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Introduction This study aims to evaluate the effectiveness of zooming in improving screen-reader performance in reporting digital mammograms. Method Two experiments were conducted. In the first experiment, 5 readers were asked to report 59 two-view bilateral mammograms retrospectively with zooming function turned off. The second session was similar to the first one except that zooming was enabled. The task of readers was to assess if the mammograms were normal or abnormal and rate the confidence levels for each of the lesion they detected. The reader performances were evaluated via case sensitivity, lesion sensitivity, specificity, receiver operating characteristics (ROC) area under the curve (AUC) and jackknife free-response receiver operating characteristics (JAFROC) figure of merit (FOM). Results There was no significant improvement in overall reader performance in detecting abnormalities in zooming condition compared with no zooming in terms of case sensitivity (96% and 87%, P = 0.285) or lesion sensitivity (88% and 81%, P = 0.224). However, differences in ROC AUC and JAFROC FOM (P ≤ 0.05) were found in two readers when they performed the test set with zooming function. Conclusion The results suggested that the use of the zooming function did improve the performance of some readers in detecting abnormal cases.

The purpose is to develop a new image toggle tool with automatic density normalization (ADN) and automatic alignment (AA) for comparing serial digital mammograms (DMGs).We developed an ADN and AA process to compare the images of serial DMGs. In image density normalization, a linear interpolation was applied by taking two points of high- and low-brightness areas. The alignment was calculated by determining the point of the greatest correlation while shifting the alignment between the current and prior images. These processes were performed on a PC with a 3.20-GHz Xeon processor and 8 GB of main memory. We selected 12 suspected breast cancer patients who had undergone screening DMGs in the past. Automatic processing was retrospectively performed on these images. Two radiologists subjectively evaluated them.The process of the developed algorithm took approximately 1 s per image. In our preliminary experience, two images could not be aligned approximately. When they were aligned, image toggling allowed detection of differences between examinations easily.We developed a new tool to facilitate comparative reading of DMGs on a mammography viewing system. Using this tool for toggling comparisons might improve the interpretation efficiency of serial DMGs.

Rationale and Objectives The aim of this study was to analyze the dominant factors affecting fatigue caused by soft-copy reading to identify a method for decreasing fatigue in clinical practice. Materials and Methods Two types of fatigue—fatigue in the central nervous system and subjective visual fatigue—were evaluated using a critical fusion frequency test and a questionnaire administered to 17 male radiologists before and after soft-copy reading. Reading-induced fatigue was assumed to be affected by 20 hypothetical factors associated with personal characteristics, time required for reading, content or amount of reading, and the reading environment. We used multiple linear regression analysis with a variable selection method to detect the best combination of factors capable of expressing variations in each of the measured fatigue values. The effects of the detected (dominant) factors on fatigue were also examined based on coefficients of the dominant factors in multiple regression models. Results Fatigue in the central nervous system decreased with a higher corrected visual acuity and a higher ambient illuminance in the reading room and was also affected by the type of monitor used. Visual fatigue was relieved when there was a larger difference in the brightness of the monitor and the surfaces surrounding the monitor and tended to be more severe when glasses rather than contact lenses were worn. Conclusions Increasing the ambient illuminance, using an appropriate type of monitor, improving the corrected visual acuity, and using contact lenses rather than eyeglasses could help decrease reading-induced fatigue in male radiologists.

Background: Recent studies have reported the clinical usefulness of the soft-copy reading of mammograms. However, image-processing parameters for soft-copy reading of digital mammograms have not been established. Purpose: To compare observer performance in detecting breast cancer by soft-copy reading of digital mammograms using a routine image-processing parameter versus each of several high-contrast parameters. Material and Methods: The mammograms of 154 breasts, including 48 abnormal breasts with breast cancer and 106 normal breasts, were examined. Cancers were classified into 34 mass-dominant cancers, 11 microcalcification-dominant cancers, two cancers showing only architectural distortion, and one cancer without abnormal findings. All mammograms were performed using a computed radiography (CR) system. Each image was processed using GA (1.2), which was the contrast parameter recommended by the manufacturer for hard-copy film, GA (1.4), GA (1.6), and GA (1.8). These images were displayed on 5-megapixel (M) liquid-crystal display monitors. Five experienced radiologists classified them into BI-RADS category 1–2 or 3–5, and were also asked to rate the images on a scale of 0 to 100 for the likelihood of the presence of masses and microcalcifications in each breast. Results: In mass-dominant cancers of dense breast tissue, the mean sensitivities of GA (1.2), GA (1.4), GA (1.6), and GA (1.8) were 32.7, 38.2, 36.4, and 40.0, and the AZ values were 0.67, 0.73, 0.71, and 0.73, respectively; in microcalcification-dominant cancers, the mean sensitivities were 80.0, 74.5, 80.0, and 78.2, respectively; however, there were no significant differences among them. Conclusion: High-contrast parameters tended to show relatively high sensitivity and AZ values in the detection of masses in dense breast tissue, but relatively low sensitivity for microcalcifications.

