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Patient-centred care with self-compression mammography in clinical practice: a randomized trial compared to standard compression

European Radiology volume 33, pages 450–460 (2023)Cite this article

Abstract

Objective

To test the efficacy of self- compared to radiographer-led compression to reduce the average glandular dose without affecting image quality and compliance to follow-up mammography.

Materials and methods

Women presenting for mammography for breast cancer follow-up, symptoms, opportunistic screening, or familial risk were asked to participate and, if willing, were randomized to self-compression or radiographer-led compression. Image quality was assessed blindly by two independent radiologists and two radiographers. Pain and discomfort were measured immediately after mammography and their recall was asked when the women participated in the follow-up mammogram, 1 or 2 years later.

Results

In total, 495 women (mean age 57 years +/-14) were enrolled, 245 in the self-compression and 250 radiographer-compression arms. Image quality was similar in the two arms (radiologists’ judgement p = 0.90; radiographers’ judgement p = 0.32). A stronger compression force was reached in the self- than in the radiographer-arm (114.5 vs. 10.25 daN, p < .001), with a 1.7-mm reduction in thickness (p = .14), and almost no impact on dose per exam (1.90 vs. 1.93 mGy, p = .47). Moderate/severe discomfort was reported by 7.8% vs 9.6% (p = .77) and median pain score was 4.0 in both arms (p = .55). Median execution time was 1 min longer with self-compression (10.0 vs. 9.1 min, p < 0.001). No effect on subsequent mammography was detectable (p = 0.47).

Conclusion

Self-compression achieved stronger compression of the breast, with comparable image quality, but did not substantially reduce glandular dose. The proportion of women who attended follow-up mammography was also similar in the two groups.

Trial registration

clinicaltrials.gov NCT04009278

Key Points

• In mammography, appropriate compression is essential to obtain high image quality and reduce dose. Compression causes pain and discomfort.

• Self-compression has been proposed to reach better compression and possibly increase participation in mammography.

• In a randomized trial, self-compression reached stronger compression of the breast, with comparable image quality but with no glandular dose reduction or impact on participation in follow-up mammography.

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Acknowledgements

The following are members of the Self-Compression Reggio Emilia Working Group: Radiographers: Alessandra Ronzoni, Manuela Sassi, Monica Canovi, Cristina Bianchi, Morena Bertolini, Filomena Morsillo, Luana Desio, Manuela Lopes, Rossana Colafemmina, Silvia Guidetti, Valeria Vecchi, Emanuela Zecchetti, Giulia Gentili.

We thank all the women who participated for their fundamental contribution to our study. We thank Jacqueline Costa for editing the text.

Funding

The study was conducted with the institutional research funds of the AUSL-IRCCS di Reggio Emilia. It was supported by GE Healthcare (Buc, France), which loaned one Senographe Pristina system for the duration of the study recruitment.

Author information

Authors and Affiliations

  1. Radiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy

    Valentina Iotti, Laura Canovi, Monica Guberti, Vanessa Marchesi, Giulia Besutti, Rita Vacondio & Pierpaolo Pattacini

  2. Epidemiology Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy

    Paolo Giorgi Rossi & Marta Ottone

  3. Medical Physics Unit, Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia, via Amendola 2, 42122, Reggio Emilia, Italy

    Andrea Nitrosi & Davide Giosuè Lippolis

Authors
  1. Valentina Iotti
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  2. Paolo Giorgi Rossi
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  9. Marta Ottone
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  10. Rita Vacondio
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  11. Pierpaolo Pattacini
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Consortia

for the Self-Compression Reggio Emilia Working Group

Corresponding author

Correspondence to Paolo Giorgi Rossi.

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Guarantor

The scientific guarantor of this publication is Pierpaolo Pattacini.

Conflict of interest

PP, AN, and VI have received travel and lodging expenses and a fee for presentation of other studies on breast cancer screening and diagnosis, at several congresses and meetings from GE Healthcare; they have received speaker fees and travel grants from GE Healthcare. RV has received 500€ for payment for development of educational presentations from GE Healthcare. Other authors declare no relevant competing interest.

Statistics and biometry

Marta Ottone is a biostatistician and she has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

The study was approved by the Reggio Emilia Ethics Committee (no. 2017/0103951 on 03/11/2017) and registered on clinicaltrials.gov NCT04009278.

Methodology

• prospective

• randomized controlled trial

• performed at one institution

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Iotti, V., Giorgi Rossi, P., Canovi, L. et al. Patient-centred care with self-compression mammography in clinical practice: a randomized trial compared to standard compression. Eur Radiol 33, 450–460 (2023). https://doi.org/10.1007/s00330-022-09002-z

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  • DOI: https://doi.org/10.1007/s00330-022-09002-z

Keywords

  • Breast cancer
  • Mammography
  • Self-care
  • Pain
  • Radiation dosage