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Technical and clinical breast cancer screening performance indicators for computed radiography versus direct digital radiography

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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.

Key Points

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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Correspondence to Hilde Bosmans.

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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).

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