Artificial Intelligence for Assessment of Digital Mammography Positioning Reveals Persistent Challenges.
Authors
Affiliations (7)
Affiliations (7)
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA.
- Endeavor Health North Shore University Health System, Evanston, IL, USA.
- Department of Radiology, University of Chicago, Chicago, IL, USA.
- Nova Scotia Breast Screening Program, Nova Scotia Health, Halifax, NS, Canada.
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada.
- QEII Health Sciences Centre, Victoria General Hospital, Victoria, BC, Canada.
- Department of Diagnostic Imaging, Dalhousie University, Halifax, NS, Canada.
Abstract
Mammographic breast cancer detection depends on high-quality positioning, which is traditionally assessed and monitored subjectively. This study used artificial intelligence (AI) to evaluate mammography positioning on digital screening mammograms to identify and quantify unmet mammography positioning quality (MPQ). Data were collected within an IRB-approved collaboration. In total, 126 367 digital mammography studies (553 339 images) were processed. Unmet MPQ criteria, including exaggeration, portion cutoff, posterior tissue missing, nipple not in profile, too high on image receptor, inadequate pectoralis length, sagging, and posterior nipple line (PNL) length difference, were evaluated using MPQ AI algorithms. The similarity of unmet MPQ occurrence and rank order was compared for each health system. Altogether, 163 759 and 219 785 unmet MPQ criteria were identified, respectively, at the health systems. The rank order and the probability distribution of the unmet MPQ criteria were not statistically significantly different between health systems (P = .844 and P = .92, respectively). The 3 most-common unmet MPQ criteria were: short PNL length on the craniocaudal (CC) view, inadequate pectoralis muscle, and excessive exaggeration on the CC view. The percentages of unmet positioning criteria out of the total potential unmet positioning criteria at health system 1 and health system 2 were 8.4% (163 759/1 949 922) and 7.3% (219 785/3 030 129), respectively. Artificial intelligence identified a similar distribution of unmet MPQ criteria in 2 health systems' daily work. Knowledge of current commonly unmet MPQ criteria can facilitate the improvement of mammography quality through tailored education strategies.