To compare technical and clinical screening performance parameters between computed radiography (CR) and direct digital radiography (DR) systems.
The number of women screened with CR was 73,008 and with DR 116,945. Technical and patient dose survey data of 25 CR and 37 DR systems were available. Technical performance was expressed by threshold thickness values at the mean glandular dose (MGD) level of routine practice. Clinical indicators included recall rate (RR), cancer detection rate (CDR), percentage of ductal carcinoma in situ (DCIS), percentage of cancers with T-scores smaller than 1 cm and positive predictive value (PPV).
Contrast threshold values for the 0.1-mm gold disk were 1.44 μm (SD 0.13 μm) for CR and 1.20 μm (SD 0.13 μm for DR). MGD was 2.16 mGy (SD 0.36 mGy) and 1.35 mGy (SD 0.32 mGy) for CR and DR respectively. We obtained for CR, respectively DR, the following results: RR in the first round of 5.48 % versus 5.61 %; RR in subsequent rounds of 2.52 % versus 2.65 %; CDR of 0.52 % versus 0.53 %; DCIS of 0.08 % versus 0.11 %; a rate of cancers with T-scores smaller than 1 cm of 0.11 % versus 0.11 %; PPV of 18.45 % versus 18.64 %; none of them was significantly different.
Our screening indicators are reassuring for the use of CR and DR, with CR operating at 60 % higher MGD.
• Breast cancer screening can employ both computed (CR) and direct digital radiography (DR).
• Screening performance parameters for CR and DR technology are not significantly different.
• Screening parameters are in accordance with European Guidelines.
• Radiation doses employed for CR are generally 60 % greater than for DR.
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The official journal of the European Union, ‘Council Recommendation of 2 December 2003 on Cancer Screening’ (2003/878/EC), L327/34 – L327/38, Dec 16, 2003
Perry N, Broeders M, de Wolf C, Törnberg S, Holland R, von Karsa L (2006) European Guidelines for breast cancer screening and diagnosis. Office for the Official Publications of the European Communities, Luxemburg
Bick U, Diekmann F (2009) Digital mammography. Springer Verlag, Berlin
IAEA Human Health Series, No 17. Quality assurance programme for digital mammography. Downloadable from http://www.iaea.org/Publications/index.html
Marshall NW, Monnin P, Bosmans H, Bochud FO, Verdun FR (2011) Image quality assessment in digital mammography: part I. Technical characterization of the systems’. Phys Med Biol 56:4201–4220
Rivetti S, Lanconelli N, Campanini R et al (2006) Comparison of different commercial FFDM units by means of physical characterization and contrast-detail analysis. Med Phys 33:4198–4209
Warren LM, Mackenzie A, Cooke J et al (2012) Effect of image quality on calcification detection in digital mammography. Med Phys 39:3202–3213
Monnin P, Marshall NW, Bosmans H, Bochud FO, Verdun FR (2011) Image quality assessment in digital mammography: part II. NPWE as a validated alternative for contrast detail analysis. Phys Med Biol 56:4221–4238
Pisano ED, Gatsonis C, Hendrick E et al (2005) Diagnostic performance of digital versus film mammography for breast-cancer screening; Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group. N Engl J Med 353:1773–1783
Skaane P, Hofvind S, Skjennald A (2007) Randomized trial of screen-film versus full-field digital mammography with soft-copy reading in population-based screening program: follow-up and final results of Oslo II study’. Radiology 244:708–717
Skaane P, Balleyguier C, Diekmann F et al (2005) Breast lesion detection and classification: comparison of screen-film mammography and full-field digital mammography with soft-copy reading–observer performance study. Radiology 237:37–44
Lewin JM, Hendrick RE, D’Orsi CJ et al (2001) Comparison of full-field digital mammography with screen-film mammography for cancer detection: results of 4,945 paired examinations. Radiology 218:873–880
Hambly NM, McNicholas MM, Phelan N, Hargaden GC, O'Doherty A, Flanagan FL (2009) Comparison of digital mammography and screen-film mammography in breast cancer screening: a review in the Irish breast screening program’. AJR Am J Roentgenol 193:1010–1018
Bluekens AM, Karssemeijer N, Beijerinck D et al (2010) Consequences of digital mammography in population-based breast cancer screening: initial changes and long-term impact on referral rates. Eur Radiol 20:2067–2073
Bluekens AM, Holland R, Karssemeijer N, Broeders MJ, den Heeten GJ (2012) Comparison of digital screening mammography and screen-film mammography in the early detection of clinically relevant cancers: a multicenter study. Radiology 265:707–714
Sala M, Comas M, Macià F, Martinez J, Casamitjana M, Castells X (2009) Implementation of digital mammography in a population-based breast cancer screening program: effect of screening round on recall rate and cancer detection. Radiology 252:31–39
Van Ongeval C, Van Steen A, Vande Putte G et al (2010) Does digital mammography in a decentralized breast cancer screening program lead to screening performance parameters comparable with film-screen mammography? Eur Radiol 20:2307–2314
Vinnicombe S, Pinto Pereira SM, McCormack VA, Shiel S, Perry N, Dos Santos Silva IM (2009) Full-field digital versus screen-film mammography: comparison within the UK breast screening program and systematic review of published data. Radiology 251:347–358
Lipasti S, Anttila A, Pamilo M (2010) Mammographic findings of women recalled for diagnostic work-up in digital versus screen-film mammography in a population-based screening program. Acta Radiol 51:491–497
Skaane P (2009) Studies comparing screen-film mammography and full-field digital mammography in breast cancer screening: updated review. Acta Radiol 50:3–14
Thierens H, Bosmans H, Buls N et al (2009) Type testing of physical characteristics of digital mammography systems for screening within the Flemish breast cancer screening programme. Eur J Radiol 70:539–548
Dance DR, Skinner CL, Young KC, Beckett JR, Kotre CJ (2000) Additional factors for the estimation of mean glandular breast dose using the UK mammography dosimetry protocol. Phys Med Biol 45:3225–3240
Michielsen K, Jacobs J, Bosmans H (2007) Patient dosimetry for mammography. AIP Conference Proceedings of the Fourth International Summer School on Nuclear Physics Methods and Accelerators in Biology and Medicine 958:292–293
Chevalier M, Morán P, Ten JI, Fernández Soto JM, Cepeda T, Vañó E (2004) Patient dose in digital mammography. Med Phys 31:2471–2479
Young KC, Cook JJH, Okudo JM, Bosmans H (2006) Comparison of software and human observers in reading images of the CDMAM test object to assess digital mammography systems. Proc SPIE 6142, 614206-1 – 614206-13
Bennett RL, Blanks RG, Moss SM (2009) Evaluation of extension of breast screening to women aged 65–70 in England using screening performance measures. Br J Cancer 100:1043–1047
Marshall NW, Lemmens K, Bosmans H (2012) Physical evaluation of a needle photostimulable phosphor based CR mammography system. Med Phys 39:811–824
Yaffe MJ, Mainprize JG (2011) Risk of radiation-induced breast cancer from mammographic screening. Radiology 258:98–105
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Bosmans, H., De Hauwere, A., Lemmens, K. et al. Technical and clinical breast cancer screening performance indicators for computed radiography versus direct digital radiography. Eur Radiol 23, 2891–2898 (2013). https://doi.org/10.1007/s00330-013-2876-0