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

¹ Department of Radiology, University of Cologne Medical School, Kerpenerstraße 62, Cologne NRW 50924, Germany.
² Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Schematic shows box made of square acrylic plastic sheets that was packed in 50 variations with nine different silicone cubes and that served as phantom for study. Each cube had surface area of 3 x 3 cm edge length and 1.5 cm in height. Some cubes contained either round silicone columns or holes devised to simulate masses with elevated or low density to contrast with surroundings. Some cubes had no simulated masses.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Radiographs of phantom shown in Figure 1 containing columns (positive contrast) and holes (negative contrast) between 3 and 7 mm in diameter and 1 and 4 mm in height. Analog image of phantom without ground-meat scatter body.

View larger version (140K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Radiographs of phantom shown in Figure 1 containing columns (positive contrast) and holes (negative contrast) between 3 and 7 mm in diameter and 1 and 4 mm in height. Digital image of phantom without ground-meat scatter body.

View larger version (158K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Radiographs of phantom shown in Figure 1 containing columns (positive contrast) and holes (negative contrast) between 3 and 7 mm in diameter and 1 and 4 mm in height. Analog image of phantom with ground-meat scatter body.

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Radiographs of phantom shown in Figure 1 containing columns (positive contrast) and holes (negative contrast) between 3 and 7 mm in diameter and 1 and 4 mm in height. Digital image of phantom with ground-meat scatter body.

View larger version (22K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Bar graphs of number of correct positive findings (ordinate) according to raters 1–4 and images in series A (analog film), B (digital film), and C (digital monitor viewing) without scatter body made of ground meat (abscissa). Black solid horizontal lines indicate respective number of cubes with simulated masses. Each rater's stated degree of confidence is given on 3-item ordinal scale: Finding is certainly present (black), probably present (gray), or questionably present (white). Raters 1–4 had 18, 4, 6, and 2 years of experience, respectively, with analog mammography; raters 1–3 had 3 years of experience with digital mammography and rater 4, 2 years. Category I (volume, 0.1–< 3.8 mm3, 139 cubes).

View larger version (28K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Bar graphs of number of correct positive findings (ordinate) according to raters 1–4 and images in series A (analog film), B (digital film), and C (digital monitor viewing) without scatter body made of ground meat (abscissa). Black solid horizontal lines indicate respective number of cubes with simulated masses. Each rater's stated degree of confidence is given on 3-item ordinal scale: Finding is certainly present (black), probably present (gray), or questionably present (white). Raters 1–4 had 18, 4, 6, and 2 years of experience, respectively, with analog mammography; raters 1–3 had 3 years of experience with digital mammography and rater 4, 2 years. Category II (volume, 3.8–< 7.7 mm3, 159 cubes).

View larger version (30K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Bar graphs of number of correct positive findings (ordinate) according to raters 1–4 and images in series A (analog film), B (digital film), and C (digital monitor viewing) without scatter body made of ground meat (abscissa). Black solid horizontal lines indicate respective number of cubes with simulated masses. Each rater's stated degree of confidence is given on 3-item ordinal scale: Finding is certainly present (black), probably present (gray), or questionably present (white). Raters 1–4 had 18, 4, 6, and 2 years of experience, respectively, with analog mammography; raters 1–3 had 3 years of experience with digital mammography and rater 4, 2 years. Category III (volume, 7.7–< 13.1 mm3, 143 cubes).

View larger version (29K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Bar graphs of number of correct positive findings (ordinate) according to raters 1–4 and images in series A (analog film), B (digital film), and C (digital monitor viewing) without scatter body made of ground meat (abscissa). Black solid horizontal lines indicate respective number of cubes with simulated masses. Each rater's stated degree of confidence is given on 3-item ordinal scale: Finding is certainly present (black), probably present (gray), or questionably present (white). Raters 1–4 had 18, 4, 6, and 2 years of experience, respectively, with analog mammography; raters 1–3 had 3 years of experience with digital mammography and rater 4, 2 years. Category IV (volume, 13.1 mm3, 147 cubes).

View larger version (38K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Sensitivity as function of contrast (positive contrast = column on silicone cube, negative contrast = hole in silicone cube; compare with Fig. 1). Raters 1–4 had 18, 4, 6, and 2 years of experience, respectively, with analog mammography; raters 1–3 had 3 years of experience with digital mammography and rater 4, 2 years.

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