Researchers have developed a new device that may result in more comfortable mammography for women. According to a study standardizing the pressure applied in mammography would reduce pain associated with breast compression without sacrificing image quality.

Compression of the breast is necessary in mammography to optimize image quality and minimize absorbed radiation dose. However, mechanical compression of the breast in mammography often causes discomfort and pain and deters some women from mammography screening.

An additional problem associated with compression is the variation that occurs when the technologist adjusts compression force to breast size, composition, skin tautness and pain tolerance. Over-compression, or unnecessarily high pressures during compression, is common in certain European countries, especially for women with small breasts. Over-compression occurs less frequently in the United States, where under-compression, or extremely low applied pressure, is more common.

‘This means that the breast may be almost not compressed at all, which increases the risks of image quality degradation and extra radiation dose,’ said Woutjan Branderhorst, Ph.D., researcher in the Department of Biomedical Engineering and Physics at the Academic Medical Center in Amsterdam.

Overall, adjustments in force can lead to substantial variation in the amount of pressure applied to the breast, ranging from less than 3 kilopascals (kPa) to greater than 30 kPa.

Dr. Branderhorst and colleagues theorized that a compression protocol based on pressure rather than force would reduce the pain and variability associated with the current force-based compression protocol. Force is the total impact of one object on another, whereas pressure is the ratio of force to the area over which it is applied.

The researchers developed a device that displays the average pressure during compression and studied its effects in a double-blinded, randomized control trial on 433 asymptomatic women scheduled for screening mammography.

Three of the four compressions for each participant were standardized to a target force of 14 dekanewtons (daN). One randomly assigned compression was standardized to a target pressure of 10 kPa.

Participants scored pain on a numerical rating scale, and three experienced breast screening radiologists indicated which images required a retake. The 10 kPa pressure did not compromise radiation dose or image quality, and, on average, the women reported it to be less painful than the 14 daN force.

The study’s implications are potentially significant, Dr. Branderhorst said. There are an estimated 39 million mammography exams performed every year in the U.S. alone, which translates into more than 156 million compressions. Pressure standardization could help avoid a large amount of unnecessary pain and optimize radiation dose without adversely affecting image quality or the proportion of required retakes.

‘Standardizing the applied pressure would reduce both over- and under-compression and lead to a more reproducible imaging procedure with less pain,’ Dr. Branderhorst said.

The device that displays average pressure is easily added to existing mammography systems, according to Dr. Branderhorst. EurekAlert

Research suggests team-based care is most effective way to control hypertension
Patients diagnosed with high blood pressure are given better control of their condition from a physician-pharmacist collaborative intervention than physician management alone, according to new research.

Pharmacists can play a key role in communicating with physicians to address suboptimal therapy, helping physicians to provide counselling on lifestyle change and performing patient follow-up.

The research was carried out to evaluate the individual care processes of the physician-pharmacist collaborative intervention in treating hypertension, a major cause of heart disease, strokes and aneurysms of the arteries.

In a study combining two randomised controlled clinical trials, the team of researchers led by Brunel University London found that, resulting from the physician-pharmacist team, each antihypertensive medication alone led to systolic blood pressure (SBP) reduction of 7.19mm Hg, and each session of counselling about lifestyle change alone resulted in a SBP reduction of 5.30mm Hg.

The six-month data was taken from two US studies in 2008 and 2009, in which a total of 496 patients were treated.

Puttarin Kulchaitanaroaj, Research Fellow at Brunel University London

Despite the variety of effective treatments, and physicians who specialize in treating pain, women often suffer unnecessarily from conditions ranging from backaches to pain after cancer surgery, and also treat their pain with medications that may be ineffective and possibly harmful, according to a review of research related to women and pain by the American Society of Anesthesiologists.

ASA conducted the literature review and issued the Women

In a study of nearly 2,000 adults, researchers found that a buildup of plaque in the body’s major arteries was associated with mild cognitive impairment.

‘It is well established that plaque buildup in the arteries is a predictor of heart disease, but the relationship between atherosclerosis and brain health is less clear,’ said Christopher D. Maroules, M.D., radiology resident at UT Southwestern Medical Center in Dallas. ‘Our findings suggest that atherosclerosis not only affects the heart but also brain health.’

Atherosclerosis is a condition in which fat, cholesterol and other substances collect in the arteries, forming a substance called plaque that can build up, limiting blood flow. It can occur in any artery of the body, including the carotid, which supplies blood to the brain, coronary arteries and the aorta, which carries oxygenated blood from the heart through the abdomen to the rest of body.

In the study, researchers analysed the test results of 1,903 participants (mean age, 44 years) in the Dallas Heart Study, a multiethnic population-based study of adults from Dallas County, Texas. The participants included both men and women who had no symptoms of cardiovascular disease.

Study participants completed the Montreal Cognitive Assessment (MoCA), a 30-point standardized test for detecting mild cognitive impairment, and underwent magnetic resonance imaging (MRI) of the brain to identify white matter hyperintensity (WMH) volume. Bright white spots known as high signal intensity areas on a brain MR images indicate abnormal changes within the white matter.

‘Increased white matter hyperintensity volume is part of the normal aging process,’ Dr. Maroules explained. ‘But excessive WMH volume is a marker for cognitive impairment.’

Study participants also underwent imaging exams to measure the buildup of plaque in the arteries in three distinct vascular areas of the body: MRI to measure wall thickness in the carotid arteries and the abdominal aorta, and computed tomography (CT) to measure coronary artery calcium, or the amount of calcified plaque in the arteries of the heart.

Using the results, researchers performed a statistical regression to correlate the incidence of atherosclerosis and mild cognitive impairment. After adjusting for traditional risk factors for atherosclerosis