1
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van Lier MGJTB, de Groot JE, Muller S, den Heeten GJ, Schilling KJ. Pressure-based Compression Guidance of the Breast in Digital Breast Tomosynthesis Using Flexible Paddles Compared to Conventional Compression. J Breast Imaging 2020; 2:541-551. [PMID: 38424851 DOI: 10.1093/jbi/wbaa070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE We investigated the effect of introducing a pressure-based flexible paddle on compression parameters and user and patient experience of digital breast tomosynthesis (DBT) combined with patient-assisted compression or technologist compression. METHODS After institutional review board approval, women with a DBT appointment who gave informed consent received pressure-based flexible paddle breast compression. Eight lights on the paddle were illuminated (1.9 kPa per light) as pressure was applied, aiming for an 8-13.9 kPa target range. The compression level was applied by the technologist or the participant utilizing a remote control device. The participant's and technologist's experiences were assessed by a questionnaire. Compression parameters were compared to previous examinations. Comparative statistics were performed using t-tests. RESULTS Pressure-based compression (PBC) was judged to be similar or more comfortable compared with previous traditional exams (80%, 83/103), and 87% (90/103) of participants would recommend PBC to friends. Pressure variability decreased for craniocaudal (CC) views (-55%, P < 0.001) and mediolateral oblique (MLO) views (-34%, P < 0.0001). Subgroup analysis showed a similar glandular dose for CC views, while breast thickness was reduced (-3.74 mm, P < 0.0001). For MLO views, both glandular dose (-0.13 mGy, P < 0.0001) and breast thickness were reduced (-6.70 mm, P < 0.0001). Mean compression parameters were similar for technologist compression and patient-assisted examinations. CONCLUSION Use of the pressure-based flexible paddle in DBT, with or without patient-assisted compression, improved participant and technologist experience and reduced compression pressure variability, mean breast thickness, and glandular dose.
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Affiliation(s)
| | | | | | - Gerard J den Heeten
- Sigmascreening, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, The Netherlands
| | - Kathy J Schilling
- Christine E. Lynn Women's Health & Wellness Institute, Boca Raton Regional Hospital, Boca Raton, FL
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2
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de Munck L, Fracheboud J, de Bock GH, den Heeten GJ, Siesling S, Broeders MJM. Is the incidence of advanced-stage breast cancer affected by whether women attend a steady-state screening program? Int J Cancer 2018; 143:842-850. [PMID: 29574967 DOI: 10.1002/ijc.31388] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 11/05/2022]
Abstract
In this cross-sectional population-based study, we assessed the incidence of advanced breast cancer based on screening attendance. Women from the Netherlands Cancer Registry were included if aged ≥49 years and diagnosed with breast cancer between 2006 and 2011, and data were linked with the screening program. Cancers were defined as screen-related (diagnosed <24 months after screening) or nonscreened (all other breast cancers). Two cut-offs were used to define advanced breast cancer: TNM-stage (III-IV vs 0-I-II) and T-stage alone (≥15 mm vs <15 mm or DCIS). The incidence rates were adjusted for age and logistic regression was used to compare groups. Of the 72,612 included women diagnosed with breast cancer, 44,246 (61%) had screen-related breast cancer. By TNM stage, advanced cancer was almost three times as likely to be at an advanced TNM stage in the nonscreened group compared with the screen-related group (38 and 94 per 100,000, respectively; OR: 2.86, 95%CI: 2.72-3.00). By T-stage, the incidence of advanced cancer was higher overall, and in nonscreened women was significantly higher than in screened women (210 and 169 per 100,000; OR: 1.85, 95%CI: 1.78-1.93). Data on actual screening attendance showed that the incidence of advanced breast cancer was significantly higher in nonscreened women than in screened women, supporting the expectation that screening would cause a stage shift to early detection. Despite critical evaluations of breast cancer screening programs, our data show that breast cancer screening is a valuable tool that can reduce the disease burden in women.
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Affiliation(s)
- Linda de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacques Fracheboud
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerard J den Heeten
- Dutch Reference Centre for Screening, Nijmegen, The Netherlands.,Department of Radiology, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Mireille J M Broeders
- Dutch Reference Centre for Screening, Nijmegen, The Netherlands.,Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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3
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Holland K, Sechopoulos I, Mann RM, den Heeten GJ, van Gils CH, Karssemeijer N. Influence of breast compression pressure on the performance of population-based mammography screening. Breast Cancer Res 2017; 19:126. [PMID: 29183348 PMCID: PMC5706300 DOI: 10.1186/s13058-017-0917-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 11/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In mammography, breast compression is applied to reduce the thickness of the breast. While it is widely accepted that firm breast compression is needed to ensure acceptable image quality, guidelines remain vague about how much compression should be applied during mammogram acquisition. A quantitative parameter indicating the desirable amount of compression is not available. Consequently, little is known about the relationship between the amount of breast compression and breast cancer detectability. The purpose of this study is to determine the effect of breast compression pressure in mammography on breast cancer screening outcomes. METHODS We used digital image analysis methods to determine breast volume, percent dense volume, and pressure from 132,776 examinations of 57,179 women participating in the Dutch population-based biennial breast cancer screening program. Pressure was estimated by dividing the compression force by the area of the contact surface between breast and compression paddle. The data was subdivided into quintiles of pressure and the number of screen-detected cancers, interval cancers, false positives, and true negatives were determined for each group. Generalized estimating equations were used to account for correlation between examinations of the same woman and for the effect of breast density and volume when estimating sensitivity, specificity, and other performance measures. Sensitivity was computed using interval cancers occurring between two screening rounds and using interval cancers within 12 months after screening. Pair-wise testing for significant differences was performed. RESULTS Percent dense volume increased with increasing pressure, while breast volume decreased. Sensitivity in quintiles with increasing pressure was 82.0%, 77.1%, 79.8%, 71.1%, and 70.8%. Sensitivity based on interval cancers within 12 months was significantly lower in the highest pressure quintile compared to the third (84.3% vs 93.9%, p = 0.034). Specificity was lower in the lowest pressure quintile (98.0%) compared to the second, third, and fourth group (98.5%, p < 0.005). Specificity of the fifth quintile was 98.4%. CONCLUSION Results suggest that if too much pressure is applied during mammography this may reduce sensitivity. In contrast, if pressure is low this may decrease specificity.
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Affiliation(s)
- Katharina Holland
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Ioannis Sechopoulos
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Ritse M. Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Gerard J. den Heeten
- Department of Radiology/Biomedical Engineering and Physics, Academic Medical Center Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Carla H. van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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4
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Bouwman RW, Mackenzie A, van Engen RE, Broeders MJM, Young KC, Dance DR, den Heeten GJ, Veldkamp WJH. Toward image quality assessment in mammography using model observers: Detection of a calcification-like object. Med Phys 2017; 44:5726-5739. [PMID: 28837225 DOI: 10.1002/mp.12532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/17/2017] [Accepted: 08/17/2017] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Model observers (MOs) are of interest in the field of medical imaging to assess image quality. However, before procedures using MOs can be proposed in quality control guidelines for mammography systems, we need to know whether MOs are sensitive to changes in image quality and correlations in background structure. Therefore, as a proof of principle, in this study human and model observer (MO) performance are compared for the detection of calcification-like objects using different background structures and image quality levels of unprocessed mammography images. METHOD Three different phantoms, homogeneous polymethyl methacrylate, BR3D slabs with swirled patterns (CIRS, Norfolk, VA, USA), and a prototype anthropomorphic breast phantom (Institute of Medical Physics and Radiation Protection, Technische Hochschule Mittelhessen, Germany) were imaged on an Amulet Innovality (FujiFilm, Tokyo, Japan) mammographic X-ray unit. Because the complexities of the structures of these three phantoms were different and not optimized to match the characteristics of real mammographic images, image processing was not applied in this study. In addition, real mammograms were acquired on the same system. Regions of interest (ROIs) were extracted from each image. In half of the ROIs, a 0.25-mm diameter disk was inserted at four different contrast levels to represent a calcification-like object. Each ROI was then modified, so four image qualities relevant for mammography were simulated. The signal-present and signal-absent ROIs were evaluated by a non-pre-whitening model observer with eye filter (NPWE) and a channelized Hotelling observer (CHO) using dense difference of Gaussian channels. The ROIs were also evaluated by human observers in a two alternative forced choice experiment. Detectability results for the human and model observer experiments were correlated using a mixed-effect regression model. Threshold disk contrasts for human and predicted human observer performance based on the NPWE MO and CHO were estimated. RESULTS Global trends in threshold contrast were similar for the different background structures, but absolute contrast threshold levels differed. Contrast thresholds tended to be lower in ROIs from simple phantoms compared with ROIs from real mammographic images. The correlation between human and model observer performance was not affected by the range of image quality levels studied. CONCLUSIONS The correlation between human and model observer performance does not depend on image quality. This is a promising outcome for the use of model observers in image quality analysis and allows for subsequent research toward the development of MO-based quality control procedures and guidelines.
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Affiliation(s)
- Ramona W Bouwman
- Dutch Expert Centre for Screening (LRCB), Radboud University Medical Center, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
| | - Alistair Mackenzie
- National Co-ordinating Centre for the Physics of Mammography (NCCPM), Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, UK
| | - Ruben E van Engen
- Dutch Expert Centre for Screening (LRCB), Radboud University Medical Center, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
| | - Mireille J M Broeders
- Dutch Expert Centre for Screening (LRCB), Radboud University Medical Center, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Kenneth C Young
- National Co-ordinating Centre for the Physics of Mammography (NCCPM), Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, UK
- Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - David R Dance
- National Co-ordinating Centre for the Physics of Mammography (NCCPM), Royal Surrey County Hospital, Guildford, Surrey, GU2 7XX, UK
- Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Gerard J den Heeten
- Dutch Expert Centre for Screening (LRCB), Radboud University Medical Center, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
- Department of Radiology, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Wouter J H Veldkamp
- Dutch Expert Centre for Screening (LRCB), Radboud University Medical Center, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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5
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Sankatsing VDV, van Ravesteyn NT, Heijnsdijk EAM, Looman CWN, van Luijt PA, Fracheboud J, den Heeten GJ, Broeders MJM, de Koning HJ. The effect of population-based mammography screening in Dutch municipalities on breast cancer mortality: 20 years of follow-up. Int J Cancer 2017; 141:671-677. [PMID: 28457023 DOI: 10.1002/ijc.30754] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 01/09/2017] [Accepted: 01/24/2017] [Indexed: 11/07/2022]
Abstract
Long-term follow-up data on the effects of screening are scarce, and debate exists on the relative contribution of screening versus treatment to breast cancer mortality reduction. Our aim was therefore to assess the long-term effect of screening by age and time of implementation. We obtained data on 69,630 breast cancer deaths between 1980 and 2010 by municipality (N = 431) and age of death (40-79) in the Netherlands. Breast cancer mortality trends were analyzed by defining the municipality-specific calendar year of introduction of screening as Year 0. Additionally, log-linear Poisson regression was used to estimate the turning point in the trend after Year 0, per municipality, and the annual percentage change (APC) before and after this point. Twenty years after introduction of screening breast cancer mortality was reduced by 30% in women aged 55-74 and by 34% in women aged 75-79, compared to Year 0. A similar and significant decrease was present in municipalities that started early (1987-1992) and late (1995-1997) with screening, despite the difference in availability of effective adjuvant treatment. In the age groups 55-74 and 75-79, the turning point in the trend in breast cancer mortality was estimated in Years 2 and 6 after the introduction of screening, respectively, after which mortality decreased significantly by 1.9% and 2.6% annually. These findings show that the implementation of mammography screening in Dutch municipalities is associated with a significant decline in breast cancer mortality in women aged 55-79, irrespective of time of implementation.
