and androgens as well as sex hormone binding globulin (SHBG) in relation to breast density. Methods We conducted a cross-sectional study among 775 postmenopausal women, using baseline data of a random sample of the Prospect-EPIC study. Prospect-EPIC is one of two Dutch cohorts participating in the European Prospective Investigation into Cancer and Nutrition, and women were recruited via a breast cancer screening programme. At enrolment a nonfasting blood sample was taken and a mammogram was made. Oestrone, oestradiol, dehydroepiandrosterone sulfate, androstenedione, testosterone and SHBG levels were measured, using double-antibody radioimmunoassays. Concentrations of free oestradiol and free testosterone were calculated from the measured oestradiol, testosterone and SHBG levels Mammographic dense and nondense areas were measured using a semiquantitative computerized method and the percentage breast density was calculated. Mean breast measures for quintiles of hormone or SHBG levels were estimated using linear regression analyses. Results Both oestrogens and testosterone were inversely related with percent breast density, but these relationships disappeared after adjustment for BMI. None of the sex steroids or SHBG was associated with the absolute measure of breast density, the dense area. Conclusion The results of our study do not support the hypothesis that sex steroids increase postmenopausal breast cancer risk via an increase in breast density. PMID:17692133

Positive predictive values by mammographic density and screening mode in the Norwegian Breast Cancer Screening Program.

PubMed

Moshina, Nataliia; Ursin, Giske; Roman, Marta; Sebuødegård, Sofie; Hofvind, Solveig

2016-01-01

To investigate the probability of breast cancer among women recalled due to abnormal findings on the screening mammograms (PPV-1) and among women who underwent an invasive procedure (PPV-2) by mammographic density (MD), screening mode and age. We used information about 28,826 recall examinations from 26,951 subsequently screened women in the Norwegian Breast Cancer Screening Program, 1996-2010. The radiologists who performed the recall examinations subjectively classified MD on the mammograms into three categories: fatty (<30% fibroglandular tissue); medium dense (30-70%) and dense (>70%). Screening mode was defined as screen-film mammography (SFM) and full-field digital mammography (FFDM). We examined trends of PPVs by MD, screening mode and age. We used logistic regression to estimate odds ratio (OR) of screen-detected breast cancer associated with MD among women recalled, adjusting for screening mode and age. PPV-1 and PPV-2 decreased by increasing MD, regardless of screening mode (p for trend <0.05 for both PPVs). PPV-1 and PPV-2 were statistically significantly higher for FFDM compared with SFM for women with fatty breasts. Among women recalled, the adjusted OR of breast cancer decreased with increasing MD. Compared with women with fatty breasts, the OR was 0.90 (95% CI: 0.84-0.96) for those with medium dense breasts and 0.85 (95% CI: 0.76-0.95) for those with dense breasts. PPVs decreased by increasing MD. Fewer women needed to be recalled or undergo an invasive procedure to detect one breast cancer among those with fatty versus dense breasts in the screening program in Norway, 1996-2010. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Relationship of Terminal Duct Lobular Unit Involution of the Breast with Area and Volume Mammographic Densities

PubMed Central

Gierach, Gretchen L.; Patel, Deesha A.; Pfeiffer, Ruth M.; Figueroa, Jonine D.; Linville, Laura; Papathomas, Daphne; Johnson, Jason M.; Chicoine, Rachael E.; Herschorn, Sally D.; Shepherd, John A.; Wang, Jeff; Malkov, Serghei; Vacek, Pamela M.; Weaver, Donald L.; Fan, Bo; Mahmoudzadeh, Amir Pasha; Palakal, Maya; Xiang, Jackie; Oh, Hannah; Horne, Hisani N.; Sprague, Brian L.; Hewitt, Stephen M.; Brinton, Louise A.; Sherman, Mark E.

2016-01-01

Elevated mammographic density (MD) is an established breast cancer risk factor. Reduced involution of terminal duct lobular units (TDLUs), the histologic source of most breast cancers, has been associated with higher MD and breast cancer risk. We investigated relationships of TDLU involution with area and volumetric MD, measured throughout the breast and surrounding biopsy targets (peri-lesional). Three measures inversely related to TDLU involution (TDLU count/mm2, median TDLU span, median acini count/TDLU) assessed in benign diagnostic biopsies from 348 women, ages 40–65, were related to MD area (quantified with thresholding software) and volume (assessed with a density phantom) by analysis of covariance, stratified by menopausal status and adjusted for confounders. Among premenopausal women, TDLU count was directly associated with percent peri-lesional MD (P-trend=0.03), but not with absolute dense area/volume. Greater TDLU span was associated with elevated percent dense area/volume (P-trend<0.05) and absolute peri-lesional MD (P=0.003). Acini count was directly associated with absolute peri-lesional MD (P=0.02). Greater TDLU involution (all metrics) was associated with increased nondense area/volume (P-trend≤0.04). Among postmenopausal women, TDLU measures were not significantly associated with MD. Among premenopausal women, reduced TDLU involution was associated with higher area and volumetric MD, particularly in peri-lesional parenchyma. Data indicating that TDLU involution and MD are correlated markers of breast cancer risk suggest that associations of MD with breast cancer may partly reflect amounts of at-risk epithelium. If confirmed, these results could suggest a prevention paradigm based on enhancing TDLU involution and monitoring efficacy by assessing MD reduction. PMID:26645278

Event-related potentials reveal the relations between feature representations at different levels of abstraction.

PubMed

Hannah, Samuel D; Shedden, Judith M; Brooks, Lee R; Grundy, John G

2016-11-01

In this paper, we use behavioural methods and event-related potentials (ERPs) to explore the relations between informational and instantiated features, as well as the relation between feature abstraction and rule type. Participants are trained to categorize two species of fictitious animals and then identify perceptually novel exemplars. Critically, two groups are given a perfectly predictive counting rule that, according to Hannah and Brooks (2009. Featuring familiarity: How a familiar feature instantiation influences categorization. Canadian Journal of Experimental Psychology/Revue Canadienne de Psychologie Expérimentale, 63, 263-275. Retrieved from http://doi.org/10.1037/a0017919), should orient them to using abstract informational features when categorizing the novel transfer items. A third group is taught a feature list rule, which should orient them to using detailed instantiated features. One counting-rule group were taught their rule before any exposure to the actual stimuli, and the other immediately after training, having learned the instantiations first. The feature-list group were also taught their rule after training. The ERP results suggest that at test, the two counting-rule groups processed items differently, despite their identical rule. This not only supports the distinction that informational and instantiated features are qualitatively different feature representations, but also implies that rules can readily operate over concrete inputs, in contradiction to traditional approaches that assume that rules necessarily act on abstract inputs.

