Impact of Patient-Assisted Compression and Pressure-Guided Paddles onMammography/DBT Performance

Abstract

Background: Breast compression optimizes image quality and dose in mammography and digital breast tomosynthesis (DBT), yet pain can deter re-attendance. Patient-assisted compression (PAC) and pressureguided paddles aim to improve tolerability while preserving technical performance.

Methods: A PRISMA-conformant PubMed search (inception-31 March 2025) identified English-language human studies comparing PAC or pressure-/shape-guided paddles with technologist-controlled compression. Two reviewers screened/extracted data with calibration (κ=0.84) and used Joanna Briggs Institute tools for risk of bias. No meta-analysis was undertaken.

Results: Of 1,063 records (92 duplicates removed), 971 titles/abstracts were screened and 102 full texts assessed; 12 studies were included (3 randomized trials, 9 cohorts; sample sizes 39-25,286). The primary outcome, pain (0-10 scale), was modestly reduced: a multicentre trial of curved paddles showed a mean difference -0.19 (95% CI -0.28 to -0.09); a PAC randomized study reported lower discomfort (P=0.014). A DBT cohort reported mean pain 1.9/10 with 19.3% moderate/severe. Pressure-guided flexible paddles standardized compression, lowering thickness (-3.74 mm craniocaudal; -6.70 mm mediolateral oblique), reducing pressure variability (-55% and -34%), and decreasing average glandular dose (AGD) (-0.13 mGy MLO); 87% would recommend. Implementation studies reduced mean pressure (17.1to12.8 kPa) and “over-compressed” views (26% to 2%).

Conclusions: PAC and pressure-guided paddles provided small but consistent gains in patient experience and compression standardization without systematic loss of image quality or dose performance. Implementation should prioritize pressure targets (8-14 kPa), structured PAC coaching, and monitoring of positioning, recalls, dose, and re-attendance.