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Affiliation(s)
- Valérie D V Sankatsing
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | | | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Caspar W N Looman
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Paula A van Luijt
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Jacques Fracheboud
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | | | - Mireille J M Broeders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Dutch Reference Centre for Screening, Nijmegen, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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6
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Otten JD, van Schoor G, Peer PG, den Heeten GJ, Holland R, Broeders MJ, Verbeek AL. Growth rate of invasive ductal carcinomas from a screened 50-74-year-old population. J Med Screen 2017; 25:40-46. [PMID: 28084888 DOI: 10.1177/0969141316687791] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective As breast cancer growth rate is associated with menopause, most screening programmes target mainly women aged 50-74. We studied the association between age at diagnosis and growth rate in this screening-specific age range. Methods We used data from breast cancer patients diagnosed in the screening programme in Nijmegen, the Netherlands. The data were restricted to the screening rounds when analogue mammography was used in both the screening and clinical setting. Growth rate expressed as tumour volume doubling time was based on increasing tumour size in longitudinal series of mammograms. Estimates were based on (a) tumours showing at least two measurable shadows, (b) tumours showing a shadow at detection only (left censored), and (c) tumours showing no growth (right-censored observation). All 293 tumours were consecutively diagnosed invasive ductal breast cancers in participants of the Nijmegen screening programme in the period 2000-2007. Results Depending on the assumptions made on tumour margins and mammographic density, the relation of volume doubling time with age non-significantly varies from a decrease of 3.3% to an increase of 1.4% for each year increase in age at diagnosis (all P-values ≥ 0.18). Applying left censoring on indistinct tumours, the geometric mean volume doubling time was 191 days (95% confidence interval 158-230). Conclusion We found no significant change in growth rate with age in women diagnosed with invasive ductal breast cancer in the screening age range 50-74. This outcome does not support differential screening intervals by age based solely on breast cancer growth rate for this particular group.
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Affiliation(s)
- Johannes Dm Otten
- 1 Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido van Schoor
- 2 Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petronella Gm Peer
- 1 Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerard J den Heeten
- 3 Dutch Reference Centre for Screening, Nijmegen, The Netherlands.,4 Department of Radiology, Biomechcanical Engineering & Physics, Academic Medical Centre Amsterdam, The Netherlands
| | - Roland Holland
- 5 Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mireille Jm Broeders
- 1 Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,3 Dutch Reference Centre for Screening, Nijmegen, The Netherlands
| | - André Lm Verbeek
- 1 Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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7
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Holland K, van Zelst J, den Heeten GJ, Imhof-Tas M, Mann RM, van Gils CH, Karssemeijer N. Consistency of breast density categories in serial screening mammograms: A comparison between automated and human assessment. Breast 2016; 29:49-54. [PMID: 27420382 DOI: 10.1016/j.breast.2016.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 12/23/2022] Open
Abstract
Reliable breast density measurement is needed to personalize screening by using density as a risk factor and offering supplemental screening to women with dense breasts. We investigated the categorization of pairs of subsequent screening mammograms into density classes by human readers and by an automated system. With software (VDG) and by four readers, including three specialized breast radiologists, 1000 mammograms belonging to 500 pairs of subsequent screening exams were categorized into either two or four density classes. We calculated percent agreement and the percentage of women that changed from dense to non-dense and vice versa. Inter-exam agreement (IEA) was calculated with kappa statistics. Results were computed for each reader individually and for the case that each mammogram was classified by one of the four readers by random assignment (group reading). Higher percent agreement was found with VDG (90.4%, CI 87.9-92.9%) than with readers (86.2-89.2%), while less plausible changes from non-dense to dense occur less often with VDG (2.8%, CI 1.4-4.2%) than with group reading (4.2%, CI 2.4-6.0%). We found an IEA of 0.68-0.77 for the readers using two classes and an IEA of 0.76-0.82 using four classes. IEA is significantly higher with VDG compared to group reading. The categorization of serial mammograms in density classes is more consistent with automated software than with a mixed group of human readers. When using breast density to personalize screening protocols, assessment with software may be preferred over assessment by radiologists.
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Affiliation(s)
- Katharina Holland
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Jan van Zelst
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Gerard J den Heeten
- LRCB - Dutch Reference Center for Screening, PO Box 6873, 6503 GJ Nijmegen, The Netherlands; Department of Radiology/Biomedical Engineering and Physics, Academic Medical Center Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Mechli Imhof-Tas
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Ritse M Mann
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
| | - Nico Karssemeijer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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8
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Ripping TM, Hubbard RA, Otten JDM, den Heeten GJ, Verbeek ALM, Broeders MJM. Towards personalized screening: Cumulative risk of breast cancer screening outcomes in women with and without a first-degree relative with a history of breast cancer. Int J Cancer 2015; 138:1619-25. [PMID: 26537645 DOI: 10.1002/ijc.29912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/29/2015] [Indexed: 12/29/2022]
Abstract
Several reviews have estimated the balance of benefits and harms of mammographic screening in the general population. The balance may, however, differ between individuals with and without family history. Therefore, our aim is to assess the cumulative risk of screening outcomes; screen-detected breast cancer, interval cancer, and false-positive results, in women screenees aged 50-75 and 40-75, with and without a first-degree relative with a history of breast cancer at the start of screening. Data on screening attendance, recall and breast cancer detection were collected for each woman living in Nijmegen (The Netherlands) since 1975. We used a discrete time survival model to calculate the cumulative probability of each major screening outcome over 19 screening rounds. Women with a family history of breast cancer had a higher risk of all screening outcomes. For women screened from age 50-75, the cumulative risk of screen-detected breast cancer, interval cancer and false-positive results were 9.0, 4.4 and 11.1% for women with a family history and 6.3, 2.7 and 7.3% for women without a family history, respectively. The results for women 40-75 followed the same pattern for women screened 50-75 for cancer outcomes, but were almost doubled for false-positive results. To conclude, women with a first-degree relative with a history of breast cancer are more likely to experience benefits and harms of screening than women without a family history. To complete the balance and provide risk-based screening recommendations, the breast cancer mortality reduction and overdiagnosis should be estimated for family history subgroups.
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Affiliation(s)
- Theodora Maria Ripping
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Johannes D M Otten
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Gerard J den Heeten
- Dutch Reference Centre for Screening, Nijmegen, the Netherlands.,Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - André L M Verbeek
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mireille J M Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands.,Dutch Reference Centre for Screening, Nijmegen, the Netherlands
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9
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Timmers J, Voorde MT, Engen REV, Landsveld-Verhoeven CV, Pijnappel R, Greve KDD, Heeten GJD, Broeders MJM. Mammography with and without radiolucent positioning sheets: Comparison of projected breast area, pain experience, radiation dose and technical image quality. Eur J Radiol 2015; 84:1903-9. [PMID: 26272030 DOI: 10.1016/j.ejrad.2015.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/29/2015] [Accepted: 07/01/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare projected breast area, image quality, pain experience and radiation dose between mammography performed with and without radiolucent positioning sheets. METHODS 184 women screened in the Dutch breast screening programme (May-June 2012) provided written informed consent to have one additional image taken with positioning sheets. 5 cases were excluded (missing data). Pain was scored using the Numeric Rating Scale. Radiation dose was estimated using the Dance model and projected breast area using computer software. Two radiologists and two radiographers assessed image quality. RESULTS With positioning sheets significantly more pectoral muscle, lateral and medial breast tissue was projected (CC-views) and more and deeper depicted pectoral muscle (MLO-views). In contrast, visibility of white and darker areas was better on images without positioning sheets, radiologists were therefore better able to detect abnormalities (MLO-views). Women experienced more pain with positioning sheets (MLO-views only, mean difference NRS 0.98; SD 1.71; p=0,00). CONCLUSION Mammograms with positioning sheets showed more breast tissue. Increased breast thickness after compression with sheets resulted in less visibility of white and darker areas and thus reduced detection of abnormalities. Also, women experienced more pain (MLO-views) due to the sheet material. A practical consideration is the fact that more subcutaneous fat tissue and skin are being pulled forward leading to folds in the nipple area. On balance, improvement to the current design is required before implementation in screening practice can be considered.
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Affiliation(s)
- Janine Timmers
- Dutch reference centre for screening, Nijmegen, The Netherlands.
| | - Marloes Ten Voorde
- Organization for cancer screening in the Eastern Part of the Netherlands, Deventer, The Netherlands.
| | | | | | - Ruud Pijnappel
- Dutch reference centre for screening, Nijmegen, The Netherlands; Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands.
| | - Kitty Droogh-de Greve
- Organization for cancer screening in the Eastern Part of the Netherlands, Deventer, The Netherlands; Department of Radiology, Gelre Ziekenhuizen, Deventer, The Netherlands.
| | - Gerard J den Heeten
- Dutch reference centre for screening, Nijmegen, The Netherlands; Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
| | - Mireille J M Broeders
- Dutch reference centre for screening, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands.
