title: The potential use of ultra-low radiation dose images in digital mammography--a clinical proof-of-concept study in craniocaudal views.
abstract: OBJECTIVE
  To estimate the potential of low-dose images in digital mammography by analysing the effect of substantial dose reduction in craniocaudal (CC) views on clinical performance.
  
  
  METHODS
  At routine mammography, additional CC views were obtained with about 10% of the standard dose. Five radiologists retrospectively read the standard [mediolateral oblique (MLO) + CC] and combination low-dose mammograms (standard MLO + low-dose CC). If present, lesion type, conspicuity and suggested work-up were recorded. Final diagnoses were made by histology or follow up. A t-test or χ(2) test was used to compare results.
  
  
  RESULTS
  421 cases were included, presenting 5 malignancies, 66 benign lesions and multiple non-specific radiologic features. Using MLO with low-dose CC, all lesions were detected by at least one reader, but altogether less often than with standard mammography (sensitivity, 73.9% vs 81.5%). Missed lesions concerned all types. Lesions detected with both protocols were described similarly (p = 0.084) with comparable work-up recommendations (p = 0.658).
  
  
  CONCLUSIONS
  Mammography with ultra-low-dose CC images particularly influences detection. While sensitivity decreased, specificity was unaffected. In this proof-of-concept study a lower limit was to be determined that is not intended nor applicable for clinical practice. This should facilitate further research in optimization of a low-dose approach, which has potential in a relatively young and largely asymptomatic population.
  
  
  CONCLUSIONS
  Tungsten/silver-acquired mammography images might facilitate substantial dose reduction. Ultra-low-dose CC images reduce sensitivity, but not specificity. Low-dose images have potential in a largely young and asymptomatic population; a baseline is set for further research in optimization of a low-dose approach.
authors.affiliation: 1 St Elisabeth Hospital, Department of Radiology, Tilburg, Netherlands.
authors.forename: A M J
authors.initials: AM
authors.lastname: Bluekens
authors.forename: W J H
authors.initials: WJ
authors.lastname: Veldkamp
authors.forename: K H
authors.initials: KH
authors.lastname: Schuur
authors.forename: N
authors.initials: N
authors.lastname: Karssemeijer
authors.forename: M J M
authors.initials: MJ
authors.lastname: Broeders
authors.forename: G J
authors.initials: GJ
authors.lastname: den Heeten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000000981:diagnostic imaging*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D012372:ROC Curve; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies