Comparison of a flexible versus a rigid breast compression paddle: pain experience, projected breast area, radiation dose and technical image quality

PURPOSE: To compare pain, projected breast area, radiation dose and image quality between flexible (FP) and rigid (RP) breast compression paddles. METHODS: The study was conducted in a Dutch mammographic screening unit (288 women). To compare both paddles one additional image with RP was made, consisting of either a mediolateral-oblique (MLO) or craniocaudal-view (CC). Pain experience was scored using the Numeric Rating Scale (NRS). Projected breast area was estimated using computer software. Radiation dose was estimated using the model by Dance. Image quality was reviewed by three radiologists and three radiographers. RESULTS: There was no difference in pain experience between both paddles (mean difference NRS: 0.08 ± 0.08, p = 0.32). Mean radiation dose was 4.5 % lower with FP (0.09 ± 0.01 p = 0.00). On MLO-images, the projected breast area was 0.79 % larger with FP. Paired evaluation of image quality indicated that FP removed fibroglandular tissue from the image area and reduced contrast in the clinically relevant retroglandular area at chest wall side. CONCLUSIONS: Although FP performed slightly better in the projected breast area, it moved breast tissue from the image area at chest wall side. RP showed better contrast, especially in the retroglandular area. We therefore recommend the use of RP for standard MLO and CC views. KEY POINTS: • Pain experience showed no difference between flexible and rigid breast compression paddles. • Flexible paddles do not depict clinically relevant retroglandular areas as well. • Flexible paddles move breast tissue from image area at the chest wall side. • Rigid paddles depict more breast tissue and shows better contrast. • Rigid breast compression paddles are recommended for standard mediolateral-oblique and craniocaudal views. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00330-014-3422-4) contains supplementary material, which is available to authorized users.