Slider 8 Publications
Slider 8 Publications
A breakthrough innovation in mammography based on extensive scientific research.
Slider 6 Publications
Slider 6 Publications
Highly reproducible breast compression, year after year.
Slider 3 Publications
Slider 3 Publications
Reproducible mammogram with similar image quality while avoiding extreme pressures.

News, publications and more related articles

Publications in peer-reviewed journals Abstracts and PhD Thesis News Publications in the media
2021-04-08 - Diagnostic Imaging Europe
This article in DIEurope, March 2021 edition, summarizes the results of a recently published paper evaluating the introduction of a pressure sensing flexible paddle in digital breast tomosynthesis (DBT). 
2020 - Pressure-based compression guidance of the breast in digital breast tomosynthesis using flexible paddles compared to conventional compression

This study showed that the use of the pressure-based flexible paddle in DBT, with or without patient-assisted compression, improved participant and technologist experience and reduced compression pressure variability, mean breast thickness, and glandular dose.


2020 - ECR - Online presentation
During the online-only ECR 2020 the following research abstract will be presented:
K.J. Schilling, M. van Lier, S. Muller, "Impact of a pressure-based flexible paddle in digital breast tomosynthesis on the participant and technologist." ECR 2020 Book of Abstracts. Insights Imaging, 2020. 11(Suppl 1): p. 145.
2020 - Mammographic compression practices of force- and pressure-standardisation protocol: A scoping review
In this review, the current standing of mammographic compression practices available in the existing literature was assessed. They concluded: "As a suggested mammographic guideline, compression pressures of approximately 10kPa aid in image acquisition reproducibility both within and between women; pain levels decrease, with minimal variations to breast thickness, AGD and image quality."
2020-01-13 Project meeting of the German-Dutch "InMediValue" project
Innovations for medical imaging: This is what the German-Dutch project "InMediValue" is about, in which our colleagues from the University Clinic Münster, Department of Clinical Radiology, are project partners.
2019 - RSNA - Presentation
de Groot, J., van Lier, M., Grimbergen, C., den Heeten, G., "Comparison of Software for Retrospective Calculation of Applied Pressure in Mammography."
2019 - Breast compression and reported pain during mammographic screening
This study showed that a compression pressure of 10.3 - 13.5 kPa was acceptable with respect to reported pain during mammography. Besides, the lowest predicted reported pain scores were observed for compression pressures between 8 kPa and 13 kPa, when using a conventional fixed compression paddle.
2019-10-25 Sint Lucas’ experience with the pressure-based mammography paddle.
Interview by DIEurope with dr. Hilde Goris, specialized breast radiologist in the Sint Lucas Hospital, Bruges, Belgium and Prof. Hilde Bosmans, head of the Department of Medical Physics & Quality assessment at the UZ Leuven on their clinical experience and “type testing” for the use in the Flemish breast cancer screening. 
2019-10-16 Interview with co-founder of Sigmascreening
Sigmascreening has revolutionised mammography with its personalised pressure-based technology. Will this innovation save thousands of lives?
2019 - EUSOBI - Poster presentation
Christiaens, D., van Lier, M.G., Goris, H.K., and Claikens, B. "Mammographic examination cycle time decreased after introducing a real-time pressure indicator in two independent radiology departments"
2019-10-04 EUSOBI Annual Scientific Meeting
Looking back on a very interesting EUSOBI conference in Budapest where we presented the improvement of mammographic workflow after introducing the Sensitive Sigma paddle in two independent radiology departments.
2019 - Evaluation of pressure-controlled mammography compression paddles with respect to force-controlled compression paddles in clinical practice
The objective of this study, published in European Radiology, was to evaluate the pressure-controlled paddle by comparing it to the standard force-controlled paddle.

