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Hi there.

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Hi, everybody.

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Thank you all so much.

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And it's really an honor to be here.

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Um, got a lot to talk about, and I

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look forward to all your questions.

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Um, let me see if I can get this going.

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There we go.

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Okay.

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So we're going to talk

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abbreviated breast MRI today.

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The how and why of clinical implementation here.

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A couple of disclosures,

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research support, et cetera.

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We're going to review breast MRI screening

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in high, intermediate, and average risk women

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initially, just to get some background information

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and then look at the evidence supporting why

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we want to go with this abbreviated format

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of the breast MRI and how we can expand our

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use of MRI in larger populations and then

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give you some early clinical outcomes.

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So, background: abbreviated

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protocols are really where it's at.

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Can we cut these down?

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Can we make them

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equally accurate, but more efficient?

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And it really is about money, keeping the

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accuracy, but making a faster, more efficient

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study so that we can decrease the cost and

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hopefully allow more access to more patients that

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need these studies of all sorts, not just breast.

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So, we know mammography is basically

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the basis of screening, and we know that

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we can decrease breast cancer mortality

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by routine screening with mammography.

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However, it is far from

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perfect. As you know, it's got

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fairly low specificity, lots of false

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positives. You know, in mammography, you see

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a mass; you don't know if it's a cyst or

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what, so they're recalled, and then sometimes

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even many times, most biopsies are benign.

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So, low specificity and then low

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sensitivity, and we know that is particularly

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impacted by increasing breast density.

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Density.

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So here, for women of the four BI-RADS categories

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of breast density: all the way on the left, A

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is the fatty; then B is the scattered; C is the

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heterogeneous; and D is the extremely dense.

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And all of these women have breast cancers.

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And this increasing density we know is

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also an independent risk factor beyond

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just family history and things like that.

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The more dense glandular tissue you have,

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the larger the garden for cancers to grow.

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So, increasing density means increasing

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risk of breast cancer and also

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decreasing mammographic performance.

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We can't see them.

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So here are the cancers in these women.

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Oh, 50 percent of women have dense

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breasts in the United States.

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So here are the cancers.

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There's a tiny one in the fatty

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breast A; you can barely

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see it, but it was detected.

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There's a larger one in the scattered.

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There are actually calcifications in the category

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C woman that were detected mammographically.

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And the woman in category D, extremely dense,

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you can't see anything, even

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on a tomosynthesis image.

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And this is it on ultrasound.

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It was detected by abbreviated MRI.

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I'll show you those images later.

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So you can see the size.

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Um, seven millimeters, two

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centimeters, three centimeters, 3.5

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centimeters. Again, increasing risk of cancer

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development and decreasing performance.