Rationale and Objectives The purposes of the present study were to investigate the impact of viewing size on soft-copy diagnosis for detecting abnormalities on digital chest radiographs and to verify the usefulness of reduced digital chest radiography. Materials and Methods Receiver-operating characteristic (ROC) and localized ROC (LROC) analysis of clinical images was performed using the standard digital image database of the Japanese Radiation Technology Society. A total of 30 images with and 20 images without nodule samples were extracted randomly from the database and used for ROC analysis. A total of 100 images were prepared for observation of reduced and nonreduced images. Observers' viewing images were adjusted as nonreduced size (large, 30 × 30 cm) and reduced size (small, 15 × 15 cm). Results The estimated mean areas under the LROC curves were 0.665 ± 0.071 for large-size images and 0.669 ± 0.087 for small-size images. However, no statistically significant difference was found between the two groups ( P = .823). The viewing time of small-size images (1201.4 seconds) was significantly shorter than that of large-size images (1719.7 seconds). A statistically significant difference was also found in viewing times between reduced and nonreduced digital images with Wilcoxon's signed-rank test ( P Conclusion This study provided important information that there was a statistically significant difference in viewing times between reduced and nonreduced digital chest radiographic images, whereas no significant difference was found in areas under the LROC curves for the accuracy of diagnosis between the two groups. However, the double-check method for chest x-ray screening would be done efficiently by changing the viewing size to improve the specificity of diagnosis.

Zusammenfassung Gegenstand und Ziel: Es erfolgte ein Vergleich zwischen digitalen, am Monitor ausgewerteten Röntgenaufnahmen und solchen, die als Laser-ausdruck am Röntgenfilmbetrachter analysiert werden, hinsichtlich Qualität der Abbildung anatomischer Strukturen. Weiterhin wurde geprüft, ob die Belichtung das Ergebnis beeinflusst. Material und Methode: In einer prospektiven Untersuchung wurden seitliche Thoraxaufnahmen von 57 gesunden Katzen mit einem Speicherfoliensystem erzeugt. Die Bildqualität des Monitorbildes wurde mit der des Filmausdrucks am Röntgenfilmbetrachter verglichen. Vier in der Beurteilung digitaler Röntgenaufnahmen erfahrene Tierärzte hatten die Aufgabe, fünf definierte Bildmerkmale anhand einer fünfstufigen Konfidenzskala zu bewerten. Ergebnisse: Es ließ sich eine Überlegenheit der Bildschirmbefundung gegenüber der Auswertung am Leuchtkasten nachweisen. Die Aufnahmedosis beeinflusste das Ergebnis nicht. Schlussfolgerung und klinische Relevanz: Die Auswertung am Monitor eröffnet die Möglichkeit, die aufgezeichnete Bildinformation umfassender für die Diagnosestellung zu nutzen. Der Bildschirmarbeitsplatz muss bestimmte Mindestanforderungen erfüllen, insbesondere hinsichtlich der Leistungsfähigkeit des Monitors.

Background: Liquid crystal display (LCD) monitors and cathode ray tube (CRT) monitors are currently the two most common types used in digital mammography systems. The appropriate selection of a monitor is very important and requires balancing the monitor's performance and its cost. A previous study of soft-copy reading in digital mammography of microcalcifications showed that 3-megapixel (M) LCD monitors were similar in diagnostic performance to 5M CRT monitors in a diagnostic setting. Purpose: To compare 5M CRT monitors with 3M LCD monitors for soft-copy reading of digital mammography of a mass in a diagnostic setting. Material and Methods: Seventy mass lesions having undergone either breast biopsies or definitive surgery (46 malignant and 24 benign) and 30 normal cases were recruited into the study. The median size of the lesions was 16 mm (range 7–20 mm). The digital mammograms in the 100-case set were assigned to two blocks, block A (50 cases) and block B (50 cases), for 5M CRT and 3M LCD monitors. A single radiologist read all 100 cases with both types of monitors, starting with the images in block A on the 5M CRT monitors and then the images in block B on the 3M LCD monitors. The radiologist analyzed the soft-copy images on 5M CRT and 3M LCD monitors with 5 months between the interpretations to reduce the effects of learning and memory. Again, the reader started with the images in block A on the 3M LCD monitors and then read the images in block B on the 5M CRT monitors. A five-point rating scale for the probability of malignancy was used for interpreting the soft-copy mammograms. The mass descriptor was scored on a six-point scale. Breast density was scored on a four-point scale. The positive predictive value (PPV) and negative predictive value (NPV) were calculated based on the criteria of the Breast Imaging Reporting and Data System. The interpretation time was also measured. Results: No significant difference was observed in the probability of malignancy ( P=1), mass descriptor ( P=0.317), and breast density ( P=0.739). The PPV and NPV of soft-copy reading on the 5M CRT monitors were 91% (42/46) and 94% (51/54), respectively, identical to the results using 3M LCD monitors. The total interpretation time averaged 62 s for the 5M CRT monitors and 60 s for the 3M LCD monitors ( P Conclusion: Soft-copy reading of a digital mammography of mass with 3M LCD monitors was similar in diagnostic performance to 5M CRT monitors in this study. On the basis of the results of this and a previous study, 3M LCD monitors can replace 5M CRT monitors without any loss in the ability to diagnose digital mammograms.

The purpose of this study is to compare observer performance for detection of abnormalities on chest radiographs with 5-megapixel resolution liquid-crystal displays (LCD) and 5-megapixel resolution cathode-ray tube (CRT) monitors under bright and subdued ambient light conditions. Six radiologists reviewed a total of 254 digital chest radiographs under four different conditions with a combination of two types of monitors (a 5-megapixel resolution LCD and a 5-megapixel resolution CRT monitor) and with two types of ambient light (460 and 50 lux). The abnormalities analyzed were nodules, pneumothorax and interstitial lung disease. For each reader, the detection performance using 5-megapixel LCD and 5megapixel CRT monitors under bright and subdued ambient light conditions were compared using multi-case and multi-modality ROC analysis. For each type of ambient light, the average detection performance with the two types of monitors was also compared. For each reader, the observer performance of 5-megapixel LCD and 5-megapixel CRT monitors, under both bright and subdued ambient light conditions, showed no significant statistical differences for detecting nodules, pneumothorax and interstitial lung disease. In addition, there was no significant statistical difference in the average performance when the two monitor displays, under both bright and subdued ambient light conditions, were compared. © 2007 Elsevier Ireland Ltd. All rights reserved.

Digital mammography has extensively replaced conventional film screen mammography and is now the standard in combination with soft copy reading in clinical as well as screening mammography. Large international multicenter studies demonstrate an equivalent or superior detection rate of breast cancers by digital in comparison to conventional mammography especially in dense breasts, premenopausal and perimenopausal women and women less than 50 years old. Computer-aided detection (CAD) is important for the experienced investigator (increased specificity). Digital mammography also offers further options, such as tomosynthesis, digital contrast-enhanced mammography and the combination of digital mammography and ultrasound. The future in breast diagnosis will be the fusion of images from different digital systems.

We sought to evaluate whether soft-copy reading of simulated pulmonary chest lesions is influenced by ambient light and automatic optimization of cathode ray tube (CRT) monitor luminance.Four types of simulated lesions (nodules, lines, micronodules, and patchy opacities) were superimposed over an anthropomorphic chest phantom. Lesion detection with soft-copy reading was assessed using a high-contrast grayscale 2K CRT monitor under the following conditions: (1) subdued lighting (50 lux); (2) normal lighting conditions (450 lux) without, and (3) with a sensitivity modulation to automatically adjust the CRT luminance to the increased amount of ambient light. Reading data were analyzed according to receiver operating curve. Significance of differences was tested using an analysis of variance for repeated measures.Ambient room light of 450 lux did not significantly influence the detection of nodules and patchy opacities. However, bright ambient light significantly decreased detection of micronodules (0.60 vs. 0.74) and lines (0.52 vs. 0.66) relative to subdued lighting conditions. Automatic luminance adjustment could compensate the effect of ambient light for the micronodules (0.77) but not for the lines (0.53).Bright ambient light significantly decreases detection of small low-contrast structures. This may be partially but not completely compensated by an automatic luminance adaptation.

Digital mammography is the technology of the future in breast diagnosis. This article provides an overview of all digital mammography units admitted by the Food and Drug Administration (FDA), results of clinical studies, soft copy reading, CAD (computer aided detection), and presents an overview on possible further developments. It is obvious that clinical results are equivalent to conventional screen film mammography and digital mammography.

The purpose of this work is to compare computed radiography (Kodak CR 400) and film/screen combination (Speed 400) systems in regards of patient dose, technique settings, and contrast‐detail detectability. A special contrast‐detail phantom with drilled holes of varying diameter (detail) and varying depth (contrast) was utilized. Various thicknesses of the Lucite sheets were utilized to simulate scattering tissues. Images of the phantom were acquired using a range of 60–120 kVp for film/screen and CR with a conventional x‐ray tube and then for CR with additional 2 mm aluminum added filtration to the x‐ray beam. The patient entrance skin dose was measured while maintaining 1.6 o.d. for film/screen images and 1900 Exposure Index for CR images. CR phantom images were displayed on the diagnostic workstation for soft copy reading as well as printed on films for hard copy reading on viewbox. Four physicists evaluated the images by scoring the threshold target depth along the row of the same target diameter. Detection ratio was calculated by counting the number of detectable targets divided by the total number of targets in the phantom. The overall score was related to the patient entrance skin dose, kVp, and the thickness of the scattering material. The patient entrance skin dose was reduced as the additional aluminum filter was added to the x‐ray beam. Our findings suggested using a higher kVp setting and additional added filtration would reduce the patient entrance skin dose without compromising the contrast‐detail detectability, which was compensated by the contrast manipulation on soft‐copy display workstations. © 2003 American College of Medical Physics. PACS number(s): 87.57.–s, 87.62.+n

Toward the end of 1997 vendors were succeeding in installing picture, archiving and communication systems (PACS) in larger numbers. It was hard to separate fact from fiction at times. This survey was undertaken by 2 members of the academic community to confirm what was operational, how well the installed systems worked, and what they were doing. Fax questionnaires were sent to nearly 1,000 facilities worldwide to identify PACS of any size in clinical operation on a date certain, February 1, 1998. A total of 177 PACS were identified. Facilities furnished responses during the first survey period from May 1 to November 1, 1998. A second survey, done in February and March of 2000, sought long-term follow-up data. Many systems operated 5 or more types of modalities. Computed tomography (CT) was the most common modality type at 83%, but the distribution of the rest held surprises. There also was an unexpectedly large use of soft copy reading and filmless operation in 1998. Clear trends toward increased use of computed radiography and digital radiography and a significant expansion on the percentage of all of a facility's examinations on the PACS were seen over the 2 years. Satisfaction with original PACS vendors was relatively high. Eighty-nine percent remained with their original vendor. Only 10 sites reported they changed vendors, and 4 facilities said they abandoned their system. The users reported their expectations of the PACS had been met in 81% of cases. Some (65%) declared their systems were cost effective. The most striking response was that 97% of the users would recommend PACS to others.

In this paper, we develop a medical image clear vision technique for soft copy reading. We first transform different type medical images into 10 bits data. Then, an adaptive enhancement method is proposed. Our method combines compressing the global dynamic range of the transformed image and an improved unsharp masking. The main contribution of this method is to design different feature extracting filters for different type medical images and preset some parameters for monitor quality assurance and quality control in PACS. Moreover, we make DICOM calibration for used monitor and decide the parameters. Experimental results show that the proposed technique can improve effectively the visual quality of image displayed in monitors.

Digital mammography has been proposed as an alternative to screen-film mammography. Digital mammography has many technical advantages over film mammography, including image-enhancement capability, faster image acquisition, and better storage and transmission for archiving. However, its full potential can only be achieved through soft-copy reading. Soft-copy reading in digital mammography is still a relatively new technique, and has several issues which must still be resolved. It is necessary to optimize display formats and software as soon as possible to standardize soft-copy reading in digital mammography.

The purpose of this study was to determine the effects of a commercially available postprocessing algorithm on the detection of masses and microcalcifications of breast cancer by soft-copy reading.The study included 64 digital mammograms with 16 histologically proven abnormal findings (eight masses and eight microcalcifications) and 48 normal breasts. Two image-processing algorithms were applied to the digital images, which were acquired using General Electric units. The commercially available advanced and standard postprocessed digital mammograms were evaluated in a localization receiver operating characteristic (ROC) curve experiment involving seven mammography radiographers.The mean area under the ROC curve was 0.921 +/- 0.022 for the commercially available advanced postprocessed digital mammograms session and 0.904 +/- 0.026 for the standard postprocessed digital mammograms session (P = 0.1953). Observer agreement among the readers was better for the advanced postprocessed digital mammograms than for the standard postprocessed digital mammograms.During soft-copy reading, the interpretation accuracy might be influenced by the postprocessing algorithm.

Digital imaging is rapidly becoming modern radiology practice, resulting in the gradual replacement of conventional radiographs. At present high-quality digital mammography has been available for several years and is increasingly used for diagnostic and screening mammography. Some different digital mammography systems exist, which all have their advantages and disadvantages. Diagnostic accuracy of digital mammography has been shown to be at least equivalent to screen-film mammography (SFM). Digital mammography offers some potential advantages over SFM. This article describes the current state of digital mammography and presents data from clinical trials that support the use of digital mammography technology.

The UK National Health Service Breast Screening Programme (NHSBSP) provides free mammographic screening for all women between the ages of 50 and 69. This paper examines in detail the way in which the programme is implemented in one of the busiest breast screening centres, discussing the implications of current practice for the introduction of computer aided detection systems. The paper also investigates the different types of abnormality that arise in older and younger women within the screening age group, and discusses how this is likely to affect prompting systems.

Purpose: To compare cancer detection rates of screen-film (SFM) and full-field digital mammography (FFDM) with soft-copy reading in a screening program including the initial positive scores for interval cancers and cancers in the subsequent screening round, and to analyze the false-negative FFDM interpretations. Material and Methods: Using a paired study design, 3683 women underwent SFM and FFDM in a population-based screening program. Two standard views of each breast were acquired. The images were interpreted without previous films for comparison. Independent double reading using a 5-point rating scale for probability of cancer was used for each modality. An examination was defined as positive if at least one of the two independent readers scored 2 or higher on the 5-point rating scale. SFM-positive cases were discussed in a SFM consensus meeting and FFDM-positive cases in a separate FFDM consensus meeting before recall. The study population was followed for more than 2 years so that interval cancers and screen-detected cancers in the subsequent screening round could be included. Cancer detection rates were compared using the McNemar test for paired proportions. The kappa statistic and Wilcoxon signed-rank test for matched pairs were used for comparing rating scores. The reading time was recorded for all FFDM interpretations. Results: A total of 31 cancers (detection rate 0.84%) were diagnosed initially, of which SFM detected 28 and FFDM 23 (McNemar test P = 0.23, discordant pair 8 and 3). Two cancers with a positive score at initial SFM reading and three with a positive score at initial FFDM reading were dismissed at SFM and FFDM consensus meetings, respectively. The difference in cancer detection after recall (discordant pair 11 and 5) was not significant (McNemar test, P = 0.21). Of the 10 interval cancers and 16 screen-detected cancers in the subsequent round, 3 had true-positive SFM scores while 4 had true-positive FFDM scores in the initial reading session. A total of 38 cancers therefore had a positive result at double reading at one or both modalities, 31 at SFM and 27 at FFDM (McNemar test, P = 0.48). Comparison of SFM and FFDM interpretations using the mean score for each case revealed no statistically significant difference between the two modalities (Wilcoxon signed-rank test for matched pairs; P-value = 0.228). Two initial round cancers (one tumor found incidentally at work-up for a mass proved to be a simple cyst with a positive score at FFDM but a negative score at SFM, and one tumor with positive score at SFM but negative score at FFDM due to positioning failure) were excluded from the further analysis. Excluding these two cancers from comparison, there were 31% (22 of 72) false-negative SFM and 47% (34 of 72) false-negative FFDM individual interpretations. The overall mean interpretation time for normal FFDM examinations was 45 s. For most false-negative FFDM results, the reading time was shorter or longer than for normal examinations. The recorded FFDM interpretation time was noticeably short for several overlooked cancers manifesting as microcalcifications (ductal carcinoma in situ). Conclusion: There is no statistically significant difference in cancer detection rate between SFM and FFDM with soft-copy reading in a mammography screening program. Analysis of cancers missed at FFDM with soft-copy reading indicates that close attention has to be paid to systematic use of image display protocols.

To retrospectively compare screen-film and full-field digital mammography with soft-copy interpretation for reader performance in detection and classification of breast lesions in women in a screening program.Regional ethics committee approved the study; signed patient consents were obtained. Two-view mammograms were obtained with digital and screen-film systems at previous screening studies. Six readers interpreted images. Interpretation included Breast Imaging Reporting and Data System (BI-RADS) and five-level probability-of-malignancy scores. A case was one breast, with two standard views acquired with both screen-film mammography and digital mammography. The standard for an examination with normal findings was classification of normal (category 1) assigned by two independent readers; for cases with benign findings, the standard was benign results at diagnostic work-up in patients who were recalled. Cases with normal or benign findings that manifested as neither interval cancer nor as cancer at subsequent screening were considered the standard. All cancers were confirmed histologically. Images were interpreted by readers in two sessions 5 weeks apart; the same case was not seen twice in any session. Receiver operating characteristic (ROC) analysis and, for a given true-positive fraction, 2 x 2 table analysis and the McNemar test were used. For binary outcome, classification of BI-RADS category 3 or higher was defined as positive for cancer.Cases with proved findings (n = 232) were displayed: 46 with cancers, 88 with benign findings, and 98 with normal findings. ROC analysis for all readers and all cases revealed a higher area under ROC curve (A(z)) for digital mammography (0.916) than for screen-film mammography (0.887) (P = .22). Five of six readers had a higher performance rating with digital mammography; one of five demonstrated a significant difference in favor of digital mammography with A(z) values; two showed a significant difference in favor of digital mammography with ROC analysis for a given false-positive fraction (P = .01 and .03, respectively). For cases with cancer, digital mammography resulted in correct classification of an average of three additional cancers per reader. For digital versus screen-film mammography, 2 x 2 table analysis for cancers revealed a higher true-positive rate; for benign masses, a higher true-negative rate. Neither of these differences nor any others from analysis of subgroups between the modalities were significant.Digital mammography allowed correct classification of more breast cancers than did screen-film mammography. A(z) value was higher for digital mammography; this difference was not significant.

To examine the combined effects of monitor luminance and ambient light on observer performance for detecting abnormalities in a soft-copy interpretation of digital chest radiographs.A total of 254 digital chest radiographs were displayed on a high-resolution cathode ray tube monitor at three luminance levels (25, 50, and 100 foot-lamberts) under three ambient light levels (0, 50, and 460 lux). Six chest radiologists reviewed each image in nine modes of combined luminance and ambient light. The observers were allowed to adjust the window width and level of the soft-copy images. The abnormalities included nodule, pneumothorax, and interstitial disease. Observer performance was analyzed in terms of the receiver operating characteristics. The observers reported their subjective level of visual fatigue with each viewing mode. A statistical test was conducted for each of the abnormalities and for fatigue score by using repeated-measures two-way analysis of variance with an interaction.The detection of nodules was the only reading that was affected by the ambient light with a statistically significant difference (P.05). Otherwise, observer performance for detecting a nodule, pneumothorax, and interstitial disease was not significantly different in the nine-mode comparison. There was no evidence that the luminance of the monitors was related to the ambient light for any of the abnormalities. The fatigue score showed a statistically significant difference due to both the luminance and ambient light.When adequate window width and level are applied to soft-copy images, the primary diagnosis with chest radiographs on the monitor is unlikely to be affected under low ambient light and a monitor luminance of 25 foot-lamberts or more.

