To help providers in different countries perform quality breast screenings, the International Atomic Energy Agency’s Division of Human Health’s Dosimetry and Medical Radiation Physics Section has published a new guidance document, its Worldwide Implementation of Digital Mammography Imaging.

Published on October 19, which is World Breast Cancer Day, the guide is a roadmap designed to help decision-makers, planners, program administrators, and healthcare policy professionals establish or upgrade digital mammography facilities with the right equipment, staff, infrastructure, resources, and practices.

“Digital advancements provide promise, but without proper infrastructure and training, we risk compromising patient care. This guidance offers a path forward, ensuring that healthcare facilities worldwide can provide the best possible care to their patients,” said Maria-Ester Brandan, professor of physics at the National Autonomous University of Mexico and one of the document’s authors, in a statement.

The guide addresses different care scenarios in low-, middle-, and high-income countries, from having no medical imaging facility nearby to hospitals with existing general radiology and computed radiography mammography systems. It includes recommended solutions to the diverse challenges of each situation. Here is a breakdown of them on a case-by-case basis:

• No medical imaging facility – In these cases, installing general radiography or CT systems may be a higher priority. These solutions can be applied to breast imaging if a radiologist, medical radiation technologist, and clinically qualified medical physicist specifically trained in breast imaging are present.


• Limited resource environments with no mammography – For these sites, which can perform some general radiological exams, depending on financial constraints and available expertise, investing in screen-film mammography (SFM), direct digital mammography (DDM), or computed radiography mammography (CRM) are all options, but each requires specialized training for medical radiation technologists on patient positioning, breast compression, exposure, and quality control. Radiologists require special training in interpreting mammograms. Tele-mammography and mobile mammography programs are also options.


• Hospitals with an SFM facility – These local or regional hospitals can opt for SFM screenings as long as image quality complies with recognized guidelines. They should consider a DDM or a CRM system if replacing a machine. Should they not be able to afford a DDM system, low-cost retrofits for digital detectors and acquisition systems may be better to use than computed radiography (CR) plates. Inadequate SFM image quality should be addressed immediately, and if there is no improvement, systems should ideally be replaced with DDM.


• Hospital with a CRM facility – If the necessary finances can be found, upgrading to a DDM system is recommended. If the image quality is compliant with necessary guidelines, continuing with CRM systems is reasonable, but if a replacement is needed or quality improvements cannot be made with CR plates, then switching to DDM is recommended.


• Tertiary care hospital with breast imaging – At these sites, DDM is preferred, with a dedicated breast imaging service of multiple mammography units, several mammography medical radiation technologists, an adequate number of breast radiologists, and access to clinically qualified medical physicists and service engineers. Proper quality control and training standards are needed to ensure the DDM system is operating properly and used correctly, in order to provide the highest image quality.