Mammography Positioning Standards in the Digital Era: Is the Status Quo Acceptable?

Area of Science:

• Radiology
• Medical Imaging
• Breast Cancer Screening

Background:

• Traditional film-screen (FS) mammography positioning standards were established decades ago.
• Advancements in digital breast imaging, including full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT), offer improved visualization capabilities.
• The applicability of established positioning standards to newer digital mammography techniques requires evaluation.

Purpose of the Study:

• To compare the positioning accuracy of FFDM and DBT with historical FS mammography standards.
• To assess whether current positioning practices adequately utilize the capabilities of newer digital mammography technologies.

Main Methods:

• A retrospective analysis of 170 patients (340 examinations) undergoing FFDM and DBT screening was performed.
• Examinations were conducted by experienced technologists with updated positioning training.
• Positioning criteria were evaluated by three breast radiologists and compared against data from a 1993 FS mammography study.

Main Results:

• FFDM and DBT showed significant differences in positioning compared to FS standards (p < 0.05).
• Newer technologies (FFDM, DBT) more frequently included posterior/lateral glandular tissue, pectoralis muscle visualization (CC view), and inframammary fold (MLO view).
• Differences were also noted in the inclusion of skin folds and the shape of the pectoralis muscle between FFDM and DBT.

Conclusions:

• DBT and FFDM mammography more consistently visualize posterior/lateral breast tissue, inframammary folds, pectoralis muscles, and skin folds compared to FS mammography.
• Current positioning standards, with updated training, remain relevant for digital mammography, potentially leading to increased inclusion of skin folds.
• The findings suggest that while newer technologies capture more tissue, adherence to established positioning principles is effective.