Qualitative and quantitative comparison of colonic microendoscopy image features to histopathology

NASA Astrophysics Data System (ADS)

Prieto, Sandra P.; Powless, Amy J.; Lai, Keith; Laryea, Jonathan A.; Mizell, Jason S.; Muldoon, Timothy J.

2015-03-01

Colorectal cancer is the second leading cause of cancer deaths in the United States, affecting more than 130,000 Americans every year1. Determining tumor margins prior to surgical resection is essential to providing optimal treatment and reducing recurrence rates. Colorectal cancer recurrence can occur in up to 20% of cases, commonly within three years after curative treatment. Typically, when colorectal cancers are resected, a margin of normal tissue on both sides of the tumor is required. The minimum margin required for colon cancer is 5 cm and for the lower rectum 2 cm. However, usually more normal tissue is taken on both sides of the tumor because the blood supply to the entire segment is removed with the surgery and therefore the entire segment must be removed. Anastomotic recurrences may result from inadequate margins. Pathologists look at the margins to ensure that there is no residual tumor and this is usually documented in the pathology report. We have developed a portable, point-of-care fiber bundle microendoscopy imaging system for detection of abnormalities in colonic epithelial microstructure. The system comprises a laptop, a modified fiber bundle image guide with a 1mm active area diameter and custom LabVIEW interface, and is approved for imaging surgically resected colon tissue at the University of Arkansas for Medical Sciences. The microendoscopy probe provides high-resolution images of superficial epithelial histology in real-time to assist surgical guidance and to localize occult regions of dysplasia which may not be visible. Microendoscopy images of freshly resected human colonic epithelium were acquired using the microendoscopy device and subsequently mosaicked using custom post-processing software. Architectural changes in the glands were mapped to histopathology H&E slides taken from the precise location of the microendoscopy images. Qualitatively, glandular distortion and placement of image guide was used to map normal and dysplastic areas of

Overview of qualitative research.

PubMed

Grossoehme, Daniel H

2014-01-01

Qualitative research methods are a robust tool for chaplaincy research questions. Similar to much of chaplaincy clinical care, qualitative research generally works with written texts, often transcriptions of individual interviews or focus group conversations and seeks to understand the meaning of experience in a study sample. This article describes three common methodologies: ethnography, grounded theory, and phenomenology. Issues to consider relating to the study sample, design, and analysis are discussed. Enhancing the validity of the data, as well reliability and ethical issues in qualitative research are described. Qualitative research is an accessible way for chaplains to contribute new knowledge about the sacred dimension of people's lived experience.

Situating methodology within qualitative research.

PubMed

Kramer-Kile, Marnie L

2012-01-01

Qualitative nurse researchers are required to make deliberate and sometimes complex methodological decisions about their work. Methodology in qualitative research is a comprehensive approach in which theory (ideas) and method (doing) are brought into close alignment. It can be difficult, at times, to understand the concept of methodology. The purpose of this research column is to: (1) define qualitative methodology; (2) illuminate the relationship between epistemology, ontology and methodology; (3) explicate the connection between theory and method in qualitative research design; and 4) highlight relevant examples of methodological decisions made within cardiovascular nursing research. Although there is no "one set way" to do qualitative research, all qualitative researchers should account for the choices they make throughout the research process and articulate their methodological decision-making along the way.

A qualitative study of attachment relationships in ASD during middle childhood.

PubMed

Keenan, Belinda M; Newman, Louise K; Gray, Kylie M; Rinehart, Nicole J

2017-02-01

Although research has indicated that children with Autism Spectrum Disorder (ASD) display normative attachment behaviours, to date there has been limited qualitative research exploring these relationships. This study aimed to describe qualitative features of the child-caregiver attachment relationship in children with ASD. Primary caregivers to 26 children with ASD (aged 7-14 years) and 23 typically developing children (aged 7-13 years) were administered the Disturbances of Attachment Interview (Smyke & Zeanah, 1999) to elicit descriptions of children's attachment behaviours. Thematic analysis of interview transcripts indicated that while children with ASD demonstrated a range of normative attachment behaviours, they displayed impairments in the use of the caregiver as a secure base and co-regulating agent. ASD-associated impairments in emotion processing, sharing/reciprocity, and emotion co-regulation, as well as the caregiver's experience, were important in understanding attachment relationships in ASD. Findings highlight the need to consider the bidirectional nature of the attachment relationship in ASD.

Qualitative research methods for medical educators.

PubMed

Hanson, Janice L; Balmer, Dorene F; Giardino, Angelo P

2011-01-01

This paper provides a primer for qualitative research in medical education. Our aim is to equip readers with a basic understanding of qualitative research and prepare them to judge the goodness of fit between qualitative research and their own research questions. We provide an overview of the reasons for choosing a qualitative research approach and potential benefits of using these methods for systematic investigation. We discuss developing qualitative research questions, grounding research in a philosophical framework, and applying rigorous methods of data collection, sampling, and analysis. We also address methods to establish the trustworthiness of a qualitative study and introduce the reader to ethical concerns that warrant special attention when planning qualitative research. We conclude with a worksheet that readers may use for designing a qualitative study. Medical educators ask many questions that carefully designed qualitative research would address effectively. Careful attention to the design of qualitative studies will help to ensure credible answers that will illuminate many of the issues, challenges, and quandaries that arise while doing the work of medical education. Copyright © 2011 Academic Pediatric Association. All rights reserved.

Feature engineering for drug name recognition in biomedical texts: feature conjunction and feature selection.

PubMed

Liu, Shengyu; Tang, Buzhou; Chen, Qingcai; Wang, Xiaolong; Fan, Xiaoming

2015-01-01

Drug name recognition (DNR) is a critical step for drug information extraction. Machine learning-based methods have been widely used for DNR with various types of features such as part-of-speech, word shape, and dictionary feature. Features used in current machine learning-based methods are usually singleton features which may be due to explosive features and a large number of noisy features when singleton features are combined into conjunction features. However, singleton features that can only capture one linguistic characteristic of a word are not sufficient to describe the information for DNR when multiple characteristics should be considered. In this study, we explore feature conjunction and feature selection for DNR, which have never been reported. We intuitively select 8 types of singleton features and combine them into conjunction features in two ways. Then, Chi-square, mutual information, and information gain are used to mine effective features. Experimental results show that feature conjunction and feature selection can improve the performance of the DNR system with a moderate number of features and our DNR system significantly outperforms the best system in the DDIExtraction 2013 challenge.

Quantitative estimates of the impact of sensitivity and specificity in mammographic screening in Germany.

