During his career at Grande Ronde Hospital, Imaging Services Manager Troy Juniper has seen mammography technology advance from film developing to 21st-century 3-D imaging, which can detect invasive breast cancers and subsequently save lives.
In 1987, when the La Grande native started working in radiology at GRH, mammogram X-rays were still being developed as film. Since the 1960s, radiologists had been performing mammography exams using general purpose X-ray tubes and no compression. They captured the imaging onto direct-exposure films, similar to chest X-rays.
These images were low in contrast, and the area of tissue close to the chest wall often appeared white due to underexposure.
By the time Juniper began at GRH, the technology had advanced with the introduction of screen-film mammography, which made imaging easier, required a lower radiation dose and provided greater contrast, making it easier to “see through” breast tissues. Improvements in screen-film technology and the establishment of dedicated mammography units during the 1980s and 1990s increasingly enhanced the images.
“The first thing (I was charged with) when I got here was to establish a dedicated mammography,” said Juniper, explaining that prior to his employment most patients traveled to Boise for their mammograms.
“At the time, the film-screen mammography was state-of-the-art,” Juniper said. He said when GRH installed a screen-film mammography machine, there was such an uptick in patients that they had to install a second one.
Around 1997, the hospital upgraded to digital mammography units. While they no longer had to worry about developing film, and they could see the image right away on their computers, there were still difficulties.
If anything looked suspicious, radiology would have to call the patient back for a second mammogram –– in most cases causing unnecessary concern and wasting time and money in order to get a better image.
In 2011, 3-D digital mammography first became available, and in April of 2017 GRH received two 3-D machines of their own.
“Each time we got a new machine, it was like, ‘It can’t get any better,’” Juniper said. “But the (3-D mammography) definitely (had) a wow factor.”
He said before the 3-D machines there were 15-20 percent more women coming back for a second screening.
“For a patient, the first thing that goes through their mind (when they get called back for a second screening) is, ‘I have cancer,’” Juniper said. “If I’m looking at a static image –– tissue stacked on top of each other –– a lot of tissue can look like a mass,” he said. “One year (for another annual screening) is a long time to wait. I can’t take that chance if I think I’m looking at a mass.”
He also said the new technology can eliminate a lot of unnecessary anxiety and expenses for patients and their loved ones.
Juniper said when the 3-D mammography machines were installed, excited radiologists would come to his office and tell him to come look at the impressive images it was taking.
“We can catch masses so small, and so early, that survival rate is so much better,” he said.
According to information from a 3-D mammography pamphlet, the machine detects 41 percent more invasive breast cancers and reduces false positives by up to 40 percent. Due to early detection, the five-year survival rate can be almost 100 percent.
The 21st-century machines take multiple exposures –– the number depends on the density of the tissue, but 60 images on average –– millimeter by millimeter, scanning the entire breast, rather than just the one image the previous machines were taking. This way, instead of viewing an image where a mass could be hidden by tissue on the top or bottom, radiologists can view the entire breast layer by layer.
Mammographer Jenny Kellstrom, a former professor at Oregon Institute of Technology, has been working at GRH for the last 14 years — during the summer only until her retirement two years ago when she came on full time at the hospital.
She said the evolution of mammography has been astounding.
“In a way (3-D mammography) is more simple, but you have to be willing to learn the technology,” Kellstrom said.
She said as a teacher it has been great to learn with the wave of technology, and one of the main reasons she didn’t retire from her job at GRH when she retired from teaching was to learn how to use the 3-D mammography.
Juniper shares her excitement.
“It’s amazing technology,” he said. “We’re extremely fortunate to have it.”
The 3-D machines cost $450,000 each, and most of the funds were raised by the GRH Foundation.
“You (would expect to) have to go to a city for some of the equipment we have,” said Mardi Ford, GRH’s director of communications and marketing. “We have state-of-the-art equipment.”
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