To prospectively compare cancer detection rates, recall rates, and positive predictive values at screen-film mammography (SFM) with those at full-field digital mammography (FFDM) with soft-copy reading in a population-based screening program in Norway.Of 43,429 women invited, 25,263 women aged 45-69 years attended the screening program and were randomized, with adjustments for age and area of residence, to undergo SFM or FFDM. Two standard views of each breast were acquired. Independent double reading was performed with use of a five-point rating scale for probability of cancer. Recall rates, positive predictive values, and cancer detection rates were compared for two age groups (45-49 and 50-69 years) by using the chi(2) test.Overall, 73 cancers in 17,911 women were detected at SFM (detection rate, 0.41%), compared with 41 cancers in 6,997 women at FFDM (detection rate, 0.59%; P =.06). In the group aged 50-69 years, 56 cancers in 10,304 women were detected at SFM (detection rate, 0.54%), compared with 33 cancers in 3,985 at FFDM (detection rate, 0.83%); the difference in cancer detection rates approached significance (P =.053). In the group aged 45-49 years, 17 cancers in 7,607 women were detected at SFM (detection rate, 0.22%), compared with eight cancers in 3,012 at FFDM (detection rate, 0.27%). Recall rates in both age groups were significantly higher at FFDM than at SFM (P.05), but positive predictive value was not significantly different.FFDM allowed a higher cancer detection rate than did SFM in the group aged 50-69, although the difference did not reach statistical significance. The detection rate was nearly equal for the two modalities in the group aged 45-49. SFM and FFDM with soft-copy reading are comparable techniques for population-based screening mammography programs.

The objective of this study was to compare soft copy reading at a mammography work station with hard copy reading of full-field digital mammographic images. Mammograms of 60 patients ( n = 29 malignant, n = 31 benign) performed with full-field digital mammography (Senographe 2000D, GE, Buc, France) were evaluated. Reading was performed based on hard copy prints (Scopix, Agfa, Leverkusen, Germany) and on 2 k x 2.5 k high-resolution monitors (Sun Ultra 60, Sun Microsystems, Palo Alto, California, USA). Four readers with different levels of experience in mammography categorized the mammograms according to the BI-RADS classification. The comparative study was performed by four readers, and at least 2 months elapsed between the reading sessions. Postprocessing, of course, was available only at the work station (windowing and leveling, zooming, inversion). Sensitivity, specificity, and positive predictive value were evaluated. Diagnostic accuracy of the evaluation was determined. Sensitivity for malignant lesions in hard copy versus soft copy reading was 97% vs 90%, 97% vs 97%, 93% vs 97%, and 76% vs 76% for the four readers, respectively. Specificity was 52% vs 68%, 58% vs 74%, 65% vs 48%, and 61% vs 68%. Accuracy for the classification of malignant lesions according to the BI-RADS categories showed no difference between hard copy and soft copy reading. Soft copy reading is possible with the available system and enables radiologists to use the advantages of a digital system.

The introduction of digital mammography into the clinical practice will considerably change the radiologists’ reviewing process. The MammoTrainer is a self-training software for PC that allows physicians, technicians, and medical students to improve and test their skills in soft-copy reading of screening mammograms. It is built on a database of 350 screening cases (300 non-suspicious cases and 50 histologically proven cancers) with more than 2.000 mammograms from the Dutch national breast cancer screening program. A training session is divided into three phases: (1) specification of an individual training set, (2) reading and classification into suspicious (recall for further diagnosis) or non-suspicious (no further diagnosis required) cases, and finally (3) results and solution based on the ground truth obtained from follow-up mammograms (normals) and pathology (cancers). The MammoTrainer is designed to run on standard PCs under Windows.

Evidence is accumulating on the use of digital mammography. But there is relatively little published guidance on how to manage hardcopy film-screen prior images in a soft-copy reporting environment. For a population screening program, one pressing question is 'to digitise priors, or not?'. The BreastScreen Victoria programme screens 200,000 women each year, with two-view mammography at 2-yearly intervals. Many women have completed their fifth round of screening. Ten million films are archived. Existing standards require independent double-blind reporting comparing prior and current images. As digital is introduced, each reader needs to compare soft-copy images with hard-copy priors. How do we merge the two different reading worlds, analogue and digital, or indeed should we even attempt this? Possibilities include digitising; using a special multi-viewer; using a dental viewing box; or loading an analogue multi-viewer alongside the soft-copy 5 MP monitors. Factors specific to digitising include the following: Is it possible to digitise in such numbers? Is it too time consuming or too expensive? What resolution should be used to digitise? Is the quality of digitised priors sufficient for comparative review? This poster traces the decision-making process to digitise prior images in the context of a digital mammography pilot within BreastScreen Victoria.