Purpose
The recent technical developments in digital as well as screenfilm
X-ray mammography have been reviewed in order to evaluate their clinical potential and to analyse possible lines for future development.
Material and methods
The scientific literature has been reviewed, conferences covered and contacts with colleagues developed. Companies in the field have been inquired and invited for presentations. Own experience has been gathered from different screen-film and digital mammography systems.
Results and conclusions: Although there are important complementary techniques such as ultrasound and magnetic resonance imaging (MRI), X-ray mammography is still the golden standard for breast imaging. It is relatively simple and cost-effective, and it is presently the only realistic technique for screening in a large scale. It is still largely the only technique that can detect breast cancer in a preinvasive stage.
Equipment for digital mammography is commercially available both with small area and full field technique (FFDM). The development of FFDM systems is now intense, as well as the development of dedicated workstations and computer-aided detection CAD). In spite of this, the introduction of digital mammography has been very slow compared to most other X-ray examinations due to high costs and technical challenges to meet the high demands on image quality and dose in mammography as well as the demands on specialised workflow support for screening mammography and suitable display techniques. Film reading of digital mammograms has been the most common display mode so far, but to take full advantage of the digital concept, diagnostic as well as logistic, monitor reading must be applied.
There is a potential of FFDM systems for significantly higher image quality or significantly lower dose than screen-film mammography (SFM), or both. Further research is necessary to fully use this potential. The investment costs are much higher for digital than screen-film mammography today. Nevertheless digital mammography will most likely replace screen-film mammography to a large extent, especially in large-scale operations. However, further evaluation of digital and screen-film mammography must be performed regarding image quality and dose as well as diagnostic outcome in terms of sensitivity, specificity and cost-effectiveness. The question is whether the higher investment costs are outweighed by increased sensitivity and specificity, more rational handling and storing, and the possibilities to use new techniques for image productionand analysis.
The future use of mammography technique will probably be varying, with the availability of different kinds of digital techniques and also the continued use of screenfilm, depending on the patient volume and medical as well as financial aspects.