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10
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van der Waal D, Emaus MJ, Bakker MF, den Heeten GJ, Karssemeijer N, Pijnappel RM, Veldhuis WB, Verbeek ALM, van Gils CH, Broeders MJM. Geographic variation in volumetric breast density between screening regions in the Netherlands. Eur Radiol 2015; 25:3328-37. [PMID: 26134996 PMCID: PMC4595533 DOI: 10.1007/s00330-015-3742-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/10/2015] [Accepted: 03/25/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Differences in breast density between populations may explain part of the variation in regional breast cancer screening performance. This study aimed to determine whether regional differences in breast density distribution are present in the Dutch screening population. METHODS As part of the DENSE trial, mammographic density was measured using a fully-automated volumetric method. The regions in our study were based on the geographic coverage of 14 reading units representing a large part of the Netherlands. General linear models were used. RESULTS Four hundred eighty-five thousand and twenty-one screening participants with a median age of 60 years were included (2013-2014). The proportion of women with heterogeneously or extremely dense breasts ranged from 32.5% to 45.7% between regions. Mean percent dense volume varied between 6.51% (95% confidence interval [CI]: 6.46-6.55) and 7.68% (95% CI: 7.66-7.71). Age differences could not explain the variation. Socio-economic status (SES) was positively associated with volumetric density in all analyses (low SES: 6.95% vs. high SES: 7.63%; p trend < 0.0001), whereas a potential association between urbanisation and breast density only became apparent after SES adjustment. CONCLUSION There appears to be geographic variation in mammographic density in the Netherlands, emphasizing the importance of including breast density as parameter in the evaluation of screening performance. KEY POINTS • Mammographic density may affect regional breast cancer screening performance. • Volumetric breast density varies across screening areas. • SES is positively associated with breast density. • Implications of volumetric breast density differences need to be studied further.
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Affiliation(s)
- Daniëlle van der Waal
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Marleen J Emaus
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije F Bakker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerard J den Heeten
- Dutch Reference Centre for Screening, Nijmegen, The Netherlands.,Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Nico Karssemeijer
- Department of Radiology, Radboud university medical center, Nijmegen, The Netherlands
| | - Ruud M Pijnappel
- Dutch Reference Centre for Screening, Nijmegen, The Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - André L M Verbeek
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Carla H van Gils
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mireille J M Broeders
- Radboud Institute for Health Sciences (Department for Health Evidence, Mailbox 133), Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Dutch Reference Centre for Screening, Nijmegen, The Netherlands
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11
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Geertse TD, Holland R, Timmers JMH, Paap E, Pijnappel RM, Broeders MJM, den Heeten GJ. Value of audits in breast cancer screening quality assurance programmes. Eur Radiol 2015; 25:3338-47. [DOI: 10.1007/s00330-015-3744-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/11/2015] [Accepted: 03/26/2015] [Indexed: 11/29/2022]
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12
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Branderhorst W, de Groot JE, Highnam R, Chan A, Böhm-Vélez M, Broeders MJ, den Heeten GJ, Grimbergen CA. Mammographic compression – A need for mechanical standardization. Eur J Radiol 2015; 84:596-602. [PMID: 25596915 DOI: 10.1016/j.ejrad.2014.12.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 11/24/2022]
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13
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de Groot JE, Broeders MJM, Grimbergen CA, den Heeten GJ. Pain-preventing strategies in mammography: an observational study of simultaneously recorded pain and breast mechanics throughout the entire breast compression cycle. BMC Womens Health 2015; 15:26. [PMID: 25783657 PMCID: PMC4369109 DOI: 10.1186/s12905-015-0185-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/04/2015] [Indexed: 11/24/2022]
Abstract
Background Many women consider mammography painful. Existing studies on pain-preventing strategies only mention pain scores reported before and after breast compression. Studying the pain dynamics during the entire compression cycle may provide new insights for effective pain-preventing strategies. Methods This observational study included 117 women who consented to use a custom turning knob to indicate their pain experience during standard mammographic breast compressions in the Academic Medical Center in Amsterdam, The Netherlands. The breast thickness, compression force, contact area, contact pressure and pain experience were recorded continuously. Breast volume was calculated retrospectively from the mammograms. We visualized the progression of pain in relation to breast mechanics for five groups of breast volumes and we performed multivariable regressions to identify factors that significantly predict pain experience. Results Breast compressions consisted of a deformation phase for flattening, and a clamping phase for immobilization. The clamping phase lasted 12.8 ± 3.6 seconds (average ± standard deviation), 1.7 times longer than the 7.5 ± 2.6 seconds deformation phase. During the clamping phase, the average pain score increased from 4.75 to 5.88 (+24%) on a 0 – 10 Numerical Rating Scale (NRS), and the proportion of women who reached severe pain (NRS ≥ 7) increased from 23% to 50% (more than doubled). Moderate pain (NRS ≥ 4) was reported up to four days after the mammogram. Multivariable analysis showed that pain recollection of the previous mammogram and breast pain before the compression, are significant predictors for pain. Women with smallest breasts experienced most pain: They received highest contact pressures (force divided by contact area) and the pressure increased at the highest rate. Conclusion We suggest further research on two pain-preventing strategies: 1) using a personalized compression protocol by applying to all breasts the same target pressure at the same, slow rate, and 2) shortening the phase during which the breast is clamped.
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Affiliation(s)
- Jerry E de Groot
- Department of Biomedical Engineering & Physics, Academic Medical Center, Meibergdreef 9, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands,
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14
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Broeders MJM, Ten Voorde M, Veldkamp WJH, van Engen RE, van Landsveld-Verhoeven C, 't Jong-Gunneman MNL, de Win J, Greve KDD, Paap E, den Heeten GJ. Comparison of a flexible versus a rigid breast compression paddle: pain experience, projected breast area, radiation dose and technical image quality. Eur Radiol 2015; 25:821-9. [PMID: 25504427 PMCID: PMC4328113 DOI: 10.1007/s00330-014-3422-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/12/2014] [Accepted: 08/28/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare pain, projected breast area, radiation dose and image quality between flexible (FP) and rigid (RP) breast compression paddles. METHODS The study was conducted in a Dutch mammographic screening unit (288 women). To compare both paddles one additional image with RP was made, consisting of either a mediolateral-oblique (MLO) or craniocaudal-view (CC). Pain experience was scored using the Numeric Rating Scale (NRS). Projected breast area was estimated using computer software. Radiation dose was estimated using the model by Dance. Image quality was reviewed by three radiologists and three radiographers. RESULTS There was no difference in pain experience between both paddles (mean difference NRS: 0.08 ± 0.08, p = 0.32). Mean radiation dose was 4.5 % lower with FP (0.09 ± 0.01 p = 0.00). On MLO-images, the projected breast area was 0.79 % larger with FP. Paired evaluation of image quality indicated that FP removed fibroglandular tissue from the image area and reduced contrast in the clinically relevant retroglandular area at chest wall side. CONCLUSIONS Although FP performed slightly better in the projected breast area, it moved breast tissue from the image area at chest wall side. RP showed better contrast, especially in the retroglandular area. We therefore recommend the use of RP for standard MLO and CC views.
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Affiliation(s)
- Mireille J M Broeders
- Dutch Reference Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands,
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15
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Landsveld-Verhoeven C, den Heeten GJ, Timmers JMH, Broeders MJM. [The correct mammographic positioning in breast cancer screening]. Ned Tijdschr Geneeskd 2015; 159:A9488. [PMID: 26507067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare the positioning quality of mammograms produced by new (NRs) versus experienced (ERs) screening radiographers in the Dutch breast cancer screening programme. DESIGN Retrospective study. METHOD NRs must successfully complete an education programme before being allowed to start work in Dutch screening practice. This education programme consists of a theoretical component, a practical component and a final practical examination, including a portfolio review. Furthermore, each unit undergoes an audit once every three years. During the audit, mammograms produced by ERs in the unit are assessed on the basis of criteria relating to the positioning of the breast. In this retrospective study, we analysed 13,520 images from portfolios (NRs) and 14,896 images from audits (ERs) on the basis of pre-specified quality criteria, e.g. depiction of the pectoral muscle. RESULTS Positioning quality was significantly better by NRs than ERs (CC views: 97% versus 86% adequate, p<0.01; MLO views: 92% versus 84% adequate, p<0.01). NRs scored better for most of the CC criteria but had more difficulty with for example the inframammary angle in MLO views than ERs. Overall, the mammograms from NRs were more often considered adequate, because their errors were less serious. CONCLUSION NRs perform better than ERs in terms of quality of positioning technique. These results stress the need for continuous monitoring of and feedback into the Dutch breast cancer screening programme to maintain high-quality screening mammography.
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Affiliation(s)
- Cary Landsveld-Verhoeven
- *Dit onderzoek werd eerder gepubliceerd in European Radiology (2015; epub 19 mei) met als titel 'Mammographic positioning quality of newly trained versus experienced radiographers in the Dutch breast cancer screening programme'. Afgedrukt met toestemming
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16
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de Groot JE, Branderhorst W, Grimbergen CA, den Heeten GJ, Broeders MJM. Towards personalized compression in mammography: a comparison study between pressure- and force-standardization. Eur J Radiol 2014; 84:384-391. [PMID: 25554008 DOI: 10.1016/j.ejrad.2014.12.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/19/2014] [Accepted: 12/03/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare a conventional 14 decanewton (daN) force-standardized compression protocol with a personalized 10kilopascal (kPa) pressure-standardized protocol. METHODS A new add-on contact area detector, which enables pressure-standardized compression, is validated in a double-blinded intra-individual comparison study. Breast screening participants (433) received one craniocaudal (CC) and one mediolateral oblique (MLO) compression for both breasts. Three of these compressions were force-standardized, and one, blinded and randomly assigned, was pressure-standardized. Participants scored their pain experience on an 11-point numerical rating scale (NRS). Three experienced breast-screening radiologists, blinded for compression protocol, indicated which images required retakes. RESULTS An unanticipated under-compression issue that occurred at forces below 5daN was effectively solved with minimal extra radiographer training during the study. For pressure-standardized compressions obtained at 5daN or more, the compressed breasts thickness increased on average 4.2% (MLO)-6.3% (CC), average pain scores were reduced by 10% (MLO)-17% (CC) and the proportion of women experiencing severe pain (NRS≥7) was reduced by 27% (MLO)-32% (CC), compared with force-standardized compressions (all p-values <0.05). Average glandular dose (AGD) and proportions of retakes were similar for both protocols. CONCLUSION Pressure-standardized compressions resulted in AGD values and a retake proportion similar to force-standardized compressions, while pain was significantly reduced.
