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ADVANCING BREAST SCREENING AND PREVENTION
A recent edition of the ACR’s Voice of Radiology Blog commended the critical role that research plays in “developing new opportunities for improved patient care” and attributes research as a key factor in the ongoing success of radiology.
“We owe a debt of thanks to all researchers and innovators in clinical practice, at academic centers and within industry that strive to improve patient care in breast cancer screening,” said Luke Delaney, General Manager of Automated Breast Ultrasound at GE Healthcare. “Without their dedication, focus and tremendous effort, breast imaging would not be able to address progress to better meet the needs of all women and to move toward a model of personalized breast care and prevention.”

“For decades, we’ve been getting better mammography, better ultrasound, better risk tools, but we haven’t always been able to apply these advances to the right patients at the right time. What often holds us back is the passion to cling to one technology because we believe in it; but research continues to show that technology performs differently for different patients. There is not a one size fits all approach to breast cancer screening. We must let go of that passion for one technology and be open to both find and successfully treat the full diversity of cancers that plague women worldwide,” said Connie Lehman, M.D., Ph.D., from Massachusetts General Hospital (MGH) in Boston.
Solving the important problems
“In order to develop guidelines for personalized screening that move breast care forward, clinical research is needed to evaluate how new technologies address screening compliance, cancer detection, as well as help identify the right combination of technologies that work together with high specificity to support risk stratification models,” Delaney added.

Designed to support risk adapted screening, the Tyrer-Cuzick Risk Assessment Tool includes family history, genetic factors and breast density to help identify high-risk women and guide clinical decisions about adjunctive screening options. “Using a risk adapted screening protocol will help determine where we need to do more or less screening, based on women’s specific risk factors. If we’re going to optimize screening for each woman, we have to start looking at individual risk profiles and density,” said Jack Cuzick, PhD, FRS, John Snow Professor of Epidemiology, Director, Wolfson Institute of Preventive Medicine, Queen Mary University of London.

According to Dr. Cuzick, “cardiologists have been very effective combining screening and prevention with cholesterol and statins. However, it’s not enough to identify someone as being high risk unless you’re prepared to do something about it. In breast care, we must look at combining risk assessment with preventive therapy. We have to re-think a screening process that relies on one size fits all approach – ideally, every woman would be risk assessed on her first visit and then we could determine the screening program based on her specific density and risks. Ultimately, we need to educate the general public – and physicians – that cancer is preventable and mortality from breast cancer is definitely preventable with a good screening program.”
Investing in personalized screening research
As a leader in precision health solutions, GE Healthcare has adopted a systematic approach toward breast care research and has a current focus on how ABUS can best serve the path to personalize breast care. This includes an extensive initiative calling for research proposals to support the pursuit to personalized breast care.

Awards for the Invenia™ ABUS Prospective Call for Proposals 2 were recently announced during the 2018 Radiological Society of North America (RSNA) annual conference. The four $100,000 grants were preceded by four $25,000 grants awarded in the summer of 2018 for the Invenia ABUS Retrospective Call for Proposals 1. The awarded proposals address a diverse set of research questions to investigate the value of ABUS in both screening and diagnostic applications:
Invenia ABUS Prospective Call for Proposals 2 Awards
Dr. Bob Nishikawa, MD, from the University of Pittsburgh, Pittsburgh, Pennsylvania, USA, was awarded for his proposal titled, “The Effect of Priors on the Recall Rate in Breast Cancer Screening with Invenia.
Dr. Mustafa Aribal from Acibadem M.A.A. University, Altunizade Acibadem Hospital, Üsküdar/Istanbul, Turkey, was awarded for his proposal titled, “Value of Automated Breast US (ABUS) in screening setting with tomosynthesis.
Dr. Connie Lehman from Mass General Hospital and Harvard Medical School, Boston, Massachusetts, USA, for her research proposal titled, “Automated Breast Ultrasound for Diagnostic Evaluation.
Dr. Marc Inciardi, from the University of Kansas Health System, Kansas City, Kansas, USA, for his proposal titled, “Comparing Interpretation Accuracy of ABUS Reading Styles: Coronal vs coronal/transverse.
Additionally, GE awarded 8 additional proposals which were submitted as part of the Prospective Call for Proposals. Please visit the Invenia ABUS Research Portal for information on those additional awards.

In addition to the Calls for Proposals awarded, GE is proud to support the BRAID study, “Breast screening – Risk Adaptive Imaging for Density” designed to evaluate a risk adaptive screening approach including ABUS, CESM and abbreviated MRI. According to the lead researcher, Professor Fiona Gilbert, University of Cambridge, London, UK, “mammography screening is the gold standard but we see a significant sensitivity reduction in women with dense breasts. This study proposes a tailored modality imaging approach with a goal of determining what type of cancers can we find with each tool and test the feasibility of using the tools in actual clinical practice.”

