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Dr. Daniel Kopans - the father of breast tomosynthesis

by Lauren Dubinsky, Senior Reporter | November 30, 2014
From the November 2014 issue of HealthCare Business News magazine


HCBN: Other than reimbursement, are there any other challenges standing in the way of wide-spread adoption?
DK:
I do not see any major impediments. Most of the opposition to DBT that I have seen is from those who have never used it. I have not met anyone who would return to 2-D mammography once they have experienced its advantages.

It takes getting used to the fact that it takes longer to review a screening DBT study, but it took awhile to get used to CT instead of plain X-rays of the chest and abdomen, yet we recognized that CT was superior and we now, routinely, review multiple slices instead of two “plain films.” In addition, since DBT leads to fewer recalls and fewer “diagnostic” evaluations, the considerable time saved in not having to do diagnostic imaging can be cost accounted to screening DBT reducing much of the extra time involved.

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HCBN: Are there any improvements for breast tomosynthesis on your wish list?
DK:
Just as 2-D mammography screening is not the ultimate answer to breast cancer — it does not find all cancers and does not find all cancers early enough to result in a cure — DBT is not going to end all deaths from breast cancer.

DBT is a major advance, but there will still be cancers that are hidden even on DBT and others that are metastatic before they can be detected. The death rate from breast cancer has been significantly reduced since 1990 by the introduction of screening and earlier detection.

DBT will help to further drive down the death rate. There will still be some cancers that are not visible on DBT, but are detectable using ultrasound and certainly, using MRI. Our immediate goal at the MGH, actually one that we have hoped to do for many years, is to try to incorporate ultrasound into the DBT system so that ultrasound and DBT can be acquired together. Having registered images should allow for maximizing the detection of cancer while further improving specificity.

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