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Affiliation(s)
- Jerry E de Groot
- Academic Medical Center, Room L0-151, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic Medical Center, Department of Biomedical Engineering & Physics, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Woutjan Branderhorst
- Academic Medical Center, Department of Biomedical Engineering & Physics, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; Sigmascreening B.V., Meibergdreef 45, 1105 BA Amsterdam, The Netherlands.
| | - Cornelis A Grimbergen
- Academic Medical Center, Department of Biomedical Engineering & Physics, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; Sigmascreening B.V., Meibergdreef 45, 1105 BA Amsterdam, The Netherlands.
| | - Gerard J den Heeten
- Academic Medical Center, Department of Radiology, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; LRCB Dutch Reference Center for Screening, P.O. Box 6873, 6503 GJ Nijmegen, The Netherlands.
| | - Mireille J M Broeders
- Radboud University Medical Center, Department for Health Evidence, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; LRCB Dutch Reference Center for Screening, P.O. Box 6873, 6503 GJ Nijmegen, The Netherlands.
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17
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Timmers JM, Damen JA, Pijnappel RM, Verbeek AL, den Heeten GJ, Adang EM, Broeders MJ. Cost-effectiveness of non-invasive assessment in the Dutch breast cancer screening program versus usual care: a randomized controlled trial. Can J Public Health 2014; 105:e342-7. [PMID: 25365268 PMCID: PMC6972061 DOI: 10.17269/cjph.105.4463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 09/17/2014] [Accepted: 07/04/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Increased recall rates in the Dutch breast cancer screening program call for a new assessment strategy aiming to reduce unnecessary costs and anxiety. Diagnostic work-up (usual care) includes multidisciplinary hospital assessment and is similar for all recalled women, regardless of the radiologist's suspicion of breast cancer. This is similar in many Canadian settings. We developed a novel assessment strategy that offers women with a low suspicion of breast cancer a quick and non-invasive assessment by a screening radiologist (intervention). We compared these two strategies in a cost-effectiveness analysis based on a randomized controlled trial: multicentre randomized controlled trial (MASS trial, Netherlands National Trial Register: NTR1480). METHODS Participants were enrolled between August 2010 and December 2012 and were randomly assigned to either the intervention or control group (allocation ratio 2:1). Fourteen assessment centres participated in the study. Questionnaires were used to record quality of life (EuroQol-5D), health care use and costs after recall. RESULTS Our study comprised 366 women, of whom 288 were randomly assigned to the intervention group and 88 to the control group. The mean difference in cost was €153/CAD $226 (95% confidence interval €107-199/CAD $158-294, p<0.001). We found no significant differences in quality of life. The bootstrapped incremental cost-effectiveness ratios in the cost-effectiveness plane showed that the intervention was the efficient, cost-saving modality. CONCLUSION Our data show the benefits of tailoring diagnostic assessment to the screening radiologist's suspicion of breast cancer. Scenarios of implementing such a strategy in the Dutch screening or health care system are currently being discussed with various stakeholders.
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Affiliation(s)
- Johanna M Timmers
- Dutch National Expert and Training Centre for Breast Cancer Screening.
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18
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Klompenhouwer EG, Duijm LEM, Voogd AC, den Heeten GJ, Strobbe LJ, Louwman MW, Coebergh JW, Venderink D, Broeders MJM. Re-attendance at biennial screening mammography following a repeated false positive recall. Breast Cancer Res Treat 2014; 145:429-37. [DOI: 10.1007/s10549-014-2959-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 04/07/2014] [Indexed: 11/27/2022]
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19
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Paap E, Verbeek ALM, Botterweck AAM, van Doorne-Nagtegaal HJ, Imhof-Tas M, de Koning HJ, Otto SJ, de Munck L, van der Steen A, Holland R, den Heeten GJ, Broeders MJM. Breast cancer screening halves the risk of breast cancer death: a case-referent study. Breast 2014; 23:439-44. [PMID: 24713277 DOI: 10.1016/j.breast.2014.03.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 03/03/2014] [Accepted: 03/03/2014] [Indexed: 10/25/2022] Open
Abstract
Large-scale epidemiologic studies have consistently demonstrated the effectiveness of mammographic screening programs, however the benefits are still subject to debate. We estimated the effect of the Dutch screening program on breast cancer mortality. In a large multi-region case-referent study, we identified all breast cancer deaths in 2004 and 2005 in women aged 50-75 who had been invited for screening (cases). Cases were individually matched to referents from the population invited to screening. Conditional logistic regression was used to estimate the odds ratio (OR) of breast cancer death according to individual screening history. The OR was adjusted for self-selection bias using regional correction factors for the difference in baseline risk for breast cancer death between screened and unscreened women. A total of 1233 cases and 2090 referents were included in this study. We found a 58% reduction in breast cancer mortality in screened versus unscreened women (adjusted OR = 0.42, 95% CI 0.33-0.53). Screening, i.e. early detection and treatment, has resulted in a substantial reduction in breast cancer mortality, indicating that the Dutch breast cancer screening program is highly effective.
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Affiliation(s)
- Ellen Paap
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Mechli Imhof-Tas
- Department of Radiology, Radboud University Medical Center, Nijmegen, The Netherlands; Screening Program Early Detection of Breast Cancer in the Eastern Part of the Netherlands, Nijmegen, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzie J Otto
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Linda de Munck
- Comprehensive Cancer Centre the Netherlands, Utrecht, The Netherlands
| | - Annemieke van der Steen
- Screening Program Early Detection of Breast Cancer in the South-West Part of the Netherlands, Vlaardingen, The Netherlands
| | - Roland Holland
- National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands
| | - Gerard J den Heeten
- National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands; Department of Radiology, Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands; National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands.
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Bluekens AM, Broeders MJ, den Heeten GJ. Digital mammography in breast cancer screening: a step forward? Expert Rev Anticancer Ther 2013; 13:505-7. [PMID: 23617341 DOI: 10.1586/era.13.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Bluekens AMJ, Holland R, Karssemeijer N, Broeders MJM, den Heeten GJ. Comparison of Digital Screening Mammography and Screen-Film Mammography in the Early Detection of Clinically Relevant Cancers: A Multicenter Study. Radiology 2012; 265:707-14. [DOI: 10.1148/radiol.12111461] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Hupse R, Samulski M, Lobbes MB, Mann RM, Mus R, den Heeten GJ, Beijerinck D, Pijnappel RM, Boetes C, Karssemeijer N. Computer-aided detection of masses at mammography: interactive decision support versus prompts. Radiology 2012; 266:123-9. [PMID: 23091171 DOI: 10.1148/radiol.12120218] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare effectiveness of an interactive computer-aided detection (CAD) system, in which CAD marks and their associated suspiciousness scores remain hidden unless their location is queried by the reader, with the effect of traditional CAD prompts used in current clinical practice for the detection of malignant masses on full-field digital mammograms. MATERIALS AND METHODS The requirement for institutional review board approval was waived for this retrospective observer study. Nine certified screening radiologists and three residents who were trained in breast imaging read 200 studies (63 studies containing at least one screen-detected mass, 17 false-negative studies, 20 false-positive studies, and 100 normal studies) twice, once with CAD prompts and once with interactive CAD. Localized findings were reported and scored by the readers. In the prompted mode, findings were recorded before and after activation of CAD. The partial area under the location receiver operating characteristic (ROC) curve for an interval of low false-positive fractions typical for screening, from 0 to 0.2, was computed for each reader and each mode. Differences in reader performance were analyzed by using software. RESULTS The average partial area under the location ROC curve with unaided reading was 0.57, and it increased to 0.62 with interactive CAD, while it remained unaffected by prompts. The difference in reader performance for unaided reading versus interactive CAD was statistically significant (P = .009). CONCLUSION When used as decision support, interactive use of CAD for malignant masses on mammograms may be more effective than the current use of CAD, which is aimed at the prevention of perceptual oversights.
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Affiliation(s)
- Rianne Hupse
- Department of Radiology, Diagnostic Image Analysis Group, Radboud University Nijmegen Medical Centre, Geert Grooteplein-Zuid 10, Route 667, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
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23
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Smallenburg VVB, Duijm LE, den Heeten GJ, Groenewoud JH, Jansen FH, Fracheboud J, Plaisier ML, van Doorne-Nagtegaal HJ, Broeders MJ. Two-view versus single-view mammography at subsequent screening in a region of the Dutch breast screening programme. Eur J Radiol 2012; 81:2189-94. [DOI: 10.1016/j.ejrad.2011.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 07/15/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
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24
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Kallenberg MGJ, van Gils CH, Lokate M, den Heeten GJ, Karssemeijer N. Effect of compression paddle tilt correction on volumetric breast density estimation. Phys Med Biol 2012; 57:5155-68. [PMID: 22842727 DOI: 10.1088/0031-9155/57/16/5155] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
For the acquisition of a mammogram, a breast is compressed between a compression paddle and a support table. When compression is applied with a flexible compression paddle, the upper plate may be tilted, which results in variation in breast thickness from the chest wall to the breast margin. Paddle tilt has been recognized as a major problem in volumetric breast density estimation methods. In previous work, we developed a fully automatic method to correct the image for the effect of compression paddle tilt. In this study, we investigated in three experiments the effect of paddle tilt and its correction on volumetric breast density estimation. Results showed that paddle tilt considerably affected accuracy of volumetric breast density estimation, but that effect could be reduced by tilt correction. By applying tilt correction, a significant increase in correspondence between mammographic density estimates and measurements on MRI was established. We argue that in volumetric breast density estimation, tilt correction is both feasible and essential when mammographic images are acquired with a flexible compression paddle.
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Affiliation(s)
- Michiel G J Kallenberg
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 18, 6525 GA Nijmegen, the Netherlands.
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25
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Visser R, Veldkamp WJH, Beijerinck D, Bun PAM, Deurenberg JJM, Imhof-Tas MW, Schuur KH, Snoeren MM, den Heeten GJ, Karssemeijer N, Broeders MJM. Increase in perceived case suspiciousness due to local contrast optimisation in digital screening mammography. Eur Radiol 2011; 22:908-14. [PMID: 22071778 PMCID: PMC3297744 DOI: 10.1007/s00330-011-2320-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/31/2011] [Accepted: 09/12/2011] [Indexed: 11/27/2022]
Abstract
Objectives To determine the influence of local contrast optimisation on diagnostic accuracy and perceived suspiciousness of digital screening mammograms. Methods Data were collected from a screening region in the Netherlands and consisted of 263 digital screening cases (153 recalled,110 normal). Each case was available twice, once processed with a tissue equalisation (TE) algorithm and once with local contrast optimisation (PV). All cases had digitised previous mammograms. For both algorithms, the probability of malignancy of each finding was scored independently by six screening radiologists. Perceived case suspiciousness was defined as the highest probability of malignancy of all findings of a radiologist within a case. Differences in diagnostic accuracy of the processing algorithms were analysed by comparing the areas under the receiver operating characteristic curves (Az). Differences in perceived case suspiciousness were analysed using sign tests. Results There was no significant difference in Az (TE: 0.909, PV 0.917, P = 0.46). For all radiologists, perceived case suspiciousness using PV was higher than using TE more often than vice versa (ratio: 1.14–2.12). This was significant (P <0.0083) for four radiologists. Conclusions Optimisation of local contrast by image processing may increase perceived case suspiciousness, while diagnostic accuracy may remain similar. Key Points • Variations among different image processing algorithms for digital screening mammography are large. • Current algorithms still aim for optimal local contrast with a low dynamic range. • Although optimisation of contrast may increase sensitivity, diagnostic accuracy is probably unchanged. • Increased local contrast may render both normal and abnormal structures more conspicuous.
