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![Wilhelm Conrad Röntgen
German] mechanical engineer and physicist
who, on 8 November 1895, produced and
detected electromagnetic radiation in
a wavelength range known as X-rays or
Röntgen rays.
About six weeks after his discovery, he took
a picture—a radiograph—using X-rays of
his wife Anna Bertha's hand
By 1896 doctors around the world were using x-rays to take pictures of patients](https://image.slidesharecdn.com/cancerimaging-210421223447/85/Cancer-imaging-4-320.jpg)
Uploaded byRobert J Miller MD
Cancer imaging
Cancer imaging has advanced significantly with improvements in technologies such as CT, MRI, PET, and ultrasound. Mammography remains the standard breast cancer screening tool, though its accuracy depends on breast density. MRI and ultrasound provide additional information. PET scans help evaluate cancer spread and treatment response. Lung cancer screening involves low-dose CT scans. CT and PET scans precisely evaluate lung tumors and lymph node involvement. Brain tumors are best imaged with MRI which provides detailed soft tissue contrast compared to CT. Bone scans effectively detect bone metastases earlier than plain films. PET scans can further characterize bone lesions found on other imaging.
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More from Robert J Miller MD
Cancer imaging
- 1. Cancer Imaging ASPEC /January 2021 / Robert Miller MD
- 2. 1.History of imaging technology 2.Guidelinesfor screening or staging 3.Breast (mammograms, ultrasound, MRI) 4.Lung (chest X-rays, CT, PET scan) 5.Brain (CT, MRI) 6.Miscellaneous sites
- 3.
- 4. Wilhelm Conrad Röntgen German]mechanical engineer and physicist who, on 8 November 1895, produced and detected electromagnetic radiation in a wavelength range known as X-rays or Röntgen rays. About six weeks after his discovery, he took a picture—a radiograph—using X-rays of his wife Anna Bertha's hand By 1896 doctors around the world were using x-rays to take pictures of patients
- 11. Radiology : useof radiation (X-rays and high energy radiation) for diagnosis, and now called Medical Imaging Ultrasound – using focused high-frequency sound waves X-rays – chest, mammograms, bone films CT Scan (computed tomography) – slices of x-ray images combined by computer MRI (magnetic resonance imaging) – strong magnetic field that aligns the protons of hydrogen atoms and spins the protons to produce a faint signal that is detected Nuclear Medicine – injecting an isotope into the patient and getting images to show where the radiation concentrates Bone Scan – use an isotope that concentrates in the bone PET Scan (positron emission tomography) – use a positron releasing isotope attached to a specific agent that will concentrate in the target (glucose for cancer or infection or high blood flow 18F-FDG or for bone NaF-F18) No radiation exposure using ultrasound or MRI US Food and Drug Administration (FDA) estimates that exposure to 10 mSv from an imaging test would be expected to increase the risk of death from cancer by about 1 chance in 2000
- 14.
- 15. Risk of radiationinduced cancer is related to the patient age and the type of procedure (dose of radiation they are exposed to)
- 16. Only include mammogramsfor breast cancer screening, Low dose CT scans for lung cancer screening, and option of CT for colon/rectal cancer screening NCCN.Org Which stages or cancers need CT, MRI or PET scans and the frequency
- 17.
- 18. right lung left lung heart Normal right breast Cancerleft breast aorta Reconstructed PET Scan of locally advanced left breast cancer
- 19. Three techniques that showa 2.7cm left breast cancer -Mammogram -MRI -PET Scan
- 20. Imaging for AdvancedBreast Cancer Young woman with large, triple negative cancer in the left breast mammogram ultrasound PET scan MRI scan
- 21. Ducts and glandsare dense and look white or grey on an X-ray and fat is lower density and looks black on an X- ray So mammograms may miss cancer on younger women or women with very dense breasts, and they may do better with an MRI or ultrasound.
- 22. Internal mammary supraclavicular axillary Lymph Nodes Thetail of the breast may extend high into the axilla Lymph nodes may not be seen on a mammogram but may show up on an MRI or PET scan
- 24. BIRADS What does the mammogram reportmean by BIRAD ? Breast Imaging, Reporting & Data System (BI-RADS)
- 25. Probability of BreastCancer by BIRADS BI-RADS 3 1.0% BI-RADS 4 18.6% 4A 6% 4B 15% 4C 53% Am J Prev Med. 2013 Jan; 44(1): 15–22.
- 26. Mammography sensitivity: overall 80% age:< 40y 54 – 58% > 65y 81 – 94% High breast density is associated with 10 – 29% lower sensitivity Sensitivity of only 50% in women with dense breasts and 33% in BRACA study Breast cancer is accurately diagnosed through mammography in about 78 percent of all women tested, while diagnostic accuracy rises to about 83 percent for women over 50. false positives, about 6-8%, estimated 17% of breast cancers missed by mammography. The number may rise as high as 30% for women with dense breasts
- 27. How often willa mammogram miss finding a cancer in a young woman? 42 – 46% Never!
