Specimen Radiography of MRI-Guided Breast Biopsy Enables Immediate Assessment of Surgical Margins
Focused on MRI-Guided Breast Biopsy?the ATEC Emerald Finds its Niche
MR Software Provides Multiple Views in Single Acquisition
Product Showcase: Sunnex Lights Up the MRI Surgical Suite
Running the Numbers
Prostate Coil for 3T Enables Targeted Radiation Therapy

Specimen Radiography of MRI-Guided Breast Biopsy Enables Immediate Assessment of Surgical Margins

In an attempt to identify abnormalities on specimen radiography previously seen only on MRI, Basak Erguvan-Dogan, MD, and her fellow researchers at the University of Texas MD Anderson Cancer Center (Houston) recently developed a procedure for verifying surgical margins of specimens obtained via MR-guided needle localization of breast lesions.

The procedure, reported on in the August issue of the American Journal of Roentgenology,1 indicates that radiologists can help confirm if an MRI-guided breast biopsy successfully removed the lesion—before leaving surgery.

“By taking x-rays of the lesion specimen, then slicing it up and taking additional x-rays, we can determine if the lesion has been removed or if additional tissue needs to be excised while the patient is still in the operating room,” says Erguvan-Dogan, who believes that patients, surgeons, and pathologists benefit from careful evaluation of the surgical specimen. “Immediate confirmation of removal of the lesion detected on MRI is made possible with this method. The pathologist is able to identify the malignant or benign lesion without having to process the entire surgical specimen. The surgeon can confirm that the surgical excision is successful and that the surgical margins are clear.”

The process applied during the study requires performing a specimen radiograph after surgical excision of the lesion attached to the needle-guidewire system. The tissue is oriented by the surgeon, the pathologist inks the tissue, and then a radiograph of the entire specimen is obtained.

“That radiograph is reviewed, and then the specimen is sliced like a loaf of bread. The slices are then radiographed, which allows for a three-dimensional assessment of the margins,” Erguvan-Dogan explains. “The whole-specimen radiograph and the sliced-specimen radiographs are reviewed by a breast imager, who consults with the pathologist and the surgeon.”

Based on the specimen radiograph and pathologic evaluation of the specimen, the consultation delivers a decision on whether or not additional tissue should be excised.

Whole-specimen and sliced-specimen radiography were performed in 10 patients for the study. In all five malignant cases, sliced-specimen radiographs showed the lesion in question, helped the pathologist correctly identify the lesion while the patient was still in the operating room, and helped the surgeon obtain negative surgical margins, according to Erguvan-Dogan.

“Although the study population is low, we were able to identify 82% of all MRI lesions and 100% of all malignant lesions on specimen radiography,” she notes. “Borderline malignant-benign lesions, such as atypical ductal and lobular hyperplasia, were identified on specimen radiography, whereas only 42% of benign lesions were identified on specimen radiography.”

Erguvan-Dogan believes specimen radiography is a reliable, cost-efficient alternative to repeat contrast-enhanced MRI in the confirmation of lesion removal after surgery, with the additional advantage of enabling immediate assessment of surgical margins and confirming the integrity of the localization wire.

Dana Hinesly is a contributing writer for Medical Imaging.


  1. Erguvan-Dogan B, Whitman GJ, Nguyen VA, et al. Specimen radiography in confirmation of MRI-guided needle localization and surgical excision of breast lesions. AJR. 2006;187:339?344. Available at: www.ajronline.org/cgi/content/abstract/187/2/339. Accessed September 6, 2006.

Focused on MRI-Guided Breast Biopsy?the ATEC Emerald Finds its Niche

The ATEC Emerald system from Suros Surgical enables physicians to perform a 30-minute MRI-guided breast biopsy. The 7-ounce ATEC Disposable Handpiece takes 1 minute to set up and clean up, and does not require multiple clinical personnel to acquire and retrieve tissue samples.

