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Breast imaging using electrical impedance tomography: correlation of quantitative assessment with visual interpretation

Zain NM, Chelliah KK

Asian Pac J Cancer Prev, 2014;15(3):1327-31.
PMID: 24606460

BACKGROUND: Electrical impedance tomography (EIT) is a new non-invasive, mobile screening method which does not use ionizing radiation to the human breast; allows conducting quantitative assessment of the images besides the visual interpretation. The aim of this study was to correlate the quantitative assessment and visual interpretation of breast electrical impedance tomographs and associated factors.
MATERIALS AND METHODS: One hundred and fifty mammography patients above 40 years and undergoing EIT were chosen using convenient sampling. Visual interpretation of the images was carried out by a radiologist with minimum of three years experience using the breast imaging - electrical impedance (BI-EIM) classification for detection of abnormalities. A set of thirty blinded EIT images were reinterpreted to determine the intra-rater reliability using kappa. Quantitative assessment was by comparison of the breast average electric conductivity with the norm and correlations with visual interpretation of the images were determined using Chi-square. One-way ANOVA was used to compare the mean electrical conductivity between groups and t-test was used for comparisons with pre-existing Caucasians statistics. Independent t-tests were applied to compare the mean electrical conductivity of women with factors like exogenous hormone use and family history of breast cancer.
RESULTS: The mean electrical conductivity of Malaysian women was significantly lower than that of Caucasians (p<0.05). Quantitative assessment of electrical impedance tomography was significantly related with visual interpretation of images of the breast (p<0.05).
CONCLUSIONS: Quantitative assessment of electrical impedance tomography images was significantly related with visual interpretation.
Fulltext Is there an influence of dietary habits on breast density as seen on digital mammograms?

Voon NS, Chelliah KK

Asian Pac J Cancer Prev, 2011;12(8):1969-72.
PMID: 22292635

The purpose of this study was to evaluate the influence of dietary habit on breast density, which is an important risk factor for breast cancer. This cross-sectional study was performed on 64 Malaysian women of all races between the age of 35 to 70 years. All subjects underwent mammography and the breast density was analyzed from the images using BI-RADS by two independent radiologists. A validated food-frequency questionnaire was used to evaluate the nutrient intake. The data were analyzed using Chi-square test to evaluate the association of dietary habits to breast density. Based on the results, mutton, pork, vegetables, sweets, snacks, soy bean and eggs intake showed associations with increased breast density (p < 0.05) while grains, meat, beverages, oil and fruits, did not show any association (p > 0.05). As a conclusion, this study showed diet may make changes to the breast density as a risk factor for breast cancer.
Fulltext Bone mineral density and breast cancer risk factors among premenopausal and postmenopausal women: A systematic review

Zain NM, Seriramulu VP, Chelliah KK

Asian Pac J Cancer Prev, 2016;17(7):3229-34.
PMID: 27509955

BACKGROUND: Bone mineral density (BMD) is a lifetime marker of estrogen in a woman's body and has been associated with increased breast cancer risk. Nonetheless the actual association is still debatable. Furthermore, estrogen is very crucial in maintaining human bone density and gradually decreases over age. A systematic search was conducted to assess any association of BMD with breast cancer risk factors among premenopausal and postmenopausal women.

MATERIALS AND METHODS: Review identification was performed through databases searching on MEDLINE, CINAHL and SCOPUS and 19 qualified studies were elected. The keywords used were "bone mineral density", "breast cancer", and "breast density".

RESULTS: A total of 19 articles showed variation with the majority of the studies focused on postmenopausal and a few focused on premenopausal women. Overall there was no concensus on effects.

CONCLUSIONS: An enormous effort is being undertaken by researchers to prove that BMD might be one of the significant risk factors for breast cancer.
Estimates of Average Glandular Dose with Auto-modes of X-ray Exposures in Digital Breast Tomosynthesis

Kamal I, Chelliah KK, Mustafa N

Sultan Qaboos Univ Med J, 2015 May;15(2):e292-6.
PMID: 26052465

The aim of this research was to examine the average glandular dose (AGD) of radiation among different breast compositions of glandular and adipose tissue with auto-modes of exposure factor selection in digital breast tomosynthesis.
A comparative study of computed radiography-based mammography using digital phosphor storage plate and full field digital mammography

Chelliah KK, Tamanang S, Bt Elias LS, Ying KY

Indian J Med Sci, 2013 11 2;67(1-2):23-8.
PMID: 24178338

BACKGROUND: Two digital mammography systems, based on different physical concepts, have been introduced in the last few years namely the full-field digital mammography (FFDM) system and computed radiography-based mammography using digital storage phosphor plate (DSPM).
AIMS: The objective of this study was to compare the image quality for DSPM and FFDM using a grading scale based on previously published articles.
MATERIALS AND METHODS: This comparative diagnostic study was done for 5-month duration at the Breast Clinic. The system used was the Lorad Selenia FFDM system and the Mammomat 3000 Nova DSPM system. The craniocaudal and mediolateral oblique projections were done on both breast on 58 asymptomatic women using both DSPM and FFDM. The mammograms were evaluated for eight criteria of image quality: Tissue coverage, compression, exposure, contrast, resolution, noise, artifact, and sharpness by two independent radiologists.
STATISTICAL ANALYSIS: Wilcoxon Signed Rank Test and Weighted Kappa.
RESULTS: FFDM was rated significantly better (P < 0.05) for five aspects: Tissue coverage, compression, contrast, exposure, and resolution and equal to DSPM for sharpness, noise, and artifact.
CONCLUSION: FFDM was superior in five aspects and equal to DSPM for three aspects of image quality.
Validation of electrical impedance tomography qualitative and quantitative values and comparison of the numeric pain distress score against mammography

Juliana N, Shahar S, Chelliah KK, Ghazali AR, Osman F, Sahar MA

Asian Pac J Cancer Prev, 2014;15(14):5759-65.
PMID: 25081698

Electrical impedance tomography (EIT) is a potential supplement for mammogram screening. This study aimed to evaluate and feasibility of EIT as opposed to mammography and to determine pain perception with both imaging methods. Women undergoing screening mammography at the Radiology Department of National University of Malaysia Medical Centre were randomly selected for EIT imaging. All women were requested to give a pain score after each imaging session. Two independent raters were chosen to define the image findings of EIT. A total of 164 women in the age range from 40 to 65-year-old participated and were divided into two groups; normal and abnormal. EIT sensitivity and specificity for rater 1 were 69.4% and 63.3, whereas for rater 2 they were 55.3% and 57.0% respectively. The reliability for each rater ranged between good to very good (p<0.05). Quantitative values of EIT showed there were significant differences in all values between groups (ANCOVA, p<0.05). Interestingly, EIT scored a median pain score of 1.51±0.75 whereas mammography scored 4.15±0.87 (Mann Whitney U test, p<0.05). From these quantitative values, EIT has the potential as a health discriminating index. Its ability to replace image findings from mammography needs further investigation.
Fulltext Multimodality imaging in the assessment of thoraco-omphalopagus conjoined twin: lessons to learn

Chelliah KK, Faizah MZ, Dayang AA, Bilkis AA, Shareena I, Mazli M

Case Rep Radiol, 2012;2012:564036.
PMID: 22792503 DOI: 10.1155/2012/564036

Conjoined twins are rare and present a unique challenge to pediatric surgeons and radiologists. An imaging strategy to accurately define anatomic fusion, vascular anomalies, and other associated abnormalities is important for surgical planning and prognostic information. A conjoined female twin with a combined weight of 2.8 kg was born by emergency caeserean. Hence, a computed tomography scan of the thorax and entire abdomen at 1.25 mm slice thickness was performed to delineate the internal structures of the twins. CT-angiography defined specific vascular supply which determined the distribution of shared structures between the twins. An echocardiogram showed four heart chambers with atrioventricular septal defect. To further evaluate the heart chambers, the twin was planned for gated cardiac magnetic resonance imaging. Unfortunately, they succumbed 6 hours apart due to complication of septicemia. Magnetic resonance imaging and CT scan provide excellent anatomic detail, demonstrating organ position, shared viscera, and limited vascular anatomy, whilst angiography defined specific vascular supply, useful in determining the distribution of shared structures between the twins in planning for surgery.