PubMed Central

Warmerdam, P G; de Koning, H J; Boer, R; Beemsterboer, P M; Dierks, M L; Swart, E; Robra, B P

1997-01-01

STUDY OBJECTIVE: To estimate quantitatively the impact of the quality of mammographic screening (in terms of sensitivity and specificity) on the effects and costs of nationwide breast cancer screening. DESIGN: Three plausible "quality" scenarios for a biennial breast cancer screening programme for women aged 50-69 in Germany were analysed in terms of costs and effects using the Microsimulation Screening Analysis model on breast cancer screening and the natural history of breast cancer. Firstly, sensitivity and specificity in the expected situation (or "baseline" scenario) were estimated from a model based analysis of empirical data from 35,000 screening examinations in two German pilot projects. In the second "high quality" scenario, these properties were based on the more favourable diagnostic results from breast cancer screening projects and the nationwide programme in The Netherlands. Thirdly, a worst case, "low quality" hypothetical scenario with a 25% lower sensitivity than that experienced in The Netherlands was analysed. SETTING: The epidemiological and social situation in Germany in relation to mass screening for breast cancer. RESULTS: In the "baseline" scenario, an 11% reduction in breast cancer mortality was expected in the total German female population, ie 2100 breast cancer deaths would be prevented per year. It was estimated that the "high quality" scenario, based on Dutch experience, would lead to the prevention of an additional 200 deaths per year and would also cut the number of false positive biopsy results by half. The cost per life year gained varied from Deutsche mark (DM) 15,000 on the "high quality" scenario to DM 21,000 in the "low quality" setting. CONCLUSIONS: Up to 20% of the total costs of a screening programme can be spent on quality improvement in order to achieve a substantially higher reduction in mortality and reduce undesirable side effects while retaining the same cost effectiveness ratio as that estimated from the German data

Characterization of breast density in Vietnam and its association with demographic, reproductive and lifestyle factors

NASA Astrophysics Data System (ADS)

Trieu, Phuong Dung (Yun); Mello-Thoms, Claudia; Peat, Jenny; Do, Thuan Doan; Brennan, Patrick C.

2017-03-01

This study aims to investigate patterns of breast density among women in Vietnam and their association with demographic, reproductive and lifestyle features. Mammographic densities of 1,651 women were collected from the two largest breast cancer screening and treatment centers in Ha Noi and Ho Chi Minh city. Putative factors associated with breast density were obtained from self-administered questionnaires which considered demographic, reproductive and lifestyle elements and were provided by women who attended mammography examinations. Results show that a large proportion of Vietnamese women (78.4%) had a high breast density. With multivariable logistic regression, significant associations of high breast density were evident with women with less than 55 years old (OR=3.0), having BMI less than 23 (OR=2.2), experiencing pre-menopausal status (OR=2.9), having less than three children (OR=1.7), and being less than 32 years old when having their last child (OR=1.8). Participants who consumed more than two vegetable servings per day also had an increased risk of higher density (OR=2.6). The findings suggest some unique features regarding mammographic density amongst Vietnamese compared with westernized women.

Visualizing Qualitative Information

ERIC Educational Resources Information Center

Slone, Debra J.

2009-01-01

The abundance of qualitative data in today's society and the need to easily scrutinize, digest, and share this information calls for effective visualization and analysis tools. Yet, no existing qualitative tools have the analytic power, visual effectiveness, and universality of familiar quantitative instruments like bar charts, scatter-plots, and…

Consumers' Preferences for Electronic Nicotine Delivery System Product Features: A Structured Content Analysis.

PubMed

Kistler, Christine E; Crutchfield, Trisha M; Sutfin, Erin L; Ranney, Leah M; Berman, Micah L; Zarkin, Gary A; Goldstein, Adam O

2017-06-07

To inform potential governmental regulations, we aimed to develop a list of electronic nicotine delivery system (ENDS) product features important to U.S. consumers by age and gender. We employed qualitative data methods. Participants were eligible if they had used an ENDS at least once. Groups were selected by age and gender (young adult group aged 18-25, n = 11; middle-age group aged 26-64, n = 9; and women's group aged 26-64, n = 9). We conducted five individual older adult interviews (aged 68-80). Participants discussed important ENDS features. We conducted a structured content analysis of the group and interview responses. Of 34 participants, 68% were white and 56% were female. Participants mentioned 12 important ENDS features, including: (1) user experience; (2) social acceptability; (3) cost; (4) health risks/benefits; (5) ease of use; (6) flavors; (7) smoking cessation aid; (8) nicotine content; (9) modifiability; (10) ENDS regulation; (11) bridge between tobacco cigarettes; (12) collectability. The most frequently mentioned ENDS feature was modifiability for young adults, user experience for middle-age and older adults, and flavor for the women's group. This study identified multiple features important to ENDS consumers. Groups differed in how they viewed various features by age and gender. These results can inform ongoing regulatory efforts.

Positivism and qualitative nursing research.

PubMed

Paley, J

2001-01-01

Despite the hostility to positivism shown by qualitative methodologists in nursing, as in other disciplines, the epistemological and ontological instincts of qualitative researchers seem to coincide with those of the positivists, especially Bayesian positivists. This article suggests that positivists and qualitative researchers alike are pro-observation, proinduction, pro-plausibility and pro-subjectivity. They are also anti-cause, anti-realist, anti-explanation, anti-correspondence, anti-truth. In only one respect is there a significant difference between positivist and qualitative methodologists: most positivists have believed that, methodologically, the natural sciences and the social sciences are the same; most qualitative researchers are adamant that they are not. However, if positivism fails as a philosophy of the natural sciences (which it probably does), it might well succeed as a philosophy of the social sciences, just because there is a methodological watershed between the two. Reflex antagonism to positivism might therefore be a major obstacle to understanding the real reasons why qualitative research and the natural sciences are methodologically divergent; and less hostility on the part of qualitative nurse researchers might bring certain advantages in its wake.

[Qualitative Research in Health Services Research - Discussion Paper, Part 3: Quality of Qualitative Research].

PubMed

Stamer, M; Güthlin, C; Holmberg, C; Karbach, U; Patzelt, C; Meyer, T

2015-12-01

The third and final discussion paper of the German Network of Health Services Research's (DNVF) "Qualitative Methods Working Group" demonstrates methods for the evaluation and quality of qualitative research in health services research. In this paper we discuss approaches described in evaluating qualitative studies, including: an orientation to the general principles of empirical research, an approach-specific course of action, as well as procedures based on the research-process and criteria-oriented approaches. Divided into general and specific aspects to be considered in a qualitative study quality evaluation, the central focus of the discussion paper undertakes an extensive examination of the process and criteria-oriented approaches. The general aspects include the participation of relevant groups in the research process as well as ethical aspects of the research and data protection issues. The more specific aspects in evaluating the quality of qualitative research include considerations about the research interest, research questions, and the selection of data collection methods and types of analyses. The formulated questions are intended to guide reviewers and researchers to evaluate and to develop qualitative research projects appropriately. The intention of this discussion paper is to ensure a transparent research culture, and to reflect on and discuss the methodological and research approach of qualitative studies in health services research. With this paper we aim to initiate a discussion on high quality evaluation of qualitative health services research. © Georg Thieme Verlag KG Stuttgart · New York.

