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PURPOSE: To introduce proton density water-fraction (PDWF) as a confounder-corrected MR-based biomarker of mammographic breast density, a known risk factor for breast cancer. METHODS: Chemical shift encoded (CSE) MR images were acquired using a low flip angle to provide proton density contrast from multiple echo times. Fat and water images, corrected for known biases, were produced by a six-echo confounder-corrected (CC) CSE-MRI algorithm. Fibroglandular tissue (FGT) volume was calculated from whole-breast segmented PDWF maps at 1.5T and 3T. The method was evaluated in (1) a physical fat-water phantom and (2) normal volunteers. Results from two- and three-echo CSE-MRI methods were included for comparison. RESULTS: Six-echo CC-CSE-MRI produced unbiased estimates of the total water volume in the phantom (mean bias 3.3%) and was reproducible across protocol changes (repeatability coefficient=14.8 cm(3) and 13.97 cm(3) at 1.5T and 3.0T respectively) and field strengths (repeatability coefficient=51.7 cm(3)) in volunteers, while the two- and three-echo CSE-MRI approaches produced biased results in phantoms (mean bias 30.7% and 10.4%) that was less reproducible across field strengths in volunteers (repeatability coefficient=82.3 cm(3) and 126.3 cm(3)). Significant differences in measured FGT volume was found between the six-echo CC-CSE-MRI and the two- and three-echo CSE-MRI approaches (P = 0.002 and P =0.001). CONCLUSION: The use of six-echo CC-CSE-MRI to create unbiased PDWF maps that reproducibly quantify FGT in the breast is demonstrated. Further studies are needed to correlate this quantitative MR biomarker for breast density with mammography and overall risk for breast cancer.

Limited data exist to guide appropriate use of magnetic resonance imaging (MRI) screening in women with a personal history of breast cancer. We developed an algorithm to inform the use of MRI screening in patients with a personal history, implemented it, and evaluated initial implementation at our community and academic practice sites.A multidisciplinary committee of providers developed the initial algorithm on the basis of available literature and consensus. To evaluate projected MRI utilization based on the initial algorithm and inform algorithm revision, charts of patients 80 years of age diagnosed and treated in 2010 with stage 0-III breast cancer (n = 236) were reviewed. The revised algorithm was implemented into the electronic medical record (September 2013). Thirteen months after implementation (2014-2015), chart review of patients with a personal history of breast cancer who underwent screening MRI was performed to assess algorithm adherence.Before algorithm development, 9% (20/236) of patients received MRI screening (6 genetic mutation/family history, 4 occult primary, 8 young age/breast density, 2 unknown). Use of MRI screening was projected to increase to 25% with algorithm implementation. In postimplementation review, we identified 183 patients with a personal history of breast cancer who underwent screening MRI, with 94% algorithm adherence.We successfully developed and implemented an algorithm to guide MRI screening in patients with a personal breast cancer history. Clinicians can use this algorithm to guide patient discussions regarding the utility of MRI screening. Further prospective study, including cancer detection rates, biopsy rate, and mortality, are necessary to confirm the algorithm's usefulness.

The degree of normal fibroglandular tissue that enhances on breast MRI, known as background parenchymal enhancement (BPE), was initially described as an incidental finding that could affect interpretation performance. While BPE is now established to be a physiologic phenomenon that is affected by both endogenous and exogenous hormone levels, evidence supporting the notion that BPE frequently masks breast cancers is limited. However, compelling data have emerged to suggest BPE is an independent marker of breast cancer risk and breast cancer treatment outcomes. Specifically, multiple studies have shown that elevated BPE levels, measured qualitatively or quantitatively, are associated with a greater risk of developing breast cancer. Evidence also suggests that BPE could be a predictor of neoadjuvant breast cancer treatment response and overall breast cancer treatment outcomes. These discoveries come at a time when breast cancer screening and treatment have moved toward an increased emphasis on targeted and individualized approaches, of which the identification of imaging features that can predict cancer diagnosis and treatment response is an increasingly recognized component. Historically, researchers have primarily studied quantitative tumor imaging features in pursuit of clinically useful biomarkers. However, the need to segment less well-defined areas of normal tissue for quantitative BPE measurements presents its own unique challenges. Furthermore, there is no consensus on the optimal timing on dynamic contrast-enhanced MRI for BPE quantitation. This article comprehensively reviews BPE with a particular focus on its potential to increase precision approaches to breast cancer risk assessment, diagnosis, and treatment. It also describes areas of needed future research, such as the applicability of BPE to women at average risk, the biological underpinnings of BPE, and the standardization of BPE characterization. Level of Evidence: 3 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:43-61.

The sensitivity of mammography is more limited in patients with dense breasts and some patients at higher risk for breast cancer. Patients with intermediate or high risk for breast cancer may begin screening earlier and benefit from supplemental screening techniques beyond standard 2-dimensional mammography. A patient's individual risk factors for developing breast cancer, their breast density, and the evidence supporting specific modalities for a given clinical scenario help to determine the need for supplemental screening and the modality chosen. Additional factors include the availability of supplemental screening techniques at an individual institution, cost, insurance coverage, and state-specific breast density legislation.

Purpose Current breast DCE-MRI strategies provide high sensitivity for cancer detection but are known to be insufficient in fully capturing rapidly changing contrast kinetics at high spatial resolution across both breasts. Advanced acquisition and reconstruction strategies aim to improve spatial and temporal resolution and increase specificity for disease characterization. In this work, we evaluate the spatial and temporal fidelity of a modified data-driven low-rank-based model (known as MOCCO, model consistency condition) compressed-sensing (CS) reconstruction compared to CS with temporal total variation with radial acquisition for high spatial-temporal breast DCE MRI. Methods Reconstruction performance was characterized using numerical simulations of a golden-angle stack-of-stars breast DCE-MRI acquisition at 5-second temporal resolution. Specifically, MOCCO was compared with CS total variation and conventional SENSE reconstructions. The temporal model for MOCCO was prelearned over the source data, whereas CS total variation was performed using a first-order temporal gradient sparsity transform. Results The MOCCO reconstruction was able to capture rapid lesion kinetics while providing high image quality across a range of optimal regularization values. It also recovered kinetics in small lesions (1.5 mm) in line-profile analysis and error images, whereas g-factor maps showed relatively low and constant values with no significant artifacts. The CS-TV method demonstrated either recovery of high spatial resolution with reduced temporal accuracy using large regularization values, or recovery of rapid lesion kinetics with reduced image quality using low regularization values. Conclusion Simulations demonstrated that MOCCO with radial acquisition provides a robust imaging technique for improving temporal fidelity, while maintaining high spatial resolution and image quality in the setting of bilateral breast DCE MRI.

