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CTLM stands for
Computed Tomography Laser Mammography and is a method of looking at the
blood flow to the breast. Since newly forming tumors have increased blood
flow, CTLM may be the answer to finding very small tumors which can be
hidden in routine mammography. Additionally, dense breast tissue is easily
penetrated with the laser while traditional mammography has difficulty with
dense breast.
CTLM®
Frequently Asked Questions (FAQs)
Q: What is CT Laser Mammography?
A: A CT-like scanner, but its energy source for imaging is a laser diode
beam in place of ionizing radiation such as is found in conventional x-ray
mammography or CT scanners.
Q: How Is A Patient Examined?
A: A patient lies face down on the scanning table with one breast hanging
into a specially designed scanning chamber. The laser beam sweeps 360
degrees around the breast starting from the chest wall moving forward until
the entire breast is scanned. The data is acquired by our patented array of
specialized detectors, where it is reconstructed by our proprietary computed
algorithms to create three-dimensional cross sectional images of the breast.
The examination takes approximately 15 minutes to perform and requires no
breast compression.
Q: Can The CTLM Be Used In Place Of A Screening Mammogram?
A: Not currently, the CTLM is being positioned as an adjunct to mammography.
Q: Is There Any Special Requirement Necessary Prior To A CTLM Exam?
A: No, an examination can be performed during anytime of the month or day
and does not require special preparation of any kind.
Q: How Long Will It Take For My Results?
A: The CTLM reconstructs the image while the scanning is in process.
Q: Can A Patient Be Examined By The CTLM Regularly?
A: Yes, since it does not expose the patient to ionizing radiation a person
can be scanned as often as needed.
Q: Where can I get a CTLM?
A: The CTLM is not yet approved in the in the United States, but is
available internationally. The Food and Drug Administration process is
pending.
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- CT laser breast imaging is part of the emerging field of optical
imaging.
- CTLM images blood flow to the breast and thereby should visualize
Tumor Angiogenesis.
- CTLM does not use ionizing radiation (no x-rays).
- CTLM images through implants and dense breast tissue easily, unlike
mammography which has difficulty penetrating very dense tissue.
- There is NO breast compression with CTLM and the breast hangs in the
machine opening in it’s natural position.
- In a study of over 100 women, including 30 with breast cancer, optical
imaging increased sensitivity and specificity of breast cancer detection
by more than 90% (Britton Chance, Molecular Imaging, Vol. 2 #2)
- The average scan time is about 10-15 minutes per breast.
- CTLM may provide a brighter future for cancer patients due to earlier
diagnosis and treatment. Early visualization of tumors in the evolving
process will lead to breast sparing surgery and less trauma to the
patient.
Clinical - Case Studies Completed
On and Hospitals Around the World
- Pathology:
Microcalcification
- Pathology:
Sub-areolar vascularity
- Pathology:
Infiltrating ductal carcinoma grade III of III.
- Pathology:
Benign calcification
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Charite Mitte University Hospital
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Charles University
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European Institute of Oncology
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Friendship Catholic University
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Gazi University
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Gliwice Poland
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SAQR Hospital
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Udine University 
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Case Study: #1
Pathology: Microcalcification
 
Case Study: #2
Pathology: Sub-areolar vascularity
 
Case Study: #3
Pathology: Infiltrating ductal carcinoma grade
III of III
 
Case Study: #4
Pathology: Benign calcification |
A mammogram is an x-ray exam of the breast.
It is used to detect and evaluate breast abnormalities, both in women who
have no breast complaints or symptoms and in women who have breast symptoms
(problems such as a lump, pain, or nipple discharge).
Although the use of x-rays to
examine the breast was first introduced more than 90 years ago, modern
mammography has only existed since 1969, when the first dedicated x-ray
machines used just for breast imaging became available. Since then, the
technology has advanced a great deal, so that today's mammogram is very
different even from those of the mid-1980s.