MO-F-CAMPUS-I-01: Accuracy of Radiologists Interpretation of Mammographic Breast Density

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vedantham, S; Shi, L; Karellas, A

2015-06-15

Purpose: Several commercial and non-commercial software and techniques are available for determining breast density from mammograms. However, where mandated by law the breast density information communicated to the subject/patient is based on radiologist’s interpretation of breast density from mammograms. Several studies have reported on the concordance among radiologists in interpreting mammographic breast density. In this work, we investigated the accuracy of radiologist’s interpretation of breast density. Methods: Volumetric breast density (VBD) determined from 134 unilateral dedicated breast CT scans from 134 subjects was considered the truth. An MQSA-qualified study radiologist with more than 20 years of breast imaging experience reviewedmore » the DICOM “for presentation” standard 2-view mammograms of the corresponding breasts and assigned BIRADS breast density categories. For statistical analysis, the breast density categories were dichotomized in two ways; fatty vs. dense breasts where “fatty” corresponds to BIRADS breast density categories A/B, and “dense” corresponds to BIRADS breast density categories C/D, and extremely dense vs. fatty to heterogeneously dense breasts, where extremely dense corresponds to BIRADS breast density category D and BIRADS breast density categories A through C were grouped as fatty to heterogeneously dense breasts. Logistic regression models (SAS 9.3) were used to determine the association between radiologist’s interpretation of breast density and VBD from breast CT, from which the area under the ROC (AUC) was determined. Results: Both logistic regression models were statistically significant (Likelihood Ratio test, p<0.0001). The accuracy (AUC) of the study radiologist for classification of fatty vs. dense breasts was 88.4% (95% CI: 83–94%) and for classification of extremely dense breast was 94.3% (95% CI: 90–98%). Conclusion: The accuracy of the radiologist in classifying dense and extremely dense

What Is Qualitative Research?

PubMed

Otani, Takashi

2017-01-01

The article is an in-depth explanation of qualitative research, an approach increasingly prevalent among today's research communities. After discussing its present spread within the health sciences, the author addresses: 1. Its definition. 2. Its characteristics, as well as its theoretical and procedural background. 3. Its procedures. 4. Differences between qualitative and quantitative approaches. 5. Mixed methods incorporating quantitative research. And in conclusion: 6. The importance of establishing an epistemological perspective in qualitative research.

Reading Representations of Themselves: Urban Youth Use Culture and African American Textual Features to Develop Literary Understandings

ERIC Educational Resources Information Center

Brooks, Wanda

2006-01-01

This article describes a qualitative research study that explored how a middle school case-study class read and responded to "culturally conscious" African American children's books (Sims, 1982, p. 49). First, I relied on literary analyses conducted mainly by Sims (1982) and Harris (1995) to identify African American textual features contained in…

The Use of Discourse Markers as an Interactive Feature in Science Lecture Discourse in L2 Setting

ERIC Educational Resources Information Center

Rido, Akhyar

2010-01-01

The objective of this research is to investigate the function of discourse markers as an interpersonal-interactive feature in a science lecture in second language (L2) setting in Malaysia. This research employs qualitative method while the data are gathered through non-participant observation and video recording. From the findings, there are…

Parameter optimization of parenchymal texture analysis for prediction of false-positive recalls from screening mammography

NASA Astrophysics Data System (ADS)

Ray, Shonket; Keller, Brad M.; Chen, Jinbo; Conant, Emily F.; Kontos, Despina

2016-03-01

This work details a methodology to obtain optimal parameter values for a locally-adaptive texture analysis algorithm that extracts mammographic texture features representative of breast parenchymal complexity for predicting falsepositive (FP) recalls from breast cancer screening with digital mammography. The algorithm has two components: (1) adaptive selection of localized regions of interest (ROIs) and (2) Haralick texture feature extraction via Gray- Level Co-Occurrence Matrices (GLCM). The following parameters were systematically varied: mammographic views used, upper limit of the ROI window size used for adaptive ROI selection, GLCM distance offsets, and gray levels (binning) used for feature extraction. Each iteration per parameter set had logistic regression with stepwise feature selection performed on a clinical screening cohort of 474 non-recalled women and 68 FP recalled women; FP recall prediction was evaluated using area under the curve (AUC) of the receiver operating characteristic (ROC) and associations between the extracted features and FP recall were assessed via odds ratios (OR). A default instance of mediolateral (MLO) view, upper ROI size limit of 143.36 mm (2048 pixels2), GLCM distance offset combination range of 0.07 to 0.84 mm (1 to 12 pixels) and 16 GLCM gray levels was set. The highest ROC performance value of AUC=0.77 [95% confidence intervals: 0.71-0.83] was obtained at three specific instances: the default instance, upper ROI window equal to 17.92 mm (256 pixels2), and gray levels set to 128. The texture feature of sum average was chosen as a statistically significant (p<0.05) predictor and associated with higher odds of FP recall for 12 out of 14 total instances.

Prediction of breast cancer risk using a machine learning approach embedded with a locality preserving projection algorithm.

PubMed

Heidari, Morteza; Khuzani, Abolfazl Zargari; Hollingsworth, Alan B; Danala, Gopichandh; Mirniaharikandehei, Seyedehnafiseh; Qiu, Yuchen; Liu, Hong; Zheng, Bin

2018-01-30

In order to automatically identify a set of effective mammographic image features and build an optimal breast cancer risk stratification model, this study aims to investigate advantages of applying a machine learning approach embedded with a locally preserving projection (LPP) based feature combination and regeneration algorithm to predict short-term breast cancer risk. A dataset involving negative mammograms acquired from 500 women was assembled. This dataset was divided into two age-matched classes of 250 high risk cases in which cancer was detected in the next subsequent mammography screening and 250 low risk cases, which remained negative. First, a computer-aided image processing scheme was applied to segment fibro-glandular tissue depicted on mammograms and initially compute 44 features related to the bilateral asymmetry of mammographic tissue density distribution between left and right breasts. Next, a multi-feature fusion based machine learning classifier was built to predict the risk of cancer detection in the next mammography screening. A leave-one-case-out (LOCO) cross-validation method was applied to train and test the machine learning classifier embedded with a LLP algorithm, which generated a new operational vector with 4 features using a maximal variance approach in each LOCO process. Results showed a 9.7% increase in risk prediction accuracy when using this LPP-embedded machine learning approach. An increased trend of adjusted odds ratios was also detected in which odds ratios increased from 1.0 to 11.2. This study demonstrated that applying the LPP algorithm effectively reduced feature dimensionality, and yielded higher and potentially more robust performance in predicting short-term breast cancer risk.