- 28. Biopsy = 9mminvasive ductal cancer Mammogram in a woman with fatty, low density breasts
- 29. Breast Density canmake imaging very difficult, this woman had a palpable mass that was very difficult to see because her diffuse breast density mammogram CT Scan MRI
- 30. Typical benign calcifications in mammogramof 82 yo woman
- 31. Mammograms may oftenshow areas of calcification, these may be malignant. In ductal carcinoma in situ (DCIS), there is normally no mass but just an area of calcification
- 32. Micro- calcifications can be very subtle Biopsyof this area showed 8mm DCIS
- 33. Biopsy = DCISwith focal micro-invasion
- 34. Larger area of micro- calcificationsmay have invasive cancer Path = 2.9 cm area of high grade DCIS plus invasive ductal cancer
- 35. Mammogram report =7mm spiculated lesion in the upper, outer part of the breast Pathology = 1cm, grade 1, invasive ductal cancer with all nodes clear Mammogram of Early Breast Cancer
- 36. Regular Mammogram withCompression Views to Better Show the Lesion, biopsy showed 9mm Grade 1 invasive ductal cancer
- 37. Mammogram of Advanced Breast Cancer Obvioustumor mass on mammogram, mastectomy revealed a 6 cm invasive ductal cancer
- 38. Mammogram 80 yo womanwith nipple retraction and mastectomy performed Path multi centric lobular with + deep surgical margins
- 40. Ultrasound view ofbreast tumor Needle biopsy using ultrasound needle
- 41. Breast MRI Path =2.2 cm cancer in right breast, left breast was benign (False positive?) benign
- 42. Breast MRI Will showthe breast tumor as well as the lymph nodes Mastectomy = 6cm lobular cancer with 41 out of 42 lymph nodes positive for cancer spread
- 43. Breast MRI Will show the breast tumoras well as the lymph nodes
- 44.
- 45. MRI found unexpected cancerin the right breast (pink circle) when only the cancer on the left (yellow circle) was suspected
- 46. Breast MRI Scan A= Breast B = axilla C = internal mammary nodes
- 47. Breast MRI Scan Ina woman with dense breasts, the mammogram was normal but the MRI showed the cancer
- 48. mammogram Breast MRI MRI mayshow deep tumors that can be missed on the edge of the mammogram images and can be better seen and the depth on the MRI
- 49. Sometimes the BreastMRI Can Show Too Much Information
- 50. MRI Advanced LeftBreast Cancer with Lymph Node Spread normal breast cancer satellite nodules lymph node mets
- 51. MRI Advanced LeftBreast Cancer with Lymph Node Spread Side view cancer lymph node mets
- 52. MRI Advanced LeftBreast Cancer with Skin Thickening (same patient)
- 53.
- 54. cancer Normal Left Breast Heart Left lung Right lung Advancedcancer of the right breast on CT
- 55. Locally Advanced LeftBreast Cancer implant cancer implant
- 56. Internal Mammary NodeRelapse IM node aorta esophagus trachea SVC
- 57. PET - CTScan Anatomy
- 58. PET Scan Anatomyfor Breast Cancer
- 59. PET Scan Anatomyfor Breast Cancer
- 60. PET Scan Anatomyfor Breast Cancer
- 61. Normal breast Liver Heart Spine Rt Lung LtLung Cancer in Lt breast Cancer in Spine PET Scan Anatomy for Advanced Breast Cancer
- 62. 3D Mammography MoreLikely to Find Small Invasive Breast Cancers, Especially in Women Younger Than 50 Three-dimensional mammography (also called digital breast tomosynthesis, digital tomosynthesis, or just tomosynthesis) creates a three-dimensional picture of the breast using X-rays. the study found that screening with 3D mammography increased breast cancer detection rates by about 40%. •73.7% of breast cancers found with 3D mammography were 1 centimeter (cm) or smaller and node- negative •65.4% of breast cancers found with digital mammography were 1 cm or smaller and node-negative •This difference in detecting small breast cancers was especially notable in women age 40 to 49. For these women, 3D mammography found 4.41 invasive cancers per 1,000 exams in women with nondense breasts compared to 2.71 invasive cancers per 1,000 exams found by conventional 2D digital mammography.
- 63. 3D Mammogram versusConventional 2D 2D 3D 2D
- 64.
- 65. Chest X-ray….where’s thecancer?
- 66. Chest X-ray….where’s thecancer? heart aorta nodes cancer
- 67.
- 68. CT Better ThanX-ray
- 69. Lung Anatomy and ImportantLymph Node Regions
- 70. PET Showing LymphNodes Spread with Lung Cancer SupraClavicular Mediastinal Hilar N3 N2 N1 Lung Lung Heart
- 71. On a CTscan, the cancer, the fluid and the collapsed lung may all look the same (grey) The PET will show the difference since is shows metabolism (how much glucose is being consumed in the area, cancers consume a very high quantity and appear bright yellow)
- 72. SBRT with Tomotherapy PETScan before and 2 Months after Tomotherapy PET Scan helps to find the cancer and also helps to prove whether the radiation has killed the cancer (the grey scar should no longer be hot on the PET) Hot Cold
- 73.
- 74. Standard test isan MRI (not a CT scan) given with intravenous contrast (gadolinium). Since a brain biopsy may not always be an option it is critical that the radiologist can accurately identify the correct diagnosis
- 75. Better definition froman MRI than a CT CT Scan = edema MRI = multiple mets
- 76. CT Scan MRIScan Better definition from an MRI than a CT
- 77. The tumor may bealmost invisible on the MRI unless IV contrast is given
- 78. PET scans arenot very helpful for brain tumors. Since the brain uses large amounts of glucose it looks so bright on the PET a tumor would be hard to see.
- 79.
- 80. Everything in NotCancer Small Strokes Brain Abscess
- 81.
- 82.
- 83. MRI Much BetterDetail than an X-ray
- 84. CT Image showingmissing bone in vertebra
- 85. MRI side viewof cancer in a vertebra and pressure on the spinal cord and nerves causing symptoms
- 86. PET even moreinformation than the MRI MRI PET
- 87. Conventional bone scan better than plainX-rays and more modern bone scans are even better