As a response, a letter to the editor was written.
2019-08-27 Letter to the Editor - European Radiology
Reaction of Sigmascreening to the paper of Jeukens et al. Eur Radiol (2019) 29: 2545. 
2019-06-05 - Tubantia (Dutch newspaper)
"The less painful mammography system for breast cancer research faces a breakthrough. The device is a product of the company Sigmascreening and was developed with two professors from the AMC."
Affirmative paper for pressure based compression from the Norwegian screening

Recently, a paper from the Norwegian screening program appeared online in which they compared three different compression paddles. A fixed study paddle with pressure indication was compared to a conventional flex paddle and a conventional fixed paddle without pressure indication.

Pain experience (NRS) was collected in 4,675 women. Between the flex paddle and the  study paddle no significant difference was found (2.5), but between the conventional fixed paddle and the fixed study paddle with pressure indicator, a significant difference was found in favor of the pressure based study paddle.

2019 - Breast compression and experienced pain during mammography by use of three different compression paddles
In this paper from the Norwegian screening program, they compared three different compression paddles. A fixed study paddle with pressure indication was compared to a conventional flex paddle and a conventional fixed paddle without pressure indication.Pain experience (NRS) was collected in 4,675 women. Between the flex paddle and the study paddle no significant difference was found (2.5), but between the conventional fixed paddle and the fixed study paddle with pressure indicator, a significant difference was found in favor of the pressure-based study paddle. Our conclusion is that the range of the pain relieving effects of pressure based compression depends on the historical way of working, which leads to already low pain scores. The combination of a flex paddle with pressure sensing, is very promising. On top of this, a pressure-based way of working goes beyond pain and discomfort. It also reduces variations, improves workflow and facilitates a better communication with the patient.
2019 - ECR - EPOS
Christiaens, D., van Lier, M.G., and Claikens, B. "C-1955 Impact of introducing a mammographic compression paddle with pressure indicator in clinical practice on compression parameters and patient experience
2018 - RSNA - Presentation
van Lier, M., De Groot, J., Branderhorst, W., Schijf, L., Grimbergen, C., den Heeten, G., "Mammographic Compression Variability Increased after Removing Real-Time Pressure Indicator"
User experience with the Sensitive Sigma™ Paddle at the AZ St Lucas in Bruges

The Sensitive Sigma™ paddle was introduced at the Radiology department of the AZ St Lucas in Bruges, Belgium. 

Radiologist Dr. Goris shares her experiences. "The patients accept the mammographic compression better because they can follow how much compression is still needed based on the LED lights during the examination. This removes for a great extent the uncertainty about the expected pain and anxiety."


Read the user experience of Dr. Goris


Sigmascreening participates in the European Consortium "InMediValue"
Together with German-Dutch medical technology companies and research institutes, Sigmascreening participates in the European Consortium "InMediValue". The consortium is working on improving medical imaging for breast cancer with new technologies.
2018 - Clinical validation of a pressure-standardized compression mammography system
In a retrospective study, mammograms acquired using a pressure-standardized compression protocol were intra-individually compared with the prior mammograms using a force-standardized compression. Pressure-standardized compression provided a mean breast pressure that was almost independent on breast size. Additionally, the mean pressure was significantly lower and the number of over-compressions (>20 kPa) reduced significantly for the pressure-standardized compared to the force-standardized protocol, suggesting a reduction of patient discomfort and pain. 
2018-03-02 - Diagnostic Imaging Europe
This article reviews the mechanical properties of the breast in compression. The optimal mean pressure value of 10 kPa is determined and related to research on physiologic pressure effects. Stiffening of the breast tissue correlates with pathology and is analyzed by Young’s modulus, the slope of the strain stress relation of the breast. It is shown that the differences in Young’s modulus of fat, fibroglandular tissue and tumors are reduced by higher compression, probably also reducing lesion conspicuity. First published in DIEurope March 2018.
The patient becomes central to the quality of her own mammogram

It was at the Institut Curie in 2017 that the Sensitive Sigma™ compression paddle was installed and used for the 1st time in France. This technological innovation, developed by the company Sigmascreening, optimizes breast compression during mammography. This is achieved using pressure sensors which take into account the size of the breast being examined. Mrs Claire Lamy, principal technician, and Dr Pascal Cherel, radiologist, give us their impressions.

