Mammography and Next-gen Technology

J. Reed Anderson, GM Devils Lake Journal
April Sateren, left, and Janis Jaeger are the two mammographers at Altru Clinic in Devils Lake, with the 3-D machine.

"In 1983, when I started, we were still using X-ray machines," said Janis Jaeger.  "The woman would have to place herself just right on the table and we'd have to remove part of the machine.  It was like taking a picture and getting radiation treatment at the same time. But it was the best medicine at the time." Jaeger is a mammographer at Altru Clinic, here in Devils Lake.

The image produced was poor at best.  For technicians, radiologists and doctors, Jaeger said, it was like looking at a holstein in a snowstorm. Looking at some old teaching "pictures" from then, it's more like trying to identify a holstein in a blizzard while standing in front of a white wall.

"Back then," said Jaeger, "women only went in for mammograms when they felt a lump, and often by then it was too late.  The cancer had spread."

Now, the research and technology have combined to catch breast cancer at the cellular level.  The technology of mammography advanced apace with tremendous gains in the definition and sharpness of the image produced, to the point now where tiny markers, calcifications the size of a pencil point, are bright and easily seen. To the untrained eye, these appear as dust on the lens, nothing more. Nice and round and solitary and small, these are left alone.  But grouped and especially if jagged they are likely subjects for a biopsy performed with just a needle.

"In 1985 we got our first mammography machine," said Jaeger, "which was a real improvement over X-ray. For an effective image, the breast has to be uncomfortably compressed, but the machine gives two views and the quality of the image is much clearer."

This machine, with which many women are familiar, was new technology, unproven, and received an uncertain welcome by the health care industry. A film negative was still produced, and eventually film processors eliminated hand developing--dipping the negative, in a pitch black room, from one bath into another.  It was just a few years when this machine was accepted in general and still gives great service in much of the world. Then, in 2011, another jump in innovation, and the film was dispensed with and digital took its place.

"Everything became digital in 2011," said Jaeger.  "No more film, and the doctor could lighten or darken the image for contrast on a computer monitor. And just six years later, that is old technology, because we have 3-D mammography.  The lens rotates on an arc across the deck, taking fifteen different layers in seven seconds. The resolution of the image is incredible."

The 3-D machine performs digital tomosynthesis to create the image. It is still considered experimental and many insurances won't yet cover its use.  Jamestown Regional Medical Center had the first in the state, and now there nineteen machines in eight towns, including now Devils Lake. The image is stunning.  

The analogy of an old X-ray looking like a holstein against a wall in a snowstorm is not as accurate as saying it's instead a newspaper pinned to a white wall in a snowstorm.  

There is something there, on the film, but it's mostly a white mass on a white field with, to a trained eye, perhaps something dark in the midst.  The image produced by digital tomosynthesis, 3-D, shows not only a newspaper on the wall, but the outline of the paper, the difference in shading between the white of the wall and the newspaper, and through each individual and identifiable snowflake each and every word of the newspaper can be read.

A 3-D image shows the texture of the skin, a definitive outline of the breast and all of the blood vessels coursing through the breast.  And the calcifications no longer look like dust, and the small group of tiny, oddly shaped calcifications are unmistakable, and will lead to a biopsy, and possible an in situ removal, one cell at a time.

"I hear it all the time," Jaeger said, "'Oh, there's so much breast cancer in Devils Lake.'  I've conducted surveys and we see fewer than ten cases a year.  The reason it seems like there's more breast cancer is that there are more survivors of breast cancer.  People who die from other cancers aren't around and that cancer is forgotten.  Breast cancer survivors are plentiful and among us because it's treatable and women are living."