http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12120382/-/DC1.

OBJECTIVE The objective of this study was to investigate the impact of decreasing breast compression during digital mammography and breast tomosynthesis (DBT) on perceived pain and image quality. MATERIALS AND METHODS In this two-part study, two groups of women with prior mammograms were recruited. In part 1, subjects were positioned for craniocaudal (CC) and mediolateral oblique (MLO) views, and four levels of compression force were applied to evaluate changes in breast thickness, perceived pain, and relative tissue coverage. No imaging was performed. In part 2, two MLO DBT images of one breast of each patient were acquired at standard and reduced compression. Blurring artifacts and tissue coverage were judged by three breast imaging radiologists, and compression force, breast thickness, relative tissue coverage, and perceived pain were recorded. RESULTS Only the first reduction in force was feasible because further reduction resulted in inadequate breast immobilization. Mean force reductions of 48% and 47% for the CC and MLO views, respectively, resulted in a significantly reduced perceived pain level, whereas the thickness of the compressed breast increased by 0.02 cm (CC view) and 0.09 (MLO view, part 1 of the study) and 0.38 cm (MLO view, part 2 of the study), respectively, with no change in tissue coverage or increase in motion blurring. CONCLUSION Mammography and DBT acquisitions may be possible using half of the compression force used currently, with a significant and substantial reduction in perceived pain with no clinically significant change in breast thickness and tissue coverage.

Purpose: To investigate the impact of decreasing mechanical breast compression during mammography on perceived pain, compressed breast thickness and tissue coverage. Methods: In this IRB‐approved, HIPAA‐compliant study 72 women with prior mammograms were recruited to undergo positioning for both the cranio‐caudal (CC) and medio‐lateral oblique (MLO) views on a digital mammography/breast tomosynthesis system. One breast of each subject was compressed to four levels, including standard full compression for mammography. At each level of compression we recorded: (a) force in lb, (b) breast thickness in cm, (c) perceived pain (Rating: 0 (no‐pain) ‐10 (severe pain)), and (d) relative tissue coverage. Video recording was used to document compression thickness and force displayed by the imaging system, in addition to the research technologist's and participant's voice input regarding the tissue coverage measured on an adhesive ruler placed on the breast and perceived pain rating, respectively. Results: On average, perceived pain to the subjects were reduced by 1.53 and 1.75 points in the CC and MLO views, respectively, in the pain ratings scale by reducing the compression force by one level, while the thickness of the compressed breast increased by an average of 0.02 and 0.09 cm, respectively. At this reduced compression step, there was no change in tissue coverage. Additional reductions in compression force resulted in 8.6% and 11.3% of compressions too low to adequately immobilize the breast, making them clinically impractical. Conclusion: Adequate CC and MLO view acquisitions may be possible with a reduction of compression force by approximately half, resulting in a significant and substantial reduction in perceived pain with no clinically significant change in breast thickness and tissue coverage. Considerably reducing the compression force used for mammography and breast tomosynthesis imaging and therefore reducing the pain perceived by the patients appears to be feasible. Ioannis Sechopoulos is consultant for Fuji Medical Systems USA.