The aim of this study was to determine the frequency and outcomes of incidental breast lesions detected on nonbreast specific cross-sectional imaging examinations. A retrospective review of the medical records was performed to identify all patients without a known history of breast cancer, who had an incidentally discovered breast lesion detected on a nonbreast imaging examination performed at our institution between September 2008 and August 2012 for this IRB-approved, HIPAA compliant study. Outcomes of the incidental lesions were determined by follow-up with dedicated breast imaging (mammography, breast ultrasound, and/or breast MRI) or results of biopsy, if performed. Imaging modality of detection, imaging features, patient age, patient location at the time of the nonbreast imaging examination, type of follow-up, and final outcome were recorded. Rates of malignancy were also calculated, and comparison was made across the different cross-sectional imaging modalities. Kruskal-Wallis and Fisher's exact tests were used to identify factors associated with an increased rate of malignancy. Logistic regression was used to model the risk of malignancy as a function of continuous predictors (such as patient age or lesion size); odds ratios and 95% confidence intervals were obtained. A total of 292 patients with incidental breast lesions were identified, 242 of whom had incidental lesions were noted on computed tomography (CT) studies, 25 on magnetic resonance imaging (MRI), and 25 on positron emission tomography (PET). Although most of the incidental breast lesions were detected on CT examinations, PET studies had the highest rate of detection of incidental breast lesions per number of studies performed (rate of incidental breast lesion detection on PET studies was 0.29%, compared to 0.10% for CT and 0.01% for MRI). Of the 121 of 292 (41%) patients who received dedicated breast imaging work-up at our institution, 40 of 121 (33%) underwent biopsy and 25 of 121 (21%) had malignancy. There was a significantly increased rate of malignancy in older patients (odds ratio: 1.05, 95% CI: 1.02-1.093; P = .006). Additionally, patients with PET-detected incidental breast lesions had a significantly higher rate of malignancy (55%), compared to patients with CT-detected (35%) and MRI-detected (8%) incidental breast lesions (P = .038). The rate of malignancy upon follow-up of incidental breast lesions detected on nonbreast imaging examinations in this retrospective study was 21%, supporting the importance of emphasizing further work-up of all incidentally detected breast lesions with dedicated breast imaging. Additionally, we found that PET examinations had the highest rate of detection of incidental breast lesions and the highest rate of malignancy, which suggests that PET examinations may be more specific for predicting the likelihood of malignancy of incidental breast lesions, compared to CT and MRI.

Purpose To develop a volumetric imaging technique with 0.8-mm isotropic resolution and 10-s/volume rate to detect and analyze breast lesions in a bilateral, dynamic, contrast-enhanced MRI exam. Methods A local low-rank temporal reconstruction approach that also uses parallel imaging and spatial compressed sensing was designed to create rapid volumetric frame rates during a contrast-enhanced breast exam (vastly undersampled isotropic projection [VIPR] spatial compressed sensing with temporal local low-rank [STELLR]). The dynamic-enhanced data are subtracted in k-space from static mask data to increase sparsity for the local low-rank approach to maximize temporal resolution. A T1 -weighted 3D radial trajectory (VIPR iterative decomposition with echo asymmetry and least squares estimation [IDEAL]) was modified to meet the data acquisition requirements of the STELLR approach. Additionally, the unsubtracted enhanced data are reconstructed using compressed sensing and IDEAL to provide high-resolution fat/water separation. The feasibility of the approach and the dual reconstruction methodology is demonstrated using a 16-channel breast coil and a 3T MR scanner in 6 patients. Results The STELLR temporal performance of subtracted data matched the expected temporal perfusion enhancement pattern in small and large vascular structures. Differential enhancement within heterogeneous lesions is demonstrated with corroboration from a basic reconstruction using a strict 10-second temporal footprint. Rapid acquisition, reliable fat suppression, and high spatiotemporal resolution are presented, despite significant data undersampling. Conclusion The STELLR reconstruction approach of 3D radial sampling with mask subtraction provides a high-performance imaging technique for characterizing enhancing structures within the breast. It is capable of maintaining temporal fidelity, while visualizing breast lesions with high detail over a large FOV to include both breasts.

Published in the Bloomsbury Social Theory and Methodology in Education Research Series, this book edited by Mike Murphy, Ciaran Burke, Cristina Costa and Rille Raaper critically examines the curren...

Rationale and Objectives The BI-RADS Atlas 5th Edition includes screening breast magnetic resonance imaging (MRI) outcome benchmarks. However, the metrics are from expert practices and clinical trials of women with hereditary breast cancer predispositions, and it is unknown if they are appropriate for routine practice. We evaluated screening breast MRI audit outcomes in routine practice across a spectrum of elevated risk patients. Materials and Methods This Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study included all consecutive screening breast MRI examinations from July 1, 2010 to June 30, 2013. Examination indications were categorized as gene mutation carrier (GMC), personal history (PH) breast cancer, family history (FH) breast cancer, chest radiation, and atypia/lobular carcinoma in situ (LCIS). Outcomes were determined by pathology and/or ≥12 months clinical and/or imaging follow-up. We calculated abnormal interpretation rate (AIR), cancer detection rate (CDR), positive predictive value of recommendation for tissue diagnosis (PPV2) and biopsy performed (PPV3), and median size and percentage of node-negative invasive cancers. Results Eight hundred and sixty examinations were performed in 566 patients with a mean age of 47 years. Indications were 367 of 860 (42.7%) FH, 365 of 860 (42.4%) PH, 106 of 860 (12.3%) GMC, 14 of 860 (1.6%) chest radiation, and 8 of 22 (0.9%) atypia/LCIS. The AIR was 134 of 860 (15.6%). Nineteen cancers were identified (13 invasive, 4 DCIS, two lymph nodes), resulting in CDR of 19 of 860 (22.1 per 1000), PPV2 of 19 of 88 (21.6%), and PPV3 of 19 of 80 (23.8%). Of 13 invasive breast cancers, median size was 10 mm, and 8 of 13 were node negative (61.5%). Conclusions Performance outcomes of screening breast MRI in routine clinical practice across a spectrum of elevated risk patients met the American College of Radiology Breast Imaging Reporting and Data System benchmarks, supporting broad application of these metrics. The indication of a personal history of treated breast cancer accounted for a large proportion (42%) of our screening examinations, with breast MRI performance in this population at least comparable to that of other screening indications.

