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German physicist Wilhelm Röntgen (1845–1923) was experimenting with electrical current when he discovered that a mysterious and invisible "ray" would pass through his flesh but leave an outline of his bones on a screen coated with a metal compound. In 1895, Röntgen made the first durable record of the internal parts of a living human: an "X-ray" image (as it came to be called) of his wife’s hand. Scientists worldwide quickly began their own experiments with...
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Contrast-Enhanced Mammography: Does Image Acquisition Time and Projection Order Matter?

Dennis Dwan1, Christina Konstantopoulos1, Tejas S Mehta2

  • 1Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.

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|November 3, 2025
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Summary
This summary is machine-generated.

Readers prefer earlier images in contrast-enhanced mammography (CEM) for better cancer detection. Earlier imaging improves visualization and confidence in assessing breast cancer characteristics.

Keywords:
breast cancer risk assessmentbreast imaging clinical operationsbreast imaging quality and outcomescontrast-enhanced mammography

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Area of Science:

  • Radiology
  • Medical Imaging
  • Oncology

Background:

  • Contrast-enhanced mammography (CEM) is crucial for breast cancer detection.
  • Optimizing image acquisition timing is essential for maximizing cancer visualization.

Purpose of the Study:

  • To determine reader preference for image order in CEM.
  • To identify optimal contrast administration timing for cancer visualization.

Main Methods:

  • A reader study evaluated consecutive CEMs in patients with unifocal breast cancer.
  • Readers assessed cancer visibility, margin confidence, and conspicuity on images acquired with different projection orders (CC-first vs. MLO-first).
  • Contrast-to-noise ratio (CNR) was also measured.

Main Results:

  • Readers showed a significant preference for earlier-obtained images for cancer visibility, margin confidence, and lesion conspicuity.
  • Earlier imaging reduced instances of mischaracterization of lesion type.
  • Craniocaudal (CC) projection was preferred for lesion conspicuity.

Conclusions:

  • Earlier imaging in CEM significantly enhances reader ability to evaluate cancer characteristics.
  • Image timing is a critical factor in optimizing diagnostic performance of CEM.