title: Effects of Reduced Compression in Digital Breast Tomosynthesis on Pain, Anxiety, and Image Quality.
abstract: BACKGROUND
  Most women are reluctant to undergo breast cancer screenings due to the pain and anxiety they experience. Sectional three-dimensional (3-D) breasttomosynthesis was introduced to improve cancer detection, but breast compression is still used for the acquisition of images. This study was conducted to investigate the effects of reduced compression force on pain, anxiety and image quality in digital breast tomosynthesis (DBT).
  
  
  METHODS
  A total of 130 women underwent screening mammography using convenience sampling with standard and reduced compression force at the breast clinic. A validated questionnaire of 20 items on the state anxiety level and a 4-point verbal rating scale on the pain level were conducted after the mammography. Craniocaudal (CC) and mediolateral oblique (MLO) projections were performed with standard compression, but only the CC view was performed with reduced compression. Two independent radiologists evaluated the images using image criteria scores (ICS) and the Breast Imaging-Reporting and Data System (BI-RADS).
  
  
  RESULTS
  Standard compression exhibited significantly increased scores for pain and anxiety levels compared with reduced compression (P< 0.001). Both radiologists scored the standard and reduced compression images as equal, with scores of 87.5% and 92.5% for ICS and BI-RADS scoring, respectively.
  
  
  CONCLUSIONS
  Reduced compression force in DBT reduces anxiety and pain levels without compromising image quality.
authors.affiliation: Diagnostic Imaging and Radiotherapy Programme, Health Sciences Faculty, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
authors.forename: Siti Aishah
authors.initials: SA
authors.lastname: Abdullah Suhaimi
authors.affiliation: Diagnostic Imaging and Radiotherapy Programme, Health Sciences Faculty, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
authors.forename: Afifah
authors.initials: A
authors.lastname: Mohamed
authors.affiliation: Health Psychology Programme, Health Sciences Faculty, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
authors.forename: Mahadir
authors.initials: M
authors.lastname: Ahmad
authors.affiliation: Diagnostic Imaging and Radiotherapy Programme, Health Sciences Faculty, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
authors.forename: Kanaga Kumari
authors.initials: KK
authors.lastname: Chelliah
keywords: anxiety; breast; compression; pain; reduction