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Affiliation(s)
- Roelant Visser
- National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ Nijmegen, the Netherlands
| | - Wouter J. H. Veldkamp
- National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ Nijmegen, the Netherlands
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands
| | - David Beijerinck
- Screening Program Early detection of breast cancer in the Centre/Mid-West Part of the Netherlands, Utrecht, the Netherlands
| | - Petra A. M. Bun
- National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ Nijmegen, the Netherlands
- Department of Radiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jan J. M. Deurenberg
- Screening Program Early detection of breast cancer in the Centre/Mid-West Part of the Netherlands, Utrecht, the Netherlands
| | - Mechli W. Imhof-Tas
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Screening Program Early detection of breast cancer in the Eastern Part of the Netherlands, Nijmegen, the Netherlands
| | - Klaas H. Schuur
- National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ Nijmegen, the Netherlands
| | - Miranda M. Snoeren
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
- Screening Program Early detection of breast cancer in the Eastern Part of the Netherlands, Nijmegen, the Netherlands
| | - Gerard J. den Heeten
- National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ Nijmegen, the Netherlands
- Department of Radiology, Academical Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Nico Karssemeijer
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Mireille J. M. Broeders
- National Expert and Training Centre for Breast Cancer Screening, P.O. Box 6873, 6503 GJ Nijmegen, the Netherlands
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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van Schoor G, Moss SM, Otten JDM, Donders R, Paap E, den Heeten GJ, Holland R, Broeders MJM, Verbeek ALM. Effective biennial mammographic screening in women aged 40-49. Eur J Cancer 2010; 46:3137-40. [PMID: 21036034 DOI: 10.1016/j.ejca.2010.09.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 09/20/2010] [Accepted: 09/27/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND The United Kingdom is currently moving the age limit for invitation in its national breast screening programme downwards from 50 to 47. In contrast, the US Preventive Services Task Force concluded that, because of borderline statistical significance on effectiveness of mammographic screening, the current evidence is insufficient to advise screening in women aged 40-49. MATERIAL AND METHODS We designed a case-referent study to investigate the effect of biennial mammographic screening on breast cancer mortality for women in their forties. In Nijmegen, the Netherlands, screening started in 1975. A total of 272 breast cancer deaths were identified, and 1360 referents aged 40-69 were sampled from the population invited for screening. Effectiveness was estimated by calculating the odds ratio (OR) indicating the breast cancer death rate in screened versus unscreened women. RESULTS In women aged 40-49, the effect of screening was OR = 0.50 (95% confidence interval (CI) = 0.30-0.82). This result is similar to those aged 50-59 (OR = 0.54; 95% CI = 0.35-0.85) and 60-69 (OR = 0.65; 95% CI = 0.38-1.13). CONCLUSION Our results add convincing evidence about the effectiveness of biennial mammographic screening in women aged 40-49.
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Affiliation(s)
- Guido van Schoor
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Kolkman RGM, Blomme E, Cool T, Bilcke M, van Leeuwen TG, Steenbergen W, Grimbergen KA, den Heeten GJ. Feasibility of noncontact piezoelectric detection of photoacoustic signals in tissue-mimicking phantoms. J Biomed Opt 2010; 15:055011. [PMID: 21054093 DOI: 10.1117/1.3491113] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The feasibility of air-coupled ultrasound transducers to detect laser-induced ultrasound from artificial blood vessels embedded in an optically scattering phantom is demonstrated. These air-coupled transducers allow new applications in biomedical photoacoustic imaging where contact with tissue is not preferred. One promising application of such transducers is the addition of photoacoustic imaging to the regular x-ray mammographic screening procedure.
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Affiliation(s)
- Roy G M Kolkman
- University of Twente, MIRA Institute for Biomedical Technology and Technical Medicine, BioMedical Photonic Imaging, P.O. Box 217, 7500 AE Enschede, The Netherlands.
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Samulski M, Hupse R, Boetes C, Mus RDM, den Heeten GJ, Karssemeijer N. Using computer-aided detection in mammography as a decision support. Eur Radiol 2010; 20:2323-30. [PMID: 20532890 PMCID: PMC2940044 DOI: 10.1007/s00330-010-1821-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 03/23/2010] [Accepted: 04/20/2010] [Indexed: 11/21/2022]
Abstract
Objective: To evaluate an interactive computer-aided detection (CAD) system for reading mammograms to improve decision making. Methods: A dedicated mammographic workstation has been developed in which readers can probe image locations for the presence of CAD information. If present, CAD findings are displayed with the computed malignancy rating. A reader study was conducted in which four screening radiologists and five non-radiologists participated to study the effect of this system on detection performance. The participants read 120 cases of which 40 cases had a malignant mass that was missed at the original screening. The readers read each mammogram both with and without CAD in separate sessions. Each reader reported localized findings and assigned a malignancy score per finding. Mean sensitivity was computed in an interval of false-positive fractions less than 10%. Results: Mean sensitivity was 25.1% in the sessions without CAD and 34.8% in the CAD-assisted sessions. The increase in detection performance was significant (p = 0.012). Average reading time was 84.7 ± 61.5 s/case in the unaided sessions and was not significantly higher when interactive CAD was used (85.9 ± 57.8 s/case). Conclusion: Interactive use of CAD in mammography may be more effective than traditional CAD for improving mass detection without affecting reading time.
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Affiliation(s)
- Maurice Samulski
- Department of Radiology, Radboud University Nijmegen Medical Centre, Geert Grooteplein 10, 6500 HB, Nijmegen, The Netherlands.
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Peters BD, Dingemans PM, Dekker N, Blaas J, Akkerman E, van Amelsvoort TA, Majoie CB, den Heeten GJ, Linszen DH, de Haan L. White matter connectivity and psychosis in ultra-high-risk subjects: a diffusion tensor fiber tracking study. Psychiatry Res 2010; 181:44-50. [PMID: 19954931 DOI: 10.1016/j.pscychresns.2009.10.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2008] [Revised: 10/11/2009] [Accepted: 10/18/2009] [Indexed: 01/15/2023]
Abstract
This study assessed with diffusion tensor imaging (DTI) whether ultra-high-risk subjects who later develop a psychotic disorder (UHR-P) show abnormalities in association white matter fiber tracts as compared to UHR subjects who do not convert to psychosis (UHR-NP) and healthy controls. Participants comprised 17 male UHR subjects and 10 male healthy controls, who received baseline DTI scans before clinical follow-up. The uncinate and arcuate fasciculi, anterior and dorsal cingulate, and subdivisions of the corpus callosum were calculated and visualized, and tract-specific measurements were performed. At 24-month follow-up seven UHR subjects had developed a first psychotic episode. Fractional anisotropy in baseline DTI scans, including left-right asymmetry measures, did not differ between the groups. Thus, DTI measures of these association white matter tracts were not biological markers of psychosis in our UHR sample. Abnormalities of these fiber tracts may develop around or after onset of psychosis. However, further DTI studies in UHR subjects are needed in larger samples.
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Affiliation(s)
- Bart D Peters
- Department of Psychiatry, Adolescentclinic, Academic Medical Center, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands.
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Gratama van Andel HA, van Boven LJ, van Walderveen MA, Venema HW, van Rijn JC, Stam J, Grimbergen CA, den Heeten GJ, Majoie CB. Interobserver variability in the detection of cerebral venous thrombosis using CT venography with matched mask bone elimination. Clin Neurol Neurosurg 2009; 111:717-23. [PMID: 19560262 DOI: 10.1016/j.clineuro.2009.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 04/20/2009] [Accepted: 05/29/2009] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Computed tomography venography (CTV) has proven to be a reliable imaging method in the evaluation of cerebral venous thrombosis with good correlation to magnetic resonance (MR) imaging and digital subtraction angiography (DSA). It is fast and widely accessible, especially in the emergency setting. For better visualization of vascular structures bone is often removed from the images. The purpose of this study was to evaluate the quality of a fully automatic bone removal method, matched mask bone elimination (MMBE), and to assess the interobserver variability of the CTV technique. PATIENTS AND METHODS Fifty patients with clinical suspicion of cerebral venous thrombosis underwent multislice CTV with MMBE post-processing. Axial source images and maximum intensity projections were retrospectively evaluated by two neuroradiologists for quality of bone removal and for the presence or absence of thrombosis in nine dural sinuses and five deep cerebral veins. A per sinus/vein and a per patient analysis (thrombosis in at least one sinus or vein) was performed and interobserver agreement was assessed. RESULTS Both observers considered bone removal good in all patients (100%). Interobserver agreement per patient was excellent (kappa=0.83), with a full agreement in 47 of 50 patients (94%). The interobserver agreement per sinus or vein was good (kappa=0.76), with a full agreement in 679 of 700 sinuses or veins (97%). CONCLUSION CTV aided with MMBE is a robust technique for visualization of the intracranial venous circulation, removing bone effectively. CTV has high interobserver agreement for presence or absence of cerebral venous thrombosis.