For more information on featured research projects, visit the Invenia ABUS Research Portal.
Invenia ABUS 2.0: Improving detection and overall experience
As the breast care community continues to evolve protocols to personalize breast care for better outcomes, there must be a parallel path to advance technology. Supplemental screening with automated breast ultrasound (ABUS) transforms breast care from reactive to proactive, helping clinicians be more confident, and patients avoid potential delayed diagnosis. At the 2018 RSNA conference, GE Healthcare introduced the next generation of ABUS, Invenia ABUS 2.0, which offers not only heightened image quality, but significant benefits for patients, technologists and radiologists.

“The new Invenia ABUS 2.0 enhances the exam experience for both operators and patients, including new features that further customize the exam based on the patient’s body habitus. Providing a holistic view of the breast for better insight, the Invenia ABUS 2.0 brings the clinical advantages of ultrasound with the standardization and consistency needed for broader use in screening,” said Delaney.

Efficient exams
The powerful cSound™ Imageformer, a software-based graphics processor, provides a reproducible and operator-independent acquisition method to achieve consistent, high quality results. cSound imaging allows significantly more data to be collected and used to create every image. Traditional hand-held ultrasound parameters are automatically optimized, requiring no image manipulation and resulting in high image quality that is consistent from operator to operator with the touch of a button.

According to Lisa Stempel, MD, Acting Medical Director, Regenstein Breast Imaging Center, Rush University Medical Center, “All of the updates allow for better compressed images and tissue coverage. The new features can also lead to a decreased number of image sets that need to be obtained and shorter scan times. Additionally, the updated system and imaging algorithms yield images that are of much better quality and detail, with better contrast resolution and less noise. This leads to more detailed images which makes the exam more sensitive for finding cancer and decreases false positive call backs. Having the ability to compare to last year’s exams, reveals a significant improvement in image quality.”

Improving the patient experience
The gentle shape of the Reverse Curve™ transducer provides patient comfort, thorough contact and helps ensure comprehensive coverage. The 15 cm large field-of-view transducer is easy to position and maintains even compression while scanning. Since no two women are identical, exams can be customized with programmable scan protocols, adjustable scan depths and compression levels. The operator can also shorten scan time once breast tissue acquisition is complete.

“Our technologists are very happy with the new Invenia ABUS 2.0. They have found many advantages, and especially appreciate being able to unlock the scan head for enhanced compression, which gives them better contact and the ability to cover more tissue. Finally, for acquisition image review, seeing the axial images as well as the coronal images allows them to better assess compression and coverage of the tissue,” added Dr. Stempel.

Intuitive and Streamlined Reading
The Invenia ABUS Viewer is designed for fast, efficient workflow for reading and reporting, allowing radiologists to quickly review, interpret and archive patient exams. “I believe Invenia’s user interface is excellent compared to other 3D ultrasound technology I have used in the past. I am able to navigate the viewer easily in order to completely evaluate the breast and provide patients with accurate and timely results. The images that have abnormal findings are marked, stored, and sent to PACS with only a few keystrokes,” Michelle Lindgren, MD, radiologist, Midwest Center for Advanced Imaging, a Department of Rush Copley Medical Center. “I have found that Invenia’s coronal images are very detailed and extremely useful when interpreting studies. Additionally, in areas that are often difficult to image with ultrasound, such as the retroareolar regions or deep areas of the breasts, the breast tissue on ABUS exams is seen clearly without the limitation of dense shadowing.”

“I feel that ABUS is an excellent way to use breast ultrasound for screening. I prefer seeing the images from the entire breast myself to evaluate for subtle cancers. The cancers we have found are small, mammographically occult, node negative, invasive cancers and this is exactly why we added this important screening tool. These are the cancers we want to find in order to have the most significant impact on the patient’s prognosis. In addition, as we enter our second year, we are finding the comparison images to be incredibly beneficial to bringing the call back rate down,” Dr. Stempel concluded.
Hear from early evaluators of Invenia ABUS 2.0
Georgia Giakoumis Spear, MD
Chief of the Department of Breast Imaging, NorthShore University Health System, IL, USA
Susan G. Roux, MD
Medical Director, Carol Hatton Breast Care Center Community Hospital of the Monterey Peninsula, CA, USA
Invenia ABUS 2.0 is part of the suite of personalized breast care solutions from GE Healthcare. To learn more please click on the boxes below:
© 2019 General Electric Company.
GE, the GE Monogram and Invenia are trademarks of General Electric Company.
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