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.
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).
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.
• 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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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.
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.
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.
Written informed consent was obtained from all subjects (patients) in this study.
The study was approved by the Reggio Emilia Ethics Committee (no. 2017/0103951 on 03/11/2017) and registered on clinicaltrials.gov NCT04009278.
• 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
- Breast cancer
- Radiation dosage