The first place where a breast cancer patient will encounter a radiologist, ( though likely behind the scenes), is in the interpretation of their breast cancer screening mammogram.Cognitive learning theory in the classroom A mammogram is a specialized breast X-ray, basically a composite of different X-ray views of the breast from different angles. During breast cancer screening, a radiologist will examine and interpret the mammogram, noting any image findings suspicious for breast cancer.Cognitive learning theory in the classroom

An experienced breast cancer radiologist usually has a good handle on the benign or malignant characteristics of breast tumors. But if there is any doubt, and a reasonable suspicion of a potentially harmful breast tumor, a biopsy will usually be requested.Cognitive learning theory in the classroom radiologists frequently make use of breast ultrasound as well, often to better distinguish between the liquid and solid elements of suspicious breast lesions.Cognitive learning theory in the classroom

In some cases, magnetic resonance imaging, or MRI, is used in breast cancer screening. Usually a technologist will perform the actual X-ray, ultrasound, or MRI and the radiologist will view and evaluate those images shortly thereafter.Cognitive learning theory in the classroom some physicians argue that MRI is the best imaging method to screen for breast cancer in younger women with dense breast tissue. MRI is highly sensitive to abnormal changes in breast tissue.Cognitive learning theory in the classroom some might argue that leads to more biopsies than are necessary. This can sometimes be the case with very early stage DCIS or hyperplasia. Radiological detection of early stage breast cancer and DCIS

cognitive learning theory in the classroom

Not all breast cancers are discovered as a palpable mass or ‘ lump‘. Early stage and in-situ breast cancers might only be suspected on the mammogram due to an ill-defined area of unexpected ( thicker) density, or, by the presence of microcalcifications.Cognitive learning theory in the classroom ductal carcinoma in situ ( DCIS) is quite often discovered by the radiologist due to certain patterns of microcalcifications on the mammogram.Cognitive learning theory in the classroom about 75% of breast cancer can be found mammographically up to a year before they become clinically palpable. The radiologist decides whether to send a breast sample for biopsy or not

cognitive learning theory in the classroom

It is usually up to the radiologist to determine if a mild or faintly suspicious finding on a breast X-ray is to require biopsy and histological evaluation with a pathologist.Cognitive learning theory in the classroom but there is a delicate balance for the radiologist between diagnosing too many things to be biopsied, and diagnosing too few. They have to ‘ self-tune‘ in terms of their own thresholds in terms of image findings which actually turn out to be breast cancer ( or something else serious enough to be biopsied) and benign or insignificant findings.Cognitive learning theory in the classroom breast cancer screening can lead to ‘over-diagnosis’: radiologist is the ‘voice of reason’

Over-diagnosis is one of the very few downsides to breast cancer screening. ( under-diagnosing may also occur) and with the advent of more sensitive imaging technologies, such as MRI, there is a real danger of of benign breast change, hyperplasias, and very low grade in-situ breast carcinomas being sent for biopsy when not needed.Cognitive learning theory in the classroom the radiologist is in some ways the ‘ voice of reason‘ in the breast cancer treatment chain, and they have to be careful neither to be conservative, nor too alarmist, in interpreting the initial breast cancer screening results.Cognitive learning theory in the classroom the radiologist sometimes provides guidance for taking the biopsy sample, or actually performs the needle biopsy

If a biopsy is determined necessary, it is generally the job of the radiologist to perform the biopsy, and send the tissue sample to the pathologist.Cognitive learning theory in the classroom in many cases, ultrasound is employed during the actually biopsy process, in order to view and guide the needle into the breast lesion. In most cases the ultrasound imaging guiding the needle is actually performed by the radiologist.Cognitive learning theory in the classroom usually at least 3 core samples are removed from the breast tissue

To perform a biopsy, the radiologist holds the ultrasound probe in left hand, and the biopsy needle/gun in the right hand, and visa versa.Cognitive learning theory in the classroom then the radiologist watches the needle under the skin, as it approaches the target, watching with ultrasound. When the needle is pointing to the target, the radiologist pushes a button on the end of the “ gun“, and a spring makes the needle snap forward, passing it through the target breast tissue, and snipping a small tissue sample into the needle.Cognitive learning theory in the classroom

If breast cancer is a confirmed diagnosis, the treatment team then turn their attention to staging. Here the nature of the breast cancer, the extent of proliferation, and a preliminary plan for treatment are determined.Cognitive learning theory in the classroom the breast cancer treatment and management team first need to determine whether or not the cancer has spread beyond the breast.

