Breast cancer afflicts one in eight Belgian women. Early detection increases the chance of survival, thus screening is recommended. The Mammotest screening programme was introduced in Belgium and significantly improved through MammoNote, an ambitious project of UCL’s Institute of Information and Communication Technologies, Electronics and Applied Mathematics (ICTEAM).
Since 2000, Belgian authorities have operated a systematic screeningmedical examination or action to determine the presence of a disease. It can be positive (the disease is present) or negative (it is absent) programme intended for all women aged 50 to 69, as studies had demonstrated that such programmes reduce mortality up to 30%. This form of screening, or early detection, however, is quite demanding, owing especially to the double reading of mammography X-ray images: the first reading is taken by a radiologist at a centre where the mammography was performed, the second by a radiologist at a coordination centre. The Brussels Breast Cancer Screening Coordination Centre (Brumammo) performs the second reading of images sent by centres approved by the Brussels Capital Region; the Community Reference Centre for Cancer Screening (Centre Communautaire de Référence), in Mont-Saint-Guibert, receives images sent by approved centres in Wallonia. These two coordination centres and their Flemish counterpart organise the screening programme for the Belgian population.
From CD-ROM to MammoNote
Sharing images between the screening centre and the coordination centre must be performed as reliably as possible. ‘Transferring data collected by the centre responsible for the mammography’s first reading to the reference centre responsible for the second is done by sending a CD-ROM and a written report by post’, says Vincent Nicolas, CEO of Intuitim, a UCL spin-off created in 2012. ‘In addition to the risk of loss en route, there’s a risk of mismatching CD-ROMs and reports.’ Intuitim was created following a research project led by Mr Nicolas when he was an ICTEAM researcher, with funding from Innoviris (formerly IRSIB, a Brussels research and innovation assistance fund). More crucial to its creation was a particularly innovative programme for improving screening quality and supporting information exchange.
Improving diagnostics
For several years, Mr Nicolas and his team sought to support radiologist diagnostics and improve information exchange between the centre that performed the mammography and the coordination centre responsible for the second reading. They eventually created a work station that facilitates both annotation and diagnosis of lesions captured by mammography digital imagery. ‘When the image appears on screen, the radiologist uses a stylus to quickly note directly on the image what’s observed, simply by drawing icons representing standard terms next to the observed irregularity. A tape recorder is no longer necessary, and the radiologist who receives the annotated image can in a glance grasp what the first radiologist observed and read his explanation.’
The prototype was tested at the Brussels Jules Bordet Institute and at UCL’s Saint-Luc University Hospital, in collaboration with the Walloon Coordination Centre. Adjustments were made based on real situations. Next, some 15 hospitals performed trial ‘Mammotests’.
Secure transmission and digital annotation
While MammoNote’s image quality mirrors that of existing devices, it is unique in its capacity to structure information gathered by the radiologist responsible for image analysis and in its provision of digital annotation capability. ‘Annotated images are securely transmitted to the coordination centre’, Mr Nicolas explains. ‘There’s no risk of loss or mismatching reports and images. Only authorised persons have access to this personal information. In addition, the annotated images will be useful in subsequent follow-up when compared to future images of the same patient.’ It will be easy to immediately access annotations of previous images, because they will still be there on the image. And we know the importance to a radiologist of being able to compare images taken in previous years.
Interest from other countries
This speedy, self-explanatory and reliable technology is attracting the attention of many screening centres in Belgium and elsewhere. ‘Today, in Belgium,’ Mr Nicolas says, ‘we estimate some ten centres and a range of breast examination specialists use our platform. Luxembourg’s ministry of health, which manages a Mammotest type of screening programme, is also interested. Six hospitals have bought the product. So we’re trying to promote MammoNote in countries managing screening programmes, such as France and Switzerland. The Netherlands and Germany are other possible markets.’ Such progress, by expanding the practice of efficiently transferring data, whether images or reports, can further improve diagnostics, avoid false positives and false negatives, and ultimately improve—and save—many more women’s lives.
Carine Maillard