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. ...