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High frequency coded harmonics in breast ultrasound does it affect diagnosis 6 sigma evaluation

harmonics in breast US -- parameters assessed for 350 lesions". echogenicitycapsule thickness artifact -- non speckleartifact -- specklesound transmission BIRADS category. . types of 350 lesions". complex cysts133 (38%)indeterminate cyst/solid 12 ( 3%)solid nodules 111 (32%)implan

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High frequency coded harmonics in breast ultrasound does it affect diagnosis 6 sigma evaluation

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    1. high frequency coded harmonics in breast ultrasound… …does it affect diagnosis? 6 sigma evaluation Tom Stavros, Cindy Rapp, Megan Kleckner

    2. harmonics in breast US -- parameters assessed for 350 “lesions” echogenicity capsule thickness artifact -- non speckle artifact -- speckle sound transmission BIRADS category

    3. types of 350 “lesions” complex cysts 133 (38%) indeterminate cyst/solid 12 ( 3%) solid nodules 111 (32%) implants 21 ( 6%) normal tissues 73 (21%)

    4. BUS - ACR BIRADS categories

    5. solid nodules - US characterization Sep, 1995 – Mar, 2000 (1021 nodules)

    6. % of cases where coded harmonics changed BIRADS category complex cysts 34% indeterminate cyst/solid 25% solid nodules 12% implants 0% normal tissues 1%

    9. cyst with fluid more echogenic on coded harmonics (echoes real)

    11. implant echogenicity and artifacts normal gel more hypoechoic extravasated gel more echogenic

    12. solid nodules echogenicity coded harmonics vs. fundamental (111 lesions)

    13. solid hypoechoic nodule – 4a

    14. capsule definition effect of coded harmonics (277 cases)

    15. solid nodule – effect of harmonics capsule brighter, thinner – dx certainty

    16. artifact (except speckle) effect of coded harmonics (350 cases)

    17. invasive CA – effect of harmonics clutter reduction – CA better seen

    18. speckle effect of coded harmonics (350 cases) 1) markedly decreased 2) decreased 3) no change 4) increased 5) markedly increased

    19. complex cyst – effect of harmonics speckle reduction (best seen magnified)

    20. sound transmission effect of coded harmonics (350 cases)

    21. dense fibrous tissue – limitation of harmonics occasional case (6%) of inadequate penetration

    22. conclusion - coded harmonics in BUS

    23. potential 6 sigma project for 2000 scan clustered calcifications to find definitively benign causes of calcifications invasive components of ductal carcinoma extent of non-calcified intraductal components assess value of US for BIRADS 2 calcifications with and without coded harmonics assess value of positive US with and without CE invasive components extensive intraductal components

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