In June 1998 the Fourth International Workshop on Digital Mammography was held in Nijmegen, The Netherlands, where it was hosted by the department of Radiology of the University Hospital Nijmegen. This series of meetings was initiated at the 1993 SPIE Biomedical Image Processing Conference in San Jose, USA, where a number of sessions were entirely devoted to mammographic image analysis. At very successful subsequent workshops held in York, UK (1994) and Chicago, USA (1996), the scope of the conference was broadened, establishing a platform for presentation and discussion of new developments in digital mammog­ raphy. Topics that are addressed at these meetings are computer-aided diagnosis, image processing, detector development, system design, observer performance and clinical evaluation. The goal is to bring researchers from universities, breast cancer experts, and engineers together, to exchange information and present new scientific developments in this rapidly evolving field. This book contains all the scientific papers and posters presented at the work­ shop in Nijmegen. Contributions came from as many as 20 different countries and 190 participants attended the meeting. At a technical exhibit companies demon­ strated new products and work in progress. Abstracts of all papers were reviewed by members of the scientific committee. Many of the accepted papers had excellent quality, but due to limited space not all of them could be included as full papers in these proceedings. Papers that were rated high by the reviewers are included as long or short papers, others appear as extended abstracts in the last chapter.