Comparison of screening full-field digital mammography and digital breast tomosynthesis technical recalls

The Enhancing Quality Using the Inspection Program (EQUIP) augments the FDA/MQSA program to ensure image quality review and implementation of corrective processes. In our screening mammography program, we compared technical recalls between digital breast tomosynthesis (DBT) and 2D full-field digital mammography (FFDM). This HIPAA-compliant study was exempt from IRB review. In consecutive screening mammograms (October 2013 through December 2017), prospectively recorded technical recalls were compared for imaging modality (FFDM, DBT+FFDM, DBT+synthesized mammography (SynM)), images requested, and indication(s) for technical recall (motion, positioning, technical/artifact). Chi-squared tests evaluated statistical significance between proportions. Of 48,324 screening mammograms, 277 (0.57%) patients were recalled for 360 indications with 371 repeated views. There were significantly less recalls among DBT exams compared to FFDM (X-2 = 25.239; p = 0<0.001). Overall 98 (27.2%) technical recalls were for motion, 192 (53.3%) positioning, and 70 (19.4%) technique/artifacts. Of these, 91 (31.1%) FFDM indications were for motion, 138 (47.1%) positioning, and 64 (21.8%) technique/artifacts. For DBT+FFDM there were 7 (15.6%) for motion, 35 (77.8%) positioning, and 3 (6.7%) technique/artifacts, compared to DBT+SynM with 0 (0%) indications for motion, 19 (86.4%) positioning, and 3 (13.6%) technique/artifacts. There were significant differences in the indications for technical recall prior to and after implementing DBT+SynM (X-2 = 18.719; p<0.001). Technical recalls declined significantly with the inclusion of DBT (SynM/FFDM) as compared to FFDM alone; with recalls for motion demonstrating the greatest decrease. Positioning remains a dominant factor for technical recall regardless of modality, supporting the opportunity for continued technologist education in positioning to decrease technical recalls.