Download the complete testimonial

Approval for Sensitive Sigma Paddle use in Belgian screening
The Agency for Heathcare ("Agentschap Zorg en Gezondheid") has released the Sensitive Sigma Paddle for use in the Belgian breast cancer screening program.
2017-12-08 - Imaging Technology News
Study of more than 130,000 mammograms shows optimal compression pressure may improve recall rates, false positives and interval cancer rates
2017 - Influence of breast compression pressure on the performance of population-based mammography screening
In a retrospective study of 57,179 women participating in the Dutch population based screening program with a total of 132,776 digital mammographic examinations, digital image analysis was used to determine the pressure exercised during image acquisition. Volpara software was used for the analysis. The data were subdivided into quintiles of pressure and the number of screen-detected cancers, interval cancers, false positives, and true negatives were determined for each of the 5 groups. Generalized estimating equations (GEE) were used to account for confounders; pair-wise testing for significant differences was performed. In conclusion; results suggest that if too much pressure is applied during mammography this may reduce sensitivity. In contrast, if pressure is low this may decrease specificity. A similar study on data of the Norwegian population based screening was recently published by N. Moshina et al in Breast Cancer Res Tr (2017 Jun;163(3):605-613), with comparable results. 
Sensitive Sigma™ Paddle released in Screening Bremen (Germany)
Reference Center Mammography North in Germany has released the Sensitive Sigma™ Paddle from Sigmascreening in the breast screening of Bremen.
2017-10-23 - Diagnostic Imaging Europe
This article reviews the question of breast compression in mammography in general and discusses the significance of two recently published articles on the relation between breast compression and the performance characteristics of mammography. If an optimal compression pressure, namely approximately 10kPa, is applied in screening mammography,  then an increase of 5% in one-year sensitivity may be achievable. First published in DIEurope October 2017.
Asian study of over 15,000 mammograms underlines the potential value of Sigmascreening’s Sensitive Sigma™ Paddle solution for pressure guided mammography
Amsterdam, The Netherlands, 4 September, 2017 – Sigmascreening, a Dutch MedTech developer and world leader in the field of pressure based digital mammography and breast cancer screening, announces that a study of in total 15,898 in digital mammograms from 3,772 Asian women[1], underlines the need for compression guidelines. The study confirms a number of other studies indicating that a force-standardized protocol leads to large variations in compression practices. This has serious negative effects on patient experience and the efficacy of mammography, one of the most commonly used diagnostic screening tools throughout the world. Therefore pressure guided mammography with the SigmaTM Paddle, which is taking breast size into account, may lead to improved test results and less unnecessary discomfort and pain especially for Asian women.
2017-07-05 - de Telegraaf (national Dutch newspaper)
"Most women don't like breast screening due to pain and refrain from participation. The Dutch company Sigmascreening developed a technology that greatly reduced this inconvenience. A special collateral profit: with this method, more tumors can be detected."
Norwegian study confirms the potential health benefits of pressure based breast compression
Amsterdam, The Netherlands, May 22, 2017 – Sigmascreening, a Dutch MedTech developer and world leader in the field of pressure based digital mammography and breast cancer screening, announces that a large independent Norwegian study1 further confirms Sigma’s hypothesis that pressure has a clear relation with the most optimal results in mammography. The study confirms the importance of pressure in accordance with Sigmascreening’s concept of the Sensitive Sigma™ Paddle, which applies pressure guidance during mammography.
Sigmascreening present at SIFEM 2017
Sigmascreening is present for the first time at the Annual Congress of the French Society of Women’s Imaging (SIFEM), June 15 - 17 in Palais du Pharo, Marseille, France.
2017 - Mammographic compression in Asian women
