Women’s health is an imaging specialty that has developed a unique and individual sector of medical imaging. There are various imaging modalities used within women’s health for detection of breast cancer. Primarily mammography is used for detection. This has proven the best method for reliable early detection in a majority of women. The development of technology and required standards for women’s health has been driven by a combination of factors.
The specifications for mammography are set by the Mammography Quality Standards Act (MSQA). The Food and Drug Administration (FDA) put the original version in place in 1992. It has since had additions and deletions and been updated to keep up with technology. You can find the latest information online here.
Mammography was the leader in the change from film to digital. In the USA, CR was never approved by the FDA for use in mammography. This had a profoundly positive, if unexpected, impact. The companies that wanted to maintain market share devoted funds to research and develop digital mammography that would meet the FDA guidelines. This prevented a stopgap measure of CR and can arguably be said to have saved health care facilities a significant amount of capital when considered over a 10-year period. Instead of buying CR and then buying digital mammography between five and 10 years later, they were forced to go directly to digital. The speed of the change was market driven. When word got out that digital mammography showed more detail, it did not take long for everyone to start looking to have their mammography performed at a location that had digital. Currently mammography is moving to tomography. Soon digital tomography mammography will be the standard.
There are other modalities to detect breast cancer. None of the modalities that follow are used as a primary or standalone screening tool. They are all used in conjunction with mammography.
Ultrasound is used in women’s health to identify changes in lumps or breast tissue. It is also a tool for women with very dense breast tissue where mammography may be hard to interpret. There are typically specific probes used to perform these studies.
Breast MRI is often used after a diagnosis of cancer has been made to look for other suspect locations and to evaluate any cancer found by the mammogram.
Less well known is Molecular Breast Imaging. This is performed with a nuclear medicine or gamma camera. It is used to locate cancer in women with dense breast tissue that makes it difficult to interpret. There are breast imaging gamma cameras. However, due to the extreme specialization, they are not very common.
Other than breast imaging, part of women’s health is Bone Density scanning. Also called Dual Energy X-ray Absorptiometry (DEXA). It is used to measure bone density and bone loss. This modality commonly generates a report to be stored in the digital medical record. This report is reviewed and interpreted in turn by a doctor.
Much of what has developed in women’s health has been driven by a combination of not-for-profit groups. They have driven public awareness which has pushed the FDA, through politicians, to ensure improved resources for early detection of breast cancer. A win for everyone involved.