title: Digital mammography: effects of reduced radiation dose on diagnostic performance.
abstract: OBJECTIVE
  To experimentally determine the relationship between radiation dose and observer accuracy in the detection and discrimination of simulated lesions for digital mammography.
  
  
  METHODS
  This HIPAA-compliant study received institutional review board approval; the informed consent requirement was waived. Three hundred normal craniocaudal images were selected from an existing database of digital mammograms. Simulated mammographic lesions that mimicked benign and malignant masses and clusters of microcalcifications (3.3-7.4 cm in diameter) were then superimposed on images. Images were rendered without and with added radiographic noise to simulate effects of reducing the radiation dose to one half and one quarter of the clinical dose. Images were read by five experienced breast imaging radiologists. Results were analyzed to determine effects of reduced dose on overall interpretation accuracy, detection of microcalcifications and masses, discrimination between benign and malignant masses, and interpretation time.
  
  
  RESULTS
  Overall accuracy decreased from 0.83 with full dose to 0.78 and 0.62 with half and quarter doses, respectively. The decrease associated with transition from full dose to quarter dose was significant (P < .01), primarily because of an effect on detection of microcalcifications (P < .01) and discrimination of masses (P < .05). The level of dose reduction did not significantly affect detection of malignant masses (P > .5). However, reduced dose resulted in an increased mean interpretation time per image by 28% (P < .0001).
  
  
  CONCLUSIONS
  These findings suggest that dose reduction in digital mammography has a measurable but modest effect on diagnostic accuracy. The small magnitude of the effect in response to the drastic reduction of dose suggests potential for modest dose reductions in digital mammography.
authors.affiliation: Duke Advanced Imaging Laboratories, Department of Radiology, Duke University Medical Center, 2424 Erwin Rd, Suite 302, Durham, NC 27705, USA. samei@deckard.duhs.duke.edu
authors.forename: Ehsan
authors.initials: E
authors.lastname: Samei
authors.forename: Robert S
authors.initials: RS
authors.lastname: Saunders
authors.forename: Jay A
authors.initials: JA
authors.lastname: Baker
authors.forename: David M
authors.initials: DM
authors.lastname: Delong
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D002114:Calcinosis / Q000000981:diagnostic imaging*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D015588:Observer Variation; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity