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               <mods:identifier type="citation">Breast Cancer Res. 2016; 18(1):130</mods:identifier>
               <mods:identifier type="doi">10.1186/s13058-016-0787-0</mods:identifier>
               <mods:identifier type="e-issn">1465-542X</mods:identifier>
               <mods:identifier type="journal">Breast Cancer Research</mods:identifier>
               <mods:identifier type="pubmedID">27993168</mods:identifier>
               <mods:identifier type="uri">http://hdl.handle.net/20.500.12105/4851</mods:identifier>
               <mods:abstract>BACKGROUND: Inter-women and intra-women comparisons of mammographic density (MD) are needed in research, clinical and screening applications; however, MD measurements are influenced by mammography modality (screen film/digital) and digital image format (raw/processed). We aimed to examine differences in MD assessed on these image types. METHODS: We obtained 1294 pairs of images saved in both raw and processed formats from Hologic and General Electric (GE) direct digital systems and a Fuji computed radiography (CR) system, and 128 screen-film and processed CR-digital pairs from consecutive screening rounds. Four readers performed Cumulus-based MD measurements (n = 3441), with each image pair read by the same reader. Multi-level models of square-root percent MD were fitted, with a random intercept for woman, to estimate processed-raw MD differences. RESULTS: Breast area did not differ in processed images compared with that in raw images, but the percent MD was higher, due to a larger dense area (median 28.5 and 25.4 cm2 respectively, mean √dense area difference 0.44 cm (95% CI: 0.36, 0.52)). This difference in √dense area was significant for direct digital systems (Hologic 0.50 cm (95% CI: 0.39, 0.61), GE 0.56 cm (95% CI: 0.42, 0.69)) but not for Fuji CR (0.06 cm (95% CI: -0.10, 0.23)). Additionally, within each system, reader-specific differences varied in magnitude and direction (p &lt; 0.001). Conversion equations revealed differences converged to zero with increasing dense area. MD differences between screen-film and processed digital on the subsequent screening round were consistent with expected time-related MD declines. CONCLUSIONS: MD was slightly higher when measured on processed than on raw direct digital mammograms. Comparisons of MD on these image formats should ideally control for this non-constant and reader-specific difference.</mods:abstract>
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                  <mods:topic>Breast density</mods:topic>
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               <mods:subject>
                  <mods:topic>Image processing</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Mammographic density assessment</mods:topic>
               </mods:subject>
               <mods:subject>
                  <mods:topic>Breast cancer</mods:topic>
               </mods:subject>
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                  <mods:title>Mammographic density assessed on paired raw and processed digital images and on paired screen-film and digital images across three mammography systems</mods:title>
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