Objective Currently, dynamic contrast-enhanced (DCE) breast magnetic resonance imaging (MRI) prioritizes spatial resolution over temporal resolution given the limitations of acquisition techniques. The purpose of our intrapatient study was to assess the ability of a novel high spatial and high temporal resolution DCE breast MRI method to maintain image quality compared with the clinical standard-of-care (SOC) MRI. Materials and methods Thirty patients, each demonstrating a focal area of enhancement (29 benign, 1 cancer) on their SOC MRI, consented to undergo a research DCE breast MRI on a second date. For the research DCE MRI, a method (DIfferential Subsampling with Cartesian Ordering [DISCO]) using pseudorandom k-space sampling, view sharing reconstruction, 2-point Dixon fat-water separation, and parallel imaging was used to produce images with an effective temporal resolution 6 times faster than the SOC MRI (27 vs 168 seconds, respectively). Both the SOC and DISCO MRI scans were acquired with matching spatial resolutions of 0.8 × 0.8 × 1.6 mm. Image quality (distortion/artifacts, resolution, fat suppression, lesion conspicuity, perceived signal-to-noise ratio, and overall image quality) was scored by 3 radiologists in a blinded reader study. Results Differences in image quality scores between the DISCO and SOC images were all less than 0.8 on a 10-point scale, and both methods were assessed as providing diagnostic image quality in all cases. DISCO images with the same high spatial resolution, but 6 times the effective temporal resolution as the SOC MRI scans, were produced, yielding 20 postcontrast time points with DISCO compared with 3 for the SOC MRI, over the same total time interval. Conclusions DISCO provided comparable image quality compared with the SOC MRI, while also providing 6 times faster effective temporal resolution and the same high spatial resolution.

Discussions in electromobility often focus on product technologies, infrastructure systems and energy management. This unfortunately leads to the neglect of the business aspects concerning electric vehicles (EVs), which often remain a secondary issue. The development and realization of EVs requires new business models and this presupposes the implementation of new value creation networks, new production and sales systems as well as an extensive analysis of the business aspects of EVs.

Estrogen receptor (ER) and progesterone receptor (PR) are important prognostic and predictive biomarkers in breast cancer. PET using ER- and PR-specific radioligands enables a whole-body, noninvasive assessment of receptor expression. Recent investigations of ER imaging with 18F-fluoroestradiol have focused on diagnosing ER-positive metastatic disease, optimizing ER-targeted drug dosage, and predicting endocrine therapy benefit. Studies of PR imaging with 18F-fluorofuranyl norprogesterone have investigated how imaging changes in PR expression as a downstream target of ER activation may reflect an early response to ER-targeted therapy. This focused review highlights recent achievements in preclinical and clinical imaging of ER and PR in breast cancer.

Male breast cancer is a rare malignancy. Due to low prevalence and limited data to support male breast cancer screening, there are currently no recommendations for image-based screening in asymptomatic men and few recommendations for men at high risk for breast cancer. However, symptomatically diagnosed cancers in men are typically advanced, suggesting that earlier detection may improve outcomes. In this article we briefly review the risk factors for male breast cancer, and discuss the potential benefits and possible drawbacks of routine image-based screening for men at high risk for breast cancer.

To compare the measurement of glucose uptake in primary invasive breast cancer using simultaneous, time-of-flight breast PET/MRI with prone time-of-flight PET/CT.In this prospective study, women with biopsy-proven invasive breast cancer undergoing preoperative breast MRI from 2016 to 2018 were eligible. Participants who had fasted underwent prone PET/CT of the breasts approximately 60 minutes after injection of 370 MBq (10 mCi) fluorine 18 fluorodeoxyglucose (Twenty-three women (mean age, 50 years; range, 33-70 years) were included. Correlation between tumor uptake values measured with PET/MRI and PET/CT was strong (These results demonstrate measurement agreement between PET/CT, the current reference standard for tumor glucose uptake quantification, and simultaneous time-of-flight breast

BI-RADS for mammography and ultrasound subdivides category 4 assessments by likelihood of malignancy into categories 4A (2% to ≤ 10%), 4B (10% to ≤ 50%), and 4C (50% to95%). Category 4 is not subdivided for breast MRI because of a paucity of data. The purpose of the present study is to determine the utility of categories 4A, 4B, and 4C for MRI by calculating their positive predictive values (PPVs) and comparing them with BI-RADS-specified rates of malignancy for mammography and ultrasound.All screening breast MRI examinations performed from July 1, 2010, through June 30, 2013, were included in this study. We identified in medical records prospectively assigned MRI BI-RADS categories, including category 4 subdivisions, which are used routinely in our practice. Benign versus malignant outcomes were determined by pathologic analysis, findings from 12 months or more clinical or imaging follow-up, or a combination of these methods. Distribution of BI-RADS categories and positive predictive value level 2 (PPV2; based on recommendation for tissue diagnosis) for categories 4 (including its subdivisions) and 5 were calculated.Of 860 screening breast MRI examinations performed for 566 women (mean age, 47 years), 82 with a BI-RADS category 4 assessment were identified. A total of 18 malignancies were found among 84 category 4 and 5 assessments, for an overall PPV2 of 21.4% (18/84). For category 4 subdivisions, PPV2s were as follows: for category 4A, 2.5% (1/40); for category 4B, 27.6% (8/29); for category 4C, 83.3% (5/6); and for category 4 (not otherwise specified), 28.6% (2/7).Category 4 subdivisions for MRI yielded malignancy rates within BI-RADS-specified ranges, supporting their use for benefits to patient care and more meaningful practice audits.

