Compression force variability in mammography in Ghana - A baseline study

Communication Channels of Breast Cancer Screening Awareness Campaigns Among Women Presenting for Mammography in Ghana

OBJECTIVE

The channels and content of communication play an integral role in creating breast cancer screening awareness. Although breast cancer screening awareness campaigns are increasing in Ghana, no study has been conducted to investigate the communication channels used by these campaigns. This study aimed to identify the most effective source of breast cancer screening awareness information among women presenting for mammography in Ghana.

METHODS

Ethical approval was sought before data collection. A cross-sectional quantitative approach was adopted for the study and involved 192 women who visited two mammography centers in October 2020 for mammography screening. A self-administered closed-ended questionnaire was used for data collection. Descriptive and inferential statistics were carried out using SPSS version 26.

RESULTS

A total of 192 responses were obtained. Of them, 72 (37.5%) participants had diploma/Higher National Diploma/degree education, with 105 (54.7%) of them being traders or nonprofessionals. All participants had heard of mammography screening and examination before this study. Mass media was the most common source of information on mammography screening (86 [44.8%]), of which radio was the highest subcategory (34 [39.5%]). Moreover, women presenting for mammography in Ghana demonstrated a high level of knowledge of breast cancer screening.

DISCUSSION

Mass media is the most common source of information on breast cancer screening awareness in Ghana and has the potential to positively impact sensitization programs by reaching out to more women. There is a need to engage the Ghanaian population using mass media and health facilities to maximize the impact of breast cancer screening awareness campaigns.

Intra- and inter-rater reliability of compressed breast thickness, applied force, and pressure distribution in screening mammography

Background

Ensuring equivalent and reproducible breast compression between mammographic screening rounds is important for the diagnostic performance of mammography, yet the extent to which screening mammography positioning and compression is reproducible for the individual woman is unknown.

Purpose

To investigate the intra- and inter-rater reliability of breast compression in screening mammography.

Materials and Methods

Eleven breast-healthy women participated in the study. Two experienced radiographers independently positioned and compressed the breasts of each participant in two projections—right craniocaudal and left mediolateral oblique—and at two time points. The spatial pressure distribution on the compressed breast was measured using a pressure sensor matrix. Applied force, compressed breast thickness, force in field of view, contact area, mean pressure, and center of mass (anterio-posterior and mediolateral axes) were measured. The reliabilities of the measures between the time points for each radiographer (intra-rater reliability) and between the radiographers (inter-rater reliability) were analyzed using the intraclass correlation coefficient (ICC).

Results

Intra- and inter-rater reliabilities from both projections demonstrated good to excellent ICCs (≥0.82) for compressed breast thickness, contact area, and anterio-posterior center of mass. The other measures produced ICCs that varied from poor (≤0.42) to excellent (≥0.93) between time points and between radiographers.

Conclusion

Intra- and inter-rater reliability of breast compression was consistently high for compressed breast thickness, contact area, and anterio-posterior center of mass but low for mediolateral center of mass and applied force. Further research is needed to establish objective and clinically useful parameters for the standardization of breast compression.

Mammography Diagnostic Reference Levels (DRLs) in Ghana

INTRODUCTION

Diagnostic Reference Levels (DRLs) are essential for optimisation in mammography. A local DRL for screen-film mammography has been established in Ghana but none exists for the digital mammography systems. Furthermore, technological advancement is phasing out the use of screen-film mammography and replacing it with digital mammography systems. This study aims to establish the local DRLs used in digital mammography across three institutions in Ghana to guide mammography practice.

METHODS

Average glandular dose (AGD), compressed breast thickness (CBT), age of patients, entrance surface exposure (ESE), kVp, and mAs were retrospectively extracted from three digital mammography systems. The 75th and 95th percentile values were obtained for the AGD of each mammography projection and at CBT of 60 ± 5 mm. The correlation between the AGD and CBT, kVp, mAs, and ESE were investigated.

RESULTS

The 75th percentile for the AGD at CBT of 60 ± 5 mm for Centres 1, 2, 3, and all centres were 2.3, 1.8, 2.1, and 2.0 mGy respectively. The DRLs obtained were comparably higher than international studies except those of the United Kingdom. The AGD showed a strong positive correlation with the CBT, kVp, mAs, and ESE. There was variability in the AGD applied across the three centres for the craniocaudal (CC) and mediolateral oblique (MLO) projections. The mean AGD, mAs, and ESE for all the three centres and per centre recorded were higher than previous studies, but the mean kVp and CBT were lower than previous studies.

CONCLUSION

The higher DRLs estimated in this preliminary study indicates that there is a need for dose optimisation in digital mammography practice in Ghana to improve radiation protection.

IMPLICATIONS FOR PRACTICE

The findings will guide the process of optimisation and limit the variations in the radiation dose during mammography practice.