Dose In Mammography Research Articles

Determination of equivalent breast phantoms for different age groups of Taiwanese women: An experimental approach

Polymethylmethacrylate (PMMA) slab is one of the mostly used phantoms for studying breast dosimetry in mammography. The purpose of this study was to evaluate the equivalence between exposure factors acquired from PMMA slabs and patient cases of different age groups of Taiwanese women in mammography. This study included 3910 craniocaudal screen/film mammograms on Taiwanese women acquired on one mammographic unit. The tube loading, compressed breast thickness (CBT), compression force, tube voltage, and target/filter combination for each mammogram were collected for all patients. The glandularity and the equivalent thickness of PMMA were determined for each breast using the exposure factors of the breast in combination with experimental measurements from breast-tissue-equivalent attenuation slabs. Equivalent thicknesses of PMMA to the breasts of Taiwanese women were then estimated. The average +/- standard deviation CBT and breast glandularity in this study were 4.2 +/- 1.0 cm and 54% +/- 23%, respectively. The average equivalent PMMA thickness was 4.0 +/- 0.7 cm. PMMA slabs producing equivalent exposure factors as in the breasts of Taiwanese women were determined for the age groups 30-49 yr and 50-69 yr. For the 4-cm PMMA slab, the CBT and glandularity values of the equivalent breast were 4.1 cm and 65%, respectively, for the age group 30-49 yr and 4.4 cm and 44%, respectively, for the age group 50-69 yr. The average thickness of PMMA slabs producing the same exposure factors as observed in a large group of Taiwanese women is less than that reported for American women. The results from this study can provide useful information for determining a suitable thickness of PMMA for mammographic dose survey in Taiwan. The equivalence of PMMA slabs and the breasts of Taiwanese women is provided to allow average glandular dose assessment in clinical practice.

Assessment of glandular dose and image quality in mammography using computerised radiography employing a polymethylmetacrilate breast simulator

In Brazil there are around 600 mammography equipment with CR system. Taking into account the quality of image is essential to evaluate the mean glandular dose so you can optimize the radiation protection of patients evaluated with this type of system. Therefore, this study aimed to determine the mean glandular dose and quality of image for the CR system of laboratory of radioprotection applied to mammography of the Centre of Development of Nuclear Technology (CDTN). For this, we evaluated the linearity of the detector’s response, contrast to noise ratio and signal to noise ratio, which, according to European protocol, showed results within acceptable limits. Next, evaluated the quality of image with the CDMAM Phantom and mean glandular dose to the detector Fluke Biomedical TNT 12000WD, where they presented, respectively, within the results expected by the manufacturer and the limits of acceptable and desirable by the European protocol. then, the CR system of CDTN is optimized.

Image quality and dose in mammography in 17 countries in Africa, Asia and Eastern Europe: Results from IAEA projects

PurposeThe objective is to study mammography practice from an optimisation point of view by assessing the impact of simple and immediately implementable corrective actions on image quality. Materials and methodsThis prospective multinational study included 54 mammography units in 17 countries. More than 21,000 mammography images were evaluated using a three-level image quality scoring system. Following initial assessment, appropriate corrective actions were implemented and image quality was re-assessed in 24 units. ResultsThe fraction of images that were considered acceptable without any remark in the first phase (before the implementation of corrective actions) was 70% and 75% for cranio-caudal and medio-lateral oblique projections, respectively. The main causes for poor image quality before corrective actions were related to film processing, damaged or scratched image receptors, or film-screen combinations that are not spectrally matched, inappropriate radiographic techniques and lack of training. Average glandular dose to a standard breast was 1.5mGy (mean and range 0.59–3.2mGy). After optimisation the frequency of poor quality images decreased, but the relative contributions of the various causes remained similar. Image quality improvements following appropriate corrective actions were up to 50 percentage points in some facilities. ConclusionsPoor image quality is a major source of unnecessary radiation dose to the breast. An increased awareness of good quality mammograms is of particular importance for countries that are moving towards introduction of population-based screening programmes. The study demonstrated how simple and low-cost measures can be a valuable tool in improving of image quality in mammography.