This study showed that a force-standardized mammographic compression practice led to widely variable compression parameters in Asian women. Asian women, who generally have smaller breasts, are subject to force standardized protocols. These protocols have largely been optimized for Caucasian women and might not be suitable for them. The mean ± standard deviation compression pressure for all mammograms (n = 15818) was 17.77±10.51 kPa. A phantom study showed that reducing compression force in Asian women has a limited impact on image quality and mean glandular dose.
2017 - Is breast compression associated with breast cancer detection and other early performance measures in a population-based breast cancer screening program?
To investigate early performance measures in a population-based breast cancer screening program, this study extracted compression force information and calculated pressure from DICOM-images on 261,641 mammographic examinations from 93,444 subsequently screened women. Results indicate that high compression force and low compression pressure provided more favorable performance measures, compared with low compression force and high compression pressure.
Press release - Groundbreaking pressure based mammographic paddle at European Radiology Congress (ECR), Vienna
Amsterdam, March 1, 2017 – Sigmascreening, a Dutch medical device company focusing on the development of new innovative products in the area of digital mammography and breast cancer screening, will demonstrate its groundbreaking Sensitive Sigma™ Paddle at the upcoming European Radiology Congress (ECR) in Vienna, 1 – 5 March, EXPO Hall X1 – booth no. 22. The paddle is the first pressure based compression paddle in the market providing real-time and reproducible mammographic pressure information and will considerably reduce commonly experienced unnecessary pain for women during screening. This could lead to higher response to screening invitations.
2017 - Compression force and radiation dose in the Norwegian Breast Cancer Screening Program
In this analysis of 17951 screening mammograms from 14 breast centers in the Norwegian Breast Cancer Screening Program a wide variation in mean compression forces between and within the different breast centers was observed. The maximum difference in mean compression force between the centers was 63N for CC-view and 57N for MLO-view. There was a low correlation between compression force and radiation dose, possibly due to breast characteristics and differences in choice of exposure parameters between vendors.
2017 - Pressure-standardised mammography does not affect visibility, contrast and sharpness of stable lesions.
Four experienced radiologists scored visibility, contrast and sharpness for 188 stable lesions and structures that were visible in pairs of mammograms: those obtained with a pain-tolerance limited 18 decanewton target force compression protocol and those obtained with the Sigmascreening 10 kPa (75 mmHg) pressure-standardized compression protocol. The latter compressions were significantly milder but nonetheless the lesion visibility, contrast and sharpness were statistically not inferior.
2017 - Is Individualizing Breast Compression during Mammography useful?
Investigations of pain indications during mammography relating to compression force and surface area of the compressed breast. Fortschr Röntgenstr 2017; 189(01): 39-48.
Annual Symposium Breast Screening Belgium. February 4, 2017, Bruges, Belgium
During the annual symposium Breast Cancer Screening in Belgium Sigmascreening will give a presentation on pressure-based breast compression. In this lecture we go deeper into the question whether optimal compression leads to better image quality which leads to an improved detection of breast cancer?
2016-11-29 - Dutch companies praised for their technological prowess and contributions to medical imaging
An article by AuntMinnie about the Dutch contribution to the RSNA 2016 in the South Building of McCormick Place in Chicago. During a special session on Monday, companies from the Netherlands, where under Sigmascreening, were praised for their technological prowess and contributions to medical imaging.
2016-11-28 - USA Chicago - Target Pressure could Improve Breast Detection Rates
Sensitive Sigma™ Paddle from Sigmascreening, with Intermediate Target Pressure, Could Improve Breast Detection Rates Based on Research Presented at RSNA. The impact of pressure in breast compression on screening performance was the focus of research accepted for presentation here at the 102nd Annual Radiological Society of North America (RSNA) meeting, November 27-December 2, 2016. It appears that Sigmascreening’s Sensitive Sigma™ Paddle, with its intermediate target pressure, could also improve detection rates.
