Threshold in breast compression reduction for full-field digital mammography and digital breast tomosynthesis

Introduction: Breast compression is essential in mammography to improve image quality and reduce radiation dose. However, it can cause discomfort or even pain in women which could discourage them from attending future mammography examinations. Therefore, this study aims to explore the maximum reduction in breast compression in full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT) that is achievable without impacting on image quality and dose.

Methods: Ten compression force (CF) levels (20Ne110N, with 10N intervals) were assessed on Siemens MAMMOMAT Inspiration with Nuclear Associates 18e228 phantom. Imaging was carried out in craniocaudal projection using Automatic Exposure Control at 28 kVp with a Tungsten/Rhodium anode/filter combination, and at 50? sweep angle for DBT. Using ImageJ software, image quality of the acquired mammograms and central tomosynthesis slices were examined based on mass conspicuity (MC) and microcalcification conspicuity (MicroC). Entrance skin dose (ESD) and mean glandular dose (MGD) were recorded from Digital Imaging and Communication in Medicine image header. Linear regression was performed to examine the relationship between CF with ESD, MGD, MC and MicroC. Differences in image quality and radiation dose were assessed with one-way analysis of variance and Kruskal-Wallis H test.

Results: Significant correlations were noted between CF with ESD and MicroC for FFDM and DBT, with DBT also demonstrating associations with MGD and MC. No significant differences were observed for ESD, MGD, MC and MicroC when CF was reduced to 40N and 80N in FFDM and DBT respectively.

Conclusion: This study demonstrated that CF can be reduced as low as 40N and 80N in FFDM and DBT respectively, without significant impact on image quality and radiation dose.

Implications for practice: Reduced mammographic compression may reduce discomfort or pain in women, which may improve attendance rate in breast screening programmes. Findings from this study will provide reference for future work examining breast compression in mammography.