Digital mammographic artifacts on full-field systems: what are they and how do I fix them?

The recent introduction of digital mammography represents a significant technologic advance in breast imaging. However, many radiologists and technologists are unfamiliar with artifacts that are commonly seen with this modality, and recognizing these artifacts is critical for optimizing image quality. Commonly encountered artifacts include patient-related artifacts (motion artifact, antiperspirant artifact, thin breast artifact), hardware-related artifacts (field inhomogeneity, detector-associated artifacts, collimator misalignment, underexposure, grid lines, grid misplacement, vibration artifact), and software processing artifacts ("breast-within-a-breast" artifact, vertical processing bars, loss of edge, high-density artifacts). Although some of these artifacts are similar to those seen with screen-film mammography, many are unique to digital mammography--specifically, those due to software processing errors or digital detector deficiencies. In addition, digital mammographic artifacts depend on detector technology (direct vs indirect) and therefore can be vendor specific. It is important that the technologist, radiologist, and physicist become familiar with the spectrum of digital mammographic artifacts and pay careful attention to digital quality control procedures to ensure optimal image quality.