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Image Quality of Digital Direct Flat-Panel Mammography Versus an Analog Screen-Film Technique Using a Phantom Model

¹ Department of Radiology, University of Cologne, Kerpenerstraße 62, Cologne, NRW 50924, Germany.
² Department of Medical Statistics, University of Cologne, Cologne, NRW 50924, Germany.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Radiographic study of universal laser printer film. Four quadrants were labelled by wire fixed to film for better radiologic visualization. Quadrant I contains round (class of number, 3; class of size, 3), quadrant II contains round (class of number, 3; class of size, 3), and quadrant IV contains round (class of number, 3; class of size, 2) particles; quadrant III contains no silicate particles. Number of microcalcifications was characterized as follows: class 0, no microcalcifications; 1, 1-4 microcalcifications; 2, 5-9 microcalcifications; 3, 10-19 microcalcifications; 4, 20-39 microcalcifications; or 5, > 39 microcalcifications. Diameter classes were class 1, 100-199 µm; 2, 200-399 µm; 3, 400-599 µm; and 4, 600-800 µm. Digital image of film taken without scatter body for demonstration purposes.

View larger version (165K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Radiographic study of universal laser printer film. Four quadrants were labelled by wire fixed to film for better radiologic visualization. Quadrant I contains round (class of number, 3; class of size, 3), quadrant II contains round (class of number, 3; class of size, 3), and quadrant IV contains round (class of number, 3; class of size, 2) particles; quadrant III contains no silicate particles. Number of microcalcifications was characterized as follows: class 0, no microcalcifications; 1, 1-4 microcalcifications; 2, 5-9 microcalcifications; 3, 10-19 microcalcifications; 4, 20-39 microcalcifications; or 5, > 39 microcalcifications. Diameter classes were class 1, 100-199 µm; 2, 200-399 µm; 3, 400-599 µm; and 4, 600-800 µm. Analog film image.

View larger version (178K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Radiographic study of universal laser printer film. Four quadrants were labelled by wire fixed to film for better radiologic visualization. Quadrant I contains round (class of number, 3; class of size, 3), quadrant II contains round (class of number, 3; class of size, 3), and quadrant IV contains round (class of number, 3; class of size, 2) particles; quadrant III contains no silicate particles. Number of microcalcifications was characterized as follows: class 0, no microcalcifications; 1, 1-4 microcalcifications; 2, 5-9 microcalcifications; 3, 10-19 microcalcifications; 4, 20-39 microcalcifications; or 5, > 39 microcalcifications. Diameter classes were class 1, 100-199 µm; 2, 200-399 µm; 3, 400-599 µm; and 4, 600-800 µm. Digital film image.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Radiographic study of universal laser printer film. Four quadrants were labelled by wire fixed to film for better radiologic visualization. Quadrant I contains round (class of number, 3; class of size, 3), quadrant II contains round (class of number, 3; class of size, 3), and quadrant IV contains round (class of number, 3; class of size, 2) particles; quadrant III contains no silicate particles. Number of microcalcifications was characterized as follows: class 0, no microcalcifications; 1, 1-4 microcalcifications; 2, 5-9 microcalcifications; 3, 10-19 microcalcifications; 4, 20-39 microcalcifications; or 5, > 39 microcalcifications. Diameter classes were class 1, 100-199 µm; 2, 200-399 µm; 3, 400-599 µm; and 4, 600-800 µm. Magnified cutout of quadrant IV shown in A.

View larger version (159K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —Radiographic study of universal laser printer film. Four quadrants were labelled by wire fixed to film for better radiologic visualization. Quadrant I contains round (class of number, 3; class of size, 3), quadrant II contains round (class of number, 3; class of size, 3), and quadrant IV contains round (class of number, 3; class of size, 2) particles; quadrant III contains no silicate particles. Number of microcalcifications was characterized as follows: class 0, no microcalcifications; 1, 1-4 microcalcifications; 2, 5-9 microcalcifications; 3, 10-19 microcalcifications; 4, 20-39 microcalcifications; or 5, > 39 microcalcifications. Diameter classes were class 1, 100-199 µm; 2, 200-399 µm; 3, 400-599 µm; and 4, 600-800 µm. Magnified cutout of quadrant IV shown in B.

