Breast compression across consecutive examinations among females participating in BreastScreen Norway

Objectives Breast compression is used in mammography to improve image quality and reduce radiation dose. However, optimal values for compression force are not known, and studies has found large variation in use of compression forces between breast centres and radiographers. We investigated breast compression, including compression force, compression pressure and compressed breast thickness across four consecutive full field digital mammography (FFDM) screening examinations for 25,143 subsequently screened women aged 50-69 years. Methods Information from women attending four consecutive screening examinations at two breast centres in BreastScreen Norway during January 2007 - March 2016 was available. We compared the changes in compression force, compression pressure and compressed breast thickness from the first to fourth consecutive screening examination, stratified by craniocaudal (CC) and mediolateral oblique (MLO) view. Results Compression force, compression pressure and compressed breast thickness increased relatively by 18.3%, 14.4% and 8.4% respectively, from first to fourth consecutive screening examination in CC view (p<0.001 for all). For MLO view, the values increased relatively by 12.3% for compression force, 9.9% for compression pressure and 6.9% for compressed breast thickness from first to fourth consecutive screening examination (p<0.001 for all). Conclusions We observed increasing values of breast compression parameters across consecutive screening examinations. Further research should investigate the effect of this variation on image quality and women’s experiences of discomfort and pain

Compression forces used in the Norwegian Breast Cancer Screening Program

Objectives: Compression is used in mammography to reduce breast thickness, which is claimed to improve image quality and reduce radiation dose. In the Norwegian Breast Cancer Screening Program (NBCSP), the recommended range of compression force for full field digital mammography is 11-18 kg (108-177 Newton [N]). This is the first study to investigate the compression force used in the program. Methods: The study included information from 17,951 randomly selected women screened with FFDM at 14 breast centres in the NBCSP, January-March 2014. We investigated the applied compression force on left breast in craniocaudal (CC) and mediolateral oblique (MLO) view for breast centres, mammography machines within the breast centres and for the radiographers. Results: The mean compression force for all mammograms in the study was 116N and ranged from 91 to 147N between the breast centres. The variation in compression force was wider between the breast centres than between mammography machines (range 137-155N) and radiographers (95-143N) within one breast centre. Approximately 59% of the mammograms in the study complied with the recommended range of compression force. Conclusions: A wide variation in applied compression force was observed between the breast centres in the NBCSP. This variation indicates a need for evidence-based recommendations for compression force aimed at optimizing the image quality and individualising breast compression. Advances in knowledge: There was a wide variation in applied compression force between the breast centres in the NBCSP. The variation was wider between the breast centres than between mammography machines and radiographers within one breast centre

Compression force variability in mammography in Ghana – a baseline study

Introduction: Breast compression during mammographic examinations improves image quality and patient management. Several studies have been conducted to assess compression force variability among practitioners in order to establish compression guidelines. However, no such study has been conducted in Ghana. This study aims to investigate the compression force variability in mammography in Ghana. Methods: This retrospective study used data gathered from 1071 screening and diagnostic mammography patients from January, 2018–December, 2019. Data were gathered by seven radiographers at three centers. Compression force, breast thickness and practitioners' years of work experience were recorded. Compression force variability among practitioners and the correlation between compression force and breast thickness were investigated. Results: Mean compression force values recorded for craniocaudal (CC) (17.2 daN) and mediolateral oblique (MLO) (18.2 daN), were within the recommended values used by western countries. Most of the mammograms performed – 80% – were within the National Health Service Breast Screening Programme (NHSBSP) range. However, 65% were above the Norwegian Breast Cancer Screening Programme (NBCSP) range. Compression forces varied significantly (p = 0.0001) among practitioners. Compression forces increased significantly (p = 0.0001) with the years of work experience. A weak negative correlation (r = −0.144) and a weak positive correlation (r = 0.142) were established between compression force and breast thickness for CC and MLO projections respectively. Conclusion: This initial study confirmed that although wide variations in compression force exist among practitioners in Ghana, most practitioners used compression forces broadly within the range set by the NHSBSP. As no national guidelines for compression force currently exist in Ghana, provision of these may help to reduce the range of variations recorded. Implications for practice: Confirmation of variations in compression will guide future practice to minimize image quality disparities and improve quality of care

To what extent are objectively measured mammographic imaging techniques associated with compression outcomes

OBJECTIVE: To describe the association between objectively measurable imaging techniques and the resulting compression thickness and dose. METHODS: The study included 80,495 routine screens from the South-West London Breast Screening Service between March 2013 and July 2017. Average compression force, paddle tilt and dose were calculated. The Volpara® DensityTM algorithm was used to estimate pressure, breast volume and density.Linear regression models, using generalized estimating equations (GEEs) to account for clustering by practitioner, assessed the strength of the associations between the imaging compression outcomes, (thickness, dose) and imaging techniques (force, pressure and paddle tilt), adjusting for the subject's characteristics (age, ethnicity, breast volume and percent mammographic density). RESULTS: Fully adjusted linear regression models showed that compression thickness decreased by ~1 mm (~2% of mean thickness) for every 1daN increase in force and decreased by ~0.8 mm with an increase of 1 kPa of pressure (at median pressure). Increasing pressure above 15 kPa resulted in minimal reduction in thickness. Dose increased with increased force but decreased by ~1% of mean dose with every increase in 1 kPa of pressure. For 1o increase in paddle tilt, the compression thickness increased by ~1.5 mm (~2.5%) and dose increased by ~2.5%, (Pt <0.001 in all cases). CONCLUSION: Differences in imaging technique are associated with imaging outcome measures (thickness and dose). A better understanding of the association between objective image acquisition parameters and tumour conspicuity could lead to clearer guidelines for practitioners. ADVANCES IN KNOWLEDGE: Increased paddle tilt is associated with increased compression thickness and increased dose after adjustment for breast volume and force applied