The Breast Imaging Center at Dartmouth-Hitchcock Medical Center in New Hampshire, one of the leading teaching hospitals in the U.S., has gone digital with the Hologic Selenia mammography systems. The Center is also actively involved in researching what is believed to be the next wave in mammography technology: breast tomosynthesis.

"From my perspective," says Dr. Steven Poplack, co-director of the Breast Imaging Center at Dartmouth and an associate professor at the Dartmouth Medical School, "it's all about image quality. With the Selenia system, there was no question... the digital image quality was superior. And that's why we went with it.

"Because the radiologist can easily manipulate the contrast on the Selenia system, they are seeing much more detail, in much less time. Greater contrast control is especially important when dealing with patients with denser breast tissue, or implants.

One of the most important benefits to patients remains unseen. Says Dr. Poplack, "Digital mammography can be performed with less radiation exposure to the breast than analog, while maintaining excellent image quality.

"Because digital technology has eliminated the errors associated with the analog film process, and reduced the number of callbacks because of those errors, it has gone a long way towards alleviating much of the anxiety associated with mammograms.

"Most patients are anxious when they come for these exams," says Jim Roberts, clinical operations manager and interim administrative director for the Department of Radiology at Dartmouth, "patients are comforted by the fact that we don't have any film issues, which means we do far fewer repeats with faster results."

"Dartmouth-Hitchcock believes that the future of breast imaging may already be here, with the emergence of digital tomosynthesis technology for screening and diagnostics. "A lot of the problems with mammography stem from tissue overlap," Poplack says, "but if you can unravel the tissue, or eliminate the overlap, then you can avoid recalling a lot of patients who don't really need to be recalled. Tomosynthesis is currently in clinical trails at Dartmouth-Hitchcock and other sites. Our hope is that the clinical studies will prove that breast tomosynthesis reduces the number of false positive screening exams and allow usto detect cancers earlier than with standard mammograms."

"In some instances," Poplack says, "overlying tissue may be obscuring a small cancer. By being able to get a slice-by-slice look at the breast, you may then uncover the cancer that was hidden." He adds, "Tomosynthesis will probably allow us to find more breast cancers earlier."