Towards an Evidence-Based Guidance for a Lower Breast Compression Level
Abstract
Purpose
Advances in imaging technologies such as Digital Breast Tomosynthesis (DBT) have increasingly challenged the traditional rationale for applying high compression forces in mammography. While higher compression reduces breast thickness and thus patient dose, this effect is relevant primarily within the low‑compression range (e.g., below 60 N). Furthermore, the second major justification for strong compression - the reduction of tissue superposition - has diminished in importance due to the inherent tomographic nature of DBT. Therefore, this study aims to clarify how different compression levels influence breast tissue motion, as such motion may compromise image sharpness and in‑plane resolution.
Methods
Seventy volunteers were enrolled in a clinical study without the use pf any X-ray radiation. Each participant was positioned in four standard views (L‑CC, R‑CC, L‑MLO, R‑MLO) at three compression levels. During each compression phase, a 10‑s ultrasound cine loop was acquired. Multiple image‑analysis algorithms were implemented and validated to quantify inter‑frame tissue motion, enabling reliable tracking down to ~20 µm. Analyses compared motion across compression levels and for simulated acquisition times representative of DBT and FFDM.
Results
At the time of submission, only an interim analysis was available, revealing initial trends in tissue motion across compression levels. Within the low‑compression regime, increasing force was associated with reduced tissue motion; however, at medium and high compression levels, further increases in force did not yield a significant additional reduction in motion.
Conclusion
These findings can support the evidence‑based standardization of compression levels for FFDM and DBT. By narrowing conservative safety margins, the approach may help reduce unnecessary over‑compression without compromising image quality.