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Evaluating Image Quality and Comfort of an Investigational Curved Paddle Compared to a Standard Paddle

Evaluating Image Quality and Comfort of an Investigational Curved Paddle Compared to a Standard Paddle

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT03611543
Enrollment
443
Registered
2018-08-02
Start date
2016-10-20
Completion date
2018-06-18
Last updated
2025-05-21

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Breast Cancer

Keywords

Breast Cancer, Tomosynthesis, 3D Mammogram, Diagnostic Mammogram

Brief summary

The goal of this study is to evaluate patient comfort during compression with a standard flat mammographic paddle and an investigational curved paddle. This is a study that will be performed with x-ray imaging and will be used to determine if an overall reduction in pain can be appreciated in patients without loss in image quality as compared to the current standard mammogram. Another benefit of the curved paddle may be an increase of perceivable and measurable tissue capture.

Detailed description

The study will be conducted in the United States at up to 5 centers. The study will enroll up to 600 subjects. The number of subjects was chosen to allow evaluation of screening and diagnostic patients with a variety of breast densities (fatty, scattered densities, heterogeneously dense or extremely dense) and women with a range of breasts sizes that fit on the current detector. The evaluation of pain reduction will be the primary endpoint, while examining the potential of increased tissue capture without a compromise in image quality will be assessed as secondary endpoints. The enrollment will be consecutive for subjects who sign informed consent to participate. Women participating in the study will present for a screening or diagnostic imaging exam.

Interventions

DEVICEStandard of Care Flat Paddle

X-Ray Mammogram Exam. Each screening subject will receive a 4-view 2D plus 3D combination imaging: Left Cranial Caudal (LCC), Left Medial Oblique (LMO), Right Cranial Caudal (RCC), and Right Medial Oblique (RMLO) with the current standard of care (SOC) flat paddle. Each diagnostic subject will have her prescribed diagnostic 2D plus 3D combination imaging (CC or MLO) with the SOC flat paddle. The image view (CC or MLO) will be based on the visibility of the area of interest for which the diagnostic imaging was ordered. The amount of compression applied in all mammograms will be to achieve tautness.

DEVICEInvestigational Curved Paddle

X-Ray Mammogram Exam. Each screening subject will receive a CC and an MLO in one of her breasts as determined by a randomization scheme with the investigational (INV) curved paddle. Each diagnostic subject will have her prescribed diagnostic 2D plus 3D combination imaging (CC or MLO) with the INV curved paddle. The image view (CC or MLO) will be based on the visibility of the area of interest for which the diagnostic imaging was ordered. The amount of compression applied in all mammograms will be to achieve tautness.

Sponsors

Hologic, Inc.
Lead SponsorINDUSTRY

Study design

Observational model
CASE_ONLY
Time perspective
PROSPECTIVE

Eligibility

Sex/Gender
FEMALE
Age
25 Years to No maximum
Healthy volunteers
Yes

Inclusion criteria

* Subject is female of any race and ethnicity * Screening Subject is at least 40 years old, Diagnostic subjects are at least 25 years old * Subject will be referred for a screening or a diagnostic work-up with tomosynthesis as part of the exam

Exclusion criteria

* Subjects who are pregnant or who think they may be pregnant * Subjects lactating or presenting with discharge * Women too large for the detector * Subjects who cannot give informed consent

Design outcomes

Primary

MeasureTime frameDescription
Subject Comfort1 day (Day of procedure, No follow-up)The Universal Pain Assessment Tool (UPAT) was used to assess each subject's comfort perception with each paddle (SOC and INV). The UPAT ranges from 0 to 10, where 0 represents 'no pain' and 10 'worst pain possible'.

