A 6-year study of mammographic compression force: Practitioner variability within and between screening sites

Mercer, Claire; Szczepura, Katy; Kelly, Judith; Millington, Sara; Denton, Erika R. E.; Borgen, Rita; Hilton, Beverley; Hogg, Peter

doi:10.1016/j.radi.2014.07.004

Cited by 38 publications

(53 citation statements)

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“…Both guidelines accept a large range of compression forces and this might be one of the reasons for the observed variation in compression forces in this study and Mercer et al's [8][9][10] from the UK.…”

Section: Discussionmentioning

confidence: 48%

“…[8][9][10][11]22,23 Factors related to the screened female include differences in breast volume, 18 breast stiffness and compressibility 19,20 and acceptance of pain. Characteristics of the breast compression paddle, 24 positioning of the compression paddle, 22,23 positioning of the detector plate 21 and use of automated compression force methods 22 are factors related to the equipment.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 The compression force might be influenced by the radiographer age, experience and attitude towards compression force for the radiographer and screening centre. The females' BMI, the radiographer who performed the examination and the mammography machines within the breast centres were the strongest predictors of compression force in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Studies by Mercer et al [8][9][10] and Branderhorst et al 11 have reported large variations in compression force between radiographers [8][9][10] and screening sites 10,11 and that compression force is highly dependent on the radiographer rather than on the screened females. These findings have been reported for both screen film [8][9][10] and full-field digital mammography (FFDM). 11 The quality assurance manual of the Norwegian Breast Cancer Screening Program (NBCSP) recommends that the compression force for FFDM be between 11 kg and 18 kg (1 kg 5 9.81 N; 11-18 kg 5 108-177 N).…”

Section: Introductionmentioning

confidence: 96%

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Compression forces used in the Norwegian Breast Cancer Screening Program

Waade

Moshina

Sebuødegård

et al. 2017

The British Journal of Radiology

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Objective: Compression is used in mammography to reduce breast thickness, which is claimed to improve image quality and reduce radiation dose. In the Norwegian Breast Cancer Screening Program (NBCSP), the recommended range of compression force for full-field digital mammography (FFDM) is 11-18 kg (108-177 N). This is the first study to investigate the compression force used in the programme. Methods: The study included information from 17,951 randomly selected females screened with FFDM at 14 breast centres in the NBCSP, during January-March 2014. We investigated the applied compression force on the left breast in craniocaudal and mediolateral oblique views for breast centres, mammography machines within the breast centres and for the radiographers. Results: The mean compression force for all mammograms in the study was 116 N and ranged from 91 N to 147 N between the breast centres. The variation in compression force was wider between the breast centres than that between mammography machines (range 137-155 N) and radiographers (95-143 N) within one breast centre. Approximately 59% of the mammograms in the study complied with the recommended range of compression force. Conclusion: A wide variation in applied compression force was observed between the breast centres in the NBCSP. This variation indicates a need for evidencebased recommendations for compression force aimed at optimizing the image quality and individualizing breast compression. Advances in knowledge: There was a wide variation in applied compression force between the breast centres in the NBCSP. The variation was wider between the breast centres than that between mammography machines and radiographers within one breast centre.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

Compression forces used in the Norwegian Breast Cancer Screening Program

Waade

Moshina

Sebuødegård

et al. 2017

The British Journal of Radiology

Self Cite

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“…Previous quantitative research into the application of breast compression has shown that intra and inter practitioner variability does exist within and between centres, [9][10][11] and our research highlights complex assumptions that may lead to individual practitioners prioritising decision making factors differently. The practitioner ranks the different priorities in the decision process, which could be considered to be a form of Analytical Hierarchical Processing.…”