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Affiliation(s)
- Hugo A Gratama van Andel
- Department of Biomedical Engineering & Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Peters BD, de Haan L, Dekker N, Blaas J, Becker HE, Dingemans PM, Akkerman EM, Majoie CB, van Amelsvoort T, den Heeten GJ, Linszen DH. White matter fibertracking in first-episode schizophrenia, schizoaffective patients and subjects at ultra-high risk of psychosis. Neuropsychobiology 2009; 58:19-28. [PMID: 18781087 DOI: 10.1159/000154476] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 05/25/2008] [Indexed: 11/19/2022]
Abstract
There is increasing evidence of white matter pathology in schizophrenia. The aim of this study was to examine whether white matter abnormalities found with diffusion tensor imaging (DTI) in previous schizophrenia studies are present in the early phase of the illness. DTI was performed at 3 T on 10 male patients with a first (n = 8) or second (n = 2) psychotic episode of schizophrenia or schizoaffective disorder, 10 male patients at ultra-high risk of psychosis with (pre)psychotic symptoms and 10 healthy controls. Fibertracts found to be abnormal in other DTI studies (uncinate and arcuate fasciculus, anterior and dorsal cingulum, subdivisions of the corpus callosum) were calculated and visualized; tract-specific measurements (fractional anisotropy and trace) were performed. No differences were found between the healthy subjects and the 2 patient groups. These preliminary findings suggest that there is no white matter pathology of these association tracts detectable with DTI in the early stages of schizophrenic illness in males. Our findings are in contrast with DTI abnormalities found in some other first-episode studies. This discrepancy in findings may be related to differences in subject characteristics and DTI methodology. Possible effects of age, gender, level of education and illicit substance use on DTI findings in schizophrenia are discussed.
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Affiliation(s)
- Bart D Peters
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Peters BD, de Haan L, Vlieger EJ, Majoie CB, den Heeten GJ, Linszen DH. Recent-onset schizophrenia and adolescent cannabis use: MRI evidence for structural hyperconnectivity? Psychopharmacol Bull 2009; 42:75-88. [PMID: 19629024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
There is growing evidence that brain white matter abnormalities are implicated in the pathophysiology of schizophrenia. Cannabis use is an independent risk factor for schizophrenia.We tested the hypothesis that cannabis use during early adolescence is associated with white matter abnormalities in schizophrenia patients. Thirtyfive male recent-onset schizophrenia patients, with and without a history of cannabis use before age 17, and twenty-one matched healthy comparison men without illicit drug use were assessed with diffusion tensor imaging (DTI).White matter regions of interest were examined in co-registered DTI images. Compared to controls, patients with cannabis use before age 17 showed increased directional coherence in the bilateral uncinate fasciculus, anterior internal capsule and frontal white matter. These abnormalities were absent in patients without cannabis use before age 17. The abnormalities were not related to lifetime doses of cannabis or other illicit drugs.We could not exclude confounding effects of other illicit drugs. Recent-onset schizophrenia patients with start of cannabis use during early adolescence use may represent a subgroup of schizophrenia patients with increased white matter directional coherence, which may reflect structural hyperconnectivity. This is in contrast with most DTI studies in schizophrenia, which have produced evidence for hypoconnectivity. Further studies are necessary to assess the effect of adolescent cannabis and other illicit drug use on brain white matter in schizophrenia.
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Affiliation(s)
- Bart D Peters
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
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de Win MML, Jager G, Booij J, Reneman L, Schilt T, Lavini C, Olabarriaga SD, den Heeten GJ, van den Brink W. Sustained effects of ecstasy on the human brain: a prospective neuroimaging study in novel users. Brain 2008; 131:2936-45. [PMID: 18842607 DOI: 10.1093/brain/awn255] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Previous studies have suggested toxic effects of recreational ecstasy use on the serotonin system of the brain. However, it cannot be excluded that observed differences between users and non-users are the cause rather than the consequence of ecstasy use. As part of the Netherlands XTC Toxicity (NeXT) study, we prospectively assessed sustained effects of ecstasy use on the brain in novel ecstasy users using repeated measurements with a combination of different neuroimaging parameters of neurotoxicity. At baseline, 188 ecstasy-naive volunteers with high probability of first ecstasy use were examined. After a mean period of 17 months follow-up, neuroimaging was repeated in 59 incident ecstasy users and 56 matched persistent ecstasy-naives and their outcomes were compared. Neuroimaging included [(123)I]beta-carbomethoxy-3beta-(4-iodophenyl)tropane (CIT) SPECT to measure serotonin transporter densities as indicators of serotonergic function; (1)H-MR spectroscopy ((1)H-MRS) to measure brain metabolites as indicators of neuronal damage; diffusion tensor imaging (DTI) to measure the apparent diffusion coefficient and fractional anisotropy (FA) of the diffusional motion of water molecules in the brain as indicators of axonal integrity; and perfusion weighted imaging (PWI) to measure regional relative cerebral blood volume (rrCBV) which indicates brain perfusion. With this approach, both structural ((1)H-MRS and DTI) and functional ([(123)I]beta-CIT SPECT and PWI) aspects of neurotoxicity were combined. Compared to persistent ecstasy-naives, novel low-dose ecstasy users (mean 6.0, median 2.0 tablets) showed decreased rrCBV in the globus pallidus and putamen; decreased FA in thalamus and frontoparietal white matter; increased FA in globus pallidus; and increased apparent diffusion coefficient in the thalamus. No changes in serotonin transporter densities and brain metabolites were observed. These findings suggest sustained effects of ecstasy on brain microvasculature, white matter maturation and possibly axonal damage due to low dosages of ecstasy. Although we do not know yet whether these effects are reversible or not, we cannot exclude that ecstasy even in low doses is neurotoxic to the brain.
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Affiliation(s)
- Maartje M L de Win
- Department of Radiology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
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de Win MML, Jager G, Booij J, Reneman L, Schilt T, Lavini C, Olabarriaga SD, Ramsey NF, Heeten GJD, van den Brink W. Neurotoxic effects of ecstasy on the thalamus. Br J Psychiatry 2008; 193:289-96. [PMID: 18827290 DOI: 10.1192/bjp.bp.106.035089] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Neurotoxic effects of ecstasy have been reported, although it remains unclear whether effects can be attributed to ecstasy, other recreational drugs or a combination of these. AIMS To assess specific/independent neurotoxic effects of heavy ecstasy use and contributions of amphetamine, cocaine and cannabis as part of The Netherlands XTC Toxicity (NeXT) study. METHOD Effects of ecstasy and other substances were assessed with (1)H-magnetic resonance spectroscopy, diffusion tensor imaging, perfusion weighted imaging and [(123)I]2beta-carbomethoxy-3beta-(4-iodophenyl)-tropane ([(123)I]beta-CIT) single photon emission computed tomography (serotonin transporters) in a sample (n=71) with broad variation in drug use, using multiple regression analyses. RESULTS Ecstasy showed specific effects in the thalamus with decreased [(123)I]beta-CIT binding, suggesting serotonergic axonal damage; decreased fractional anisotropy, suggesting axonal loss; and increased cerebral blood volume probably caused by serotonin depletion. Ecstasy had no effect on brain metabolites and apparent diffusion coefficients. CONCLUSIONS Converging evidence was found for a specific toxic effect of ecstasy on serotonergic axons in the thalamus.
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Affiliation(s)
- Maartje M L de Win
- Department of Radiology, University of Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
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de Win MML, Reneman L, Jager G, Vlieger EJP, Olabarriaga SD, Lavini C, Bisschops I, Majoie CBLM, Booij J, den Heeten GJ, van den Brink W. A prospective cohort study on sustained effects of low-dose ecstasy use on the brain in new ecstasy users. Neuropsychopharmacology 2007; 32:458-70. [PMID: 17077812 DOI: 10.1038/sj.npp.1301225] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
It is debated whether ecstasy use has neurotoxic effects on the human brain and what the effects are of a low dose of ecstasy use. We prospectively studied sustained effects (>2 weeks abstinence) of a low dose of ecstasy on the brain in ecstasy-naive volunteers using a combination of advanced MR techniques and self-report questionnaires on psychopathology as part of the NeXT (Netherlands XTC Toxicity) study. Outcomes of proton magnetic resonance spectroscopy (1H-MRS), diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), and questionnaires on depression, impulsivity, and sensation seeking were compared in 30 subjects (12M, 21.8+/-3.1 years) in two sessions before and after first ecstasy use (1.8+/-1.3 tablets). Interval between baseline and follow-up was on average 8.1+/-6.5 months and time between last ecstasy use and follow-up was 7.7+/-4.4 weeks. Using 1H-MRS, no significant changes were observed in metabolite concentrations of N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI), and creatine (Cr), nor in ratios of NAA, Cho, and mI relative to Cr. However, ecstasy use was followed by a sustained 0.9% increase in fractional anisotropy (FA) in frontoparietal white matter, a 3.4% decrease in apparent diffusion (ADC) in the thalamus and a sustained decrease in relative regional cerebral blood volume (rrCBV) in the thalamus (-6.2%), dorsolateral frontal cortex (-4.0%), and superior parietal cortex (-3.0%) (all significant at p<0.05, paired t-tests). After correction for multiple comparisons, only the rrCBV decrease in the dorsolateral frontal cortex remained significant. We also observed increased impulsivity (+3.7% on the Barratt Impulsiveness Scale) and decreased depression (-28.0% on the Beck Depression Inventory) in novel ecstasy users, although effect sizes were limited and clinical relevance questionable. As no indications were found for structural neuronal damage with the currently used techniques, our data do not support the concern that incidental ecstasy use leads to extensive axonal damage. However, sustained decreases in rrCBV and ADC values may indicate that even low ecstasy doses can induce prolonged vasoconstriction in some brain areas, although it is not known whether this effect is permanent. Additional studies are needed to replicate these findings.
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Affiliation(s)
- Maartje M L de Win
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Kesecioglu J, Haitsma JJ, Schultz MJ, den Heeten GJ, Lachmann B. Contrast media inhibit exogenous surfactant therapy in rats with acute respiratory distress syndrome. Clin Physiol Funct Imaging 2006; 26:120-6. [PMID: 16494603 DOI: 10.1111/j.1475-097x.2006.00659.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To test the effects of various contrast media on the pulmonary surfactant system. MATERIAL AND METHODS In a rat model of acute respiratory distress syndrome (ARDS) induced by lung lavage, the effects of surfactant suspended in saline were compared with surfactant suspended in the contrast media Visipaque, Gastrografin, Omnipaque, Telebrix M, Telebrix and Hexabrix, to establish their influence on oxygenation and lung mechanics. RESULTS After the induction of ARDS, surfactant instillation improved oxygenation, total lung capacity (TLC(35)), volume at 5 cm H(2)O end-expiration (V(5)) and Gruenwald index. The effects of Visipaque and Gastrografin were comparable with those of surfactant alone from 90 min onwards and at 120 min, respectively. Surfactant suspended in the other contrast media resulted in significantly lower values in the above-mentioned parameters. Surface tension was lowest in surfactant suspended in saline alone. Surfactant suspended in Visipaque and Gastrografin had lower surface tension compared with surfactant suspended in the other contrast media. CONCLUSION The ionic and non-ionic contrast media used in this study, cause an impairment of the physico-chemical behaviour of exogenous surfactant. Therefore, these contrast media cannot be regarded as safe in case of accidental exposure.
