The breast-MRI program, now directed by Dr. Dann, has experienced significant growth in recent years, being increasingly used for breast-cancer screening of high-risk patients, as well as for diagnostic exams for cancer staging. Interventional procedures in the division include a range of image-guided needle- and vacuum-assisted biopsies utilizing all three modalities—mammography, ultrasound, and MRI. MRI exams and procedures are facilitated by a dedicated breast-MRI table/coil with built-in imaging offering greater patient comfort, increased imaging clarity, and access for interventional procedures. We work with colleagues in Radiation Oncology to perform image-guided catheter placement for accelerated partial breast irradiation. Additional imaging services include galactography, sentinel lymphadenectomy, and lymphoscintigraphy.
The curriculum for residents emphasizes direct clinical experience, with responsibilities and independence increasing in each of the three month-long rotations. At the end of these rotations, the resident is expected to be proficient in the entire spectrum of screening, diagnostic, and interventional breast imaging.
The division is active in funded and unfunded research and publishing. Dr. Poplack has for over ten years been clinical director for the multi-disciplinary Alternative Breast Cancer Imaging (ABCI) Program, in which Drs. Nagy and diFlorio have also participated. Other areas of research interest include assessing MRI in monitoring tumor cryoablation, and studies on the efficacy of the MammoSite® radiation therapy system. Dr. Lewis has recently published (AJR, 2009) an investigation about the effectiveness of preoperative MRI on patients with newly diagnosed breast cancer.
Digital breast tomosynthesis (DBT), an imaging technology which is likely to become an important adjunct to traditional mammography, continues to be a research priority for the division. Division members led by Dr. Poplack have pioneered DBT clinical studies. A new experimental DBT system installed last year will permit a number of new studies to go forward, including comparisons of DBT and breast-MRI, and—in collaboration with Thayer biomedical engineers—a new five-year NCI-funded program to assess the potential of combining DBT with near-infrared spectral tomography. The ABCI program, the DBT studies, and other breast-imaging research are described in detail later in this report. The division supports the research efforts of the New Hampshire Mammography Network, which gathers and collates mammographic and pathologic data on New Hampshire women.