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confidence: 73%

Breast compression – An exploration of problem solving and decision-making in mammography

et al. 2015

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Objective: Mammography breast compression decreases radiation dose and reduces potential for motion and geometric unsharpness, yet there is variability in applied compression force within and between some centres. This article explores the problem solving process applied to the application of breast compression force from the mammography practitioners' perspective.Methods: A qualitative analysis was undertaken using an existing full data set of transcribed qualitative data collected in a phenomenological study of mammography practitioner values, behaviours and beliefs. The data emerged from focus groups conducted at six NHS breast screening centres in England (participant n=41), and semi-structured interviews with mammography educators (n=6). A researcher followed a thematic content analysis process to extract data related to mammography compression problem solving, developing a series of categories, themes and sub-themes. Emerging themes were then peer-validated by two other researchers, and developed into a model of practice.Results: Seven consecutive stages contributed towards compression force problemsolving: assessing the request; first impressions; explanations and consent; handling the breast and positioning; applying compression force; final adjustments; feedback.The model captures information gathering, problem framing, problem solving and decision making which inform an 'ideal' compression scenario. Behavioural problem solving, heuristics and intuitive decision making are reflected within this model. Conclusion:The application of compression should no longer be considered as one single task within mammography, but is now recognised as a seven stage problem solving continuum. This continuum model is the first to be applied to mammography, and is adaptable and transferable to other radiography practice settings. In searching for the 'ideal' compression scenario, practitioners choose between often imperfect options to gain an appropriate balance between compassion and technical perfection. This decision is influenced by a range of factors and prior experiences.

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Self-compression Technique vs Standard Compression in Mammography

et al. 2019

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IMPORTANCE Many women dread undergoing mammography, and some may not attend or reattend breast cancer screening because of the discomfort or pain induced by breast compression. OBJECTIVE To evaluate the noninferiority of the self-compression mammography technique for reducing breast thickness compared with standard compression. DESIGN, SETTING, AND PARTICIPANTS This prospective, parallel-group, noninferiority randomized clinical trial was conducted from May 7, 2013, to October 26, 2015, at 6 cancer care centers in France. Participants were women aged 50 to 75 years, without a history of recent breast surgical procedure or treatment, and who could perform self-compression. Analyses were performed on intention-to-treat basis from January 27, 2017, to March 30, 2018. INTERVENTIONS Patients were randomized 1:1 to the self-compression group or the standard compression group. MAIN OUTCOMES AND MEASURES Primary end point was breast thickness expressed as the mean of 4 views: right and left craniocaudal and right and left mediolateral oblique. The predefined noninferiority margin was a difference of 3 mm, with a 1-sided 95% CI. Secondary end points included compression force, image quality, requirement for additional views, pain, and patient satisfaction and radiographer assessment questionnaires. RESULTS Among the 549 women randomized, 548 (97.3%) completed the trial. Of these, 275 (48.8%) (mean [SD] age, 61.35 [6.34] years) were randomized to the self-compression arm and 273 (48.5%) (mean [SD] age, 60.84 [6.41] years) to the standard compression arm. The difference in the mean thickness between the 2 arms was lower than the noninferiority margin, with an upper 1-sided 95% CI less than 3 mm (-0.17; 95% CI,−ϱ to 1.89 mm; P < .05). Compression force was higher in the self-compression group compared with the standard compression arm for the 4 mammographic views. Pain was statistically significantly lower in the self-compression group (n = 274) compared with the standard compression group (n = 269) (median [interquartile range (IQR)] score, 2 [1-5] vs 3 [1-5]; P = .009). No difference was reported in the image quality scores of the 2 groups or in the number of additional views performed (median [IQR] extra views, 2 [2-2] vs 2 [2-3] extra views; P = .64), whatever the indication, including insufficient image quality (29 [16.8%] vs 27 [15.0%] insufficient quality views; P = .65). No adverse effects or pain were reported by the participants after the self-compression mammography. CONCLUSIONS AND RELEVANCE Self-compression does not appear to be inferior to standard compression mammography in achieving minimal breast thickness without increasing pain or compromising image quality; this technique may be an effective option for women who want to be involved in their breast examination. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02866591

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A 6-year study of mammographic compression force: Practitioner variability within and between screening sites

Cited by 38 publications

References 10 publications

Compression forces used in the Norwegian Breast Cancer Screening Program

Compression forces used in the Norwegian Breast Cancer Screening Program

Breast compression – An exploration of problem solving and decision-making in mammography

Self-compression Technique vs Standard Compression in Mammography

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