The aim of this study was to compare the diagnostic accuracy of consumer-grade and medical-grade monitors with very different costs for breast cancer detection when used with and without the Digital Imaging and Communication in Medicine (DICOM) standard calibration. This study was retrospective, with a factorial design and repeated measures, and used 70 digital mammograms (40 benign or normal cases and 30 malignant cases), four radiologists, and three displays with and without display calibration. Film mammograms were included. The readings were classified according to the Breast Imaging Reporting and Data System. One medical-grade grayscale display and two consumer-grade displays were compared. Receiver operating characteristic curves were plotted for nodules, micro calcifications, and the degree of malignancy. The diagnostic accuracy of each device was calculated as the area under the curve, and the accuracy was compared using an analysis of variance. INTRODUCTIONBreast cancer is globally one of the most prevalent diseases among women over 50 years of age and presents the highest rate of cancer mortality in women in almost all countries. To detect this disease in its early stages, screening programs have been developed that include, among other methods, routine annual or biannual mammograms. 1-3 Screening mammography has shown effectiveness in reducing mortality, which is between 9% and 32% in women aged 40 years or older. 4, 5 Telemammography may be a solution to expand the screening coverage in a timely and efficient manner in vulnerable populations. This screening technique requires the use of digital images, but the cost of specialized equipment to generate, digitize and view digital mammograms is very high, resulting in the need for a low-cost alternative in developing countries. Before consumer-grade devices are adopted in the medical field, their diagnostic accuracy should be determined.Radiography is performed by different methods, including conventional X-ray radiography (RX) on film, computed radiography (CR), and direct digital imaging (DDI). Mammography is a special radiography technique for examining the breast, which has evolved rapidly in recent years with the following acquisition modifications: screen-film acquisition and reading in a light box, film digitization, 6 digital CR imaging, and more recently, full-field digital mammography (FFDM). Digital visualization has evolved with specialized 5-megapixel (MP) cathode-ray tube (CRT) monitors 7, 8 and specialized 5-MP liquid crystal display (LCD) monitors 9, 10 A recent study found no statistically significant differences in diagnostic accuracy for detecting nodules and calcifications between a 5-MP and a 3-MP specialized LCD medicalgrade monitor. 11 Emerging technologies are displacing existing ones, and the standards are changing. Currently, CR and FFDM with readings on specialized 5-MP LCD monitors is the standard clinical practice in mammography. LED monitors are replacing LCD monitors, and it is likely that the standard will further change. ...

Objective. The aim of this study was to evaluate and compare the clinical performance of different alternatives to implement low-cost screening telemammography. We compared computed radiography, film printed images, and digitized films produced with a specialized film digitizer and a digital camera. Material and Methods. The ethics committee of our institution approved this study. We assessed the equivalence of the clinical performance of observers for cancer detection. The factorial design included 70 screening patients, four technological alternatives, and cases interpreted by seven radiologists, for a total of 1,960 observations. The variables evaluated were the positive predictive value (PPV), accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curves (AUC). Result. The mean values for the observed variables were as follows: accuracy ranged from 0.77 to 0.82, the PPV ranged from 0.67 to 0.68, sensitivity ranged from 0.64 to 0.74, specificity ranged from 0.87 to 0.90, and the AUC ranged from 0.87 to 0.90. At a difference of 0.1 to claim equivalence, all alternatives were equivalent for all variables. Conclusion. Our findings suggest that telemammography screening programs may be provided to underserved populations at a low cost, using a film digitizer or a digital camera.

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BACKGROUND AND PURPOSE: For patients with high-grade gliomas, the appearance of a new, enhancing lesion after surgery and chemoradiation represents a diagnostic dilemma. We hypothesized that MR perfusion without and with contrast can differentiate tumor recurrence from radiation necrosis. MATERIALS AND METHODS:In this prospective study, we performed 3 MR perfusion methods: arterial spin-labeling, DSC, and dynamic contrast enhancement. For each lesion, we measured CBF from arterial spin-labeling, uncorrected relative CBV, and leakage-corrected relative CBV from DSC imaging. The volume transfer constant and plasma volume were obtained from dynamic contrast-enhanced imaging without and with T1 mapping using modified Look-Locker inversion recovery (MOLLI). The diagnosis of tumor recurrence or radiation necrosis was determined by either histopathology for patients who underwent re-resection or radiologic follow-up for patients who did not have re-resection.RESULTS: There were 26 patients with 32 lesions, 19 lesions with tumor recurrence and 13 lesions with radiation necrosis. Compared with radiation necrosis, lesions with tumor recurrence had higher CBF (P ¼ .033), leakage-corrected relative CBV (P ¼ .048), and plasma volume using MOLLI T1 mapping (P ¼ .012). For differentiating tumor recurrence from radiation necrosis, the areas under the curve were 0.81 for CBF, 0.80 for plasma volume using MOLLI T1 mapping, and 0.71 for leakage-corrected relative CBV. A correlation was found between CBF and leakage-corrected relative CBV (r s ¼ 0.54), volume transfer constant, and plasma volume (0.50 , r s , 0.77) but not with uncorrected relative CBV (r s ¼ 0.20, P ¼ .29). CONCLUSIONS:In the differentiation of tumor recurrence from radiation necrosis in a newly enhancing lesion, the diagnostic value of arterial spin-labeling-derived CBF is similar to that of DSC and dynamic contrast-enhancement-derived blood volume.ABBREVIATIONS: ASL ¼ arterial spin-labeling; AUC ¼ area under the curve; DCE ¼ dynamic contrast-enhanced; K trans ¼ volume transfer constant; MOLLI ¼ modified Look-Locker inversion recovery; pCASL ¼ pseudocontinuous pulse ASL; rCBV ¼ relative CBV (CBV lesion/CBV normal contralateral white matter); ROC ¼ receiver operating characteristic; SI ¼ signal intensity; SMART 1 Map ¼ saturation method using adaptive recovery times for cardiac T1 mapping; Vp ¼ plasma volume