Rational and objectives: Digital acquisition systems currently available limit spatial resolution in digital mammography to roughly 0.1 mm/pixel. The objective of this study is to determine if high-quality mammography is possible at this resolution.

Methods: The influence of spatial resolution on diagnostic quality was investigated by comparing observer performance on film to that on digitized film. A 0.1-mm sampling distance was used for digitization. Detection of mammographic details was studied by measuring threshold contrast as a function of detail size for small circular objects in the range of 0.12 to 2.5 mm. Characterization of microcalcifications was investigated in a receiver operating characteristic (ROC) study, in which 10 radiologists read 72 mammographic details with microcalcifications, both digitally and on film.

Results: Digitization improved the detectability of the larger, low contrast objects, whereas for small objects the detectability did not change. The authors found that even under the most optimal circumstances, isolated spherical calcifications with diameters smaller than 0.13 mm are not detectable with film-screen mammography, despite its resolution limit of 15 line patterns per mm (lp/mm). The ability to characterize microcalcification clusters did not change significantly with digitization. However, the results suggest that differentiation of benign from malignant cases decreases slightly, and that characterization of different types of malignancies somewhat improves by digitization. Mean differences between the two modalities were considerably smaller than the interobserver variability.

Conclusion: A relatively low spatial resolution of 0.1 mm/pixel does not prohibit high-quality diagnostic performance in digital mammography.