Prediction of breast cancer risk using a machine learning approach embedded with a locality preserving projection algorithm

NASA Astrophysics Data System (ADS)

Heidari, Morteza; Zargari Khuzani, Abolfazl; Hollingsworth, Alan B.; Danala, Gopichandh; Mirniaharikandehei, Seyedehnafiseh; Qiu, Yuchen; Liu, Hong; Zheng, Bin

2018-02-01

In order to automatically identify a set of effective mammographic image features and build an optimal breast cancer risk stratification model, this study aims to investigate advantages of applying a machine learning approach embedded with a locally preserving projection (LPP) based feature combination and regeneration algorithm to predict short-term breast cancer risk. A dataset involving negative mammograms acquired from 500 women was assembled. This dataset was divided into two age-matched classes of 250 high risk cases in which cancer was detected in the next subsequent mammography screening and 250 low risk cases, which remained negative. First, a computer-aided image processing scheme was applied to segment fibro-glandular tissue depicted on mammograms and initially compute 44 features related to the bilateral asymmetry of mammographic tissue density distribution between left and right breasts. Next, a multi-feature fusion based machine learning classifier was built to predict the risk of cancer detection in the next mammography screening. A leave-one-case-out (LOCO) cross-validation method was applied to train and test the machine learning classifier embedded with a LLP algorithm, which generated a new operational vector with 4 features using a maximal variance approach in each LOCO process. Results showed a 9.7% increase in risk prediction accuracy when using this LPP-embedded machine learning approach. An increased trend of adjusted odds ratios was also detected in which odds ratios increased from 1.0 to 11.2. This study demonstrated that applying the LPP algorithm effectively reduced feature dimensionality, and yielded higher and potentially more robust performance in predicting short-term breast cancer risk.

Are mammographic changes in the tumor bed more pronounced after intraoperative radiotherapy for breast cancer? Subgroup analysis from a randomized trial (TARGIT-A).

PubMed

Engel, Dorothee; Schnitzer, Andreas; Brade, Joachim; Blank, Elena; Wenz, Frederik; Suetterlin, Marc; Schoenberg, Stefan; Wasser, Klaus

2013-01-01

Intraoperative radiotherapy (IORT) with low-energy x-rays is increasingly used in breast-conserving therapy (BCT). Previous non-randomized studies have observed mammographic changes in the tumor bed to be more pronounced after IORT. The purpose of this study was to reassess the postoperative changes in a randomized single-center subgroup of patients from a multicenter trial (TARGIT-A). In this subgroup (n = 48) 27 patients received BCT with IORT, 21 patients had BCT with standard whole-breast radiotherapy serving as controls. Overall 258 postoperative mammograms (median follow-up 4.3 years, range 3-8) were retrospectively evaluated by two radiologists in consensus focusing on changes in the tumor bed. Fat necroses showed to be significantly more frequent (56% versus 24%) and larger (8.7 versus 1.6 sq cm, median) after IORT than those in controls. Scar calcifications were also significantly more frequent after IORT (63% versus 19%). The high incidence of large fat necroses in our study confirms previous study findings. However, the overall higher incidence of calcifications in the tumor bed after IORT represents a new finding, requiring further attention. © 2012 Wiley Periodicals, Inc.

Use or Non-Use of Gerontechnology—A Qualitative Study

PubMed Central

Chen, Ke; Chan, Alan Hoi-shou

2013-01-01

This study employed a qualitative approach to explore the attitudes and experiences of older people towards using gerontechnology, and to determine the underlying reasons that might account for their use and non-use of gerontechnology. Four focus group discussions and 26 individual interviews were undertaken. Qualitative data were analyzed using NVivo software and were categorized using coding and grounded theory techniques. The result indicated that old people in Hong Kong had an overall positive attitude toward technology. Positive attitudes were most frequently related to enhanced convenience and advanced features. Negative attitudes were most frequently associated with health risks and social problems arising from using technology (e.g., social isolation and addiction). Usage of technology is driven by outcome expectations and social influences, and supported by facilitators, whereas non-use of gerontechnology relates to the personal (e.g., health and functional capacities), technological (e.g., cost and complexity), and environmental barriers experienced. Use of gerontechnology is a synthesis of person, technology, and environment. To encourage non-users to adopt technology, there is a need to remove barriers at personal, technological, and environmental levels. PMID:24084674

Qualitative Case Study Guidelines

DTIC Science & Technology

2013-11-01

Introduction to Sociological Methods. 2nd ed. New York, McGraw-Hill 14. Denzin , N. K. and Lincoln , Y. S. (2011) The SAGE Handbook of Qualitative...The Art of Science. In: Denzin , N. K. and Lincoln , Y. S. (eds.) Handbook of Qualitative Research. Thousand Oaks, Sage 19. GAO (1990) Case Study...Rinehart & Winston 39. Stake, R. E. (1994) Case Studies. In: Denzin , N. K. and Lincoln , Y. S. (eds.) Handbook of Qualitative Research. Thousand Oaks, Sage

Vertical Feature Mask Feature Classification Flag Extraction

Atmospheric Science Data Center

2013-03-28

  Vertical Feature Mask Feature Classification Flag Extraction This routine demonstrates extraction of the ... in a CALIPSO Lidar Level 2 Vertical Feature Mask feature classification flag value. It is written in Interactive Data Language (IDL) ...

Conducting Qualitative Data Analysis: Qualitative Data Analysis as a Metaphoric Process

ERIC Educational Resources Information Center

Chenail, Ronald J.

2012-01-01

In the second of a series of "how-to" essays on conducting qualitative data analysis, Ron Chenail argues the process can best be understood as a metaphoric process. From this orientation he suggests researchers follow Kenneth Burke's notion of metaphor and see qualitative data analysis as the analyst systematically considering the "this-ness" of…

A Method for Qualitative Mapping of Thick Oil Spills Using Imaging Spectroscopy

USGS Publications Warehouse

Clark, Roger N.; Swayze, Gregg A.; Leifer, Ira; Livo, K. Eric; Lundeen, Sarah; Eastwood, Michael; Green, Robert O.; Kokaly, Raymond F.; Hoefen, Todd; Sarture, Charles; McCubbin, Ian; Roberts, Dar; Steele, Denis; Ryan, Thomas; Dominguez, Roseanne; Pearson, Neil; ,

2010-01-01

A method is described to create qualitative images of thick oil in oil spills on water using near-infrared imaging spectroscopy data. The method uses simple 'three-point-band depths' computed for each pixel in an imaging spectrometer image cube using the organic absorption features due to chemical bonds in aliphatic hydrocarbons at 1.2, 1.7, and 2.3 microns. The method is not quantitative because sub-pixel mixing and layering effects are not considered, which are necessary to make a quantitative volume estimate of oil.