Secondary

MeasureTime frameDescription
Breast Tissue Coverage1 Day (Day of procedure, No Follow-up)An expert technologist evaluated the performance of the SOC and the INV paddles in 388 subjects. For each participant, the technologist answered which paddle was better at pulling in more breast tissue during imaging between SOC and INV (all subjects were imaged with both paddles during the same session). The technologist rated the paddles using a 5-point Likert scale, where -2 and -1 values mean that the SOC paddle performed better or slightly better, 0 means equal performance between paddles, and 2 and 1 mean that the INV performed better or slightly better than the SOC paddle. Note that different technologists were involved in the image acquisition. An acceptable tissue coverage for this study refers to having sufficient breast tissue (a balance between fatty and glandular tissue) in the image acquired so that any potential abnormalities can be effectively identified.
Overall Determination of Image Quality1 day (Day of procedure, No Follow-up)An expert radiologist reviewed, side by side, 3D images acquired with the INV and the SOC paddles in 420 subjects. The radiologist rated the images using a 5-point Likert scale, where -2 and -1 values mean that the images acquired with the SOC paddle have better or slightly better quality, 0 means equal quality between the images, and 2 and 1 mean that the images acquired with the INV paddle have better or slightly better quality than the SOC paddle. To determine overall clinical image quality or image acceptability, the radiologist considered whether the images reviewed have fair lesion visibility (when a lesion is present), good breast tissue separations of structures, good breast tissue coverage, no artifacts due to patient motion, and can be used to determine breast tissue density. Note that not all the 420 images were reviewed by the same radiologist.

Countries

United States

Participant flow

Recruitment details

Subjects were recruited based on inclusion/exclusion criteria from protocol 16-03 at 4 clinical sites between October 2016 and June 2018.

Pre-assignment details

This study involved subjects undergoing a mammogram exam (screening or diagnostic). All subjects were X-ray imaged using the standard of care (SOC) flat paddle and the investigational (INV) curved paddle. Thus, the subjects in the SOC group were the same as those in the INV group. A total of 443 subjects were initially enrolled. Of those, 14 did not complete the study.

Participants by arm

ArmCount
All Enrolled Subjects
This study involves subjects undergoing a mammogram exam (screening or diagnostic). These subjects were X-ray imaged using the SOC and INV paddles to determine changes in their comfort level and establish a direct comparison between devices. This means the subjects in the SOC group are the same as those in the INV group. This section consolidates (combines) all the subjects enrolled as one group rather than two groups because we're evaluating both devices on the same subjects.
429
Total429

Withdrawals & dropouts

PeriodReasonFG000FG001
Overall StudyDevice failure22
Overall StudyMissing information55
Overall StudyPhysician Decision11
Overall StudyProtocol Violation22
Overall StudyWithdrawal by Subject44

Baseline characteristics

CharacteristicAll Enrolled Subjects
Age, Continuous54.6 years
STANDARD_DEVIATION 11
BI-RADS Breast Density Assessment
Blank (No breast density category was recorded for the subjects)
12 participants
BI-RADS Breast Density Assessment
Type A (Breasts are almost entirely fatty)
47 participants
BI-RADS Breast Density Assessment
Type B (Breasts are mainly fatty, with some scattered areas of dense tissue)
192 participants
BI-RADS Breast Density Assessment
Type C (Breasts are a mixture of fatty and dense tissue)
147 participants
BI-RADS Breast Density Assessment
Type D (Breasts are almost entirely dense)
31 participants
Race/Ethnicity, Customized
African American/Black
29 Participants
Race/Ethnicity, Customized
Asian
2 Participants
Race/Ethnicity, Customized
Hispanic/Latino
20 Participants
Race/Ethnicity, Customized
Indian/Persian
3 Participants
Race/Ethnicity, Customized
Unknown
1 Participants
Race/Ethnicity, Customized
White
374 Participants
Region of Enrollment
United States
429 participants
Sex: Female, Male
Female
429 Participants
Sex: Female, Male
Male
0 Participants

Adverse events

Event typeEG000
affected / at risk
deaths
Total, all-cause mortality
0 / 429
other
Total, other adverse events
0 / 429
serious
Total, serious adverse events
0 / 429

Outcome results

Primary

Subject Comfort

The Universal Pain Assessment Tool (UPAT) was used to assess each subject's comfort perception with each paddle (SOC and INV). The UPAT ranges from 0 to 10, where 0 represents 'no pain' and 10 'worst pain possible'.

