Moving Towards Filmless Mammography Across Canada


New MAP application and renewal process coming soon

The CAR will be launching a seamless and paperless web-based CAR Mammography Accreditation Program application and renewal process in the fall of 2017. In anticipation of this launch, the CAR conducted a review of CAR MAP accredited units and found that as of April 2017, 98.8% of mammography units are either computed radiography units (CR) or direct digital radiography units (DR). Only 1.2% (representing 8 units across Canada) continue to be screen-film (SF).

SF mammography records images using film which is then processed chemically. CR mammography uses a phosphor-based plate which is “read” by a special mammo CR and then digitized into a computer. DR mammography units have a detector that directly processes the X-ray image to the computer.

Of the 98.8% of mammography units that are digital, 88.7% of units are direct Digital Radiography units (DR) and 10.1% are Computed radiography units (CR).

The table below provides a breakdown of units by jurisdiction:

Studies over the years on the image quality between the three types of units have produced conflicting results, thus rendering it difficult to conclude the unit type that would provide a superior image. However, it is estimated that there is 1/3 less radiation used in DR than FS mammography. With DR and CR, the process is paperless and filmless, with no need for chemical processing. DR and CR use a computer rather than film to record x-ray images of the breasts.

From the patient’s perspective, the mammography exam remains the same whether it is SF, CR or DR, with breast compression required to ensure a clear image of the breast tissue is obtained. With DR, the image however is acquired almost in real time, and can be displayed on a high-resolution computer screen for optimum viewing.

DR and CR enable distributed reading, and facilitate the sharing of digital images across clinics as mammogram results are easier to transfer electronically than shipping film. DR and CR facilitate the practice of teleradiology particularly in remote areas or instances where the site at which the images are taken may not be the same site where the radiologists read the images.

SF remains the least expensive form of imaging while DR is the most expensive. The increased speed with which the total examination can be performed with DR can however increase daily examination capacity.

DR units will facilitate the introduction of new technologies in mammography such as tomosynthesis, which has been shown to support the identification of small cancers in dense breast tissue.

Dr. Nancy Wadden, Chair of the CAR MAP Working Group and Medical Director of the Breast Screening Program for Newfoundland and Labrador, states “the revised web-based CAR MAP Program promises to be user-friendly for most MAP client facilities and less onerous for the mammography quality control technologist. In addition, it makes it easier for radiologists to enter their breast imaging qualifications. It will reduce the paperwork required, while eliminating the redundancy in reporting. It will further eliminate the time required to transfer image files for MAP review.”

An article published in IT World Canada in September 2009 predicted that the Canadian healthcare system would be filmless by the end of 2010. With 98.8% of mammography units across Canada being filmless, we have a short way to go in 2017 to reach this milestone. The new web-based CAR MAP may be the impetus to reach 100%.

Please contact Markirit Armutlu, CAR Director of Quality Assurance, at or at 613-860-3111, ext. 202 for any questions related to the CAR Mammography program.


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