One aspect of this is to perform either a sentinel node or lymph node dissection to see if the cancer has spread to the axillary nodes.Cognitive learning theory in the classroom but the patient is also given a nuclear medicine bone scan to see if the cancer has spread to the the bones, and also a liver ultrasound or CT scan to check for liver metastasis.Cognitive learning theory in the classroom breast cancer spreads into the bones more than any other type of cancer, statistically. The radiologists will interpret ultrasound and CT scans of the liver.Cognitive learning theory in the classroom the radiologist and surgeon work together to plan surgeries

If it has been determined that some degree of surgery is required to treat the breast cancer, the radiologist plays a key role in planning the surgery.Cognitive learning theory in the classroom additional imaging may be required, possibly an MRI scan. One of the advantages of MR images is the ability to more clearly see the ‘ extent‘ of a given best cancer.Cognitive learning theory in the classroom most importantly, the surgeon and radiologist want to gain a clear understanding of exactly where the malignant tissue is, and how best to make sure that all of it is removed.Cognitive learning theory in the classroom

They might also ask the radiologist to clarify exactly where the edges of the tumor are. The surgeons need to decide if they can do a small procedure and remove a small amount of tissue, or whether they need to remove a lot of tissue.Cognitive learning theory in the classroom in other words, do they need to remove the entire breast or can it be conserved. These are important discussions between the surgeon and radiologist.Cognitive learning theory in the classroom post-treatment mammography

Once the primary treatment of the breast tumor has taken place, for example by mastectomy or breast conserving surgery, there will still be some involvement with the radiologist during follow-up.Cognitive learning theory in the classroom where mastecomy was given, a follow-up mammogram will still be performed on the remaining breast on a yearly basis. ( sometimes a follow-up mammogram is called a ‘ diagnostic mammogram‘).Cognitive learning theory in the classroom

For women in which their breast cancer was treated by lumpectomy or breast conserving surgery, the radiologist will usually interpret a follow-up mammogram performed after six months, and usually every six to 12 months after that.Cognitive learning theory in the classroom if radiotherapy was given, a mammogram will likely be taken and interpreted by the radiologist after six months in order to check for local cancer recurrence.Cognitive learning theory in the classroom radiologists and computer aided detection of breast cancers

Quite a lot of research interest in breast cancer radiology these days centers around the use of ‘ computer aided‘ detection systems for breast cancers.Cognitive learning theory in the classroom essentially, these programs operate with a simple ‘ artificial intelligence‘ which compares measured parameters of the scanned breast tumor to a database of known diagnostic results for previously scanned tumors.Cognitive learning theory in the classroom generally speaking, the computer aided detection system has proven to be useful as a ‘ second-opinion‘, but is not suitable to provide the sole interpretation of the breast X-ray or other image.Cognitive learning theory in the classroom

CAD systems are really not that much help to an experienced breast cancer radiologist, but can be quite beneficial for inexperienced radiologists, or perhaps in more remote settings where breast cancer may not be the primary area of expertise for the attending radiologist.Cognitive learning theory in the classroom using computer aided detection systems has tended to result in a higher ‘ recall‘ rate for screening patients. Computer-suggested interpretations can often ‘ psych-out‘ a less experienced radiologist, resulting in many more biopsies than are really necessary.Cognitive learning theory in the classroom incidentally, the rate of accurate radiologically detected breast cancer is usually around 91% or higher.

• helvie MA, hadjiiski L, makariou E, chan HP, petrick N, sahiner B, lo SC, freedman M, adler D, bailey J, blane C, hoff D, hunt K, joynt L, klein K, paramagul C, patterson SK, roubidoux MA.Cognitive learning theory in the classroom sensitivity of noncommercial computer-aided detection system for mammographic breast cancer detection: pilot clinical trial. Radiology. 2004 apr;231(1):208-14.Cognitive learning theory in the classroom epub 2004 feb 27.