{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T22:43:49Z","timestamp":1761864229831,"version":"3.40.5"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T00:00:00Z","timestamp":1609977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Japan Society for the Promotion of Science (JSPS) Grants-in-Aid for Scientific Research","award":["JP18K07736"],"award-info":[{"award-number":["JP18K07736"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Objective<\/jats:title><jats:p>Despite the high risk of missing lesions in mammography, the missed lesion rate is yet to be clinically established. Further, no breast phantoms with adjustable breast density currently exist. We developed a novel, adjustable-density breast phantom with a composition identical to that of actual breasts, and determined the quantitative relationship between breast density and the missed lesion rate in mammography.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>An original breast phantom consisting of adipose- and fibroglandular-equivalent materials was developed, and a receiver operating characteristic (ROC) study was performed. Breast density, which is the fraction by weight of fibroglandular to total tissue, was adjusted to 25%, 50%, and 75% by arbitrarily mixing the two materials. Microcalcification, mass lesions, and spiculated lesions, each with unique characteristics, were inserted into the phantom. For the above-mentioned fibroglandular densities, 50 positive and 50 negative images for each lesion type were used as case samples for the ROC study. Five certified radiological technologists participated in lesion detection.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The mass-lesion detection rate, according to the area under the curve, decreased by 18.0% (<jats:italic>p<\/jats:italic>= 0.0001, 95% Confidence intervals [CI] = 0.1258 to 0.1822) and 37.8% (<jats:italic>p<\/jats:italic>= 0.0003, 95% CI = 0.2453 to 0.4031) for breast densities of 50% and 75%, respectively, compared to that for a 25% breast density. A similar tendency was observed with microcalcification; however, spiculated lesions did not follow this tendency.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>We quantified the missed lesion rate in different densities of breast tissue using a novel breast phantom, which is imperative for advancing individualized screening mammography.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0245060","type":"journal-article","created":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T21:35:09Z","timestamp":1610055309000},"page":"e0245060","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["The effect of breast density on the missed lesion rate in screening digital mammography determined using an adjustable-density breast phantom tailored to Japanese 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Chau","year":"2017","journal-title":"J Prim Care Community Health"},{"key":"pone.0245060.ref021","unstructured":"https:\/\/www.qabcs.or.jp\/archives\/001\/201703\/170321_1.pdf."},{"key":"pone.0245060.ref022","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1007\/s11517-018-1882-4","article-title":"Prediction of glandularity and breast radiation dose from mammography results in Japanese women","volume":"57","author":"M Yamamuro","year":"2019","journal-title":"Med Biol Eng Comput"},{"key":"pone.0245060.ref023","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1158\/1055-9965.EPI-09-1028","article-title":"Effect of baseline breast density on breast cancer incidence, stage, mortality, and screening parameters: 25-year follow-up of a Swedish mammographic screening","volume":"19","author":"SYH Chiu","year":"2010","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"pone.0245060.ref024","first-page":"291","article-title":"Errors in mammography cannot be solved through technology alone","volume":"19","author":"EU Ekpo","year":"2018","journal-title":"Asian Pac J Cancer Prev"},{"key":"pone.0245060.ref025","doi-asserted-by":"crossref","first-page":"e1226","DOI":"10.1259\/bjr\/15168178","article-title":"Sensitivity and specificity of mammographic screening as practised in Vermont and Norway","volume":"85","author":"S Hofvind","year":"2012","journal-title":"Br J