title: Towards personalized compression in mammography: a comparison study between pressure- and force-standardization.
abstract: OBJECTIVE
  To compare a conventional 14 decanewton (daN) force-standardized compression protocol with a personalized 10kilopascal (kPa) pressure-standardized protocol.
  
  
  METHODS
  A new add-on contact area detector, which enables pressure-standardized compression, is validated in a double-blinded intra-individual comparison study. Breast screening participants (433) received one craniocaudal (CC) and one mediolateral oblique (MLO) compression for both breasts. Three of these compressions were force-standardized, and one, blinded and randomly assigned, was pressure-standardized. Participants scored their pain experience on an 11-point numerical rating scale (NRS). Three experienced breast-screening radiologists, blinded for compression protocol, indicated which images required retakes.
  
  
  RESULTS
  An unanticipated under-compression issue that occurred at forces below 5daN was effectively solved with minimal extra radiographer training during the study. For pressure-standardized compressions obtained at 5daN or more, the compressed breasts thickness increased on average 4.2% (MLO)-6.3% (CC), average pain scores were reduced by 10% (MLO)-17% (CC) and the proportion of women experiencing severe pain (NRS≥7) was reduced by 27% (MLO)-32% (CC), compared with force-standardized compressions (all p-values <0.05). Average glandular dose (AGD) and proportions of retakes were similar for both protocols.
  
  
  CONCLUSIONS
  Pressure-standardized compressions resulted in AGD values and a retake proportion similar to force-standardized compressions, while pain was significantly reduced.
authors.affiliation: Academic Medical Center, Room L0-151, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Academic Medical Center, Department of Biomedical Engineering & Physics, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: jerry.degroot@sigmascreening.com.
authors.forename: Jerry E
authors.initials: JE
authors.lastname: de Groot
authors.affiliation: Academic Medical Center, Department of Biomedical Engineering & Physics, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; Sigmascreening B.V., Meibergdreef 45, 1105 BA Amsterdam, The Netherlands. Electronic address: w.branderhorst@amc.uva.nl.
authors.forename: Woutjan
authors.initials: W
authors.lastname: Branderhorst
authors.affiliation: Academic Medical Center, Department of Biomedical Engineering & Physics, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; Sigmascreening B.V., Meibergdreef 45, 1105 BA Amsterdam, The Netherlands. Electronic address: c.a.grimbergen@amc.uva.nl.
authors.forename: Cornelis A
authors.initials: CA
authors.lastname: Grimbergen
authors.affiliation: Academic Medical Center, Department of Radiology, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; LRCB Dutch Reference Center for Screening, P.O. Box 6873, 6503 GJ Nijmegen, The Netherlands. Electronic address: g.denheeten@lrcb.nl.
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: den Heeten
authors.affiliation: Radboud University Medical Center, Department for Health Evidence, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands; LRCB Dutch Reference Center for Screening, P.O. Box 6873, 6503 GJ Nijmegen, The Netherlands. Electronic address: mireille.broeders@radboudumc.nl.
authors.forename: Mireille J M
authors.initials: MJM
authors.lastname: Broeders
mesh_terms: D000328:Adult; D001940:Breast / Q000033:anatomy & histology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008327:Mammography / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D010146:Pain / Q000517:prevention & control*; D010147:Pain Measurement / Q000379:methods; D011312:Pressure; D012015:Reference Standards
keywords: Breast compression; Force; Mammography; Pain; Pressure; Standardization