Image Quality of Digital Direct Flat-Panel Mammography Versus an Indirect Small-Field CCD Technique Using a High-Contrast Phantom

Objective . To compare the detection of microcalcifications on mammograms of an anthropomorphic breast phantom acquired by a direct digital flat-panel detector mammography system (FPM) versus a stereotactic breast biopsy system utilizing CCD (charge-coupled device) technology with either a 1024 or 512 acquisition matrix (1024 CCD and 512 CCD). Materials and Methods . Randomly distributed silica beads (diameter 100–1400  μ m) and anthropomorphic scatter bodies were applied to 48 transparent films. The test specimens were radiographed on a direct digital FPM and by the indirect 1024 CCD and 512 CCD techniques. Four radiologists rated the monitor-displayed images independently of each other in random order. Results . The rate of correct positive readings for the “number of detectable microcalcifications” for silica beads of 100–199  μ m in diameter was 54.2%, 50.0% and 45.8% by FPM, 1024 CCD and 512 CCD, respectively. The inter-rater variability was most pronounced for silica beads of 100–199  μ m in diameter. The greatest agreement with the gold standard was observed for beads >400  μ m in diameter across all methods. Conclusion . Stereotactic spot images taken by 1024 matrix CCD technique are diagnostically equivalent to direct digital flat-panel mammograms for visualizing simulated microcalcifications >400  μ m in diameter.