View larger version (185K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1F —Radiographic study of universal laser printer film. Four quadrants were labelled by wire fixed to film for better radiologic visualization. Quadrant I contains round (class of number, 3; class of size, 3), quadrant II contains round (class of number, 3; class of size, 3), and quadrant IV contains round (class of number, 3; class of size, 2) particles; quadrant III contains no silicate particles. Number of microcalcifications was characterized as follows: class 0, no microcalcifications; 1, 1-4 microcalcifications; 2, 5-9 microcalcifications; 3, 10-19 microcalcifications; 4, 20-39 microcalcifications; or 5, > 39 microcalcifications. Diameter classes were class 1, 100-199 µm; 2, 200-399 µm; 3, 400-599 µm; and 4, 600-800 µm. Magnified cutout of quadrant IV shown in C.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Digital image shows all heterogeneous (top row) and round (bottom row) silicate particles ranging from size class 1 (left) to 4 (right), respectively, without scatter body. Diameter classes were class 1, 100-199 µm; 2, 200-399 µm; 3, 400-599 µm; and 4, 600-800 µm.

View larger version (20K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Mean absolute deviation in ranks. Predefined phantom constellations for each four-quadrant phantom image (n = 65) calculated from interpretations of individual quadrants are presented in box plots for variables of number and size of microcalcifications, separated according to six observers. Outliers are indicated by dots (). Global analysis of all 65 films showed that monitor reading produced more realistic estimation of number, size, and shape of any microcalcifications present than when digital film documentations or analog films were interpreted. Data for each display medium are shown as follows: dark gray bars = analog films, striped bars = digital films, and light gray bars = monitor-displayed images. Criterion is number of detectable microcalcifications.

View larger version (28K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Mean absolute deviation in ranks. Predefined phantom constellations for each four-quadrant phantom image (n = 65) calculated from interpretations of individual quadrants are presented in box plots for variables of number and size of microcalcifications, separated according to six observers. Outliers are indicated by dots (). Global analysis of all 65 films showed that monitor reading produced more realistic estimation of number, size, and shape of any microcalcifications present than when digital film documentations or analog films were interpreted. Data for each display medium are shown as follows: dark gray bars = analog films, striped bars = digital films, and light gray bars = monitor-displayed images. Criterion is size of detectable microcalcifications.

View larger version (31K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Mean absolute deviation in ranks. Predefined phantom constellations for each four-quadrant phantom image (n = 65) calculated from interpretations of individual quadrants are presented in box plots for variables of number and size of microcalcifications, separated according to six observers. Outliers are indicated by dots (). Global analysis of all 65 films showed that monitor reading produced more realistic estimation of number, size, and shape of any microcalcifications present than when digital film documentations or analog films were interpreted. Data for each display medium are shown as follows: dark gray bars = analog films, striped bars = digital films, and light gray bars = monitor-displayed images. Criterion is shape of detectable microcalcifications. Bar diagrams clearly illustrate rate of deviations from predefined phantom constellations for shape.

View larger version (25K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Box plots of deviations in six observers' classifications from actual value of gold standard as function of presence and size of artificial microcalcifications applied to individual quadrants on 65 films. Outliers are indicated by dots (). NA = not applicable (i.e., no microcalcifications in phantom quadrant). Data for each display medium are shown as follows: dark gray bars = analog films, striped bars = digital films, and light gray bars = monitor-displayed images. Criterion is number of detectable microcalcifications as function of their presented number.

View larger version (25K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Box plots of deviations in six observers' classifications from actual value of gold standard as function of presence and size of artificial microcalcifications applied to individual quadrants on 65 films. Outliers are indicated by dots (). NA = not applicable (i.e., no microcalcifications in phantom quadrant). Data for each display medium are shown as follows: dark gray bars = analog films, striped bars = digital films, and light gray bars = monitor-displayed images. Criterion is size of detectable microcalcifications as function of their presented size.

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