Jing-Tzyh Alan Chiang

Interests

Research

Breast Imaging, MRI

Teaching

Breast Imaging, MRI

Courses

Scholarly Contributions

Journals/Publications

• Chartier, S., Kramer, J., Jordan, S., & Chiang, A. (2025). Assessing asymmetric enhancement on breast MRI: Besting the diagnostic challenge with imaging and clinical clues. Current problems in diagnostic radiology.
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  Breast magnetic resonance imaging (MRI) has the highest sensitivity for breast cancer detection compared to other breast imaging modalities such as mammography and ultrasound. As a functional modality, it captures the increased angiogenic activity of breast cancer through gadolinium-based contrast enhancement. Normal breast tissue also enhances, albeit in distinct patterns termed background parenchymal enhancement (BPE). Asymmetric enhancement, i.e., when one breast enhances more prominently than the other, can pose a diagnostic challenge for interpreting radiologists as distinguishing suspicious nonmass enhancement (NME) versus benign asymmetric BPE can be difficult. Correlating with patient history and imaging findings can help differentiate benign versus suspicious patterns of asymmetric enhancement. We present a collection of cases illustrating clues helpful for assessing asymmetric enhancement encountered on breast MRI.
• Kramer, J., Jordan, S., & Chiang, J. (2024). Use of the lateral arm in tomosynthesis-guided SCOUT Reflector placement procedures. Clinical Imaging, 109. doi:10.1016/j.clinimag.2024.110130
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  Preoperative localization procedures are important for guiding surgical excision of non-palpable findings in the breast. The SCOUT Reflector (Merit Medical, South Jordan UT, USA) is a non-wire-based localization device that has been incorporated into clinical use with great success. SCOUT Reflectors can be placed using several imaging modalities, including tomosynthesis. One drawback to SCOUT Reflector placement under tomosynthesis guidance is an inability to directly visualize the introducer needle tip, a factor that limits precision. In this brief communication, we describe the use of a lateral arm attachment for tomosynthesis guided SCOUT Reflector placement. Precise SCOUT Reflector placement can be achieved using the lateral arm due to the ability to clearly visualize the introducer needle and the SCOUT Reflector within the introducer needle bore prior to deployment.
• Larsen, T., Tseng, H., Trinate, R., Fu, Z., Chiang, J., Karellas, A., & Vedantham, S. (2024). Maximizing microcalcification detectability in low-dose dedicated cone-beam breast CT: parallel cascades-based theoretical analysis. Journal of Medical Imaging, 11(3). doi:10.1117/1.JMI.11.3.033501
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  Purpose: We aim to determine the combination of X-ray spectrum and detector scintillator thickness that maximizes the detectability of microcalcification clusters in dedicated cone-beam breast CT. Approach: A cascaded linear system analysis was implemented in the spatial frequency domain and was used to determine the detectability index using numerical observers for the imaging task of detecting a microcalcification cluster with 0.17 mm diameter calcium carbonate spheres. The analysis considered a thallium-doped cesium iodide scintillator coupled to a complementary metal-oxide semiconductor detector and an analytical filtered-back-projection reconstruction algorithm. Independent system parameters considered were the scintillator thickness, applied X-ray tube voltage, and X-ray beam filtration. The combination of these parameters that maximized the detectability index was considered optimal. Results: Prewhitening, nonprewhitening, and nonprewhitening with eye filter numerical observers indicate that the combination of 0.525 to 0.6 mm thick scintillator, 70 kV, and 0.25 to 0.4 mm added copper filtration maximized the detectability index at a mean glandular dose (MGD) of 4.5 mGy. Conclusion: Using parallel cascade systems’ analysis, the combination of parameters that could maximize the detection of microcalcifications was identified. The analysis indicates that a harder beam than that used in current practice may be beneficial for the task of detecting microcalcifications at an MGD suitable for breast cancer screening.
• Nisbet, A., Ahmadian, D., Vedantham, S., & Chiang, J. (2024). An unusual artifact observed on screening mammography in a patient with an LVAD. Journal of Applied Clinical Medical Physics, 25(2). doi:10.1002/acm2.14255
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  Purpose: Screening mammography and digital breast tomosynthesis consist of high-resolution x-ray images to identify findings that are potentially indicative of breast cancer, enabling early detection and reduction of breast cancer mortality. Imaging artifacts can occasionally occur, sometimes due to patient-related medical devices. Because of continuous evolution of new technologies, there is potential for novel artifacts to be encountered. In this technical note, we report an unusual artifact in the screening mammogram of a patient with an Abbott HeartMate 3 left ventricular assist device (LVAD). Methods: A 72-year-old patient with a HeartMate 3 LVAD presented to our breast imaging facility for a standard screening exam with digital breast tomosynthesis (Selenia Dimensions, Hologic Inc., Bedford, MA) and synthetic 2D images (C-view, Hologic Inc., Bedford, MA). Results: Linear artifacts oriented in the anteroposterior dimension demonstrating a spatial periodicity of ∼1.4 mm were seen on all left breast images, whereas concurrent right breast images did not demonstrate any artifacts. Repeat attempts using two identical digital breast tomosynthesis units demonstrated the same artifacts. No other exam at our imaging center that day demonstrated any such artifacts. Mammogram exams performed on this patient prior to her LVAD placement did not exhibit any similar artifacts. Conclusion: Findings support the patient's LVAD as the underlying source of linear artifacts observed on left breast images, particularly given the proximity of the LVAD to the left breast. With the number of patients receiving LVAD placement on the rise, as well as increasing median survival rates status post LVAD implantation, recognition of this LVAD related artifact on mammography may be important.

Proceedings Publications

• Chow, H., Roe, D., Chiang, J. A., Chalasani, P., Garcia, D. O., Centuori, S. M., Tseng, H., Vedantham, S., Chow, H., Roe, D., Chiang, J. A., Chalasani, P., Garcia, D. O., Centuori, S. M., Tseng, H., & Vedantham, S. (2023). Feasibility of quantitative breast density measurements in obese women with dedicated cone-beam breast CT.. In 2023 Program of the 10th International Breast Density & Cancer Risk Assessment Workshop, a21.
• Vedantham, S., Chow, H., Chiang, J. A., Fu, Z., & Tseng, H. (2023). Patient-specific mean glandular dose from a high-resolution dedicated cone-beam breast CT system with offset detector.. In Medical Physics 50-6, 2023 AAPM Meeting Program.