Rationale and Objectives Breast dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) scanning protocols vary widely. The purpose of this study was to determine the effects of postcontrast timing on delayed-phase lesion kinetics assessment and ability to discriminate malignant from benign lesions. Materials and Methods Following institutional review board approval, we retrospectively reviewed all lesions assessed on magnetic resonance examinations from April 2005 to June 2006. DCE-MRI was performed with 90-second temporal resolution. Delayed-phase kinetic parameters including percentages of persistent, plateau, and washout, and categorizations of predominant and worst curve type were compared between 4.5 and 7.5 minutes postcontrast. Ability to discriminate benign and malignant lesions based on delayed-phase kinetic parameters was compared between postcontrast timings by receiver operating characteristic (ROC) analysis. Results Two hundred eighty consecutive breast lesions (206 malignant and 74 benign) were evaluated in 228 women. Comparing kinetics assessments at 7.5 versus 4.5 minutes: volume percentage of washout increased in malignancies by a mean of 9.4% (P .05). There were no significant differences between timings in area under ROC curves for delayed-phase kinetic parameters. Conclusions The choice of delayed postcontrast timing more strongly affects the kinetics assessments for malignancies than benign breast lesions, but our results suggest that a shortened breast DCE-MRI protocol may not significantly impact diagnostic accuracy. Furthermore, worst curve type classifications are least affected by postcontrast timing and may provide reliable assessment of delayed-phase kinetics across protocols.

The number of fatal accidents involving pedestrians and bikers at urban intersections is still increasing. Therefore, an intersection-based perception system provides a dynamic model of the intersection scene to the vehicles. Based on that, the intersection perception facilitates to discriminate occlusions which is expected to significantly reduce the number of accidents at intersections. Therefore this contribution presents a general purpose multi-sensor tracking algorithm, the classifying multiple-model probability hypothesis density (CMMPHD) filter, which facilitates the tracking and classification of relevant objects using a single filter. Due to the different motion characteristics, a multiple-model approach is required to obtain accurate state estimates and persistent tracks for all types of objects. Additionally, an extension of the PHD filter to handle contradictory measurements of different sensor types based on the Dempster-Shafer theory of evidence is proposed. The performance of tracking and classification is evaluated using real world sensor data of a public intersection.

The Enhancing Quality Using the Inspection Program (EQUIP) augments the FDA/MQSA program to ensure image quality review and implementation of corrective processes. In our screening mammography program, we compared technical recalls between digital breast tomosynthesis (DBT) and 2D full-field digital mammography (FFDM). This HIPAA-compliant study was exempt from IRB review. In consecutive screening mammograms (October 2013 through December 2017), prospectively recorded technical recalls were compared for imaging modality (FFDM, DBT+FFDM, DBT+synthesized mammography (SynM)), images requested, and indication(s) for technical recall (motion, positioning, technical/artifact). Chi-squared tests evaluated statistical significance between proportions. Of 48,324 screening mammograms, 277 (0.57%) patients were recalled for 360 indications with 371 repeated views. There were significantly less recalls among DBT exams compared to FFDM (X2 = 25.239; p=0

The purpose of this study was to compare the differences in kinetic assessments of lesions at breast MRI performed with higher and lower temporal resolution.All consecutively evaluated BI-RADS category 4, 5, and 6 lesions imaged with breast MRI and pathologically confirmed from October 2005 to August 2009 were identified. Patients underwent MRI with one of two dynamic contrast-enhanced protocols: one with 90-second (October 2005-June 2006) and another with 180-second (July 2006-August 2009) temporal resolution. Studies were processed with a computer-aided evaluation system with initial and delayed contrast-enhanced time points with the k-space centered 90 and 450 seconds after contrast injection. Initial-phase peak enhancement, delayed-phase predominant curve type, and worst curve type were recorded and compared for benign and malignant lesions across protocols.The analysis set comprised 993 lesions: 145 imaged with the 90-second acquisition (17 benign, 28 ductal carcinoma in situ [DCIS], 100 invasive cancer) and 848 imaged with the 180-second acquisition (212 benign, 145 DCIS, 491 invasive cancer). Peak enhancement was significantly higher for both benign lesions (p = 0.01) and invasive cancers (p = 0.0008) with the 180-second protocol. Peak enhancement of DCIS was similar in the two protocols (p = 0.88). Delayed-phase kinetics were similar for the two protocols for both benign and malignant lesions when defined by predominant or worst curve type.Although it has lower temporal resolution, a 180-second acquisition may be preferable because it allows higher spatial resolution and captures higher initial-phase peak enhancement without loss of delayed-phase kinetic information.