Time frame: 1 day (Day of procedure, No follow-up)

Population: The number of participants analyzed per group differs from the number provided in the Participant Flow module (429).~Two subjects' pain scores were unclear when imaged with the INV paddle. For this reason, the analysis was done by contemplating 427 subjects.~Three subjects' pain scores were unclear when imaged with the INV paddle. For this reason, the analysis was done by contemplating 426 subjects.

ArmMeasureValue (MEAN)
INVESTIGATIONALSubject Comfort2.6 score on a scale
STANDARD OF CARESubject Comfort4.0 score on a scale
p-value: <0.0001Wilcoxon Rank-Sum test
Secondary

Breast Tissue Coverage

An expert technologist evaluated the performance of the SOC and the INV paddles in 388 subjects. For each participant, the technologist answered which paddle was better at pulling in more breast tissue during imaging between SOC and INV (all subjects were imaged with both paddles during the same session). The technologist rated the paddles using a 5-point Likert scale, where -2 and -1 values mean that the SOC paddle performed better or slightly better, 0 means equal performance between paddles, and 2 and 1 mean that the INV performed better or slightly better than the SOC paddle. Note that different technologists were involved in the image acquisition. An acceptable tissue coverage for this study refers to having sufficient breast tissue (a balance between fatty and glandular tissue) in the image acquired so that any potential abnormalities can be effectively identified.

Time frame: 1 Day (Day of procedure, No Follow-up)

Population: The number of participants analyzed per group differs from the number provided in the Participant Flow module (429).~Technologists did not provide an answer to the question about preference for tissue coverage in 41 cases. For this reason, the analysis was done in 388 subjects only.~The same 388 subjects are part of both groups: INV and SOC groups. Therefore, the results are shown combined in the data table.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
INVESTIGATIONALBreast Tissue CoverageRate -2 or -1 (SOC better or slightly better than INV)69 Participants
INVESTIGATIONALBreast Tissue CoverageRate 0 ( SOC equal INV)162 Participants
INVESTIGATIONALBreast Tissue CoverageRate 2 or 1 ( INV better or slightly better than SOC)157 Participants
Secondary

Overall Determination of Image Quality

An expert radiologist reviewed, side by side, 3D images acquired with the INV and the SOC paddles in 420 subjects. The radiologist rated the images using a 5-point Likert scale, where -2 and -1 values mean that the images acquired with the SOC paddle have better or slightly better quality, 0 means equal quality between the images, and 2 and 1 mean that the images acquired with the INV paddle have better or slightly better quality than the SOC paddle. To determine overall clinical image quality or image acceptability, the radiologist considered whether the images reviewed have fair lesion visibility (when a lesion is present), good breast tissue separations of structures, good breast tissue coverage, no artifacts due to patient motion, and can be used to determine breast tissue density. Note that not all the 420 images were reviewed by the same radiologist.

Time frame: 1 day (Day of procedure, No Follow-up)

Population: The number of participants analyzed per group differs from the number provided in the Participant Flow module (429).~Data results related to image quality were unclear in nine subjects. For this reason, the analysis considered only 420 subjects.~These 420 subjects are the same in both groups, INV and SOC, so the images can be comparable.~Therefore, the results shown are combined in the data table.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
INVESTIGATIONALOverall Determination of Image QualityRate -2 or -1 (SOC better or slightly better than INV)27 Participants
INVESTIGATIONALOverall Determination of Image QualityRate 0 (SOC equal INV)330 Participants
INVESTIGATIONALOverall Determination of Image QualityRate 2 or 1 (INV better or slightly better than SOC)63 Participants

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026