SU‐E‐I‐76: Investigation of Patient Dose in Mammography in Japan by 2010

Purpose: In Japan, mammography units are shifting from screen‐film (S/F) mammography to digital (DR) mammography. However, no studies have investigated the actual radiation dose received by patients undergoing mammography using DR units. In order to assess the present situation, we conducted a survey of the actual radiation dose at 92 participating mammography facilities in 2010. Methods: The units used were F/S (5%), computed radiography (CR) (47%), and flat panel display (FPD) (48%).The incident air kerma was obtained from the irradiation conditions of each facility, and the average glandular dose (AGD) was calculated. Specifically, the AGD was calculated using a quality control phantom (model 156 phantom) and a polymethyl methacrylate (PMMA) phantom (10, 20, 30, 40, 50 and 60 mm thicknesses) equipped with automatic exposure control (AEC) systems. An ionization chamber dosimeter （Radcal Model 9015） with a parallel plate ionization chamber calibrated based on national standards was used. Aluminum plates (99.997 % purity) were used for half value layer assessment. Results: The AGD was not greater than 3 mGy in all cases and was taken to be the patient dose. Mean dose was 1.8 mGy, and coefficient of variation (CV) was not greater than 0.3. Approximately 75% of facilities used a dose of not greater than 2 mGy. The range of doses was approximately three‐fold. Mean AGD was the lowest for F/S and highest for CR. Conclusions: There are about 10,000 radiologic technologists for mammography in Japan, and radiographic imaging at most facilities is performed by these technologists. As a result, there is little variation among facilities, and a minimum radiation dose is used.

Radiation protection of patients in diagnostic radiology: Status of practice in five Eastern-European countries, based on IAEA project

The purpose of this work was to investigate status of imaging technology and practice in five countries in Eastern-European region and evaluate the impact of IAEA projects on radiation protection of patients. Information collected using standardized IAEA protocol included status of technology, practices and patient dose levels in interventional procedure, radiography, mammography and computed tomography (CT). In spite of increased number of digital units, single phase generators or units older than 30 year are still in use. Examples of obsolete practice such as using fluoroscopy for positioning, photofluorography, chest fluoroscopy and soft-beam technique for chest radiography are also in use. Modern multi-slice CT or digital mammography units are available; however, there is lack of adequate radiation protection and medical physics support in hospitals. Information on patient doses in interventional procedures, conventional radiography, mammography and CT was collected to have baseline data and corrective measures were proposed with appropriate follow up actions taken.

Population dose from medical diagnostic exposure in Taiwan

Medical exposure showed a continuous increasing trend. This trend was due to the growth of diagnostic procedures such as computed tomography (CT) and interventional fluoroscopy (IVF). In the present work, results of a recent study on medical exposure in Taiwan are reported. This study analysed data from the National Health Insurance Research Database. Surveyed data on the dose indices, including the entrance surface dose in radiography, dose area product in fluoroscopy, CT dose index in CT and mean glandular dose in mammography, were applied. Using programmes and databases, dose indices were converted to the effective dose. For the year 2008, individual effective doses in Taiwan were estimated as 0.16, 0.37, 0.12 and 0.12 mSv for conventional radiography and fluoroscopy, CT, IVF and nuclear medicine, respectively. The total collective effective dose and the effective dose per individual for medical exposure were 17 788 person-Sv and 0.77 mSv, respectively.

Calculation of Absorbed Glandular Dose using a FORTRAN Program Based on Monte Carlo X-ray Spectra in Mammography

Introduction: Average glandular dose calculation in mammography with Mo-Rh target-filter and dose calculation for different situations is accurate and fast. Material and Methods: In this research, first of all, x-ray spectra of a Mo target bombarded by a 28 keV electron beam with and without a Rh filter were calculated using the MCNP code. Then, we used the Sobol-Wu parameters to write a FORTRAN code to calculate average glandular dose. Results: Average glandular dose variation was calculated against the voltage of the mammographic x-ray tube for d = 5 cm, HVL= 0.35 mm Al, and different value of g. Also, the results related to average glandular absorbed dose variation per unit roentgen radiation against the glandular fraction of breast tissue for kV = 28 and HVL = 0.400 mmAl and different values of d are presented. Finally, average glandular dose against d for g = 60% and three values of kV (23, 27, 35 kV) with corresponding HVLs have been calculated. Discussion and Conclusion: The absorbed dose computational program is accurate, complete, fast and user friendly. This program can be used for optimization of exposure dose in mammography. Also, the results of this research are in good agreement with the computational results of others.

Optimal beam quality selection based on contrast-to-noise ratio and mean glandular dose in digital mammography

The performance of a digital mammography system (Siemens Mammomat Novation) using different target/filter combinations and tube voltage has been assessed. The objective of this study is to optimize beam quality selection based on contrast-to-noise ratio (CNR) and mean glandular dose (MGD). Three composition of breast were studied with composition of glandular/adipose of 30/70, 50/50, and 70/30. CNR was measured using 2, 4 and 6cm-thick simulated breast phantoms with an aluminium sheet of 0.1mm thickness placed on top of the phantom. Three target/filter combinations, namely molybdenum/molybdenum (Mo/Mo), molybdenum/rhodium (Mo/Rh) and tungsten/rhodium (W/Rh) with various tube voltage and mAs were tested. MGD was measured for each exposure. For 50/50 breast composition, Mo/Rh combination with tube voltage 26kVp is optimal for 2cm-thick breast. W/Rh combination with tube voltage 27 and 28 kVp are optimal for 4 and 6cm-thick breast, respectively. For both 30/70 and 70/30 breast composition, W/Rh combination is optimal with tube voltage 25, 26 and 27kVp, respectively. From our study it was shown that there are potential of dose reduction up to 11% for a set CNR of 3.0 by using beam quality other than that are determined by AEC selection. Under the constraint of lowest MGD, for a particular breast composition, calcification detection is optimized by using a softer X-ray beam for thin breast and harder X-ray beam for thick breast. These experimental results also indicate that for breast with high fibroglandular tissues (70/30), the use of higher beam quality does not always increase calcification detection due to additional structured noise caused by the fibroglandular tissues itself.