Background: Inheritance of an abnormal BRCA 1/2 gene, a family history of breast cancer (BrCa), or a personal history of lobular carcinoma in situ (LCIS), atypical hyperplasia, or chest wall radiation can significantly increase an individual's lifetime risk for developing BrCa. In 2007, the American Cancer Society (ACS) released updated guidelines for screening in women with a lifetime risk of BrCa ≥20-25%. These guidelines added MRI screening to annual mammography. The objective of our analysis is to characterize patients referred after the release of the 2007 ACS guidelines to subspecialty providers specifically for evaluation of BrCa risk and analyze subsequent screening and risk reduction recommendations in the cohort of patients (pts) with a predicted increased lifetime risk for BrCa. Methods: Pts seen at a single center (University of Wisconsin [UW]) between 1/2007-3/2011 by medical, surgical and/or gynecology-oncology for an increased lifetime risk of BrCa were identified by billing codes or evaluation in the UW Breast Cancer Prevention, Assessment and Tailored Health Screening (PATHS) Clinic. Pts with a personal history of BrCa prior to 1/2007 are excluded. Patients with a known genetic predisposition to BrCa, family history of breast cancer, or a personal history of LCIS, atypical hyperplasia or chest wall radiation are included in this analysis. All charts will be evaluated for documentation of the individual's lifetime risk of BrCa and method used for risk-assessment, recommended and performed screening tests, concordance with ACS screening guidelines, patient adherence to initial and subsequent screening recommendations, and uptake of risk reduction strategies. Call-back rates for additional or follow-up imaging and/or biopsy following BrCa screening and characteristics of all new BrCa diagnoses will be collected. Results: 240 eligible pts were seen during the study period. 15% of pts referred had a known genetic predisposition to BrCa. Most pts (75%) were referred for a family history of BrCa. The majority of these pts had a predicted lifetime risk of BrCa in excess of 20%, with less than 10% of patients being referred having a lifetime risk Conclusion: Pts with a predicted increased lifetime risk for BrCa are often evaluated by oncology subspecialty providers. The primary factor related to referral is family history of BrCa. The majority of patients referred to a subspecialty provider have a calculated lifetime risk for BrCa in excess of 20%. This study evaluates provider assessment of BrCa risk and subsequent recommendations for screening and discussion of risk reduction strategies. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-21.

New dynamic MRI methods hold promise in better characterization of the complex structure and heterogeneous treatment response of brain tumors. These methods utilize assumptions to reduce the data samples needed to produce high temporal and spatial resolution images with complex, iterative reconstructions. Determining how these methods depict actual brain tumor pathology is difficult due to lack of a gold standard. We therefore tailor an existing digital tool, built originally to simulate dynamic MRI breast studies, to assess the performance of new dynamic methods if applied to brain cancer. The tool permits a tumor of customizable shape featuring an inner core and an adjustable surrounding rim to be overlaid on a digital 3-D brain model, which we acquired from an online database called BrainWeb, with segmented brain tissue layers. We used existing capabilities in the tool to assign pharmacokinetic parameters to each tumor region to simulate necrotic cores and rims of varying width that represent spatially varying levels of enhancement due to tumor pathology and/or radiation necrosis. The tool then computes the corresponding MR k-space data for any proposed MR sampling trajectory during a simulated passage of a contrast agent. The simulated MR k-space data can then be input to any proposed reconstruction to produce a simulated time course of image volumes. Performance of proposed dynamic MR imaging methods can be measured against the digital truth prior to clinical trials through methods including: the structural similarity (SSIM) index over the lesion region-of-interest, comparing calculated vs. assigned pharmacokinetic parameters, and root-mean-square error. We are using this tool to estimate the performance, in brain applications, of a 3-D radial acquisition and reconstruction method with compressed sensing and local low rank that was previously demonstrated to produce 0.8 mm resolution in a 10 second frame rate in bilateral breast screening.

Liver resection is the current standard treatment for patients with both primary and metastatic liver cancer. The principal causes of morbidity and mortality after liver resection are related to blood loss (typically between 0.5 and 1 L), especially in cases where transfusion is required. Blood transfusions have been correlated with decreased long-term survival, increased risk of perioperative mortality and complications. The goal of this study was to evaluate different designs of a radiofrequency (RF) electrode array for use during liver resection. The purpose of this electrode array is to coagulate a slice of tissue including large vessels before resecting along that plane, thereby significantly reducing blood loss. Finite Element Method models were created to evaluate monopolar and bipolar power application, needle and blade shaped electrodes, as well as different electrode distances. Electric current density, temperature distribution, and coagulation zone sizes were measured. The best performance was achieved with a design of blade shaped electrodes (5 × 0.1 mm cross section) spaced 1.5 cm apart. The electrodes have power applied in bipolar mode to two adjacent electrodes, then switched sequentially in short intervals between electrode pairs to rapidly heat the tissue slice. This device produces a ~1.5 cm wide coagulation zone, with temperatures over 97 ºC throughout the tissue slice within 3 min, and may facilitate coagulation of large vessels.

Rationale and Objectives At the authors' level 1 trauma center, postgraduate year 3 and 4 radiology residents interpret urgent overnight imaging studies, which are reviewed by attending radiologists the next morning. The goals of this study were to determine the discrepancy rate for torso computed tomography between resident radiologists' preliminary interpretations and attending radiologists' final interpretations and to identify adverse patient events secondary to the delayed diagnoses. Materials and Methods All torso computed tomographic studies interpreted by weekday night residents (8 pm to 8 am ) from January 1, 2005, to March 13, 2007, were evaluated retrospectively. Major discrepancies between the residents' interpretations and the attending radiologists' interpretations were compiled. Exams with major discrepancies were additionally reviewed by two radiology residents and an attending emergency radiologist. The medical records of patients with major discrepant findings were also reviewed to identify adverse events that occurred because of the delays in final interpretation. Results A total of 4768 chest, abdominal, and/or pelvic computed tomographic studies were interpreted during the study period. A total of 112 major discrepancies were collected. In 17 cases (15%), two additional radiology residents and an attending emergency radiologist agreed with the initial residents' interpretations, decreasing the major discrepancy rate to 95 of 4768 (2.0%), consistent with data from the literature (0.4%–10%). Management was changed in 16 patients (0.3%) because of the major discrepancies: 13 patients underwent additional investigations, and 3 patients were recalled to the emergency room. No mortality or morbidity was directly attributed to the delays in diagnosis. Conclusion At the authors' institution, there was a 2.0% discrepancy rate between residents' preliminary interpretations and attending radiologists' final interpretations of overnight torso computed tomography, with a small rate of additional intervention as a result of the major discrepancies. No adverse patient effects were directly attributable to discrepant interpretations. In discrepant cases, there was a 15% disagreement rate (17 of 112) between attending radiologists, suggesting some degree of interreader variance in interpretation. In addition, this disagreement rate among attending radiologists may imply that these cases were complex. Because there is educational value in overnight call, independent radiology resident coverage should continue.

