Self-compression Technique vs Standard Compression in Mammography: A Randomized Clinical Trial

Patient- vs Technologist-Controlled Mammography Compression: A Prospective Comparative Study of Patient Discomfort and Breast Compression Thickness

OBJECTIVE

We assess whether mammographic patient-assisted compression (PAC) has an impact on breast compression thickness and patient discomfort compared with technologist-assisted compression (TAC).

METHODS

A total of 382 female patients between ages 40 and 90 years undergoing screening mammography from February 2020 to June 2021 were recruited via informational pamphlet to participate in this IRB-approved study. Patients without prior baseline mammograms were excluded. The participating patients were randomly assigned to the PAC or TAC study group. Pre- and postmammogram surveys assessed expected pain and experienced pain, respectively, using a 100-mm visual analogue scale and the State-Trait Anxiety Inventory. Breast compression thickness values from the most recent mammogram were compared with the patient's recent prior mammogram.

RESULTS

Between the 2 groups, there was no significant difference between the expected level of pain prior to the mammogram (P = .97). While both study groups reported a lower level of experienced pain than was expected, the difference was greater for the PAC group (P <.0001). Additionally, the PAC group reported significantly lower experienced pain during mammography compared with the TAC group (P = .014). The correlation of trait/state anxiety scores with pre- and postmammogram pain scores was weak among the groups. Lastly, the mean breast compression thickness values for standard screening mammographic views showed no significant difference in the PAC group when compared with the patient's prior mammogram.

CONCLUSION

Involving patients in compression reduces their pain independent of the patient's state anxiety during mammography while having no effect on breast compression thickness. Implementing PAC could improve the mammography experience.

Image quality of opportunistic breast examinations in photon-counting computed tomography: A phantom study

PURPOSE

To compare the breast imaging performance of a clinical whole-body photon-counting CT (PCCT) to that of a dedicated breast CT (BCT) to determine the image quality of opportunistic breast examinations in clinical PCCT.

MATERIALS AND METHODS

To quantify image quality for breast cancer applications, acquisitions of a breast phantom including representations of calcifications, fibers, and masses were performed using a clinical PCCT and a dedicated BCT. When imaging with the PCCT, the phantom was also combined with a thorax phantom to simulate realistic patient positioning, while only the breast phantom was imaged in the BCT. Images in BCT were acquired at 7.0 mGy (CTDI16cm) and using 2.6 mGy-25.0 mGy in the PCCT. Spatial resolution between the BCT and PCCT images was matched and data were reconstructed using the default methods of each system. The dose-normalized contrast-to-noise ratio (CNRD) of masses and the structural visibility of fibers and calcifications were evaluated as figures of merit for all reconstructions.

RESULTS

CNRD between masses and background was 0.56 mGy-½, on average with BCT and varied between 0.39 mGy-½ to 1.46 mGy-½ with PCCT over all dose levels, phantom configurations, and reconstruction algorithms. Calcifications down to a size of 0.29 mm and fibers down to a size of 0.23 mm could be reliably identified in the images of both systems.

CONCLUSIONS

Clinical PCCT provides an image quality superior to that obtained with BCT in terms of CNRD and allows for the identification of calcifications and fibers at comparable dose levels.

Strategies enhancing the patient experience in mammography: A scoping review

INTRODUCTION

A positive experience in mammography is essential for increasing patient attendance and reattendance at these examinations, whether conducted for diagnostic or screening purposes. Mammograms indeed facilitate early disease detection, enhance the potential for cure, and consequently reduce breast cancer mortality. The main objective of this review was to identify and map the strategies aiming to improve the patient experience in diagnostic and screening mammography.

METHODS

This scoping review was performed following the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches were performed through databases of MEDLINE, Embase.com, CINAHL, APA PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest Dissertation and Theses, and three clinical trial registries. This review considered studies evaluating the effect of interventions, occurring within the mammography department, on the patient experience.

RESULTS

The literature search yielded 8113 citations of which 60, matching the inclusion criteria, were included. The strategies were classified into eight categories. The most represented one was breast compression and positioning, followed by relaxation techniques and analgesic care, communication and information, screening equipment, examination procedures, patient-related factors, physical environment, and finally staff characteristics. The studied outcomes related to patient experience were mainly pain, anxiety, comfort, and satisfaction. Other types of outcomes were also considered in the studies such as image quality, technical parameters, or radiation dose. Most studies were conducted by radiographers, on female patients, and none mentioned the inclusion of male or transgender patients.

