“Part of the research will be to conduct client
questionnaires regarding their experience with
3D mammography and comparing it with their
original screening mammogram and also with
focal compression views they received at
assessment,” Dr Lockie adds. “We eagerly await
the final outcomes at the end of the trial in order
to evaluate client feedback. Comfort level, length
of compression time, overall experience and
satisfaction with the outcome are all components
of the feedback questionnaire. Anecdotally,
women are finding it at least the same or better
than the current 2D technology.”
“From the perspective of the client, the system
is well tolerated, especially in terms of comfort.
For the radiographer, the unit is user-friendly and
ergonomic. And for the radiologist, the image
quality is consistent and 3D mammography
increases the diagnostic accuracy and certainty
compared with 2D imaging,” continues Dr Lockie.
The Maroondah BreastScreen team has had
experience with 3D mammography at the
associated imaging department at Maroondah
Hospital since its installation in early 2011. Initially,
it was used in selected women from the
assessment clinic, with the 3D mammography
taking place at the hospital. In January 2012,
Maroondah BreastScreen installed the 3D
imaging equipment.
“The design of our research project involves
our radiographers using both small compression
paddles and 3D mammography for the workup
for the collection of comparative data. This
design has changed the radiographers workflow.
However, we may be able to demonstrate that
using 3D mammography for the assessment
workup without needing to do coned compression
views may well save time. Therefore, it’s possible
3D mammography will help us to increase the
number of women we see at the assessment
clinic,” Dr Lockie added.
Dr Lockie adds: “The only challenge I see is in
ensuring radiologists have adequate training and
experience with the technology to become confident
in its application. Our radiographers underwent the
applications training by Hologic and our radiologists
participated in the Hologic 3D mammography
workshops. Overall, we have received excellent
support from the company.”
3D mammography and the future
of breast screening in Australia
Introducing the technology into
clinical practice
Dr Lockie says: “We went through the tendering
process to select a new digital mammography
machine to meet our screening, assessment and
stereo-tactic biopsy demand, and Hologic met all
requirements. The 3D mammography package
was well known from our experience with the
hospital unit. And we know it has been well
researched and approved through all the relevant
FDA and EU processes.
compression views or for subsequent
unnecessary procedures. Therefore, there is
an increase in the number of women avoiding
unnecessary benign biopsy.”
Improving diagnostic confidence
“One area where 3D mammography is proving
most helpful is in increasing radiologist diagnostic
certainty that any observed abnormalities are either
benign or suspicious,” Dr Lockie says.
If uncertain about an area, the radiologist scrolls
through the 3D mammography reconstructions
and is able to find the information needed without
additional views. “We are better able to categorise
the appearance as benign or suspicious rather
than indeterminate or equivocal,” says Dr Lockie.
“During assessment, 3D mammography may
reduce the need for more uncomfortable focal
“I imagine there will be a future role for 3D
mammography in both breast screening and
diagnostic breast imaging, but what that exact
role will be is still to be determined. From a clinical
point-of-view, 3D mammography has certainly
demonstrated usefulness in cancer detection and
characterisation and in reducing recall rates, but
BreastScreen Australia, quite rightly, will not make
a move until the final out-comes of larger screening
trials on the use of 3D mammography in a screening
environment are known. We must watch and wait,”
Dr Lockie says.
“For a screening program, it is critical costs are
kept as low as possible. There is a requirement to
do more with less. Once we have the final research
data to demonstrate a benefit of 3D mammography
in the screening and assessment settings, the
technology may possibly help us be more costeffective while maintaining and potentially increasing
cancer detection. Collaboration between clinicians,
governments and administrators is needed to
determine what model will work best for Australian
women and BreastScreen Australia.”
There has been minimal inconvenience to
Maroondah BreastScreen’s clients, radiographers
and radiologists. A minimal increase in
interpretation time has been seen in the assessment
clinic, although Dr Lockie says this will be different
in a screen reading environment.
Maroondah BreastScreen team (left to right): Janis Uhe, designated radiographer;
Michelle Clemson, program manager; Dr Darren Lockie, designated radiologist;
and Liz Sundram, designated radiographer.
IMPACT APRIL 2014 | 15