Comparison of Mammographic Density Assessed as Volumes and Areas among Women Undergoing Diagnostic Image-Guided Breast Biopsy

PubMed Central

Gierach, Gretchen L.; Geller, Berta M.; Shepherd, John A.; Patel, Deesha A.; Vacek, Pamela M.; Weaver, Donald L.; Chicoine, Rachael E.; Pfeiffer, Ruth M.; Fan, Bo; Mahmoudzadeh, Amir Pasha; Wang, Jeff; Johnson, Jason M.; Herschorn, Sally D.; Brinton, Louise A.; Sherman, Mark E.

2014-01-01

Background Mammographic density (MD), the area of non-fatty appearing tissue divided by total breast area, is a strong breast cancer risk factor. Most MD analyses have employed visual categorizations or computer-assisted quantification, which ignore breast thickness. We explored MD volume and area, using a volumetric approach previously validated as predictive of breast cancer risk, in relation to risk factors among women undergoing breast biopsy. Methods Among 413 primarily white women, ages 40–65, undergoing diagnostic breast biopsies between 2007–2010 at an academic facility in Vermont, MD volume (cm3) was quantified in cranio-caudal views of the breast contralateral to the biopsy target using a density phantom, while MD area (cm2) was measured on the same digital mammograms using thresholding software. Risk factor associations with continuous MD measurements were evaluated using linear regression. Results Percent MD volume and area were correlated (r=0.81) and strongly and inversely associated with age, body mass index (BMI), and menopause. Both measures were inversely associated with smoking and positively associated with breast biopsy history. Absolute MD measures were correlated (r=0.46) and inversely related to age and menopause. Whereas absolute dense area was inversely associated with BMI, absolute dense volume was positively associated. Conclusions Volume and area MD measures exhibit some overlap in risk factor associations, but divergence as well, particularly for BMI. Impact Findings suggest that volume and area density measures differ in subsets of women; notably, among obese women, absolute density was higher with volumetric methods, suggesting that breast cancer risk assessments may vary for these techniques. PMID:25139935

A method to determine the mammographic regions that show early changes due to the development of breast cancer

NASA Astrophysics Data System (ADS)

Karemore, Gopal; Nielsen, Mads; Karssemeijer, Nico; Brandt, Sami S.

2014-11-01

It is well understood nowadays that changes in the mammographic parenchymal pattern are an indicator of a risk of breast cancer and we have developed a statistical method that estimates the mammogram regions where the parenchymal changes, due to breast cancer, occur. This region of interest is computed from a score map by utilising the anatomical breast coordinate system developed in our previous work. The method also makes an automatic scale selection to avoid overfitting while the region estimates are computed by a nested cross-validation scheme. In this way, it is possible to recover those mammogram regions that show a significant difference in classification scores between the cancer and the control group. Our experiments suggested that the most significant mammogram region is the region behind the nipple and that can be justified by previous findings from other research groups. This result was conducted on the basis of the cross-validation experiments on independent training, validation and testing sets from the case-control study of 490 women, of which 245 women were diagnosed with breast cancer within a period of 2-4 years after the baseline mammograms. We additionally generalised the estimated region to another, mini-MIAS study and showed that the transferred region estimate gives at least a similar classification result when compared to the case where the whole breast region is used. In all, by following our method, one most likely improves both preclinical and follow-up breast cancer screening, but a larger study population will be required to test this hypothesis.

Accuracy and reading time for six strategies using digital breast tomosynthesis in women with mammographically negative dense breasts.

PubMed

Tagliafico, Alberto Stefano; Calabrese, Massimo; Bignotti, Bianca; Signori, Alessio; Fisci, Erica; Rossi, Federica; Valdora, Francesca; Houssami, Nehmat

2017-12-01

To compare six strategies using digital breast tomosynthesis in women with mammographically negative dense breasts. This is a substudy of the 'ASTOUND' trial. 163 women who underwent tomosynthesis with synthetically reconstructed projection images (S-2D) inclusive of 13 (7.9%) cases diagnosed with breast cancer at histopathology after surgery were evaluated. Accuracy measures and screen-reading time of six reading strategies were assessed: (A) Single reading of S-2D alone, (B) single reading of tomosynthesis alone, (C) single reading of joint interpretation of tomosynthesis + S-2D, (D) double-reading of S-2D alone, (E) double reading of tomosynthesis alone, (F) double reading of joint interpretation of tomosynthesis + S-2D. The median age of the patients was 53 years (range, 36-88 years). The highest global accuracy was obtained with double reading of tomosynthesis + S2D (F) with an AUC of 0.979 (p<0.001) and a mean reading time of 154 s versus 34 s for the fastest strategy (single reading of S-2D alone). The AUCs for the other five strategies did not differ from each other. Double reading of tomosynthesis+ S2D had the best accuracy of six screen-reading strategies although it had the longest reading time. • Tomosynthesis acquisitions are progressively implemented with reconstructed synthesized 2D images • Double reading using S-2D plus tomosynthesis had the highest global accuracy (p<0.001). • Double reading of S-2D plus tomosynthesis increased reading time.

Qualitative Approaches to Evaluating Education.

ERIC Educational Resources Information Center

Fetterman, David M.

This paper explores the variety of qualitative methods available, in the context of a larger quantitative-qualitative debate in the field of educational evaluation. Each approach is reviewed in terms of the work of its major proponents. The dominant forms of qualitative evaluation include: (1) ethnography; (2) naturalistic inquiry; (3) generic…

Knowledge representation and qualitative simulation of salmon redd functioning. Part I: qualitative modeling and simulation.

PubMed

Guerrin, F; Dumas, J

2001-02-01

This work aims at representing empirical knowledge of freshwater ecologists on the functioning of salmon redds (spawning areas of salmon) and its impact on mortality of early stages. For this, we use Qsim, a qualitative simulator. In this first part, we provide unfamiliar readers with the underlying qualitative differential equation (QDE) ontology of Qsim: representing quantities, qualitative variables, qualitative constraints, QDE structure. Based on a very simple example taken of the salmon redd application, we show how informal biological knowledge may be represented and simulated using an approach that was first intended to analyze qualitatively ordinary differential equations systems. A companion paper (Part II) gives the full description and simulation of the salmon redd qualitative model. This work was part of a project aimed at assessing the impact of the environment on salmon populations dynamics by the use of models of processes acting at different levels: catchment, river, and redds. Only the latter level is dealt with in this paper.

Likelihood of early detection of breast cancer in relation to false-positive risk in life-time mammographic screening: population-based cohort study.