CONCLUSION

This review outlined a diversity of strategies to improve patient experience, although technique-based interventions were predominant. Further research is warranted, notably on psychological strategies, and on men and transgender people.

IMPLICATIONS FOR PRACTICE

This scoping review provides guidance to healthcare providers and services for better patient/client-centered care.

Acceptability of Automated Robotic Clinical Breast Examination: Survey Study

BACKGROUND

In the United Kingdom, women aged 50 to 70 years are invited to undergo mammography. However, 10% of invasive breast cancers occur in women aged ≤45 years, representing an unmet need for young women. Identifying a suitable screening modality for this population is challenging; mammography is insufficiently sensitive, whereas alternative diagnostic methods are invasive or costly. Robotic clinical breast examination (R-CBE)-using soft robotic technology and machine learning for fully automated clinical breast examination-is a theoretically promising screening modality with early prototypes under development. Understanding the perspectives of potential users and partnering with patients in the design process from the outset is essential for ensuring the patient-centered design and implementation of this technology.

OBJECTIVE

This study investigated the attitudes and perspectives of women regarding the use of soft robotics and intelligent systems in breast cancer screening. It aimed to determine whether such technology is theoretically acceptable to potential users and identify aspects of the technology and implementation system that are priorities for patients, allowing these to be integrated into technology design.

METHODS

This study used a mixed methods design. We conducted a 30-minute web-based survey with 155 women in the United Kingdom. The survey comprised an overview of the proposed concept followed by 5 open-ended questions and 17 closed questions. Respondents were recruited through a web-based survey linked to the Cancer Research United Kingdom patient involvement opportunities web page and distributed through research networks' mailing lists. Qualitative data generated via the open-ended questions were analyzed using thematic analysis. Quantitative data were analyzed using 2-sample Kolmogorov-Smirnov tests, 1-tailed t tests, and Pearson coefficients.

RESULTS

Most respondents (143/155, 92.3%) indicated that they would definitely or probably use R-CBE, with 82.6% (128/155) willing to be examined for up to 15 minutes. The most popular location for R-CBE was at a primary care setting, whereas the most accepted method for receiving the results was an on-screen display (with an option to print information) immediately after the examination. Thematic analysis of free-text responses identified the following 7 themes: women perceive that R-CBE has the potential to address limitations in current screening services; R-CBE may facilitate increased user choice and autonomy; ethical motivations for supporting R-CBE development; accuracy (and users' perceptions of accuracy) is essential; results management with clear communication is a priority for users; device usability is important; and integration with health services is key.

CONCLUSIONS

There is a high potential for the acceptance of R-CBE in its target user group and a high concordance between user expectations and technological feasibility. Early patient participation in the design process allowed the authors to identify key development priorities for ensuring that this new technology meets the needs of users. Ongoing patient and public involvement at each development stage is essential.

Does the patient-assisted compression mode affect the mammography quality? A within-woman randomized controlled trial

OBJECTIVES

Evaluate the image quality of a mammography screening device using the patient-assisted compression (PAC) compared with the standard compression (SC) mode.

METHODS

This prospective within-woman, randomized controlled trial was conducted between September 2017 and December 2019. Participants were asymptomatic women aged 50 to 69 years attending their second or subsequent screening mammography round. By random assignment, one breast underwent the SC and the other breast, the PAC. Image quality was evaluated as perfect, good, moderate, or inadequate (PGMI) on 10 criteria for the craniocaudal (CC) view and 8 criteria for the mediolateral oblique (MLO) view. Pearson's chi-square test, with Yates' correction if pertinent, was performed to compare image quality between compression modes.

RESULTS

A total of 444 participants were included (mean [± standard deviation] age, 60 [± 4.9] years). There were no differences in the percentages of PGMI between the PAC and SC modes for the CC view (perfect, 37% [162/444] vs 37% [163/444]; good, 1% [5/444] vs 2% [9/444]; moderate, 62% [277/444] vs 61% [271/444]; inadequate, 0% vs 0.2% [1/444]; p = .88) or for the MLO view (perfect, 53% [237/444] vs 56% [247/444]; good, 22% [99/444] vs 22% [97/444]; moderate, 23% [102/444] vs 22% [98/444]; inadequate, 1% [6/444] vs 0.5% [2/444]; p = .72). No differences were found when we stratified by laterality or when analyzed by PGMI criteria.