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Affiliation(s)
- Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center, Utrecht, The Netherlands.
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Reneman L, de Win MML, van den Brink W, Booij J, den Heeten GJ. Neuroimaging findings with MDMA/ecstasy: technical aspects, conceptual issues and future prospects. J Psychopharmacol 2006; 20:164-75. [PMID: 16510475 DOI: 10.1177/0269881106061515] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Users of ecstasy (3,4-methylenedioxymethamphetamine; MDMA) may be at risk of developing MDMA-induced injury to the serotonin (5-HT) system. Previously, there were no methods available for directly evaluating the neurotoxic effects of MDMA in the living human brain. However, development of in vivoneuroimaging tools have begun to provide insights into the effects of ecstasy on the human brain. Single photon emission computed tomography (SPECT), positron emission computed tomography (PET) and proton magnetic resonance spectroscopy (1H-MRS) studies which have evaluated ecstasy's neurotoxic potential will be reviewed and discussed in terms of technical aspects, conceptual issues and future prospects. Although PET and SPECT may be limited by several factors such as the low cortical uptake and the use of a non-optimal reference region (cerebellum) the few studies conducted so far provide suggestive evidence that people who heavily use ecstasy are at risk of developing subcortical, and probably also cortical reductions in serotonin transporter (SERT) densities, a marker of 5-HT neurotoxicity. There seem to be dose-dependent and transient reductions in SERT for which females may be more vulnerable than males. 1H-MRS appears to be a less sensitive technique for studying ecstasy's neurotoxic potential. Whether individuals with a relatively low ecstasy exposure also demonstrate loss of SERT needs to be determined. Because most studies have had a retrospective design, in which evidence is indirect and differs in the degree to which any causal links can be implied, longitudinal studies in human ecstasy users are needed to draw definite conclusions.
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Affiliation(s)
- Liesbeth Reneman
- Graduate School of Neurosciences, Department of Radiology, Academic Medical Centre, University of Amsterdam, The Netherlands.
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Majoie CBLM, Sprengers ME, van Rooij WJJ, Lavini C, Sluzewski M, van Rijn JC, den Heeten GJ. MR angiography at 3T versus digital subtraction angiography in the follow-up of intracranial aneurysms treated with detachable coils. AJNR Am J Neuroradiol 2005; 26:1349-56. [PMID: 15956496 PMCID: PMC8149092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND AND PURPOSE Digital subtraction angiography (DSA) is used to follow-up intracranial aneurysms treated with detachable coils to identify recurrence and determine need for additional treatment. However, DSA is invasive and involves a small risk of neurologic complications. We assessed the feasibility and usefulness of 3D time-of-flight (TOF) MR angiography (MRA) performed at 3T compared with DSA for the follow-up of coil-treated intracranial aneurysms. METHODS In a prospective study, 20 consecutive patients with 21 intracranial aneurysms treated with coils underwent DSA and nonenhanced and enhanced multiple overlapping thin-slab acquisition 3D TOF MRA at 3T on the same day at a mean follow-up of 6 months (range, 4-14 months) after coil placement. MRA images were evaluated for presence of artifacts, presence and size of aneurysm remnants and recurrences, patency of parent and branch vessels, and added value of contrast material enhancement. MRA and DSA findings were compared. RESULTS Interobserver agreement of MRA was good, as was agreement between MRA and DSA. All three recurrences that needed additional treatment were detected with MRA. Minor disagreement occurred in four cases: three coil-treated aneurysms were scored on MRA images as having a small remnant, whereas on DSA images these aneurysms were occluded; the other aneurysm was scored on MRA images as having a small remnant, whereas on DSA images this was a small recurrence. Use of contrast material had no additional value. Coil-related MR imaging artifacts were minimal and did not interfere with evaluation of the occlusion status of the aneurysm. CONCLUSION High-spatial-resolution 3D TOF MRA at 3T is feasible and useful in the follow-up of patients with intracranial aneurysms treated with coil placement.
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Affiliation(s)
- Charles B L M Majoie
- Department of Radiology, Academic Medical Center, University of Amsterdam, the Netherlands
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de Win MML, Habraken JBA, Reneman L, van den Brink W, den Heeten GJ, Booij J. Validation of [(123)I]beta-CIT SPECT to assess serotonin transporters in vivo in humans: a double-blind, placebo-controlled, crossover study with the selective serotonin reuptake inhibitor citalopram. Neuropsychopharmacology 2005; 30:996-1005. [PMID: 15770240 DOI: 10.1038/sj.npp.1300683] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Disturbances in the serotonin (5-HT) system are associated with various neuropsychiatric disorders. The 5-HT system can be studied in vivo by measuring 5-HT transporter (SERT) densities using (123)iodine-labeled 2beta-carbomethoxy-3beta(4-iodophenyl)tropane ([(123)I]beta-CIT) and single photon emission computed tomography (SPECT). Validation of this technique is important because [(123)I]beta-CIT does not bind selectively to SERTs. Some studies have validated this technique in vivo in the human brain in SERT-rich areas, but the technique has not been validated yet in SERT-low cortical areas. The aim of this study was to further validate [(123)I]beta-CIT SPECT in assessing SERTs in vivo in humans in both SERT-rich and SERT-low areas. A double-blind, placebo-controlled, crossover design was used with the selective 5-HT reuptake inhibitor (SSRI) citalopram. Six male subjects underwent two [(123)I]beta-CIT SPECT sessions: one after pretreatment with citalopram and one after placebo. Scans were acquired 4 h and 22-27 h p.i., and both region-of-interest and voxel-by-voxel analyses were performed. Citalopram reduced [(123)I]beta-CIT binding ratios in SERT-rich midbrain and (hypo)thalamus. Binding ratios were also lower after citalopram in SERT-low cortical areas, but statistical significance was only reached in several cortical areas using voxel-by-voxel analysis. In addition, citalopram increased binding ratios in the DAT-rich striatum and increased absolute uptake in the cerebellum. The results show that [(123)I]beta-CIT SPECT is a valid technique to study SERT binding in vivo in human brain in SERT-rich areas. Although we provide some evidence that [(123)I]beta-CIT SPECT may be used to measure SERTs in SERT-low cortical areas, these measurements must be interpreted with caution.
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Affiliation(s)
- Maartje M L de Win
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Venema HW, van Straten M, den Heeten GJ. Digital Radiography of the Chest: Reassessment of the High-Voltage Technique? Radiology 2005; 235:336-7; author reply 337-8. [PMID: 15798175 DOI: 10.1148/radiol.2351041679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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van Rijn JC, Klemetsö N, Reitsma JB, Majoie CBLM, Hulsmans FJ, Peul WC, Stam J, Bossuyt PM, den Heeten GJ. Observer variation in MRI evaluation of patients suspected of lumbar disk herniation. AJR Am J Roentgenol 2005; 184:299-303. [PMID: 15615992 DOI: 10.2214/ajr.184.1.01840299] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our objective was to assess observer variation in MRI evaluation in patients suspected of lumbar disk herniation. SUBJECTS AND METHODS Two experienced neuroradiologists independently evaluated 59 consecutive patients with lumbosacral radicular pain. Per patient, three levels (L3-L4 through L5-S1) and the accompanying roots were evaluated on both sides. For each segment, the presence of a bulging disk or a herniation and compression of the root was reported. Images were interpreted twice: once before and once after disclosure of clinical information. Interobserver agreement was expressed as unweighted kappa values. RESULTS Without clinical information, interobserver agreement for the presence of herniation or bulging disk was moderate (full agreement, 84%; kappa = 0.63; 95% confidence interval [CI], 0.53-0.72). Of a total of 352 segments evaluated, there was disagreement on 58 segments (17%): bulging disk versus no defect in 26 (7.4%), bulging disk versus herniation in five (1.4%), and hernia versus no defect in 27 (7.7%). With clinical information, twice as many bulging disks were reported but no new herniations were detected. Agreement slightly decreased, but not significantly (full agreement, 77%; kappa = 0.59; 95% CI, 0.49-0.69; p = 0.12). CONCLUSION On average, more than 50% of interobserver variation in MRI evaluation of patients with lumbosacral radicular pain is caused by disagreement on bulging disks. Knowledge of clinical information does not influence the detection of herniations but lowers the threshold for reporting bulging disks.
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Affiliation(s)
- Jeroen C van Rijn
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105AZ, The Netherlands
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van Straten M, Venema HW, Streekstra GJ, Majoie CBLM, den Heeten GJ, Grimbergen CA. Erratum: “Removal of bone in CT angiography of the cervical arteries by piecewise matched mask bone elimination” [Med. Phys. 31, 2924-2933 (2004)]. Med Phys 2005. [DOI: 10.1118/1.1834832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Lindauer RJL, Booij J, Habraken JBA, Uylings HBM, Olff M, Carlier IVE, den Heeten GJ, van Eck-Smit BLF, Gersons BPR. Cerebral blood flow changes during script-driven imagery in police officers with posttraumatic stress disorder. Biol Psychiatry 2004; 56:853-61. [PMID: 15576062 DOI: 10.1016/j.biopsych.2004.08.003] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Revised: 07/23/2004] [Accepted: 08/01/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Functional brain imaging studies in posttraumatic stress disorder (PTSD) have focused mostly on war or sexual abuse victims, many of whom also had comorbid disorders. The aim of this study was to examine the neuronal circuitry underlying responses to script-driven imagery in traumatized police officers with and without PTSD and with low comorbidity rates. METHODS In a case-matched control study, 30 traumatized police officers with and without PTSD underwent clinical assessment and (99m)technetium-hexa-methyl-propylene-amine-oxime single photon emission computed tomography scanning with neutral and trauma scripts. Statistical parametric mapping was applied to analyze changes in regional cerebral blood flow. RESULTS The main findings were significantly less activation in the medial frontal gyrus and more activation in the right cuneus in the PTSD group relative to the trauma-exposed control group in reaction to trauma versus neutral scripts. Within the PTSD group, subjects showed less activation in the superior temporal gyrus, left lentiform nucleus, left middle frontal gyrus, and left inferior frontal gyrus in reaction to trauma scripts. CONCLUSIONS We confirmed previous findings of dysfunction of the medial frontal gyrus in PTSD in a new population with low comorbidity rates. Other alterations were found in certain brain structures involved in emotional, memory, linguistic, visuospatial, and motor processing.
