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.

The results of this study show very high interdevice agreement, especially for management recommendations derived from malignancy classification, which is one of the most important outcomes in screening programs. This study provides evidence to suggest the interchangeability of the devices evaluated, thereby enabling the provision of low-cost medical imaging services to underserved populations.

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The aim of this study was to evaluate the diagnostic accuracy for detecting breast cancer using different telemammography configurations, including combinations of both low-cost capture devices and consumer-grade color displays. At the same time, we compared each of these configurations to film-screen readings. This study used a treatment-by-reader-by-case factorial design. The sample included 70 mammograms with 34 malignant cases. The readers consisted of four radiologists who classified all of the cases according to the categories defined by the Breast Imaging Reporting and Data System (BI-RADS). The evaluated capture devices included a specialized film digitizer and a digital camera, and the evaluated displays included liquid crystal display (LCD) and light-emitting diode (LED) consumer-grade color displays. Receiver operating characteristic curves, diagnostic accuracy (measured as the area under these curves), accuracy of the composition classification, sensitivity, specificity, and the degree of agreement between readers in the detection of malignant cases were also evaluated. Comparisons of diagnostic accuracy between film-screen and the different combinations of digital configurations showed no significant differences for nodules, calcifications, and asymmetries. In addition, no differences were observed in terms of sensibility or specificity when the degree of malignancy using the film-screen method was compared to that provided with digital configurations. Similar results were observed for the classification of breast composition. Furthermore, all observed reader agreements of malignant detection between film-screen and digital configurations were substantial. These findings indicate that the evaluated digital devices showed comparable diagnostic accuracy to the reference treatment (film-screen).