CONCLUSION

PAC does not seem to impair mammographic image quality. Future research should focus in a daily practice setting.

KEY POINTS

No differences were found in the distribution of the PGMI classification, a tool for quality assessment, between patient-assisted compression and standard compression. Similar results were found on stratification of image quality by mammographic view and breast laterality for both types of compression. None of the PGMI criteria had significantly more errors in patient-assisted compression than in standard compression.

Comparison of technical parameters and women's experience between self-compression and standard compression modes in mammography screening: a single-blind randomized clinical trial

OBJECTIVES

We compared the compression force, breast thickness, and glandular dose, as well as the severity of discomfort and women's experience between the patient-assisted compression (PAC) and standard compression (SC) modes.

MATERIALS AND METHODS

We conducted a prospective randomized controlled study at Hospital del Mar in Barcelona, Spain. We included 448 asymptomatic women aged 50 to 69 years old, attending their screening round from December 2017 to December 2019. Mammograms included the two bilateral views. In each woman, one breast was studied with SC and the other with PAC. The mode used in each breast was selected following a randomized list. Compression force, breast thickness, and average glandular dose were obtained for each of the 1792 images. We also recorded the degree of discomfort and women's experience, after mammogram acquisitions, using a predefined survey.

RESULTS

Higher compression forces were obtained with PAC than with SC (99.27 N vs 83.25 N, p < 0.001). Breast thickness mode (56.11 mm vs 57.52 mm, p = 0.015) and glandular dose (1.34 mGy vs 1.37 mGy, p = 0.018) were lower in PAC. The discomfort score was slightly higher with PAC (mean 3.94 vs 3.69, p = 0.042), but in the satisfaction survey, more women reported that PAC caused less discomfort. Additionally, 63.2% of women (289/448) preferred PAC.

CONCLUSION

PAC achieved higher compression forces without impairing the other technical imaging parameters and enhanced women's experience of screening mammography. We believe there were no clinically significant differences in the severity of discomfort between the two modes.

KEY POINTS

• Self-compression allows higher compression forces than the standard compression mode. • Self-compression does not affect technical imaging parameters. • Self-compression improved women's experience of screening mammography when standard compression was used on one breast and self-compression on the other.

Breast Computed Tomography: Diagnostic Performance of the Maximum Intensity Projection Reformations as a Stand-Alone Method for the Detection and Characterization of Breast Findings

OBJECTIVES

This study aimed to evaluate the diagnostic performance of the maximum intensity projection (MIP) reformations of breast computed tomography (B-CT) images as a stand-alone method for the detection and characterization of breast imaging findings.

MATERIALS AND METHODS

A total of 160 women undergoing B-CT between August 2018 and December 2020 were retrospectively included; 80 patients with known breast imaging findings were matched with 80 patients without imaging findings according to age and amount of fibroglandular tissue (FGT). A total of 71 benign and 9 malignant lesions were included. Images were evaluated using 15-mm MIP in 3 planes by 2 radiologists with experience in B-CT. The presence of lesions and FGT were evaluated, using the BI-RADS classification. Interreader agreement and descriptive statistics were calculated.

RESULTS

The interreader agreement of the 2 readers for finding a lesion (benign or malignant) was 0.86 and for rating according to BI-RADS classification was 0.82. One of 9 cancers (11.1%) was missed by both readers due to dense breast tissue. BI-RADS 1 was correctly applied to 73 of 80 patients (91.3%) by reader 1 and to 74 of 80 patients (92.5%) by reader 2 without recognizable lesions. BI-RADS 2 or higher with a lesion in at least one of the breasts was correctly applied in 69 of 80 patients (86.3%) by both readers. For finding a malignant lesion, sensitivity was 88.9% (95% confidence interval [CI], 51.75%-99.72%) for both readers, and specificity was 99.3% (95% CI, 96.4%-100%) for reader 1 and 100% (95% CI, 97.20%-100.00%) for reader 2.

CONCLUSIONS

Evaluation of B-CT images using the MIP reformations may help to reduce the reading time with high diagnostic performance and confidence.

Does the use of self-compression in mammography affect compression force, breast thickness, and mean glandular dose?

