Abstract
Background: Computerized image analysis is a viable technique for evaluating image quality as a complement to human observers. Purpose: To systematically review the image analysis software used in the assessment of 2D image quality using mammography phantoms. Material and Methods: A systematic search of multiple databases was performed from inception to July 2020 for articles that incorporated computerized analysis of 2D images of physical mammography phantoms to determine image quality. Results: A total of 26 studies were included, 12 were carried out using direct digital imaging and 14 using screen film mammography. The ACR phantom (model-156) was the most frequently evaluated phantom, possibly due to the lack of accepted standard software. In comparison to the inter-observer variations, the computerized image analysis was more consistent in scoring test objects. The template matching method was found to be one of the most reliable algorithms, especially for high-contrast test objects, while several algorithms found low-contrast test objects to be harder to distinguish due to the smaller contrast variations between test objects and their backgrounds. This was particularly true for small object sizes. Conclusion: Image analysis software was in agreement with human observers but demonstrated higher consistency and reproducibility of quality evaluation. Additionally, using computerized analysis, several quantitative metrics such as contrast-to-noise ratio (CNR) and the signal-to-noise ratio (SNR) could be used to complement the conventional scoring method. Implementing a computerized approach for monitoring image quality over time would be crucial to detect any deteriorating mammography system before clinical images are impacted.