Radiol"},{"key":"pone.0245060.ref026","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1093\/jnci\/92.13.1081","article-title":"Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers","volume":"92","author":"MT Mandelson","year":"2000","journal-title":"J Natl Cancer Inst"},{"key":"pone.0245060.ref027","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1093\/jnci\/djh269","article-title":"Factors contributing to mammography failure in women aged 40\u201349 years","volume":"96","author":"DSM Buist","year":"2004","journal-title":"J Natl Cancer Inst"},{"key":"pone.0245060.ref028","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.amjsurg.2019.01.039","article-title":"Redefining the sensitivity of screening mammography: A review","volume":"218","author":"AB Hollingsworth","year":"2019","journal-title":"Am J Surg"},{"key":"pone.0245060.ref029","doi-asserted-by":"crossref","first-page":"7893","DOI":"10.1088\/0031-9155\/60\/20\/7893","article-title":"Average glandular dose in digital mammography and digital breast tomosynthesis: comparison of phantom and patient data","volume":"60","author":"RW Bouwman","year":"2015","journal-title":"Phys Med Biol"},{"key":"pone.0245060.ref030","doi-asserted-by":"crossref","first-page":"N1","DOI":"10.1088\/0031-9155\/60\/1\/N1","article-title":"Dose assessment in contrast enhanced digital mammography using simple phantoms simulating standard model breasts","volume":"60","author":"RW Bouwman","year":"2014","journal-title":"Phys Med Biol"},{"key":"pone.0245060.ref031","first-page":"40","article-title":"Determination of tube output (kVp) and exposure mode for breast phantom of various thicknesses\/glandularity for digital mammography","volume":"22","author":"K Izdihar","year":"2015","journal-title":"Malays J Med Sci"},{"key":"pone.0245060.ref032","doi-asserted-by":"crossref","first-page":"3328","DOI":"10.1007\/s00330-015-3742-z","article-title":"Geographic variation in volumetric breast density between screening regions in the Netherlands","volume":"25","author":"D Waal","year":"2015","journal-title":"Eur Radiol"},{"key":"pone.0245060.ref033","unstructured":"https:\/\/www.mammaria.jp\/dense_breast\/."},{"key":"pone.0245060.ref034","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1259\/bjr\/41095952","article-title":"Radiation doses received in the UK Breast Screening Programme in 2001 and 2002","volume":"78","author":"KC Young","year":"2005","journal-title":"Br J Radiol"},{"key":"pone.0245060.ref035","first-page":"408","volume-title":"Breast Imaging. IWDM 2016. Lecture Notes in Computer Science, 9699","author":"H Nishide","year":"2016"},{"key":"pone.0245060.ref036","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1088\/0031-9155\/45\/3\/316","article-title":"Dosimetric implications of age related glandular changes in screening mammography","volume":"45","author":"JR Beckett","year":"2000","journal-title":"Phys Med Biol"},{"year":"2008","key":"pone.0245060.ref037"},{"key":"pone.0245060.ref038","unstructured":"ICRU Report 44. Tissue substitutes in radiation dosimetry and measurement. ICRU (International Commission on Radiation Units and Measurements) 1989; Bethesda, MD."},{"key":"pone.0245060.ref039","unstructured":"Berger MJ, Hubbell J, Seltzer SM, Chang J, Coursey JS, Sukumar R, et al. Photon Cross Sections Database, NIST Standard Reference Database 8 (XGAM). https:\/\/physics.nist.gov\/PhysRefData\/Xcom\/Text\/version.shtml."},{"author":"J Eng","key":"pone.0245060.ref040"},{"key":"pone.0245060.ref041","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1080\/08854726.2017.1335050","article-title":"The t-test: an influential inferential tool in chaplaincy and other healthcare research","volume":"24","author":"KRB Jankowski","year":"2018","journal-title":"J Health Care Chaplain"},{"key":"pone.0245060.ref042","doi-asserted-by":"crossref","first-page":"540","DOI":"10.4097\/kjae.2015.68.6.540","article-title":"T test as a parametric statistic","volume":"68","author":"TK Kim","year":"2015","journal-title":"Korean J Anesthesiol"},{"key":"pone.0245060.ref043","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1007\/s12194-008-0029-y","article-title":"Analysis method of noise power spectrum for medical monochrome liquid crystal displays","volume":"1","author":"K Ichikawa","year":"2008","journal-title":"Radiol Phys Technol"},{"volume-title":"IEC 62220-1-1:2015. 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