2016-11-23 Presentation: High Breast Compression in Mammography May Reduce Sensitivity
Presentation: High Breast Compression in Mammography May Reduce Sensitivity by Nico Karssemeijer, PhD, Nijmegen, Netherlands at the RSNA on Monday, Nov. 28 10:10AM - 10:20AM Room: Arie Crown Theater, RC215-08.
2016-11-22 - Sigmascreening to Introduce Sensitive Sigma™ Paddle at RSNA 2016
Sigmascreening will introduce the Sensitive Sigma™ Paddle at the upcoming 102nd Annual Radiological Society of North America (RSNA) meeting, Nov. 27-Dec. 2 in Chicago. The Sensitive Sigma™ Paddle enables personalized compression for better quality mammograms without unnecessary discomfort for patients.
2016-11-14 - Sigmascreening to debut breast paddle at RSNA 2016
By Auntminnie – Sigmascreening will use the upcoming RSNA 2016 meeting to introduce Sensitive Sigma™ Paddle, which enables personalized compression for mammograms. The Sensitive Sigma™ Paddle makes it possible to incorporate additional parameters in the process of breast compression during mammography, such as breast size and tissue stiffness during positioning. The paddle has multiple sensors that measure each breast to optimize compression for each breast. Based on breast size and tissue stiffness, the Sensitive Sigma™ Paddle calculates the pressure to achieve an optimal compression of 75 mm Hg and allows for a highly reproducible procedure.
2016-10-01 - Diagnostic Imaging Europe
Recent results show that the performance of mammography, in terms of detect- ability of cancerous lesions can be affected by the compression pressure at which the examination is carried out. This article describes the rationale behind the development of a pressure-based compression system.
2016 - Performance of Breast Cancer Screening Depends on Mammographic Compression
Breast Cancer detection and Positive Predictive value (PPV) are 20-30% significantly better with the highest PPV at compression pressures between 9.18 kPa, and 10.7 kPa; this corresponds to approximately with 75 mmHg. These results strongly support the hypothesis that there is an optimal pressure during breast compression...
2016-01-27 - Joint project of SigmaScreening and ScreenPoint Medical receives subsidy from European Fund for Regional Development
Mechanical breast parameters that can be obtained with the Sensitive Sigma Paddel may improve the sensitivity of Computer Aided Diagnosis developed by ScreenPoint Medical.
2016-02-05 - Trouw (national Dutch paper)
Het röntgenonderzoek naar borstkanker doet vaak pijn. De borsten worden met soms twintig kilo kracht tussen twee platen platgedrukt. Eindelijk is er een nieuwe techniek.
2015-12-26 - De Morgen (Flemish newspaper)
Nieuwe techniek maakt borstonderzoek minder pijnlijk. Speciale aandrukplaat 'personaliseert' druk op de borsten bij het maken van röntgenfoto's.
2015-12-24 - Volkskrant (national Dutch paper)
Met een nieuwe techniek is het niet meer nodig borsten te pletten om een mammografie te kunnen maken.
2015-10-08 - De Ingenieur (Dutch magazine)
Voor veel vrouwen is de screening op borstkanker een martelgang. De test gebeurt met een mammograaf, een soort persmachine.
2015-08-18 - GE Healthcare magazine
Drukgestuurde borstaandrukking op de GE Senographe™ Essential: betere kwaliteit en minder onnodige pijn.
2015-06-18 - Margriet (Dutch magazine)
Geen vrouw die er niet als een berg tegenop ziet: de mammografie. Sinds kort heeft het AMC een methode die vooral bij vrouwen met kleine borsten minder pijn doet.
2015-05-11 - MTintegraal
Gepersonaliseerde borstsamendrukking tijdens mammografie.
2014-10-07 - AMC Magazine
Borstkankerscreening en -controleonderzoek zonder onnodige pijn? Het kán: de publicaties bewijzen het en de apparatuur is ervoor ontwikkeld.
2012-04-21 - Financieel Dagblad (Dutch Financial Times)
Een nieuwe test op borstkanker kan het einde inluiden van de gangbare methode die voor miljoenen vrouwen met veel pijn gepaard gaat.
2010-12-21 - Volkskrant (national Dutch paper)
Voor veel vrouwen is de screening op borstkanker een pijnlijke aangelegenheid. Onnodig, blijkt nu.
2010-12-01 - AMC Magazine
Borstkankerscreening zou in de toekomst wel eens een stuk minder onaangenaam kunnen worden.
2010-10-06 - Sigmascreening closes financing round