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Affiliation(s)
- Ramón J L Lindauer
- Centre for Psychological Trauma, Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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van Straten M, Venema HW, Streekstra GJ, Majoie CBLM, den Heeten GJ, Grimbergen CA. Removal of bone in CT angiography of the cervical arteries by piecewise matched mask bone elimination. Med Phys 2004; 31:2924-33. [PMID: 15543801 DOI: 10.1118/1.1797511] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In maximum intensity projection (MIP) images of CT angiography (CTA) scans, the arteries are often obscured by bone. A bone removal method is presented that uses an additional, nonenhanced scan to create a mask of the bone by thresholding and dilation. After registration of the CTA scan and the additional scan, the bone in the CTA scan is masked. As the cervical area contains bones that can move with respect to each other, these bones are separated first using a watershed algorithm, and then registered individually. A phantom study was performed to evaluate and quantify the tradeoff between the removal of the bone and the preservation of the arteries contiguous to the bone. The influence of algorithm parameters and scan parameters was studied. The method was clinically evaluated with data sets of 35 patients. Best results were obtained with a threshold of 150 HU and a dilation of 8 in-plane voxels and two out-of-plane voxels. The mean width of the soft tissue layer, which is also masked, was approximately 1 mm. The mAs value of the nonenhanced scan could be reduced from 250 mAs to 65 mAs without a loss of quality. In 32 cases the bones were registered correctly and removed completely. In three cases the bone separation was not completely successful, and consequently the bone was not completely removed. The piecewise matched mask bone elimination method proved to be able to obtain MIP images of the cervical arteries free from overprojecting bone in a fully automatic way and with only a slight increase of radiation dose.
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Affiliation(s)
- Marcel van Straten
- Department of Medical Physics, Academic Medical Center, Amsterdam, The Netherlands.
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van Straten M, Venema HW, Hartman J, den Heeten GJ, Grimbergen CA. Reproducibility of multi-slice spiral computed tomography scans:An experimental study. Med Phys 2004; 31:2785-6. [PMID: 15543784 DOI: 10.1118/1.1796131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In multi-slice spiral computed tomography (CT) images interpolation artifacts are present. The relationship between the x-ray tube rotation angle and these artifacts is demonstrated. A head phantom was repeatedly scanned with a four-slice CT scanner at different pitch values. Two scans, made with identical scan parameters, nearly always have different x-ray tube starting angles. Consequently, artifacts appeared differently and residual artifacts appeared when subtractions were made. We conclude that only if the x-ray tube starting angle is equal for both scans or if a very low pitch is used, images are highly reproducible.
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Affiliation(s)
- Marcel van Straten
- Department of Medical Physics, Academic Medical Center, Amsterdam, The Netherlands.
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Lindauer RJL, Vlieger EJ, Jalink M, Olff M, Carlier IVE, Majoie CBLM, den Heeten GJ, Gersons BPR. Smaller hippocampal volume in Dutch police officers with posttraumatic stress disorder. Biol Psychiatry 2004; 56:356-63. [PMID: 15336518 DOI: 10.1016/j.biopsych.2004.05.021] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Revised: 05/17/2004] [Accepted: 06/07/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous magnetic resonance imaging studies of posttraumatic stress disorder (PTSD) have reported smaller hippocampal volume, especially in war and sexual abuse victims. Our aim was to assess hippocampal volume in traumatized police officers with and without PTSD in the absence of alcohol abuse and moderate to severe major depression. METHODS In a case-matched control study, 14 police officers with current PTSD and 14 traumatized police officers without lifetime PTSD were examined using magnetic resonance imaging. Three temporal lobe areas were manually segmented: hippocampus, amygdala, and parahippocampal gyrus. Volumetric analysis was used to measure gray matter, white matter, and cerebrospinal fluid. RESULTS After controlling for total brain volume, the hippocampal volume in the PTSD group was significantly smaller in comparison with the traumatized control group (total 10.6%; left 12.6%). Volumes of amygdala, parahippocampal gyrus, gray matter, white matter, and cerebrospinal fluid were not significantly altered. A significant negative correlation was found between reexperiencing symptoms and hippocampal volume in the PTSD group. CONCLUSIONS We confirmed previous findings of smaller hippocampal volume in PTSD in a new population made up of police officers, excluding comorbidity as a confounder. The finding of smaller hippocampal volume was specific to PTSD.
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Affiliation(s)
- Ramón J L Lindauer
- Centre for Psychological Trauma, Department of Psychiatry de Bascule, University of Amsterdam, Amsterdam, The Netherlands.
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ter Rahe BSM, Majoie CBLM, Akkerman EM, den Heeten GJ, Poll-The BT, Barth PG. Peroxisomal biogenesis disorder: comparison of conventional MR imaging with diffusion-weighted and diffusion-tensor imaging findings. AJNR Am J Neuroradiol 2004; 25:1022-7. [PMID: 15205141 PMCID: PMC7975665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND AND PURPOSE Peroxisomal biogenesis disorders (PBDs) refer to a group of disorders of peroxisomal biogenesis causing neuronal migration disorder, delayed myelination, and demyelination. The aim of this study was to evaluate the added value of diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) compared with that of conventional T2-weighted imaging in assessing the extent of white matter damage in patients with PBDs. METHODS Three patients (aged 12, 16, and 80 months) with PBD (type 1 protein targeting sequence [PTS1]) and three age-matched control subjects underwent MR imaging on a 1.5-T system. The protocol included axial T2-weighted, DWI, and DTI sequences. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) changes were calculated using regions of interest at several predefined white matter areas and compared with those of age-matched control subjects. Color-coded maps were obtained to visualize the range of FA values. RESULTS On the T2-weighted images, one patient revealed severe hypomyelination throughout the brain; the two other patients showed focal abnormal high-signal-intensity areas. All patients had significantly decreased FA values in white matter areas that appeared abnormal on the T2-weighted images. In two of the three patients, significant FA reduction was also found in normal-appearing white matter. The ADC values of the patients were significantly increased compared with those of the age-matched controls. CONCLUSION Although based on a small number of patients, our data suggest that DWI and DTI can be used to characterize and quantify white matter tract injury in patients with PBD-PTS1. Furthermore, our data suggest that these techniques have the potential to identify neurodegenerative changes not yet visible on T2-weighted images.
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de Win MML, Reneman L, Reitsma JB, den Heeten GJ, Booij J, van den Brink W. Mood disorders and serotonin transporter density in ecstasy users--the influence of long-term abstention, dose, and gender. Psychopharmacology (Berl) 2004; 173:376-82. [PMID: 14726997 DOI: 10.1007/s00213-003-1723-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2003] [Accepted: 11/14/2003] [Indexed: 10/26/2022]
Abstract
RATIONALE Neurotoxic effects of 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy") on the serotonin (5-HT) system have been described in animals and humans, but little is known about long-term effects of ecstasy use on mood. OBJECTIVES To investigate short-term and long-term effects of ecstasy use on mood and its association with 5-HT neurotoxicity, dose, and gender in humans. METHODS Fifteen moderate ecstasy users, 23 heavy ecstasy users, 16 former heavy ecstasy users and 15 drug-using, but ecstasy-naive controls were included. Mood was assessed using the Composite International Diagnostic Interview (CIDI) and the Beck Depression Inventory (BDI). Outcomes were correlated with 5-HT transporter (SERT) density, assessed with [123I]beta-CIT single photon emission computed tomography (SPECT). RESULTS The prevalence of mood disorders assessed by CIDI did not differ between all groups. The overall test for differences in BDI scores between groups was near significance (P=0.056), with BDI scores higher in former heavy ecstasy users than in ecstasy-naive controls (P=0.045). BDI scores were correlated with the total number of ecstasy tablets used (r=0.310; P=0.021). No associations between CIDI or BDI outcomes and SERT density or gender were observed. CONCLUSIONS These results suggest that ecstasy use is not associated with clinical depression (CIDI). However, the number of ecstasy tablets taken lifetime was associated with higher BDI scores for depressive mood, and this relationship seemed to persist after ecstasy use had stopped. We did not find that depressed mood in ecstasy users was associated with decrease in SERT density. Prospective studies are needed to establish the causal relationship between ecstasy use and depressed mood.
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Affiliation(s)
- Maartje M L de Win
- Department of Radiology G1-229, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands,
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Majoie CBLM, van Straten M, Venema HW, den Heeten GJ. Multisection CT venography of the dural sinuses and cerebral veins by using matched mask bone elimination. AJNR Am J Neuroradiol 2004; 25:787-91. [PMID: 15140721 PMCID: PMC7974470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Matched mask bone elimination (MMBE) is a technique for the automatic removal of bone pixels from CT angiography data sets. We describe the use of this technique in two patients with the clinical suspicion of dural sinus thrombosis. We conclude that multisection CT venography with MMBE is a useful adjunct for the visualization of the intracranial venous circulation by removing bone from the image. In contrast to techniques described previously, MMBE is fully automated and operator independent.
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Affiliation(s)
- Charles B L M Majoie
- Department of Radiology, Academic Medical Center, University of Amsterdam, The Netherlands
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de Win MML, de Jeu RAM, de Bruin K, Habraken JBA, Reneman L, Booij J, den Heeten GJ. Validity of in vivo [123I]beta-CIT SPECT in detecting MDMA-induced neurotoxicity in rats. Eur Neuropsychopharmacol 2004; 14:185-9. [PMID: 15056477 DOI: 10.1016/s0924-977x(03)00101-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2003] [Revised: 05/09/2003] [Accepted: 06/24/2003] [Indexed: 10/26/2022]
Abstract
This study investigated the ability of a high-resolution pinhole single-photon emission computed tomography (SPECT) system, with [(123)I]beta-CIT as a radiotracer, to detect 3,4-methelenedioxymethamphetamine (MDMA, 'Ecstasy')-induced loss of serotonin transporters (SERTs) in the living rat brain. In vivo striatal and thalamic [(123)I]beta-CIT binding ratios, representing specific binding to dopamine and serotonin transporters, respectively, were determined 7 days before as well as 10 days after treatment of rats with neurotoxic doses of MDMA using SPECT. At the end of the experiment, radioactivity ratios were also determined ex vivo, and compared to control data. Both in vivo and ex vivo, thalamic, but not striatal, uptake ratios were statistical significantly reduced after MDMA treatment. These data show that [(123)I]beta-CIT SPECT may be able to detect MDMA-induced loss of SERTs. Therefore, this may be a promising technique to perform serial studies on MDMA-induced serotonergic neurotoxicity in living small animals.
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Affiliation(s)
- Maartje M L de Win
- Department of Radiology, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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