Artificial Intelligence for Assessment of Digital Mammography Positioning Reveals Persistent Challenges

Objective: Mammographic breast cancer detection depends on high-quality positioning, which is traditionally assessed and monitored subjectively. This study used artificial intelligence (AI) to evaluate mammography positioning on digital screening mammograms to identify and quantify unmet mammography positioning quality (MPQ). Methods: Data were collected within an IRB-approved collaboration. In total, 126367 digital mammography studies (553339 images) were processed. Unmet MPQ criteria, including exaggeration, portion cutoff, posterior tissue missing, nipple not in profile, too high on image receptor, inadequate pectoralis length, sagging, and posterior nipple line (PNL) length difference, were evaluated using MPQ AI algorithms. The similarity of unmet MPQ occurrence and rank order was compared for each health system. Results: Altogether, 163759 and 219785 unmet MPQ criteria were identified, respectively, at the health systems. The rank order and the probability distribution of the unmet MPQ criteria were not statistically significantly different between health systems (P=.844 and P=.92, respectively). The 3 most-common unmet MPQ criteria were: short PNL length on the craniocaudal (CC) view, inadequate pectoralis muscle, and excessive exaggeration on the CC view. The percentages of unmet positioning criteria out of the total potential unmet positioning criteria at health system 1 and health system 2 were 8.4% (163759/1949922) and 7.3% (219785/3030129), respectively. Conclusion: Artificial intelligence identified a similar distribution of unmet MPQ criteria in 2 health systems’ daily work. Knowledge of current commonly unmet MPQ criteria can facilitate the improvement of mammography quality through tailored education strategies.