Project

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Dedicated Breast Computer Tomography

English title Dedicated Breast Computer Tomography
Applicant Boss Andreas
Number 170791
Funding scheme R'EQUIP
Research institution Institut für Diagnostische Radiologie Departement Medizinische Radiologie Universitätsspital Zürich
Institution of higher education University of Zurich - ZH
Main discipline Clinical Cancer Research
Start/End 01.05.2017 - 31.08.2018
Approved amount 370'000.00
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All Disciplines (3)

Discipline
Clinical Cancer Research
Electrical Engineering
Technical Physics

Keywords (3)

mammography; breast cancer; computer-tomography

Lay Summary (German)

Lead
Die Computer-Tomographie der Brust erlaubt eine genauere Beurteilung bezüglich des Vorliegens eines Brustkrebses verglichen mit herkömmlichen Methoden der Brustbildgebung. Das vorliegende Projekt soll diese neue Technologie untersuchen.
Lay summary

In den letzten Jahren wurden in den Schweizer Kantonen zahlreiche Mammographie-Screening-Programme eingerichtet. Die Begründung für diese Programme basiert auf umfangreichen Studien, vor allem aus skandinavischen Ländern, die gezeigt haben, dass ein kontrolliertes Screening-Programm bei Frauen über 50 Jahren in der Lage, die Sterblichkeit an Brustkrebs zu reduzieren. In jüngster Zeit wurden diese Screening-Programme jedoch hinsichtlich ihrer Effizienz und Wirtschaftlichkeit kritisiert. Hauptargumente waren hier die geringe Nachweiswahrscheinlichkeit von Brustkrebs bei dichtem Drüsengewebe und die hohe Anzahl von falsch-positiven Befunden. Ziel des geplanten Projektes ist es, die bekannten Schwächen der konventionellen Mammographie mit einem neu entwickelten Computertomographie-System für die Brustbildgebung zu überwinden. Durch die überlagerungsfreie Darstellung des Brustgewebes in einem 3D-Datensatz kann die Genauigkeit der Beurteilung der Brust entscheidend verbessert werden.

Direct link to Lay Summary Last update: 16.12.2016

Responsible applicant and co-applicants

Collaboration

Group / person Country
Types of collaboration
AB-CT GmbH Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
- Industry/business/other use-inspired collaboration
Prof. Willi Kalender, University Erlangen Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication

Scientific events



Self-organised

Title Date Place
Festsymposium: Kompressionsfreies Spiral-CT zur Darstellung der weiblichen Brust 05.10.2018 Zürich, Switzerland

Associated projects

Number Title Start Funding scheme
139258 Micro Computer-Tomographie für in-vivo Bildgebung 01.01.2012 R'EQUIP
154472 Med-XPhase - Phase contrast X-ray imaging as a new diagnostic tool 01.01.2015 Sinergia

Abstract

Background: Within the last years, numerous mammography screening programs have been set up in Swiss cantons. The justification for these programs is based on large-scale studies mostly from Scandinavian countries, which demonstrated that a controlled screening program in women over 50 years of age is able to reduce the mortality rate of breast cancer. However, recently these screening programs have strongly been criticized regarding their efficiency and cost effectiveness. Main arguments are the decrease in sensitivity of mammograms in patients with dense breast tissue, the high number of false-positive findings, and the resulting physical and psychological stress in patients undergoing unnecessary imaging or breast biopsies.Aims of the project: The aim of the intended project is to overcome the known weaknesses of conventional mammography with a newly developed dedicated computer-tomography (CT) system for breast imaging. This new type of breast imaging devices was developed within the last years by two different companies: Koning (New York, USA) and CT Imaging (Erlangen, Germany). The introduction of spiral CTs strongly improved the clinical applicability of CT imaging in the 90s. The just now developed Breast-CT (BCT) is intended to support a similar development for breast imaging. The development of new detector technologies provides an up-to now unreachable spatial resolution in the order of 100-200 µm without the application of a radiation dose higher than conventional mammography. The project will also compare the performance of BCT in comparison to the newly developed phase-contrast mammography technique (SNF Sinergia CRSII2_154472) and a microCT reference standard (funded by SNF R’Equipe 3106030_139258).Hypotheses and specific aims: (1)Due to the cross-section image representation free from superposition in a 3-dimensional dataset, BCT provides a higher sensitivity for the detection of breast pathologies compared to conventional mammography.(2)BCT offers an improved delineation of microcalcifications and soft tissue lesions resulting in higher specificity and a lower number of false-positive findings; thereby reducing follow-up imaging examinations and/or subsequent unnecessary biopsies. (3)BCT may replace magnetic resonance (MR) mammography in the work-up of suspicious lesions by the application of iodinated contrast-agents. Patients may benefit from the shorter examination time, more comfortable patient position, and dynamic contrast-enhanced BCT may be applied in the same session directly following conventional mammography. However, great care needs to be applied regarding radiation dose of dynamic CT scans.(4)Suspicious microcalcifications may undergo CT-guided core biopsy with similar accuracy compared to vacuum-assisted stereotactic biopsy, however at substantially lower invasiveness, radiation dose and physical stress.(5)The radiation dose of the BCT remains at a similar level compared to conventional mammography at maximum 10 mSv for a complete dataset (conventional mammography up to 5 mSv for each projection).(6)Both, BCT and new phase contrast mammography are complementary imaging techniques.Work program: After installation of the BCT at the Institute of Diagnostic and Interventional Radiology of the University Hospital Zurich, approval from all necessary authorities will be sought (BAG, cantonal Ethics committee) for the conduct of pilot studies and clinical trials (further described in the research plan) to investigate the above described hypotheses potentially overcoming numerous weaknesses of current breast imaging and treatment. The clinical studies will be surrounded by a framework of methodological projects regarding image quality, dose estimations and optimization of image reconstruction techniques. Moreover two separate projects are intended in forensic and evolutionary medicine.Significance: The herein proposed project will extend and further strengthen the current research focus of breast imaging. The consortium pursuing the project provides in-depth knowledge in clinical breast imaging research and technological development. With the installation of BCT, phase-contrast mammography, a state-of-the-art microCT imager, and all other modern breast imaging techniques, the USZ will provide a unique feature strengthening the leading role of Switzerland in breast imaging research.
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