Mammography with and without radiolucent positioning sheets: Comparison of projected breast area, pain experience, radiation dose and technical image quality.
OBJECTIVE
To compare projected breast area, image quality, pain experience and radiation dose between mammography performed with and without radiolucent positioning sheets.


METHODS
184 women screened in the Dutch breast screening programme (May-June 2012) provided written informed consent to have one additional image taken with positioning sheets. 5 cases were excluded (missing data). Pain was scored using the Numeric Rating Scale. Radiation dose was estimated using the Dance model and projected breast area using computer software. Two radiologists and two radiographers assessed image quality.


RESULTS
With positioning sheets significantly more pectoral muscle, lateral and medial breast tissue was projected (CC-views) and more and deeper depicted pectoral muscle (MLO-views). In contrast, visibility of white and darker areas was better on images without positioning sheets, radiologists were therefore better able to detect abnormalities (MLO-views). Women experienced more pain with positioning sheets (MLO-views only, mean difference NRS 0.98; SD 1.71; p=0,00).


CONCLUSIONS
Mammograms with positioning sheets showed more breast tissue. Increased breast thickness after compression with sheets resulted in less visibility of white and darker areas and thus reduced detection of abnormalities. Also, women experienced more pain (MLO-views) due to the sheet material. A practical consideration is the fact that more subcutaneous fat tissue and skin are being pulled forward leading to folds in the nipple area. On balance, improvement to the current design is required before implementation in screening practice can be considered.
Dutch reference centre for screening, Nijmegen, The Netherlands. Electronic address: j.timmers@lrcb.nl.
Janine
J
Timmers
Organization for cancer screening in the Eastern Part of the Netherlands, Deventer, The Netherlands. Electronic address: m.tenvoorde@bevolkingsonderzoekoost.nl.
Marloes Ten
MT
Voorde
Dutch reference centre for screening, Nijmegen, The Netherlands. Electronic address: r.vanengen@lrcb.nl.
Ruben E van
RE
Engen
Dutch reference centre for screening, Nijmegen, The Netherlands. Electronic address: c.vanlandsveld-verhoeven@lrcb.nl.
Cary van
Cv
Landsveld-Verhoeven
Dutch reference centre for screening, Nijmegen, The Netherlands; Department of Radiology, Utrecht University Medical Center, Utrecht, The Netherlands. Electronic address: r.pijnappel@lrcb.nl.
Ruud
R
Pijnappel
Organization for cancer screening in the Eastern Part of the Netherlands, Deventer, The Netherlands; Department of Radiology, Gelre Ziekenhuizen, Deventer, The Netherlands. Electronic address: K.de.greve@gelre.nl.
Kitty Droogh-de
KD
Greve
Dutch reference centre for screening, Nijmegen, The Netherlands; Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands. Electronic address: denheeten@gmail.com.
Gerard J den
GJ
Heeten
Dutch reference centre for screening, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands. Electronic address: Mireille.broeders@radboudumc.nl.
Mireille J M
MJ
Broeders
D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008327:Mammography / Q000295:instrumentation*; D008403:Mass Screening; D059373:Mastodynia / Q000209:etiology; D008875:Middle Aged; D009558:Nipples / Q000000981:diagnostic imaging; D010147:Pain Measurement / Q000379:methods; D056888:Patient Positioning / Q000295:instrumentation*; D010369:Pectoralis Muscles / Q000000981:diagnostic imaging; D011312:Pressure; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000592:standards; D012867:Skin / Q000000981:diagnostic imaging; D012984:Software; D013314:Stress, Mechanical; D050151:Subcutaneous Fat / Q000000981:diagnostic imaging
Breast neoplasms; Early detection of cancer; Mammography; Performance; Radiographic image enhancement