Suros Surgical Systems Inc (Indianapolis) has introduced its ATEC Emerald breast MRI biopsy system. The ATEC Emerald evolved from one of Suros Surgical’s existing MRI systems, the ATEC Sapphire, which is capable of performing breast biopsy in any of the three primary diagnostic imaging modalities: stereotactic, ultrasound, and MRI. The ATEC Emerald was created specifically for clinicians performing MRI-guided breast biopsy and for facilities with dedicated breast MRI programs.

The Emerald boasts the same specs as its predecessor, including the ability to perform a 30-minute MRI-guided breast biopsy and to biopsy patients with multiple lesions in a single gadolinium injection session. The system accommodates both the grid method and the pillar-and-post method, ensuring targeting success. The Emerald is compatible with all MRI systems, regardless of Tesla strength.

“After more than 3 years of working with physicians performing MRI-guided breast biopsy and learning what our more than 350 MRI-capable customer sites need, we have answered the demand for an economical solution to a dedicated breast MRI-guided biopsy system,” Jim Pearson, Suros Surgical president and CEO, said in a press release. He added that the efficiency of an ATEC procedure combined with an exclusive MRI system makes MRI-guided breast biopsy economically feasible by performing just two breast MRI biopsies each month.

—D. Hinesly

MR Software Provides Multiple Views in Single Acquisition

Although MR technology boasts impressive 3D imaging capabilities, the magnets can be slow and, in many cases, require additional scans to obtain the desired views.

“With much of traditional MR, if you want to see the sagittal view, you’d have to do a sagittal acquisition,” explains Walter

F. Block, associate professor of biomedical engineering, medical physics, and radiology at the University of Wisconsin-Madison, who has developed a software program to combat this issue. “Not so in our case. You can take one exam with isotropic resolution and reformat it any way you want.”

Currently being used on knees, Block’s new technique, known as VIPR-SSFP, separates the fat and water signal, providing image contrast between bone and the cartilage surface. The conventional data-acquisition methods spend half of their scan time suppressing the signal from fat, instead of imaging cartilage. But the new approach exploits the difference in resonant frequencies between fat and water. During the scan time, then, the technique maximizes each component of the image, so that a technologist can view any aspect.

“Typically, in T2-weighted images, you’d spend several seconds per experiment, and you might need hundreds or thousands of them to make a complete set of images, which would result in a long scan time,” Block says. “Until now, people have known how you could do it faster, but you couldn’t get high resolution—which is what you need to see smaller cartilage defects. As others are developing therapies now to slow or stop cartilage degradation, we want to be able to see smaller defects and the effects of therapy over shorter time intervals.”

All manufacturers are working toward creating higher-powered reconstruction engines, which will be useful with this method. He says that it requires more power to do the reconstruction quickly, because after capture, the data must be interpolated from a radial data space to a Cartesian space.

According to Block, the primary reason this type of high-resolution, non-Cartesian 3D imaging hasn’t been performed successfully to date is because it requires substantial software calibration to obtain reliable, robust images from any system on which it is used. Now, Block’s data-acquisition technique calibrates the system very quickly and capitalizes on recent hardware advances that, coupled with a clever way of maintaining a high-level MR signal throughout the scan, will speed an MRI session. However, speed isn’t necessarily the ultimate goal.

Rather than using the conventional approach, which rasters horizontally to gather MR data, Block’s technique acquires the body’s signals radially. “Typically, radiologists don’t shorten a scan time; they go for a higher resolution, so the standard of what they can see improves,” Block says.

Patented through the Wisconsin Alumni Research Foundation, the technique also can be applied to other areas of the body requiring detailed images. “We started with the knee because it is simple and static and there have been a large number of exams done,” Block explains. “But we’re currently investigating ways of applying the software to T2-rated breast imaging to look at small structures in tumors that are consistent with either benign or malignant lesions.”

High-resolution 3D images are important not only from diagnostic and clinical standpoints, but also to help patients better understand their health conditions, Block says. “If you could actually look at a 3D model from different perspectives, you’d have a much better chance of making sense of the pain you are feeling, your doctor’s diagnosis, and your treatment options,” he adds.

The algorithms were built on a platform from GE Healthcare (Waukesha, Wis), but they are applicable to virtually any MR system above 1.5T. Block is currently collaborating with researchers at Stanford University, the Mayo Clinic, and the universities at Michigan State and Toronto to conduct a multi-center study of the technique.

Dana Hinesly is a contributing writer for Medical Imaging.

Product Showcase: Sunnex Lights Up the MRI Surgical Suite

The Celestial Star from Sunnex is available in four different configurations and provides 114-inch coverage. Shown here is the dual ceiling.

A new MRI surgical light from Sunnex Inc (Natick, Mass), the Celestial Star can illuminate the MRI surgical suite in any of four different configurations: wall, single ceiling, dual ceiling, or mobile.

With a light intensity of 6,000 footcandles (or 64,500 Lux), the Celestial Star boasts 114-inch coverage with minimal shadows. The surgical light features a patented shade to reduce heat output from its three 35W long-life halogen bulbs, as well as a drift-free balance arm design. Designed to maximize operating space and to be serviceable without tools, the light has a removable, sterilizable handle. The mobile configuration weighs 54 pounds.

The Celestial Star meets FDA Class II standards and has been certified by both GE Healthcare (Waukesha, Wis) and Siemens Medical Solutions (Malvern, Pa) for use with their MRI solutions. For more information, visit www.sunnex.com.

Running the Numbers

280% more accurate than ultrasound and mammography combined is a new software for MRI in detecting breast cancer. The software has been developed at the University of Kansas Hospital (Kansas City) by William Smith, MD, and Marc F. Inciardi, dedicated breast radiologists in the hospital’s breast imaging center. When breast cancer is diagnosed, patients undergo an MRI to further determine the size and scope of the cancer. And with this software, Smith and his team can see at the millimeter level. “We are now realizing just how bad we?ve been,” Smith said in a press release. “It’s hard to believe we can do this; [it’s] like we are looking with a whole different set of sensors.”

Prostate Coil for 3T Enables Targeted Radiation Therapy

The new 3T Prostate eCoil balloon from MEDRAD Inc (Indianola, Pa) aims to improve prostate imaging for earlier diagnosis and staging of prostate cancer. Designed for use with Signa HDx 3T MR scanners from GE Healthcare (Waukesha, Wis), the Prostate eCoil creates consistent contact between the prostate and the coil’s signal-amplifying elements, enabling more accurate imaging.

The MEDRAD 3T Prostate eCoil gets closer to the problem than other imaging options by conforming to the size and shape of the prostate. The resulting images are very accurate and enable physicians to localize radiation therapy and to stage and diagnose cancer.

More than 200,000 patients are diagnosed with prostate cancer annually, and treatment often requires a radical prostatectomy or radiation therapy. The Prostate eCoil, which can be used to plan radiation therapy for more localized treatment, could enable personalization of treatment. “It will provide urologists, radiologists, and radiation oncologists with better information for treatment planning, recognizing that each patient is unique and that their treatment for prostate cancer should be as well,” Gary Bucciarelli, senior vice president of the magnetic resonance business unit at MEDRAD, said in a press release.

MEDRAD touts the eCoil’s small field of view and high spatial resolution as major improvements to ordinary prostate imaging. “The increased spectral dispersion obtainable at 3T allows for better quantification of metabolites, notably the elevation of choline resonance, which has emerged as the most specific marker for prostate cancer,” said John Kurhanewicz, PhD, director of the Prostate Imaging Group and Biomedical NMR Lab, and professor of radiology at the University of California, San Francisco, School of Medicine.

The Prostate eCoil is the first endorectal coil for MR imaging, and it is available for 1.5T magnet strengths as well. In addition, MEDRAD is aiming to develop similar products for other manufacturers’ 3T MRIs. “Although we can’t go into details,” says MEDRAD Spokesperson Daniel Dieter, “it’s safe to say that there are plans for compatibility with other manufacturers’ scanners.”