Skip to main content

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



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.

Trial registration 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.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Eurostat (2021) Breast cancer screening statistics. Available via Accessed 3 Sep 2021

  2. Center for Disease Control and Preventions (2019) Health, United States, 2019 – Data Finder. Available via Accessed 3 Sep 2021

  3. American College of Radiologists (2021) Appropriateness criteria. Available via Accessed 3 Sep 2021

  4. Miller D, Livingstone V, Herbison GP (2008) Interventions for relieving the pain and discomfort of screening mammography. Cochrane Database Syst Rev.

  5. Davey B (2007) Pain during mammography: Possible risk factors and ways to alleviate pain. Radiography 13(3):229–234

    Article  Google Scholar 

  6. Nelson DJ, England A, Cheptoo M, Mercer CE (2020) A comparative study of pain experienced during successive mammography examinations in patients with a family history of breast cancer and those who have had breast cancer surgery. Radiography (Lond) 26(1):76–81

    Article  CAS  Google Scholar 

  7. Akansel N, Gülşen M, Gültaş M (2020) Influence of discomfort tolerance of women who undergo mammography on the perceived pain intensity due to the procedure. Eur J Breast Health 17(1):68–75

    Article  Google Scholar 

  8. Kornguth PJ, Keefe FJ, Wright KR, Delong DM (2020) mammography pain in women treated conservatively for breast cancer. J Pain 1(4):268–274

  9. Moshina N, Sagstad S, Sebuødegård S et al (2020) Breast compression and reported pain during mammographic screening. Radiography (Lond) 26(2):133–139

    Article  CAS  Google Scholar 

  10. Serwan E, Matthews D, Davies J, Chau M (2020) Mammographic compression practices of force- and pressure-standardisation protocol: a scoping review. J Med Radiat Sci 67(3):233–242

    Article  Google Scholar 

  11. Whelehan P, Evans A, Wells M, Macgillivray S (2013) The effect of mammography pain on repeat participation in breast cancer screening: a systematic review. Breast 22(4):389–394

    Article  Google Scholar 

  12. Moshina N, Sebuødegård S, Holen ÅS, Waade GG, Tsuruda K, Hofvind S (2018) The impact of compression force and pressure at prevalent screening on subsequent re-attendance in a national screening program. Prev Med 108:129–136

    Article  Google Scholar 

  13. de Groot JE, Broeders MJ, Grimbergen CA, den Heeten GJ (2015) Pain-preventing strategies in mammography: an observational study of simultaneously recorded pain and breast mechanics throughout the entire breast compression cycle. BMC Womens Health 15(1):26

    Article  Google Scholar 

  14. Lee J, Hardesty LA, Kunzler NM, Rosenkrantz AB (2016) Direct interactive public education by breast radiologists about screening mammography: impact on anxiety and empowerment. J Am Coll Radiol 13(11S):R89–R97

    Article  Google Scholar 

  15. Goethem MV, Mortelmans D, Bruyninckx E et al (2003) Influence of the radiographer on the pain felt during mammography. Eur Radiol 13(10):2384–2389

    Article  Google Scholar 

  16. Waade GG, Sanderud A, Hofvind S (2017) Compression force and radiation dose in the Norwegian Breast Cancer Screening Program. Eur J Radiol 88:41–46

    Article  Google Scholar 

  17. Balleyguier C, Cousin M, Dunant A, Attard M, Delaloge S, Arfi-Rouche J (2018) Patient-assisted compression helps for image quality reduction dose and improves patient experience in mammography. Eur J Cancer 103:137–142

    Article  Google Scholar 

  18. Ulus S, Kovan Ö, Arslan A, Elpen P, Arıbal E (2019) A new technical mode in mammography: self-compression improves satisfaction. Eur J Breast Health 15(4):207–212

    Article  Google Scholar 

  19. Henrot P, Boisserie-Lacroix M, Boute V et al (2019) Self-compression technique vs standard compression in mammography: a randomized clinical trial. JAMA Intern Med 179(3):407–414

    Article  Google Scholar 

  20. Alukic E, Bravhar P, Mekis N (2021) Does the use of self-compression in mammography affect compression force, breast thickness, and mean glandular dose? Eur J Radiol 139:109694

    Article  Google Scholar 

  21. Kornguth PJ, Rimer BK, Conaway MR et al (1993) Impact of patient-controlled compression on the mammography experience. Radiology 186(1):99–102

    Article  CAS  Google Scholar 

  22. Campari C, Rossi PG, Mori CA et al (2016) Impact of the introduction of digital mammography in an organized screening program on the recall and detection rate. J Digit Imaging 29(2):235–242

    Article  Google Scholar 

  23. de Groot JE, Broeders MJ, Branderhorst W, den Heeten GJ, Grimbergen CA (2014) Mammographic compression after breast conserving therapy: controlling pressure instead of force. Med Phys 41(2):023501

    Article  Google Scholar 

  24. Otsu N (1979) A threshold selection method from gray level histograms. IEEE Trans Syst Man Cybern 9:62–66

    Article  Google Scholar 

  25. Spielberger CD, Sydeman SJ (1994) State-trait anxiety inventory and state-trait anger expression inventory. In: Maruish ME (ed) The use of psychological testing for treatment planning and outcome assessment. Lawrence Erlbaum Associates, Hillsdale, NJ, pp 292–321

    Google Scholar 

  26. Spielberger CD (1996) State-Trait Anxiety Inventory. Forma Y italian (ed) Organizzazioni Speciali, Firenze

  27. Pattacini P, Nitrosi A, Giorgi Rossi P et al (2018) Digital mammography versus digital mammography plus tomosynthesis for breast cancer screening: the Reggio Emilia Tomosynthesis Randomized Trial. Radiology 288(2):375–385

    Article  Google Scholar 

  28. Mendat CC, Mislan D, Hession-Kunz L (2017) Patient comfort from the technologist perspective: factors to consider in mammographic imaging. Int J Womens Health 9:359–364

    Article  Google Scholar 

Download references


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.

Author information

Authors and Affiliations



Corresponding author

Correspondence to Paolo Giorgi Rossi.

Ethics declarations


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 NCT04009278.


• prospective

• randomized controlled trial

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information


(PDF 783 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


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