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Technology assessment: observer study directly compares screen/film to CR mammography

A new study supports and expands upon a previous reporting that computed radiography (CR) mammography offers as good, or better, image quality than state-of-the-art screen/film mammography. The suitability of CR mammography is explored through qualitative and quantitative study components: feature comparison and cancer detection rates of each modality. Images were collected from 150 normal and 50 biopsy-confirmed subjects representing a range of breast and pathology types. Comparison views were collected without releasing compression, using automatic exposure control on Kodak MIN-R films, followed by CR. Digital images were displayed as both softcopy (S/C) and hardcopy (H/C) for the feature comparison, and S/C for the cancer detection task. The qualitative assessment used preference scores from five board-certified radiologists obtained while viewing 100 screen/film-CR pairs from the cancer subjects for S/C and H/C CR output. Fifteen general image-quality features were rated, and up to 12 additional features were rated for each pair, based on the pathology present. Results demonstrate that CR is equivalent or preferred to conventional mammography for overall image quality (89% S/C, 95% H/C), image contrast (95% S/C, 98% H/C), sharpness (86% S/C, 93% H/C), and noise (94% S/C, 91% H/C). The quantitative objective was satisfied by asking 10 board-certified radiologists to provide a BI-RADSTM score and probability of malignancy per breast for each modality of the 200 cases. At least 28 days passed between observations of the same case. Average sensitivity and specificity was 0.89 and 0.82 for CR and 0.91 and 0.82 for screen/film, respectively.