PubMed

Otten, J D M; Fracheboud, J; den Heeten, G J; Otto, S J; Holland, R; de Koning, H J; Broeders, M J M; Verbeek, A L M

2013-10-01

Women require balanced, high-quality information when making an informed decision on screening benefits and harms before attending biennial mammographic screening. The cumulative risk of a false-positive recall and/or (small) screen-detected or interval cancer over 13 consecutive screening examinations for women aged 50 from the start of screening were estimated using data from the Nijmegen programme, the Netherlands. Women who underwent 13 successive screens in the period 1975-1976 had a 5.3% cumulative chance of a screen-detected cancer, with a 4.2% risk of at least one false-positive recall. The risk of being diagnosed with interval cancer was 3.7%. Two decades later, these estimates were 6.9%, 7.3% and 2.9%, respectively. The chance of detection of a small, favourable invasive breast cancer, anticipating a normal life-expectancy, rose from 2.3% to 3.7%. Extrapolation to digital screening mammography indicates that the proportion of false-positive results will rise to 16%. Dutch women about to participate in the screening programme can be reassured that the chance of false-positive recall in the Netherlands is relatively low. A new screening policy and improved mammography have increased the detection of an early screening carcinoma and lowering the risk of interval carcinoma.

Using qualitative research to inform development of a diagnostic algorithm for UTI in children.

PubMed

de Salis, Isabel; Whiting, Penny; Sterne, Jonathan A C; Hay, Alastair D

2013-06-01

Diagnostic and prognostic algorithms can help reduce clinical uncertainty. The selection of candidate symptoms and signs to be measured in case report forms (CRFs) for potential inclusion in diagnostic algorithms needs to be comprehensive, clearly formulated and relevant for end users. To investigate whether qualitative methods could assist in designing CRFs in research developing diagnostic algorithms. Specifically, the study sought to establish whether qualitative methods could have assisted in designing the CRF for the Health Technology Association funded Diagnosis of Urinary Tract infection in Young children (DUTY) study, which will develop a diagnostic algorithm to improve recognition of urinary tract infection (UTI) in children aged <5 years presenting acutely unwell to primary care. Qualitative methods were applied using semi-structured interviews of 30 UK doctors and nurses working with young children in primary care and a Children's Emergency Department. We elicited features that clinicians believed useful in diagnosing UTI and compared these for presence or absence and terminology with the DUTY CRF. Despite much agreement between clinicians' accounts and the DUTY CRFs, we identified a small number of potentially important symptoms and signs not included in the CRF and some included items that could have been reworded to improve understanding and final data analysis. This study uniquely demonstrates the role of qualitative methods in the design and content of CRFs used for developing diagnostic (and prognostic) algorithms. Research groups developing such algorithms should consider using qualitative methods to inform the selection and wording of candidate symptoms and signs.

Celluloid devils: a research study of male nurses in feature films.

PubMed

Stanley, David

2012-11-01

To report a study of how male nurses are portrayed in feature films. It was hypothesized that male nurses are frequently portrayed negatively or stereotypically in the film media, potentially having a negative impact on male nurse recruitment and the public's perception of male nurses. An interpretive, qualitative methodology guided by insights into hegemonic masculinity and structured around a set of collective case studies (films) was used to examine the portrayal of male nurses in feature films made in the Western world from 1900 to 2007. Over 36,000 feature film synopses were reviewed (via CINAHL, ProQuest and relevant movie-specific literature) for the keyword 'nurse' and 'nursing' with an additional search for films from 1900 to 2010 for the word 'male nurse'. Identified films were labelled as 'cases' and analysed collectively to determine key attributes related to men in nursing and explore them for the emergence of concepts and themes related to the image of male nurses in films. A total of 13 relevant cases (feature films) were identified with 12 being made in the USA. Most films portrayed male nurses negatively and in ways opposed to hegemonic masculinity, as effeminate, homosexual, homicidal, corrupt or incompetent. Few film images of male nurses show them in traditional masculine roles or as clinically competent or self-confident professionals.   Feature films predominantly portray male nurses negatively. Given the popularity of feature films, there may be negative effects on recruitment and on the public's perception of male nurses. © 2012 Blackwell Publishing Ltd.

Consumers’ Preferences for Electronic Nicotine Delivery System Product Features: A Structured Content Analysis

PubMed Central

Kistler, Christine E.; Crutchfield, Trisha M.; Sutfin, Erin L.; Ranney, Leah M.; Berman, Micah L.; Zarkin, Gary A.; Goldstein, Adam O.

2017-01-01

To inform potential governmental regulations, we aimed to develop a list of electronic nicotine delivery system (ENDS) product features important to U.S. consumers by age and gender. We employed qualitative data methods. Participants were eligible if they had used an ENDS at least once. Groups were selected by age and gender (young adult group aged 18–25, n = 11; middle-age group aged 26–64, n = 9; and women’s group aged 26–64, n = 9). We conducted five individual older adult interviews (aged 68–80). Participants discussed important ENDS features. We conducted a structured content analysis of the group and interview responses. Of 34 participants, 68% were white and 56% were female. Participants mentioned 12 important ENDS features, including: (1) user experience; (2) social acceptability; (3) cost; (4) health risks/benefits; (5) ease of use; (6) flavors; (7) smoking cessation aid; (8) nicotine content; (9) modifiability; (10) ENDS regulation; (11) bridge between tobacco cigarettes; (12) collectability. The most frequently mentioned ENDS feature was modifiability for young adults, user experience for middle-age and older adults, and flavor for the women’s group. This study identified multiple features important to ENDS consumers. Groups differed in how they viewed various features by age and gender. These results can inform ongoing regulatory efforts. PMID:28590444

Qualitative research: comments and controversies.

PubMed

Schutz, R W

1989-03-01

Larry Locke's timely and well-written introduction to qualitative research procedures will undoubtedly serve its purpose. It makes us reassess our traditional beliefs and practices, educates us on the rudiments of qualitative methodology, and, hopefully, makes us more tolerant and appreciative of alternate ways of conducting research. Although Locke focuses his paper on pedagogical research issues, it is important to realize that many other sub-disciplines within the general field of physical education also utilize qualitative procedures. For example, 10 years ago Martens (1979) called for a paradigm shift in sport psychology by appealing to researchers to abandon their labs and to embark on naturalistic field studies. While North American sport psychologists, and psychologists in general, have been slow to formalize qualitative techniques, the European psychology community has been much more active (e.g., Ashworth, Giorgi, & de Koning, 1986). Perhaps Locke's article will encourage researchers in all our sub-disciplines to consider the utility of qualitative research. Hopefully, readers will treat Locke's article as an introduction to the broad area of qualitative research and not as a rigorous set of procedures for conducting participant observation research in school physical education studies. Additionally, it must be recognized that there are other approaches and other applications, that the area has its critics and its unresolved methodological problems, and that qualitative research does not necessarily exclude the application of formalized data analyses. Keeping these issues in mind, the addition of qualitative approaches to our repetoire of research methodologies can only enhance the quality of research in physical education and exercise and sport science.

Opportunities and Constraints in Disseminating Qualitative Research in Web 2.0 Virtual Environments.

