The threshold contrast thickness evaluated with different CDMAM phantoms and software

The image quality in digital mammography is described by specifying the thickness and diameter of disks with threshold visibility. The European Commission recommends the CDMAM phantom as a tool to evaluate threshold contrast visibility in digital mammography [1, 2]. Inaccuracy of the manufacturing process of CDMAM 3.4 phantoms (Artinis Medical System BV), as well as differences between software used to analyze the images, may lead to discrepancies in the evaluation of threshold contrast visibility. The authors of this work used three CDMAM 3.4 phantoms with serial numbers 1669, 1840, and 1841 and two mammography systems of the same manufacturer with an identical types of detectors. The images were analyzed with EUREF software (version 1.5.5 with CDCOM 1.6. exe file) and Artinis software (version 1.2 with CDCOM 1.6. exe file). The differences between the observed thicknesses of the threshold contrast structures, which were caused by differences between the CDMAM 3.4 phantoms, were not reproduced in the same way on two mammography units of the same type. The thickness reported by the Artinis software (version 1.2 with CDCOM 1.6. exe file) was generally greater than the one determined by the EUREF software (version 1.5.5 with CDCOM 1.6. exe file), but the ratio of the results depended on the phantom and diameter of the structure. It was not possible to establish correction factors, which would allow correction of the differences between the results obtained for different CDMAM 3.4 phantoms, or to correct the differences between software. Great care must be taken when results of the tests performed with different CDMAM 3.4 phantoms and with different software application are interpreted.