Het Life Sciences FundAmsterdam, dat in 2009 van start is gegaan om biomedische bedrijven binnen de regio groot-Amsterdam te financieren, heeft de financiering verstrekt en is toegetreden als aandeelhouder tot
2016 - Force balancing in mammographic compression
Skin stretching is often regarded as an inevitable side-effect of mammographic breast compression, but this study shows that much unnecessary stretching can be avoided by adequately adjusting the position of the X-ray image receptor to the height of the patient...
2015-11-06 - CE marking for Sensitive Sigma™ Paddle
SigmaScreening B.V. earned an important certification for the EU this week and wants to quickly make this innovation available to as many women as possible.
2015-06-19 - Participation fund invests in SigmaScreening
SigmaScreening B.V. has successfully concluded its financing round after signing a strategic collaboration with the Participation Fund of De Friesland Insurance (DFZ)...
2015-03-02 - Press release of EJR paper
One of our latest papers, "Mammographic compression - A need for mechanical standardization", was featured in a...
2014-11-30 - Presentation at RSNA 2014 Annual Meeting
Dr. Woutjan Branderhorst has presented the results of our validation study at the RSNA 2014 Annual Meeting. This study was also selected for a...
2014-11-26 - Sigma™ Paddle explained on Canadian television
An independent expert, professor Martin J. Yaffe from the University of Toronto, comments on the Sigma™ Paddle in CTV News Toronto.
2014-11-25 - Interview about Sigma™ Paddle
Today a nice interview was published on TODAY Health about the validation study to be presented at the RSNA 2014 Annual Meeting.
2014-06-26 - SigmaScreening winner of MedTech Innovation Award
Sigmascreening was chosen today as the best medical technological innovation of this year. Out of 24 submissions, this invention was expected to be the best capable of improving the current medical practice, and moreover of yielding a favourable cost/benefit ratio for patient, doctor, hospital and health care insurers.
2015 - Mammographic compression - A need for mechanical standardization
This report reveals how large the variation in applied force and pressure is in current daily practice, and concludes that calculating and tracking compression pressure could help to standardize quality and patient experience in mammography...
2014-03-07 - SigmaScreening closes financing round and signs strategic collaboration
SigmaScreening B.V. has successfully concluded its financing round after signing a strategic collaboration with an investor syndicate...
2015 - Towards personalized compression in mammography: A comparison study between pressure- and force-standardization
This validation study describes our first experience with pressure standardization, showing that its implementation is feasible, and that it can reduce pain without affecting radiation dose or image quality.
2015 - Pain-preventing strategies in mammography: an observational study of simultaneously recorded pain and breast mechanics throughout the entire breast compression cycle
In this observational study, the pain dynamics during the entire compression cycle was studied using a custom turning knob indicating the pain experience. During the clamping phase of the compression, when the paddle is motionless, the pain score continued to increase. Women with the smallest breasts experienced the most pain, they received the highest pressure applied at the highest rate during the deformation phase. Recommended further research on pain-preventing strategies should be focussed on a pressure based personalized compression protocol at the same slow rate and shortening the clamping phase. 
2014 - Mammographic compression after breast conserving therapy: Controlling pressure instead of force
This study shows that especially patients treated with breast conserving therapy benefit from a pressure-controlled compression protocol. 
2013 - A novel approach to mammographic breast compression: improved standardization and reduced discomfort by controlling pressure instead of force
To show that a pressure-controlled compression protocol improves standardization and reduces discomfort and pain, with limited effects on image quality and radiation dose.
2013 - Pressure and breast thickness in mammography: what about physics?
Pressure and breast thickness in mammography: what about physics?
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