For a mammogram, the breast is squeezed
between 2 plastic plates attached to the mammogram machine unit in order to
spread the tissue apart. This squeezing or compression ensures that there
will be very little movement, that the image is sharper, and that the exam
can be done with a lower x-ray dose. Although this compression causes some
discomfort, it only lasts for a few seconds and is needed to produce a good
mammogram. The entire procedure for a mammogram takes about 20 minutes.
What Does the Doctor Look
for on Your Mammogram?
The doctor reading your films will look for several types of changes:
Calcifications are tiny mineral deposits within the breast
tissue, which look like small white spots on the films. They may or may not
be caused by cancer. There are 2 types of calcifications:
Macrocalcifications are coarse (larger) calcium deposits that
are most likely changes in the breasts caused by aging of the breast
arteries, old injuries, or inflammation. These deposits are related to
non-cancerous conditions and do not require a biopsy. Macrocalcifications
are found in about half the women over 50, and in 1 of 10 women under 50.
Microcalcifications are tiny specks of calcium in the breast.
They may appear alone or in clusters. Microcalcifications seen on a
mammogram are more concerning, but still usually do not always mean that
cancer is present. The shape and layout of microcalcifications help the
radiologist judge how likely it is that cancer is present. In most
instances, the presence of microcalcifications does not mean a biopsy is
needed. In other cases, the microcalcifications look more suspicious and a
biopsy is needed.
A mass, which may occur with or without calcifications, is another important
change seen on mammograms. Masses can be caused by many things, including
cysts (non-cancerous, fluid-filled sacs) and non-cancerous solid tumors
(such as fibroadenomas), but they could be cancer and usually should be
biopsied if they are not cysts.
A cyst cannot be diagnosed by physical exam alone, nor can it
be diagnosed by a mammogram alone. To confirm that a mass is really a cyst,
either breast ultrasound or removal of fluid with a thin, hollow needle
(aspiration) is needed.
If a mass is not a simple cyst (that is, if it is at least
partly solid), then you may need to have more imaging tests. Some masses can
be watched with periodic mammograms, while others may need a biopsy. The
size, shape, and margins (edges) of the mass help the radiologist to
determine whether cancer may be present.
Your prior mammograms may help show that a mass has not changed for many
years, which would mean that the mass is likely a benign condition and a
biopsy would not be needed. Having your prior mammograms available to the
radiologist, as discussed above, is very important.
A mammogram may show something
suspicious, but by itself it cannot prove that an abnormal area is cancer.
If a mammogram raises a suspicion of cancer, tissue must be removed and
looked at under the microscope to tell if it is cancer. This can be done
with a needle biopsy or an open surgical biopsy.
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Mammograms in younger women: Mammography is a
greater challenge in younger women, usually because their breasts are dense,
which can hide a tumor. Since most breast cancers occur in older women, this
is often not a problem, and mammography is not recommended for average-risk
women under age 40.
In younger women who are at high risk for developing breast cancer (due to a
BRCA1 or BRCA2 gene mutation, a strong family history, or other factors),
yearly breast MRIs and mammograms are recommended. For most of these women,
screening should begin at age 30 years and continue for as long as the woman
is in good health. But because the evidence is limited regarding the best
age at which to start screening, this decision should be based on shared
decision making between patients and their health care providers, taking
into account personal circumstances and preferences.
Mammograms after breast-conserving treatment: Removing the entire breast
(mastectomy) is one way of treating breast cancers. Most breast cancers can
now be treated just as effectively by breast-conserving treatment (BCT)
without removing the entire breast. Lumpectomy, one type of BCT, involves
removing a cancerous lump and a narrow margin of the surrounding benign
breast tissue. Lumpectomy is almost always combined with radiation
treatment.
A woman who has had BCT will need to continue having mammograms of the
affected breast and her opposite breast.
