Objective. The aim of this study was to evaluate and compare the clinical performance of different alternatives to implement low cost\nscreening telemammography. We compared computed radiography, film printed images, and digitized films produced with\na specialized film digitizer and a digital camera. Material and Methods. The ethics committee of our institution approved this\nstudy. We assessed the equivalence of the clinical performance of observers for cancer detection.The factorial design included 70\nscreening patients, four technological alternatives, and cases interpreted by seven radiologists, for a total of 1,960 observations.\nThe variables evaluated were the positive predictive value (PPV), accuracy, sensitivity, specificity, and the area under the receiver\noperating characteristic curves (AUC). Result.The mean values for the observed variables were as follows: accuracy ranged from\n0.77 to 0.82, the PPV ranged from 0.67 to 0.68, sensitivity ranged from 0.64 to 0.74, specificity ranged from 0.87 to 0.90, and the AUC\nranged from 0.87 to 0.90. At a difference of 0.1 to claim equivalence, all alternatives were equivalent for all variables. Conclusion.\nOur findings suggest that telemammography screening programs may be provided to underserved populations at a low cost, using\na film digitizer or a digital camera.
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