David Beylin

Objectives: Positron Emission Mammography (PEM) with F18‐FDG has been useful in breast cancer diagnosis and characterization [1]. Clinical PEM scanners produce high resolution (2mm) PET images of immobilized breasts in 5–10 minutes. This allows the PEM scanner to guide breast interventions, with the help of a localization accessory including software for procedure planning and hardware for needle support. We report the development of a quality control procedure to test the performance of the… Show more

Objectives: Positron Emission Mammography (PEM) with F18‐FDG has been useful in breast cancer diagnosis and characterization [1]. Clinical PEM scanners produce high resolution (2mm) PET images of immobilized breasts in 5–10 minutes. This allows the PEM scanner to guide breast interventions, with the help of a localization accessory including software for procedure planning and hardware for needle support. We report the development of a quality control procedure to test the performance of the accessory in a clinical setting on a daily basis. Materials and Methods: A quality control procedure was designed to evaluate the functionality of the Stereo Navigator accessory to the PEM Flex PET Scanner (Naviscan PET Systems, Inc., San Diego, CA). During the procedure, 1 microCurie point source was placed in the field of view of the PEM scanner. PEM scan of the point source was performed. The software was used to select the point source as a target and guide a radioactive rod containing 0.1 microCurie/cm of Germanium‐68 toward the source. A distance of less than 5mm from the tip of the rod to the point source was considered acceptable. A second PEM image was acquired, and regions of interest were used to verify the activities of the sources. To test the validity of the procedure, failures were introduced such as incompatible hardware/software and incorrect calibration rod activity. Time to perform the procedure was recorded. Results: The procedure detects clinically‐relevant failures and can be performed by a trained user in less than 5 minutes. Conclusions: The quality control procedure for the localization accessory to the PEM scanner can be performed in clinically acceptable time. Show less

Objectives: Positron Emission Mammography (PEM) with F18‐FDG has been useful in breast cancer diagnosis and characterization [1]. Clinical PEM scanners produce high resolution (2mm) PET images of immobilized breasts in 5–10 minutes. This allows the PEM scanner to guide breast interventions, with the help of a localization accessory including software for procedure planning and hardware for needle support. We report the development of a quality control procedure to test the performance of the… Show more

Objectives: Positron Emission Mammography (PEM) with F18‐FDG has been useful in breast cancer diagnosis and characterization [1]. Clinical PEM scanners produce high resolution (2mm) PET images of immobilized breasts in 5–10 minutes. This allows the PEM scanner to guide breast interventions, with the help of a localization accessory including software for procedure planning and hardware for needle support. We report the development of a quality control procedure to test the performance of the accessory in a clinical setting on a daily basis. Materials and Methods: A quality control procedure was designed to evaluate the functionality of the Stereo Navigator accessory to the PEM Flex PET Scanner (Naviscan PET Systems, Inc., San Diego, CA). During the procedure, 1 microCurie point source was placed in the field of view of the PEM scanner. PEM scan of the point source was performed. The software was used to select the point source as a target and guide a radioactive rod containing 0.1 microCurie/cm of Germanium‐68 toward the source. A distance of less than 5mm from the tip of the rod to the point source was considered acceptable. A second PEM image was acquired, and regions of interest were used to verify the activities of the sources. To test the validity of the procedure, failures were introduced such as incompatible hardware/software and incorrect calibration rod activity. Time to perform the procedure was recorded. Results: The procedure detects clinically‐relevant failures and can be performed by a trained user in less than 5 minutes. Conclusions: The quality control procedure for the localization accessory to the PEM scanner can be performed in clinically acceptable time. Show less

Objectives: Positron Emission Mammography (PEM) with F18-FDG is useful in planning breast surgery and accurately depicting DCIS. In current clinical practice imaging abnormalities identified on PEM are often sampled under US guidance. Since some lesions, in particular linear distributions a/w DCIS, may be poorly visualized under US, a procedure employing PEM for needle guidance was previously proposed. Here we report the refinement of a technique to perform PEM-guided breast biopsies, using… Show more

