Conventional Film versus Digital Mammography Breast Cancer Screening: Pros and Cons

Due to very high demands on image quality mammography appears to be the last field of conventional imaging that goes digital.

For screening in particular significant logistic improvements may be expected:

By electronic identification (bar codes; standardized hanging protocols) errors may be avoided, reading time may be reduced; double reading may be simplified and images remain available for all readers and involved clinicians – improving the possibility of interdisciplinary communication and feed-back. Inerim test of vililance and CAD support appear promising new possibilities to improve reader performance.

However, so far, only part of the questions are solved. Data trasfer may not be trivial due to the large data volume of mammographic images. Compression algorithms (particularly lossy compression) requires diligent testing. Data volume is also important for archiving. Initial studies showed that interpretation of digital images may have a learning curve. Which display algorithms may influence perception of lesions?

A first large study (DMIST) in the US showed promising results for digital mammographic screening. However, only few units were tested. Meanwhile further systems (various phosphor storage plates; a low-dose system, which uses different beam energy) are on the market. Their physical parameters vary. Also, physical parameters can only paertly predict influence on perception. Therefore, clinical studies would be needed, but are still lacking.

Overall, digital mammographic screening may offer significant advantages, however, critical evaluation of the systems used and the various technical parameters remains critical. Unknown influences may endanger the value of mammographic screening.

Lernziele:

• potentials of digital mammographic screening

• overview of available results

• learning curve for digital image interpretation

• awareness of differences between digital systems

• physical parameters may not allow to predict influence on perception

• impaired percetion of cancers may endanger advantages of screening

• Critical check of the used technique, QA,and of available clinical results is mandatory. Novel techniques require systematic testiing in controlled studies

Korrespondierender Autor: Heywang-Köbrunner S

Klinikum rechts der Isar der TU München, Institut für Röntgendiagnostik, Ismaningerstraße 19, 81675 München

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