Most radiologists recommend that patients have a mammogram of the treated
breast 6 months after the completion of radiation treatment. Radiation and
chemotherapy both cause changes in the skin and breast tissues that show up
on the mammogram, making it harder to interpret. These changes usually peak
6 months after the radiation is completed; the mammogram at this time
establishes a new baseline for the affected breast for that woman. Future
mammograms will be compared to this exam to follow healing and check for
recurrence. The next exam is then 6 months later when the woman is due for
her yearly mammogram of both breasts. Experts differ on the best follow-up
plan from this point on. Some prefer a mammogram of the treated breast every
6 months for 2 to 3 years; others suggest that annual mammograms are
adequate. Each woman should talk with her doctor about the plan that is best
for her.
Mammograms after mastectomy (without breast reconstruction): Women who have
undergone total, modified radical, or radical mastectomy for breast cancer
need no further routine mammograms of the affected side (or sides, if both
breasts are removed). Modified radical mastectomy removes the breast, skin,
nipple, areola, and most of the lymph nodes under the arm on the same side,
leaving the chest muscles intact. Partial or segmental mastectomy removes
less than the whole breast, taking only part of the breast in which the
cancer occurs and a margin of healthy breast tissue surrounding the tumor.
(Radical mastectomy is surgery for breast cancer in which the breast, chest
muscles and all of the lymph nodes under the arm are moved. This surgery is
rarely used now and usually only when the cancer has spread to the chest
muscles.) Mammograms are usually continued for the unaffected breast at
standard one-year intervals. This is very important, since women who have
had one breast cancer are at higher risk of developing a new cancer of the
other breast.
One type of mastectomy that does require a follow-up mammogram is the
subcutaneous mastectomy. In this operation, the woman retains her nipple and
the tissue just under the skin; enough breast tissue is left behind to
require yearly screening mammography in these patients. Any woman who is not
sure what type of mastectomy she has had should ask her doctor.
Mammograms after mastectomy (with breast reconstruction): Women who have had
a breast removed by total, modified radical, or radical mastectomy and
reconstructed with silicone gel or saline implants do not need routine
mammograms. If the woman has had subcutaneous mastectomy annual imaging is
still needed.
After mastectomy, some women choose to have a breast reconstructed using
tissue from their own body, most often the stomach (abdomen) area. This type
of reconstruction is called a TRAM (transverse rectus abdominis myocutaneous)
flap reconstruction. A patient who has had complete (not subcutaneous)
mastectomy followed by TRAM flap reconstruction needs no further screening
mammograms on the affected side. If there is an area of the TRAM flap that
is of concern on the physical exam, a diagnostic mammogram may occasionally
be obtained. Further imaging with ultrasound or MRI may also be helpful.
Mammograms after breast enlargement with implants: Women who have implants
are a special challenge for mammography screening. The x-rays used for
imaging the breasts cannot penetrate silicone or saline implants well enough
to show the overlying or underlying breast tissue. Therefore, some breast
tissue covered up by the implant will not be seen on the mammogram.
In order to see as much breast tissue as possible, women with implants have
4 additional films (2 on each side) as well as the 4 standard images taken
during a screening mammogram. In these additional x-ray pictures, called
implant displacement (ID) views, the implant is pushed back against the
chest wall and the breast is pulled forward over it. This allows better
imaging of the forward most part of each breast. The implant displacement
views are not as successful in women who have formation of hard scar tissue
around the implants (contractures). They are easiest to take in women whose
implants are placed underneath (behind) the chest muscle.
While the number of pictures taken for each exam is greater, the guidelines
for the frequency of screening mammograms for women with implants are the
same as for women without them.
Although an implant rupture can sometimes be diagnosed on a mammogram, often
the ruptured implant will look normal. Magnetic resonance imaging (MRI), on
the other hand, is extremely accurate in detecting implant rupture. MRI is
the imaging method of choice to evaluate the implant itself while
mammography is still the best test for evaluating breast tissue. See the
section "Other Breast Imaging Tests" in this document for more information
on MRI.
Very rarely, mammography can cause an implant to rupture, so it is important
to tell the technologist if you have implants.
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