PURPOSE

The purpose of the study was to investigate whether the use of self-compression in craniocaudal (CC) projection has an effect on compression force, breast thickness, radiation dose and image quality compared to the standard mammographic procedure.

METHODS

The study was conducted on 200 female patients that were referred for mammographic imaging. Patients were randomly divided into two equal groups. In the first group, self-compression was performed on the right breast and in the second group on the left breast. The data about compression force (N), breast thickness (mm), and mean glandular dose (MGD; mGy) were collected. In addition, the differences in the mentioned variables according to the side of self-compression were compared. All mammographic images were evaluated by two experienced radiologists according to the criteria established by the European Commission.

RESULTS

The use of self-compression resulted in a significant increase in compression force by 21.7 % (19.8 N) and a significant reduction of breast thickness by 5% (2.43 mm) and MGD by 6.3 % (0.09 mGy), respectively. There were no statistically significant differences based on the self-compression side, and no differences were observed in image quality assessment.

CONCLUSION

This study demonstrates that the imaging protocol in mammography of the CC projection can be adopted by the use of self-compression in order to achieve better results.

Pressure-based Compression Guidance of the Breast in Digital Breast Tomosynthesis Using Flexible Paddles Compared to Conventional Compression

OBJECTIVE

We investigated the effect of introducing a pressure-based flexible paddle on compression parameters and user and patient experience of digital breast tomosynthesis (DBT) combined with patient-assisted compression or technologist compression.

METHODS

After institutional review board approval, women with a DBT appointment who gave informed consent received pressure-based flexible paddle breast compression. Eight lights on the paddle were illuminated (1.9 kPa per light) as pressure was applied, aiming for an 8-13.9 kPa target range. The compression level was applied by the technologist or the participant utilizing a remote control device. The participant's and technologist's experiences were assessed by a questionnaire. Compression parameters were compared to previous examinations. Comparative statistics were performed using t-tests.

RESULTS

Pressure-based compression (PBC) was judged to be similar or more comfortable compared with previous traditional exams (80%, 83/103), and 87% (90/103) of participants would recommend PBC to friends. Pressure variability decreased for craniocaudal (CC) views (-55%, P < 0.001) and mediolateral oblique (MLO) views (-34%, P < 0.0001). Subgroup analysis showed a similar glandular dose for CC views, while breast thickness was reduced (-3.74 mm, P < 0.0001). For MLO views, both glandular dose (-0.13 mGy, P < 0.0001) and breast thickness were reduced (-6.70 mm, P < 0.0001). Mean compression parameters were similar for technologist compression and patient-assisted examinations.

CONCLUSION

Use of the pressure-based flexible paddle in DBT, with or without patient-assisted compression, improved participant and technologist experience and reduced compression pressure variability, mean breast thickness, and glandular dose.

Dedicated Spiral Breast Computed Tomography With a Single Photon-Counting Detector: Initial Results of the First 300 Women

OBJECTIVES

The aim of this study was to describe our initial clinical experiences using a dedicated spiral breast computed tomography (B-CT) with a single photon-counting detector.

MATERIALS AND METHODS

This retrospective study was approved by the institutional review board. Examinations of 300 consecutive women undergoing B-CT were evaluated on reason of assignment for B-CT instead of mammography, detection rate of breast cancer, and quality criteria of data acquisition. Further evaluated performance indicators were the number of additional ultrasounds examinations due to unclear findings or dense breast tissue and reliability of the technical data acquisition.

RESULTS

Five hundred ninety-one B-CT acquisitions in 300 women were performed. The main reason for preference of B-CT over mammography was the lack of breast compression (254 of 300, 84.7%), which was desired due to personal reasons or mastodynia, whereas 10 patients (0.3%) had implants hampering mammography. One hundred two possible lesions were detected in B-CT including 4 cases of breast cancer (1.3% of all patients). Additional ultrasound was performed in 226 patients (102 due to detected lesions and 124 due to dense breast tissue). Three malignant lesions were only detected in an additional ultrasound (1% of all patients). As a quality criterion, the pectoralis muscle was included in 341 of 591 examinations, but complete assessment of breast tissue was only possible in 149, respectively 140 examinations. No movement artifacts were noted. In 99% of all women, the examination could be realized.

CONCLUSIONS

The dedicated B-CT provides high-quality images. It can be used as alternative particularly in those patients not otherwise willing to perform mammography because of the breast compression.