The purpose of this study was to determine magnetic resonance imaging (MRI) screening recommendations and the subsequent outcomes in women with increased risk for breast cancer evaluated by oncology subspecialists at an academic center. Patients evaluated between 1/1/2007 and 3/1/2011 under diagnosis codes for family history of breast or ovarian cancer, genetic syndromes, lobular carcinoma in situ or atypical hyperplasia were included. Patients with a history of breast cancer were excluded. Retrospective review of prospectively acquired demographics, lifetime risk of breast cancer, and screening recommendations were obtained from the medical record. Retrospective review of the results of prospectively interpreted breast imaging examinations and image-guided biopsies were analyzed. 282 women were included. The majority of patients were premenopausal with a median age of 43. Most (69%) were referred due to a family history of breast or ovarian cancers. MRI was recommended for 84% of patients based on a documented lifetime risk >20%. Most women referred for MRI screening (88%) were compliant with this recommendation. A total of 299 breast MRI examinations were performed in 146 patients. Biopsy was performed for 32 (11%) exams and 10 cancers were detected for a positive predictive value (PPV) of 31% (based on biopsy performed) and an overall per exam cancer yield of 3.3%. Three cancers were detected in patients who did not undergo screening MRI. The 13 cancers were Stage 0-II; all patients were without evidence of disease with a median follow-up of 22 months. In a cohort of women seen by breast subspecialty providers, screening breast MRI was recommended according to guidelines, and used primarily in premenopausal women with a family history or genetic predisposition to breast cancer. Adherence to MRI screening recommendations was high and cancer yield from breast MRI was similar to that in clinical trials.

Most Canadian software developers are employed by equipment manufacturers, aerospace companies, telecommunications companies, and other system integrators rather than working for pure software product companies. The paper discusses the Canadian software industry, its educational system, quality standards and processes, its labour situation and challenges.

Public intersections are, due to their complexity, challenging locations for drivers. Therefore the German joint project Ko-PER, which is part of the project initiative Ko-FAS, has equipped a public intersection with several laserscanners and video cameras to generate a comprehensive dynamic model of the ongoing traffic. Results of the intersection perception can be communicated to equipped vehicles by wireless communication. This contribution presents a dataset of the Ko-PER intersection to the research community for further research in the field of multi-object detection and tracking. Therefor the dataset consists of sensor data from the laserscanners network and cameras as well as reference data and object labels. With that dataset, the authors aim to stimulate further research in this area.

During a test program on flange-to-flange connectors for double tees, the behavior of stud-welded deformed bar anchors (DBA) became in doubt after several weld failures occurred prematurely. Since DBAs are commonly used for connections in many other types of precast concrete members, their reliability had been assumed to be satisfactory. This paper describes a small investigation into why these brittle failures occurred and what changes could be made to the stud welding process to prevent them. For this purpose, sixty-nine 3/8 in. (9.52 mm) diameter stud-welded deformed anchor bars were tested in tension to fracture. The specimens were fabricated by four manufacturers from different parts of the United States to obtain a sample of weld quality in practice. The results show that 19 percent of the specimens fractured at the weld. The data also showed that nearly all the specimens that fractured at the weld were fabricated using a particular stud gun setting procedure. Based on the test results, quality control procedures and revised settings are recommended for stud welding of 3/8 in. (9.52 mm) diameter DBAs.

Four papers and a roundtable discussion shed light on the current state of software testing practices. Case studies from industry experience address topics including unit-testing practices, agile testing, and automating software testing. Although many of these approaches show promise, software testing is still one of the more neglected practices within the software development life cycle. Suggestions for improvements in industry and academia are offered.

We report a case of distal radioulnar joint (DRUJ) arthroplasty with a Scheker prosthesis. Arthropathy of the DRUJ can occur as the result of a variety of mechanisms, including inflammatory arthritis, osteoarthritis, and post-traumatic arthritis. Resection of the distal ulna is often performed to relieve pain at the DRUJ. However, this can also disrupt the stability of the entire forearm, leading to convergence instability of the stump of the ulna against the radius. Several DRUJ prostheses have been developed to replace the mechanical function of the ulnar head in patients with pain related to distal ulnar resection and post-traumatic arthritis. However, most of them are designed to be used in patients with intact soft tissue and stabilizing ligaments at the DRUJ. These devices, therefore, are not appropriate for use in patients who have undergone resection of the DRUJ. The Scheker prosthesis was designed for patients who are symptomatic after ablation of the DRUJ from trauma or prior surgical resection. It uses a two plate and ball design, which has a unique appearance on post-operative radiographs.

Background The purpose of this systematic review was to summarize previously published case reports of primary lung carcinoma metastasis to the breast to assess common clinical and pathologic features and management strategies. Materials and methods Case reports describing breast metastasis of primary lung carcinoma were systematically evaluated in MEDLINE and EMBASE. Results Thirty-one reported cases of non-small-cell lung carcinoma (NSCLC) metastasized to the breast were identified, along with eight cases of small-cell lung carcinoma. Sixty-seven percent of reported NSCLC metastases to the breast were detected metachronously with the primary lung abnormality, whereas 80% of small-cell lung carcinoma breast metastases appeared synchronously. Thyroid transcription factor 1 was found to be expressed in 58% of total NSCLC breast metastases, including 83% of those of adenocarcinoma origin. Therapeutic strategies among NSCLC cases varied widely, and only 36% of NSCLC breast metastasis patients were administered chemotherapy. Additional sites of metastasis in these cases are summarized as well. Conclusions It is recommended to include metastatic lung cancer in the differential diagnosis of patients presenting with a breast abnormality in the context of a suspected lung cancer. Thyroid transcription factor 1 expression should be examined in these cases. The metachronous versus synchronous nature of lung carcinoma metastasis to the breast has consequences for both detection of the primary and secondary lesions and patient outlook. Clinical correlation is vital to effective management of the care of patients harboring these atypical secondary lesions.

Intersections are challenging locations for drivers. Complex situations are common due to the variety of road users and intersection layouts. This contribution describes a real time method for detecting and tracking vehicles at intersections using images captured by a static camera network. After background subtraction, the foreground segments are projected on a common fusion map. Using this fusion map, the pose, width, and height of the vehicles can be determined. After that, the detected objects are tracked by a Gaussian-Mixture approximation of the Probability Hypothesis Density filter. Results of the intersection perception can further be communicated to equipped vehicles by wireless communication.

