Comparison of screening full-field digital mammography and digital breast tomosynthesis technical recalls

Abstract

Enhancing quality using the inspection program (EQUIP) augments the FDA/MQSA program ensuring image quality review and implementation of corrective processes. We compared technical recalls between digital breast tomosynthesis (DBT) and full-field digital mammography (FFDM). Prospectively recorded technical recalls of consecutive screening mammograms (10/2013 - 12/2017) were compared for imaging modality [FFDM, DBT + FFDM, DBT + synthesized mammography (SynM)], images requested, and indication(s) (motion, positioning, technical/artifact). Chi-squared tests evaluated statistical significance between proportions. Of 48,324 screening mammograms, 277 (0.57%) patients were recalled for 360 indications with 371 repeated views. DBT exams had significantly less recalls compared to FFDM ( $X^2=25.239$ ; $p=0<0.001$ ). 98 (27.2%) recalls were for motion, 192 (53.3%) positioning, and 70 (19.4%) technique/artifacts. Theses indications for technical recall were compared for FFDM, DBT + FFDM, and DBT + SynM. There were significant differences in the indications for technical recall prior to and after implementing DBT + SynM ( $X^2=18.719$ ; $p<0.001$ ). Technical recalls declined significantly with the inclusion of DBT (SynM/FFDM) compared to FFDM alone. Recalls for motion demonstrated the greatest decrease. Positioning remains a dominant factor for technical recall regardless of modality, supporting the opportunity for continued technologist education in positioning to decrease technical recalls.

Keywords: EQUIP; FFDM; breast imaging; digital mammography; technical recall; tomosynthesis.

Fig. 1

Illustration of positioning criteria of the breast. (a) Left MLO view demonstrating the pectoralis muscle, nipple in profile, and the IMF. (b) Left CC view demonstrating the nipple in profile and centered. The white line indicates the PNL comparison between the CC and MLO views.

Fig. 2

Distribution of the technical recalls per number of exams performed over the study by technologists. Each technologist is represented by a data point.

Fig. 3

Distribution of the technical recalls per number of exams interpreted over the study by radiologists. Each radiologist is represented by a data point.

Fig. 4

Distribution of indications for technical recalls for FFDM and DBT.

Fig. 5

Changes in the indications for technical recall prior to and after the implementation of SynM with DBT imaging.

Fig. 6

(a) FFDM of the left MLO axillary region. The white arrow is pointing to tiny white “calcifications” in the axillary region, which may represent either calcifications or deodorant artifact. Breast tissue extends into the axilla; thus, this may be clinically important. (b) Left MLO DBT image of the same patient. These tiny white “calcifications” are only seen on the image for slice 1 (long white arrow pointing to slice number indicator), thus signifying that they are located on the skin surface and can be disregarded as artifact.