Mammographic Breast Positioning Assessment via Deep Learning

Breast cancer remains a leading cause of cancer-related deaths among women worldwide, with mammography screening as the most effective method for the early detection. Ensuring proper positioning in mammography is critical, as poor positioning can lead to diagnostic errors, increased patient stress, and higher costs due to recalls. Despite advancements in deep learning (DL) for breast cancer diagnostics, limited focus has been given to evaluating mammography positioning. This paper introduces a novel DL methodology to quantitatively assess mammogram positioning quality, specifically in mediolateral oblique (MLO) views using attention and coordinate convolution modules. Our method identifies key anatomical landmarks, such as the nipple and pectoralis muscle, and automatically draws a posterior nipple line (PNL), offering robust and inherently explainable alternative to well-known classification and regression-based approaches. We compare the performance of proposed methodology with various regression and classification-based models. The CoordAtt UNet model achieved the highest accuracy of 88.63% $\pm$ 2.84 and specificity of 90.25% $\pm$ 4.04, along with a noteworthy sensitivity of 86.04% $\pm$ 3.41. In landmark detection, the same model also recorded the lowest mean errors in key anatomical points and the smallest angular error of 2.42 degrees. Our results indicate that models incorporating attention mechanisms and CoordConv module increase the accuracy in classifying breast positioning quality and detecting anatomical landmarks. Furthermore, we make the labels and source codes available to the community to initiate an open research area for mammography, accessible at https://github.com/tanyelai/deep-breast-positioning.