The application of breast compression in mammography: a new perspective

Abstract

Purpose Breast compression during mammography is one of a number of essential components in the production of an optimally diagnostic mammogram. Breast compression optimises image quality and hence the visualisation of small lesions by reducing breast thickness (Barnes G, editor. Mammography equipment: compression, scatter control, and automatic exposure control. In: Haus A, Yaffe M, editors. Syllabus: a categorical course in physics. Oak Brook: RSNA Publications; 1993). The amount of applied compression is currently determined by subjective criteria relating to physical characteristics of the breast. The aim of this study was to develop breast compressibility curves and use them to develop objective criteria for applying compression force. Methods The study was conducted at a breast screening service in Sydney, Australia. Thirty-one women attending regular breast screening participated in the study. Breast compressibility curves were constructed and the categorisation of firm and soft breasts was carried out by adapting a method used to evaluate breast implant surgery (Plast Reconstr Surg 92 (1993) 1078). These curves were compared to the breast compression applied during the mammogram. The categorisations were related to the amount of breast thickness reduction following the application of the first 30 N of compression force. Results The difference between the breast thickness reduction demonstrated by the curves and the actual mammogram was sufficient to compromise image quality. The potential for breast compressibility can be identified by the radiographer when the first 30 N of breast compression are applied. Conclusions The differences in breast thickness reduction demonstrated in this study using current criteria for the application of breast compression have the potential to compromise small cancer detection in breast screening. A new perspective focusing on minimising breast thickness should be the goal in mammography. Minimising breast thickness will ensure that image quality and hence the potential for small cancer detection are maximised.