To significantly reduce injury and fatal accidents smart intersections equipped with sensors and communication infrastructure have been proposed. In this publication a novel multi sensor network to perceive the intersection environment is presented. Based on an intensive analysis of accident scenarios in Germany the system was designed to address 75 % of all severe and lethal accidents. 14 laserscanners, 10 cameras, signal phase tapping and an I2V communication unit have been installed at a public intersection in Aschaffenburg, Germany. By using computer based field of view modelling the sensor positions are carefully selected to avoid occlusions. Thus, the infrastructure perception system provides a bird's eye view. Our experiments show that spatial and temporal alignment of sensor data is achieved. We also demonstrate that a part of the sensor network, a calibrated stereo system, allows 3D coordinates in the field of view region of the cameras to be determined with an accuracy of 30 mm.

This International Workshop on Global Software Development for the Practitioner (GSD2006) was held in conjunction with the 28th International Conference on Software Engineering (ICSE 2006) on May 23rd, 2006 in Shanghai, China. The workshop was motivated by the industry trend towards developing software in globally distributed settings: geographically distributed teams, or outsourcing parts of the software development to other organizations in other parts of the world. Topics presented and discussed in the workshop focused on grounded, practical strategies and techniques that address the geographic, temporal, organizational, and cultural boundaries inherent in global software projects.

This International Workshop on Global Software Development for the Practitioner (GSD2006) is held in conjunction with the 28TH International Conference on Software Engineering (ICSE 2006) on May 23RD , 2006 in Shanghai, China. The workshop is motivated by the industry trend toward developing software in globally distributed settings: geographically distributed teams or outsourcing part of software development to other organizations in other parts of the world. Topics presented and discussed in the workshop focus on grounded, practical strategies and techniques that address the geographical, temporal, organizational and cultural boundaries inherent in global software projects.

If an acoustic source and a pair of passive, acoustic, angle­ measuring sensors lie i!1 a plne, it is po.sible to locize . te source using triangulation . GIVen the abllty to loc��ze, Its then possible to characterize the errors In the pOSItIon esti­ mate given estimates of thmeasuement . errors .. Thpurpose of this research is to quantify the sIngle fix localIzatIoaccu­ racy of a pair of short linear arrays when those acou .stIC sen­ sors are not in the same plane but are separated In depth from the source. Sensitivity of localization accuracy . to the geometric rlation­ ship between the source and a parr of sensors establIshes .a fundamental basis for the examination of other factors. ThiS paper is limited to an examination of the sensitivity of per­ formance to geometric variations . We show that geometry alone will allow measurement accu­ racy with enough precision to suggest the need for fer research' the additional research is required to detenrune whether 'the received SNR is sufficient to satisfy the require­ ments of operational sonar and acoustic-range tracking sys­ tems .

The rat forelimb compression model has been used widely to study bone response to mechanical loading. We used strain gages to assess load sharing between the ulna and radius in the forelimb of adult Fisher rats. We used histology and peripheral quantitative computed tomography (pQCT) to quantify ulnar bone formation 12 days after in vivo fatigue loading. Lastly, we developed a finite element model of the ulna to predict the pattern of surface strains during compression. Our findings indicate that at the mid-shaft the ulna carries 65% of the applied compressive force on the forelimb. We observed large variations in fatigue-induced bone formation over the circumference and length of the ulna. Bone formation was greatest 1-2 mm distal to the mid-shaft. At the mid-shaft, we observed woven bone formation that was greatest medially. Finite element analysis indicated a strain pattern consistent with a compression-bending loading mode, with the greatest strains occurring in compression on the medial surface and lesser tensile strains occurring laterally. A peak strain of -5190 microepsilon (for 13.3N forelimb compression) occurred 1-2 mm distal to the mid-shaft. The pattern of bone formation in the longitudinal direction was highly correlated to the predicted peak compressive axial strains at seven cross-sections (r2 = 0.89, p = 0.014). The in-plane pattern of bone formation was poorly correlated to the predicted magnitude of axial strain at 51 periosteal locations (r2 = 0.21, p < 0.001), because the least bone formation was observed where tensile strains were highest. These findings indicate that the magnitude of bone formation after fatigue loading is greatest in regions of high compressive strain.

Summary form only given. The labour shortage in information technology is becoming one of the biggest challenges for the software industry. This paper describes the approach to an experiment with several software companies to increase productivity in a measurable way. The pilot project draws on the authors' experience from over 60 software development process assessments and publications on productivity and software development costs over the last twenty years.

Over the last five years MacDonald Dettwiler and Associates (MDA), a major Canadian systems integrator, has managed the transition from innovative high-tech systems development to the successful production of large software systems for the aerospace industry. It has received international recognition in meeting budget, schedule, and requirements for software systems in excess of one million lines of code. The author describes the management challenges in moving toward a structured approach with emphasis on quality, reliability, and predictability. He presents the introduction of standards, methodologies, and quality management without stifling individual creativity and innovation. Lessons learned at MDA are presented. >

The capability maturity model was originally developed for large military and aerospace contractors. It represents an excellent framework of software process concepts and embodies some general principles which apply to companies of any size and product orientation. We found, however, that it was less suited for small and medium sized enterprises. This paper describes three years of experience with a modified assessment technique. The paper also looks beyond process related issues and analyzes other fundamental problems which are rooted in the management of software.