PubMed

Hays, Charles A; Spiers, Judith A; Paterson, Barbara

2015-11-01

The Web 2.0 digital environment is revolutionizing how users communicate and relate to each other, and how information is shared, created, and recreated within user communities. The social media technologies in the Web 2.0 digital ecosystem are fundamentally changing the opportunities and dangers in disseminating qualitative health research. The social changes influenced by digital innovations shift dissemination from passive consumption to user-centered, apomediated cooperative approaches, the features of which are underutilized by many qualitative researchers. We identify opportunities new digital media presents for knowledge dissemination activities including access to wider audiences with few gatekeeper constraints, new perspectives, and symbiotic relationships between researchers and users. We also address some of the challenges in embracing these technologies including lack of control, potential for unethical co-optation of work, and cyberbullying. Finally, we offer solutions to enhance research dissemination in sustainable, ethical, and effective strategies. © The Author(s) 2015.

A Qualitative Study of the UK Academic Role: Positive Features, Negative Aspects and Associated Stressors in a Mainly Teaching-Focused University

ERIC Educational Resources Information Center

Darabi, Mitra; Macaskill, Ann; Reidy, Lisa

2017-01-01

The literature demonstrates that stress in the working life of academics has increased over recent years. However, qualitative research on how academics cope with this is very scarce. Using online interviewing with thematic analysis, this paper examines how 31 academics in a post-92 predominantly teaching-focused UK university cope with the…

Further exploration of dissemination bias in qualitative research required to facilitate assessment within qualitative evidence syntheses.

PubMed

Toews, Ingrid; Booth, Andrew; Berg, Rigmor C; Lewin, Simon; Glenton, Claire; Munthe-Kaas, Heather M; Noyes, Jane; Schroter, Sara; Meerpohl, Joerg J

2017-08-01

To conceptualise and discuss dissemination bias in qualitative research. It is likely that the mechanisms leading to dissemination bias in quantitative research, including time lag, language, gray literature, and truncation bias also contribute to dissemination bias in qualitative research. These conceptual considerations have informed the development of a research agenda. Further exploration of dissemination bias in qualitative research is needed, including the extent of non-dissemination and related dissemination bias, and how to assess dissemination bias within qualitative evidence syntheses. We also need to consider the mechanisms through which dissemination bias in qualitative research could occur to explore approaches for reducing it. Copyright © 2017 Elsevier Inc. All rights reserved.

Features of everyday life in psychiatric inpatient care for self-harming: an observational study of six women.

PubMed

Lindgren, Britt-Marie; Aminoff, Carina; Hällgren Graneheim, Ulla

2015-02-01

This study aimed to describe the features of everyday life in psychiatric inpatient care as experienced by women who self-harm. Participant observations and informal interviews were conducted with six women and were subjected to qualitative content analysis. The major feature of everyday life in psychiatric inpatient care was 'being surrounded by disorder', which consisted of 'living in a confusing environment, being subject to routines and rules that offer safety but lack consistency' and 'waiting both in loneliness and in togetherness'. The nursing staff spent minimal time with the patients and the women turned to each other for support, care and companionship.

Structured Qualitative Research: Organizing “Mountains of Words” for Data Analysis, both Qualitative and Quantitative

PubMed Central

Johnson, Bruce D.; Dunlap, Eloise; Benoit, Ellen

2008-01-01

Qualitative research creates mountains of words. U.S. federal funding supports mostly structured qualitative research, which is designed to test hypotheses using semi-quantitative coding and analysis. The authors have 30 years of experience in designing and completing major qualitative research projects, mainly funded by the US National Institute on Drug Abuse [NIDA]. This article reports on strategies for planning, organizing, collecting, managing, storing, retrieving, analyzing, and writing about qualitative data so as to most efficiently manage the mountains of words collected in large-scale ethnographic projects. Multiple benefits accrue from this approach. Several different staff members can contribute to the data collection, even when working from remote locations. Field expenditures are linked to units of work so productivity is measured, many staff in various locations have access to use and analyze the data, quantitative data can be derived from data that is primarily qualitative, and improved efficiencies of resources are developed. The major difficulties involve a need for staff who can program and manage large databases, and who can be skillful analysts of both qualitative and quantitative data. PMID:20222777

Qualitative Descriptive Methods in Health Science Research.

PubMed

Colorafi, Karen Jiggins; Evans, Bronwynne

2016-07-01

The purpose of this methodology paper is to describe an approach to qualitative design known as qualitative descriptive that is well suited to junior health sciences researchers because it can be used with a variety of theoretical approaches, sampling techniques, and data collection strategies. It is often difficult for junior qualitative researchers to pull together the tools and resources they need to embark on a high-quality qualitative research study and to manage the volumes of data they collect during qualitative studies. This paper seeks to pull together much needed resources and provide an overview of methods. A step-by-step guide to planning a qualitative descriptive study and analyzing the data is provided, utilizing exemplars from the authors' research. This paper presents steps to conducting a qualitative descriptive study under the following headings: describing the qualitative descriptive approach, designing a qualitative descriptive study, steps to data analysis, and ensuring rigor of findings. The qualitative descriptive approach results in a summary in everyday, factual language that facilitates understanding of a selected phenomenon across disciplines of health science researchers. © The Author(s) 2016.

Phenomenological features of dreams: Results from dream log studies using the Subjective Experiences Rating Scale (SERS).

PubMed

Kahan, Tracey L; Claudatos, Stephanie

2016-04-01

Self-ratings of dream experiences were obtained from 144 college women for 788 dreams, using the Subjective Experiences Rating Scale (SERS). Consistent with past studies, dreams were characterized by a greater prevalence of vision, audition, and movement than smell, touch, or taste, by both positive and negative emotion, and by a range of cognitive processes. A Principal Components Analysis of SERS ratings revealed ten subscales: four sensory, three affective, one cognitive, and two structural (events/actions, locations). Correlations (Pearson r) among subscale means showed a stronger relationship among the process-oriented features (sensory, cognitive, affective) than between the process-oriented and content-centered (structural) features--a pattern predicted from past research (e.g., Bulkeley & Kahan, 2008). Notably, cognition and positive emotion were associated with a greater number of other phenomenal features than was negative emotion; these findings are consistent with studies of the qualitative features of waking autobiographical memory (e.g., Fredrickson, 2001). Copyright © 2016 Elsevier Inc. All rights reserved.

Part two: Qualitative research.

PubMed

Quick, J; Hall, S

2015-01-01

This second article in the series Spotlight on Research focuses on qualitative research, its applications, principles and methodologies. It provides an insight into how this approach can be used within the perioperative setting and gives advice for practitioners looking to undertake a qualitative research study.

Buffered Qualitative Stability explains the robustness and evolvability of transcriptional networks

PubMed Central

Albergante, Luca; Blow, J Julian; Newman, Timothy J

2014-01-01