cancer imaging/screening in clinical practice - swiss redc77e147-a0dd-48a2-84a3... ·...
TRANSCRIPT
![Page 1: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/1.jpg)
Cancer imaging/screening in clinical
practice
Thomas F. Hany MD
![Page 2: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/2.jpg)
/282
Cancer
![Page 3: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/3.jpg)
/283
Diagnostic imaging
X-ray– Breast cancer (-screening)
Computer tomography- based on x-raxs
- Lung Cancer (-screening)
Magnetic resonance imaging– Imaging of hydrogen atoms in a magnetic field
Positron emission tomography/CT - MRI
![Page 4: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/4.jpg)
/284
Chest x-ray
![Page 5: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/5.jpg)
/285
Bronchial carcinoma- chest x-ray
Accuracy of detecting lung cancer by chest x-ray is 70-80% (low!)
Evaluating older chest x-rays are as important as reviewing current films
Older films to determine whether an abnormality is new, old, or has changed.
No change in 2 or more years or show benign calcification pattern are classified as benign
In terms of staging, the chest x-ray is poor at defining T status (29% accurate) and N status, identifying less than 10% of abnormal lymph nodes.
![Page 6: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/6.jpg)
/286
Cause ...
![Page 7: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/7.jpg)
/287
Screening by low-dose CT
![Page 8: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/8.jpg)
/288
![Page 9: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/9.jpg)
/289
Chest CT vs. conventional Rx
![Page 10: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/10.jpg)
/2810
Lung cancer screening US
![Page 11: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/11.jpg)
/2811
Recommendations
![Page 12: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/12.jpg)
/2812
Screening mammography
– Screening mammography is an x-ray examination of the breasts in a woman who is asymptomatic (has no complaints or symptoms of breast cancer).
– The goal of screening mammography is to detect cancer when it is still too small to be felt by a woman or her physician.
– Screening mammography is recommended each year for women once they reach 40 years of age.
– In some instances, physicians may recommend beginning screening mammography before age 40 (i.e. if the woman has a strong family history of breast cancer
![Page 13: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/13.jpg)
/2813
Mammography
Mammography is the only exam approved by
the FDA to screen for breast cancer in
women who do not show any signs or
symptoms of the disease.
Mammography can detected approximately
85% of breast cancers.
The average cost for screening mammography
in the U.S. is about $100.
![Page 14: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/14.jpg)
/2814
![Page 15: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/15.jpg)
/2815
What is PET/CT ?
Kinahan PE, Townsend DW, Beyer T, Sashin D. Attenuation correction for a combined 3D PET/CT scanner.
Med Phys. 1998 Oct;25(10):2046-53.
![Page 16: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/16.jpg)
/2816
4 – 128 slice MSCT
fullring-detector PETLutetium- or Germanium based crystal material
Most used tracer: Fluor-18 – deoxyglucose = FDG
In-Line PET-CT system
![Page 17: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/17.jpg)
/2817
Contralateral mediastinal
![Page 18: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/18.jpg)
/2818
50 patients prospectively evaluated
PET/CT additional information in 41% over PET + CT
T stage Paired Sign Test P-value
PET/CT vs. CT 0.001*
PET/CT vs. PET <0.001*
PET/CT vs. PET+CT 0.013*
N stage Paired Sign Test P-Value
PET/CT vs. CT 0.12
PET/CT vs. PET 0.013*
___________ PET/CT vs. PET+CT 0.021*significant after Bonferroni correction
T staging in NSCL with PET/CT vs. PET+CTLardinois, Weder, Hany, Steinert HC et al., N Engl J Med 2003;348:2500-7
![Page 19: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/19.jpg)
/2819
![Page 20: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/20.jpg)
/2820
![Page 21: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/21.jpg)
/2821
Today – insert vs. rail-way vs. full
integration
![Page 22: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/22.jpg)
/2822
PET Radiotracers
Body/oncology
- F-18-FDG
- F-18-DOPA
- Ga-68-DOTATOC
- Ga-68-PMSA
- F-18 Fluoride
- F-18 Choline
- F-18 Ethyl-Tyrosine (FET); Methyl-Tyrosin (FMT)
Neuro
- F-18 FDG (Dementia)
- F-18 Flobetapir (Alzheimer)
![Page 23: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/23.jpg)
/2823
Work horse – FDG – not to be replaced so
fast….
![Page 24: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/24.jpg)
/2824
![Page 25: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/25.jpg)
/2825
![Page 26: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/26.jpg)
/2826
Don`t forget...
![Page 27: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/27.jpg)
/2827
![Page 28: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/28.jpg)
/2828
![Page 29: Cancer imaging/screening in clinical practice - Swiss Redc77e147-a0dd-48a2-84a3... · 2019-06-04 · 12 /28 Screening mammography –Screening mammography is an x-ray examination](https://reader034.vdocuments.us/reader034/viewer/2022050115/5f4bf2f8993d1c4ed36f8fde/html5/thumbnails/29.jpg)
/2829
Basic Copyright Notice & Disclaimer
©2016 This presentation is copyright protected. All rights reserved. You may download or print out a hard copy for your private or internal use. You are not permitted to create any modifications or derivatives of this presentation without the prior written permission of the copyright owner.
This presentation is for information purposes only and contains non-binding indications. Any opinions or views expressed are of the author and do not necessarily represent those of Swiss Re. Swiss Re makes no warranties or representations as to the accuracy, comprehensiveness, timeliness or suitability of this presentation for a particular purpose. Anyone shall at its own risk interpret and employ this presentation without relying on it in isolation. In no event will Swiss Re be liable for any loss or damages of any kind, including any direct, indirect or consequential damages, arising out of or in connection with the use of this presentation.