Software Productivity Center Inc. (SPC) was formed in 1992 as a nonprofit organization promoting the use of best practices and processes to increase the efficiency, reliability, and predictability of the software development process. The SPC is located in Vancouver, BC, Canada. Its clients are situated around the world with the majority in the United States. The goal outlined in the original business plan was for the center to become self-sustaining in five years. It reached this and privatized in 1997. SPC has a few attributes that set it apart from other leading centers for software process. SPC has a business perspective. SPC advocates best practices that will have the greatest initial impact on the success of the business, while helping to put a structure in place to ensure ongoing learning and advancement of the organization and its staff. SPC has over 100 member companies that enjoy benefits such as discounts on training and products, free monthly seminars, and advice and information from SPC experts. Interaction with these member companies ensures SPC stays current with the challenges and issues facing software organizations each day. Member companies also benefit from SPC's affiliation and participation in international organizations such as the International Organization for Standardization (ISO standards), The Institute of Electrical and Electronics Engineers, Inc. (IEEE), and the Project Management Institute (PMI). Keywords: framework; plan; improvement; electronic newsletter; services

Author(s): Burnside, Elizabeth S; Lin, Yunzhi; Munoz del Rio, Alejandro; Pickhardt, Perry J; Wu, Yirong; Strigel, Roberta M; Elezaby, Mai A; Kerr, Eve A; Miglioretti, Diana L | Abstract: BackgroundMotivated by the challenges in assessing physician-level cancer screening performance and the negative impact of misclassification, we propose a method (using mammography as an example) that enables confident assertion of adequate or inadequate performance or alternatively recognizes when more data is required.MethodsUsing established metrics for mammography screening performance-cancer detection rate (CDR) and recall rate (RR)-and observed benchmarks from the Breast Cancer Surveillance Consortium (BCSC), we calculate the minimum volume required to be 95% confident that a physician is performing at or above benchmark thresholds. We graphically display the minimum observed CDR and RR values required to confidently assert adequate performance over a range of interpretive volumes. We use a prospectively collected database of consecutive mammograms from a clinical screening program outside the BCSC to illustrate how this method classifies individual physician performance as volume accrues.ResultsOur analysis reveals that an annual interpretive volume of 2770 screening mammograms, above the United States' (US) mandatory (480) and average (1777) annual volumes but below England's mandatory (5000) annual volume is necessary to confidently assert that a physician performed adequately. In our analyzed US practice, a single year of data uniformly allowed confident assertion of adequate performance in terms of RR but not CDR, which required aggregation of data across more than one year.ConclusionFor individual physician quality assessment in cancer screening programs that target low incidence populations, considering imprecision in observed performance metrics due to small numbers of patients with cancer is important.

Background: Multiple factors are associated with an increased lifetime risk of breast cancer, including inheritance of an abnormal BRCA 1/2 gene, history of lobular carcinoma in situ (LCIS) or atypical hyperplasia, family history of breast cancer or previous chest wall radiation. In 2007, the American Cancer Society released updated guidelines for breast cancer screening based on risk stratification. These guidelines added annual MRI screening to mammography for women with greater than or equal to a 20–25% lifetime risk. Breast MRI screening trials have consistently demonstrated a higher sensitivity of MRI for malignancy compared with mammography, with an additional cancer yield from MRI of approximately 3%. The purpose of this study was to evaluate MRI screening outcomes in women with an increased risk for breast cancer evaluated in an established breast subspecialty clinic within the University of Wisconsin (UW) Hospital and Clinics. Methods: Patients (Pts) were included if they were seen by a UW breast center nurse practitioner, medical or surgical oncologist between 1/1/2007–3/1/2011 with a diagnosis code of: family history of breast or ovarian cancer, genetic susceptibility to malignant neoplasm or genetic carrier, Hodgkin's disease, LCIS, or atypical hyperplasia. Pts with a co-existing diagnosis of invasive breast cancer or ductal carcinoma in situ prior to initial encounter were excluded. Demographic information, breast cancer risk factors, estimated lifetime risk of breast cancer and screening recommendations were abstracted from the medical record. Results of subsequent breast imaging examinations (including breast MRI, diagnostic and screening mammography, and image-guided biopsies) were analyzed with the use of the mammography information system (PenRad™). Results: Of 276 women who met the inclusion criteria, 148 underwent at least 1 screening breast MRI. The majority of MRI screened pts were premenopausal (82%) and Caucasian (96.6%) with a mean age of 42.5 (range 20–68) at their initial encounter. Eighty five percent had a first degree relative with breast cancer and 72.3% of pts undergoing MRI screening had a documented lifetime risk of breast cancer of 20% or greater using a validated model. Within this MRI-screened cohort, 18.2% had a known genetic predisposition to breast cancer. Over the time assessed, 307 MRIs were performed in the 148 pts. Biopsy was recommended and performed based on the results of the MRI in 31 of 307 exams (10%). Ten cancers were detected for a positive predictive value based on biopsy performed of 32% and an overall cancer yield of 3.3% (10 of 307 MRI exams). All cancers were stage 0 - II. All pts are currently with no evidence of disease. Conclusion: Breast MRI has a high positive predictive value and cancer yield with an acceptable biopsy rate in a diverse group of high risk women undergoing breast MRI at an academic center outside of a clinical trial. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-11.

This paper describes the extent and objectives of private industrial planning in the Federal Republic of Germany. The IFO-Institute conducted an extended survey of the scope and type of industrial planning in 1965, and repeated some of the questions on the incentives to investment planning at the end of 1969. The different results of the two surveys are likely to be typical not only for the Federal Republic but to reflect in some respects industrial planning habits in other Western countries. The IFO survey covered 1,600 firms representing a third of the total industrial turnover in West Germany, and included questions on: The intensity of planning, the frequency of longer term planning, the scope of the plans, the use of official forecasts, the impulses for planning and the motives for capital expenditure, in manufacturing industry.

We have an abundance of economic data to describe the economic process. We can state with relative precision how demand in industry is changing, whether trade turnovers are rising or falling, and how long average working hours are. We know whether producers feel their stocks in hand to be too great or too small; we even know something about business expectations, and about plans for investment in the economy. Despite this and much other information there are many phenomena in our society, and in our economy, which cannot be satisfactorily explained. What do we in fact know about the people who decide on investments and production in our economy? Yet, if we had a time series giving ascertained survey data about the attitudes of business executives to various aspects of life, that is just what might be useful for analyzing and evaluating economic plans und expectations. Is the economy suffering, say, from general pessimism about growth? Are the people who stand at the command posts in our economy dissatisfied, and if so, why? Can we say at all what factors influence the satisfaction of an employer or of employees? Does the satisfaction of leading people in our economy depend more on the size of their income, on their age, or even on their education? Or do other factors govern the matter?