Digital Screening Mammography - Critical Analysis of the Article by Chiarelli (2013) and Literature Review


Three types of technologies currently co-exist for breast cancer screening in Quebec and 76% of devices are using computed radiography (CR). A recent article by Chiarelli et al., published in Radiology, challenged the detection capability of CR compared with that of the screen-film mammography (SFM) and direct radiography (DR). Following this publication, Ontario health authorities indicated their intention to switch to digital direct (DR) mammography in its breast cancer screening program and to phase out CR devices.

In light of these new data, the ministère de la Santé et des Services sociaux (MSSS) asked the Institut national d’excellence en santé et en services sociaux (INESSS) to examine if Chiarelli’s research study (2013) is scientifically robust enough to support a decision that would justify changing the mammography units in Québec.

Conclusions and results

The critical analysis of Chiarelli’s research study shows that it meets most of the methodological criteria commonly accepted by observational study experts. However, it does not directly compare the DR and CR technologies with each other and its results reflect reality in Ontario. The literature review found only a small number of articles directly comparing those two technologies. Analysis of the selected studies shows that no significant difference between CR mammography and DR mammography was observed in the clinical efficacy parameters.


The literature review targeted studies presenting direct comparisons of CR and DR digital mammography. A total of 258 studies were identified, and the selection process led to only three primary studies directly comparing CR digital mammography and DR digital mammography [Bosmans et al., 2013; Schueller et al., 2008; Heddson et al., 2007]. The parameters analyzed were technical efficacy (image quality), clinical efficacy (detection rate, recall rate, positive predictive value) and safety (mean glandular radiation dose). Two health technology assessment reports were also selected (CADTH, 2008, and NHS Scotland, 2008).

Further research/reviews required

It would be essential to combine the results obtained and an analysis of the Québec context, including the types of technologies used, the brands of devices currently in use and their upgrading, and conformity with standards on the quality and volume of mammogram readings recognized by regulatory bodies, in order to guide the best decision for Québec. Such an analysis, taking into account these numerous parameters, will permit a more informed decision as to whether it is necessary to change the CR devices immediately or gradually.

Written by

Khalil Moqadem and Jim Boulanger, INESSS, Canada

INAHTA Brief issue: 2013/003

Agency: INESSS, Institut national d'excellence en santé et en services
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ETMIS 2013 9  ETMIS 2013 9 (5)
Printed French edition 978-2-550-68795-5
English summary (PDF) 978-2-550-68796-2

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English summary (PDF) 978-2-550-68796-2

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English summary (PDF) 978-2-550-68796-2

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