title: Teleradiology with uncompressed digital mammograms: clinical assessment.
abstract: OBJECTIVE
  The purpose of our study was to demonstrate the feasibility of sending uncompressed digital mammograms in a teleradiologic setting without loss of information by comparing image quality, lesion detection, and BI-RADS assessment.
  
  
  METHODS
  CDMAM phantoms were sent bidirectionally to two hospitals via the network. For the clinical aspect of the study, 200 patients were selected based on the BI-RAD system: 50% BI-RADS I and II; and 50% BI-RADS IV and V. Two hundred digital mammograms (800 views) were sent to two different institutions via a teleradiology network. Three readers evaluated those 200 mammography studies at institution 1 where the images originated, and in the two other institutions (institutions 2 and 3) where the images were sent. The readers assessed image quality, lesion detection, and BI-RADS classification.
  
  
  RESULTS
  Automatic readout showed that CDMAM image quality was identical before and after transmission. The image quality of the 200 studies (total 600 mammograms) was rated as very good or good in 90-97% before and after transmission. Depending on the institution and the reader, only 2.5-9.5% of all studies were rated as poor. The congruence of the readers with respect to the final BI-RADS assessment ranged from 90% and 91% at institution 1 vs. institution 2, and from 86% to 92% at institution 1 vs. institution 3. The agreement was even higher for conformity of content (BI-RADS I or II and BI-RADS IV or V). Reader agreement in the three different institutions with regard to the detection of masses and calcifications, as well as BI-RADS classification, was very good (κ: 0.775-0.884). Results for interreader agreement were similar.
  
  
  CONCLUSIONS
  Uncompressed digital mammograms can be transmitted to different institutions with different workstations, without loss of information. The transmission process does not significantly influence image quality, lesion detection, or BI-RADS rating.
authors.affiliation: Department of Radiology, Division of Molecular and Gender Imaging, Medical University of Vienna,Waehringer Guertel 18-20, 1090 Vienna, Austria. Julia.fruehwald-pallamar@meduniwien.ac.at
authors.forename: Julia
authors.initials: J
authors.lastname: Fruehwald-Pallamar
authors.forename: Marion
authors.initials: M
authors.lastname: Jantsch
authors.forename: Katja
authors.initials: K
authors.lastname: Pinker
authors.forename: Ricarda
authors.initials: R
authors.lastname: Hofmeister
authors.forename: Friedrich
authors.initials: F
authors.lastname: Semturs
authors.forename: Kathrin
authors.initials: K
authors.lastname: Piegler
authors.forename: Daniel
authors.initials: D
authors.lastname: Staribacher
authors.forename: Michael
authors.initials: M
authors.lastname: Weber
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Helbich
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval / Q000379:methods*; D008327:Mammography / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D017216:Telemedicine / Q000379:methods*