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The basic advantages and disadvantages of digital mammography and the relevant technology are discussed in other chapters of this book. Results of the Digital Mammographic Imaging Screening Trial (DMIST), released in September 2005, show that digital mammography may be more accurate at detecting breast cancer in some women than standard film-screen mammography [1,2]. In that study, digital and standard film-screen mammography had similar accuracy for many women. However, digital mammography was significantly better at screening women younger than 50 years, regardless of their breast tissue density, and women of any age with very dense or extremely dense breasts. In this context, the significant advantages of digital mammography for image interpretation include the following:
physician manipulation of breast images for more accurate detection of breast cancer
ability to correct underexposure or overexposure of images without having to repeat the mammogram
transmittal of images over a network for remote consultation with other physicians
The primary focus of this chapter is post-processing of raw digital mammography images for interpretation, including digital mammography display, and comparison with prior mammography studies, including analog (film-screen or digitized) mammography studies.
Digital and film-screen screening mammography are fairly similar in their ability to detect cancer. Depending on which paper one is reading, this might be measured by sensitivity and specificity or by comparing other measures including cancer detection rate, recall rate, and positive predictive value. Because it is not the mammogram itself that may exhibit a certain accuracy but rather the radiologist interpreting the mammogram, it follows that radiologists’ interpretation of digital screening mammograms is similar in accuracy to their interpretation of film-screen screening mammograms. There are, however, differences in the approach that may be taken. These are addressed here, and we will provide some suggestions.
Digital mammograms may be of two types, either computed radiography (CR) or digital radiography (DR). To make it more interesting, digital mammograms may be printed on film for interpretation or interpreted using soft copy on a computer monitor. Film-screen mammograms are normally interpreted on film, but they can be digitized and viewed on a computer screen, usually to serve as a comparison study to a mammogram that will be interpreted on the computer. The main focus of this chapter will be interpretation of DR-type digital mammograms on computer monitors.
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