Digital mammography in breast cancer screening: Evaluation and innovation

With all other imaging modalities in radiology being digitised and conventional mammography being ready to phase out the transition to digital mammography was inevitable.
This thesis describes the performance of digital screening mammography and the consequences of implementation in a population-based screening programme and points out one of many possible innovations that the introduction of digital mammography (DM) has brought forth.
1. Based on the results of a large pilot study carried out to evaluate DM in the Dutch breast cancer screening programme the introduction of DM significantly improved cancer detection. This, however, at the expense of a higher recall rate and a lower positive predictive value of recall. With DM (high grade) DCIS and invasive carcinoma are detected more often, while the share of low grade DCIS -indicative of possible overdiagnosis- remains unaffected. Tumours detected with DM tend to be smaller, which may indicate that cancers are detected at an earlier stage.
2. The digital environment has created room for improvement and innovation in mammography. One of many advances may lie in dose control. In the pursuit of a widely applicable method to substantially reduce radiation dose in mammography without compromising on diagnostic performance we developed a protocol with low-dose CC views based on acquisition with higher effective energy beams and post-process noise reduction. Although further (clinical) research has to be done, we believe these images have the potential to be of great value in controlling the radiation burden, especially in a relatively young and largely asymptomatic population.