The presence of cardiac implantable electronic devices may affect mammography image quality, according to research published May 2 in Radiography.
Experts led by Joanne Fitzgerald from Charles Sturt University in Wagga Wagga, Australia, found that these devices lead to more challenges for radiographers (the equivalent to radiologic technologists in the U.S.) in meeting image-quality criteria.
“Of concern, the difficulty in meeting image evaluation systems criteria can change the way radiographers approach image quality assessment, which may lead to repeat or additional views and increased patient radiation exposure,” Fitzgerald and colleagues wrote.
Prior studies have shown that pacemakers, implantable cardioverter-defibrillators, and implantable loop recorders may have a negative impact on image quality when included in the field of view. Image evaluation systems are applied to routine breast presentation, meaning any nonroutine breast presentation like cardiac implantable electronic devices may make it difficult for mammograms to meet benchmark image quality criteria.
The researchers also noted that the experiences of radiographers in these situations are underexplored. The Fitzgerald team added to the literature in its survey study, reporting the experiences of radiographers on how these cardiac devices affect mammographic image quality and assessment. It also sought to find differences between screening and diagnostic mammography settings.
Final analysis included responses from 220 radiographer members of the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) who have mammography experience.
The researchers reported the following regarding survey participants' challenges when dealing with cardiac implantable electronic devices on mammography imaging:
82.7% of respondents said they either sometimes or often face more difficulty in meeting image quality criteria.
84.3% of respondents said they performed “suboptimal” mammograms according to image criteria.
71.1% of respondents said the presence of cardiac implantable electronic devices changes their approach in assessing image quality.
53.6% of cases led to repeat exposure of suboptimal images.
The team also observed statistically significant differences between settings for changing approach to image quality assessment in women with a cardiac device (p = 0.05).
Finally, radiographers in screening settings were significantly more reliant on automatic exposure control compared to those in diagnostic settings (p < 0.001).
The study authors urged radiographers to be aware that the presence of these cardiac devices will affect image quality, adding that this may lead to variability in approaches toward assessing image quality in mammography.
“The absence of dedicated protocols contributes to inconsistent approaches to compression, exposure selection and repeat imaging, with potential implications for radiation dose and diagnostic confidence,” the authors wrote.
They also called for evidence-based guidelines to support standardized practice.
“Imaging of women with [cardiac devices] remains underexplored, and further research is needed to validate these findings and optimize care,” the team added.
Read the full study here.