Objectives: Positron Emission Mammography (PEM) with F18-FDG is useful in planning breast surgery and accurately depicting DCIS. In current clinical practice imaging abnormalities identified on PEM are often sampled under US guidance. Since some lesions, in particular linear distributions a/w DCIS, may be poorly visualized under US, a procedure employing PEM for needle guidance was previously proposed. Here we report the refinement of a technique to perform PEM-guided breast biopsies, using tools available for the MRI-guided localizations. A phantom study was carried out to confirm the ability of PEM to guide sampling of masses and linear distributions of activity. Methods: Ten breast phantoms were constructed containing physiologic amount of F18-FDG (0.01-0.1uCi/cc). Each phantom contained an 8mm "hot" mass connected to a "hot" linear extension 3mm in cross-section, 5cm in length. Both the mass and the linear extension were filled with F18-FDG to create a lesion-to-background ratio of 8:1. Mass, extension, and background were differently colored. The phantom was immobilized between the paddles of the PEM scanner. A 10 minute PEM scan was performed, and the resulting image was used to plan biopsy of both the mass and linear extension. The needle guide accessory was installed according to software instructions. The needle track was made and a Germanium-68 line source, encapsulated in a sterile casing, was used to visualize the position of the needle track relative to the targeted abnormality on the PEM image. Imaging abnormalities were sampled using a 9Ga vacuum-assisted core biopsy device. Samples were visually inspected for the presence of the appropriately colored material. Results: All ten attempts at biopsy of primary lesions and linear extensions were successful. Conclusions: The developed localization technique can aid in sampling of masses and linear distributions of activity seen on PEM. Clinical application of the biopsy method is planned. Show less

Objectives: Positron Emission Mammography (PEM) with F18-FDG is useful in planning breast surgery and accurately depicting DCIS. In current clinical practice imaging abnormalities identified on PEM are often sampled under US guidance. Since some lesions, in particular linear distributions a/w DCIS, may be poorly visualized under US, a procedure employing PEM for needle guidance was previously proposed. Here we report the refinement of a technique to perform PEM-guided breast biopsies, using… Show more

Objectives: Positron Emission Mammography (PEM) with F18-FDG is useful in planning breast surgery and accurately depicting DCIS. In current clinical practice imaging abnormalities identified on PEM are often sampled under US guidance. Since some lesions, in particular linear distributions a/w DCIS, may be poorly visualized under US, a procedure employing PEM for needle guidance was previously proposed. Here we report the refinement of a technique to perform PEM-guided breast biopsies, using tools available for the MRI-guided localizations. A phantom study was carried out to confirm the ability of PEM to guide sampling of masses and linear distributions of activity. Methods: Ten breast phantoms were constructed containing physiologic amount of F18-FDG (0.01-0.1uCi/cc). Each phantom contained an 8mm "hot" mass connected to a "hot" linear extension 3mm in cross-section, 5cm in length. Both the mass and the linear extension were filled with F18-FDG to create a lesion-to-background ratio of 8:1. Mass, extension, and background were differently colored. The phantom was immobilized between the paddles of the PEM scanner. A 10 minute PEM scan was performed, and the resulting image was used to plan biopsy of both the mass and linear extension. The needle guide accessory was installed according to software instructions. The needle track was made and a Germanium-68 line source, encapsulated in a sterile casing, was used to visualize the position of the needle track relative to the targeted abnormality on the PEM image. Imaging abnormalities were sampled using a 9Ga vacuum-assisted core biopsy device. Samples were visually inspected for the presence of the appropriately colored material. Results: All ten attempts at biopsy of primary lesions and linear extensions were successful. Conclusions: The developed localization technique can aid in sampling of masses and linear distributions of activity seen on PEM. Clinical application of the biopsy method is planned. Show less