title: The relationship between cancer detection in mammography and image quality measurements.
abstract: OBJECTIVE
  To investigate the relationship between image quality measurements and the clinical performance of digital mammographic systems.
  
  
  METHODS
  Mammograms containing subtle malignant non-calcification lesions and simulated malignant calcification clusters were adapted to appear as if acquired by four types of detector. Observers searched for suspicious lesions and gave these a malignancy score. Analysis was undertaken using jackknife alternative free-response receiver operating characteristics weighted figure of merit (FoM). Images of a CDMAM contrast-detail phantom were adapted to appear as if acquired using the same four detectors as the clinical images. The resultant threshold gold thicknesses were compared to the FoMs using a linear regression model and an F-test was used to find if the gradient of the relationship was significantly non-zero.
  
  
  RESULTS
  The detectors with the best image quality measurement also had the highest FoM values. The gradient of the inverse relationship between FoMs and threshold gold thickness for the 0.25mm diameter disk was significantly different from zero for calcification clusters (p=0.027), but not for non-calcification lesions (p=0.11). Systems performing just above the minimum image quality level set in the European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis resulted in reduced cancer detection rates compared to systems performing at the achievable level.
  
  
  CONCLUSIONS
  The clinical effectiveness of mammography for the task of detecting calcification clusters was found to be linked to image quality assessment using the CDMAM phantom. The European Guidelines should be reviewed as the current minimum image quality standards may be too low.
authors.affiliation: National Coordinating Centre for the Physics in Mammography (NCCPM), Level B, St Luke's Wing, Royal Surrey County Hospital, Guildford GU2 7XX, UK. Electronic address: alistairmackenzie@nhs.net.
authors.forename: Alistair
authors.initials: A
authors.lastname: Mackenzie
authors.affiliation: National Coordinating Centre for the Physics in Mammography (NCCPM), Level B, St Luke's Wing, Royal Surrey County Hospital, Guildford GU2 7XX, UK. Electronic address: Lucy.Warren@nhs.net.
authors.forename: Lucy M
authors.initials: LM
authors.lastname: Warren
authors.affiliation: Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge & NIHR Cambridge Biomedical Research Centre, Cambridge, UK. Electronic address: matthew.wallis1@nhs.net.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Wallis
authors.affiliation: Department of Radiology, St George's Healthcare NHS Trust, London, UK. Electronic address: Rosalind.Given-Wilson@stgeorges.nhs.uk.
authors.forename: Rosalind M
authors.initials: RM
authors.lastname: Given-Wilson
authors.affiliation: Jarvis Breast Screening and Diagnostic Centre, Guildford, UK. Electronic address: cookejulie@hotmail.com.
authors.forename: Julie
authors.initials: J
authors.lastname: Cooke
authors.affiliation: National Coordinating Centre for the Physics in Mammography (NCCPM), Level B, St Luke's Wing, Royal Surrey County Hospital, Guildford GU2 7XX, UK; Department of Physics, University of Surrey, Guildford GU2 7XH, UK. Electronic address: daviddance@nhs.net.
authors.forename: David R
authors.initials: DR
authors.lastname: Dance
authors.affiliation: Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: dpc10ster@gmail.com.
authors.forename: Dev P
authors.initials: DP
authors.lastname: Chakraborty
authors.affiliation: Scientific Computing, Department of Medical Physics, Royal Surrey County Hospital, Guildford, UK. Electronic address: mhalling-brown@nhs.net.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Halling-Brown
authors.affiliation: National Coordinating Centre for the Physics in Mammography (NCCPM), Level B, St Luke's Wing, Royal Surrey County Hospital, Guildford GU2 7XX, UK. Electronic address: padraig.looney@nhs.net.
authors.forename: Padraig T
authors.initials: PT
authors.lastname: Looney
authors.affiliation: National Coordinating Centre for the Physics in Mammography (NCCPM), Level B, St Luke's Wing, Royal Surrey County Hospital, Guildford GU2 7XX, UK; Cambridge Breast Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge & NIHR Cambridge Biomedical Research Centre, Cambridge, UK. Electronic address: ken.young@nhs.net.
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Young
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008327:Mammography / Q000379:methods* / Q000592:standards; D011856:Radiographic Image Enhancement / Q000379:methods
keywords: Cancer detection; Contrast detail; Digital detector; Mammography