Average glandular dose and phantom image quality in mammography

Abstract

Doses in mammography should be maintained as low as possible without reducing the high image quality needed for early detection of the breast cancer. The breast is composed of tissues with very close composition and densities. It increases the difficulty to detect small changes in the normal anatomical structures which may be associated with breast cancer. To achieve the standards of definition and contrast for mammography, the quality and intensity of the X-ray beam, the breast positioning and compression, the film-screen system, and the film processing have to be in optimal operational conditions. This study sought to evaluate average glandular dose (AGD) and image quality on a standard phantom in 134 mammography units in the state of Minas Gerais, Brazil, between December 2004 and May 2006. AGDs were obtained by means of entrance kerma measured with TL LiF100 dosimeters on phantom surface. Phantom images were obtained with automatic exposure technique, fixed 28 kV and molybdenum anode–filter combination. The phantom used contained structures simulating tumoral masses, microcalcifications, fibers and low contrast areas. High-resolution metallic meshes to assess image definition and a stepwedge to measure image contrast index were also inserted in the phantom. The visualization of simulated structures, the mean optical density and the contrast index allowed to classify the phantom image quality in a seven-point scale. The results showed that 54.5% of the facilities did not achieve the minimum performance level for image quality. It is mainly due to insufficient film processing observed in 61.2% of the units. AGD varied from 0.41 to 2.73 mGy with a mean value of 1.32±0.44 mGy. In all optimal quality phantom images, AGDs were in this range. Additionally, in 7.3% of the mammography units, the AGD constraint of 2 mGy was exceeded. One may conclude that dose level to patient and image quality are not in conformity to regulations in most of the facilities. This indicates that ongoing actions are needed to optimize image quality and radiation dose for early detection of the breast cancer.