Cone-Beam CT for Breast Imaging: Radiation Dose, Breast Coverage, and Image Quality

The primary objectives of this pilot study were to evaluate the radiation dose, breast coverage, and image quality of cone-beam breast CT compared with a conventional mammographic examination. Image quality analysis was focused on the concordance of cone-beam breast CT with conventional mammography in terms of mammographic findings. This prospective study was performed from July 2006 through August 2008. Twenty-three women were enrolled who met the inclusion criteria, which were age 40 years or older with final BI-RADS assessment category 1 or 2 lesions on conventional mammograms within the previous 6 months. The breasts were imaged with a flat-panel detector-based cone-beam CT system, and the images were reviewed with a 3D visualization system. Cone-beam breast CT image data sets and the corresponding mammograms were reviewed by three qualified mammographers. The parameters assessed and compared in this pilot study were radiation dose, breast tissue coverage, and image quality, including detectability of masses and calcifications. The mammograms and cone-beam breast CT images were independently reviewed side by side, and the reviewers were not blinded to the other technique. The observed agreement and Cohen's kappa were used to evaluate agreement between the mammographic and cone-beam breast CT findings and interobserver agreement. Each subject responded to a questionnaire on multiple parameters, including comfort of the cone-beam breast CT examination compared with mammography. For a conventional mammographic examination, the average glandular radiation dose ranged from 2.2 to 15 mGy (mean, 6.5 [SD, 2.9] mGy). For cone-beam breast CT, the average glandular dose ranged from 4 to 12.8 mGy (mean, 8.2 [SD, 1.4] mGy). The average glandular dose from cone-beam breast CT was generally within the range of that from conventional mammography. For heterogeneously dense and extremely dense breasts, the difference between the mean dose of conventional mammography and that of cone-beam breast CT was not statistically significant (7.0 vs 8.1 mGy, p = 0.06). Breast tissue coverage was statistically significantly better with cone-beam breast CT than with mammography in the lateral (p < 0.0001), medial (p < 0.0001), and posterior (p = 0.0002) aspects. Mammography had statistically significantly better coverage than cone-beam breast CT in the axilla and axillary tail (p < 0.0001). Overall, most calcifications and all masses detected with mammography were also detected with cone-beam breast CT. The interobserver agreement on cone-beam breast CT was 83.7% in the detectability of imaging findings. The overall interobserver agreement on type of findings, size of findings (<1, 1-4.99, and > or = 5 mm), and location of findings was 77.2%, 84.8%, and 78.3%, respectively. The results of this study show that cone-beam breast CT can be used to image the entire breast from chest wall to nipple with sufficient spatial and contrast resolution for detection of masses and calcifications at a radiation dose within the range of that of conventional mammography.

Evaluation of scatter-to-primary ratio, grid performance and normalized average glandular dose in mammography by Monte Carlo simulation including interference and energy broadening effects

In this work, a computational code for the study of imaging systems and dosimetry in conventional and digital mammography through Monte Carlo simulations is described. The developed code includes interference and Doppler energy broadening for simulation of elastic and inelastic photon scattering, respectively. The code estimates the contribution of scattered radiation to image quality through the spatial distribution of the scatter-to-primary ratio (S/P). It allows the inclusion of different designs of anti-scatter grids (linear or cellular), for evaluation of contrast improvement factor (CIF), Bucky factor (BF) and signal difference-to-noise ratio improvement factor (SIF). It also allows the computation of the normalized average glandular dose, . These quantities were studied for different breast thicknesses and compositions, anode/filter combinations and tube potentials. Results showed that the S/P increases linearly with breast thickness, varying slightly with breast composition or the spectrum used. Evaluation of grid performance showed that the cellular grid provides the highest CIF with smaller BF. The SIF was also greater for the cellular grid, although both grids showed SIF < 1 for thin breasts. Results for showed that it increases with the half-value layer (HVL) of the spectrum, decreases considerably with breast thickness and has a small dependence on the anode/filter combination. Inclusion of interference effects of breast tissues affected the values of S/P obtained with the grid up to 25%, while the energy broadening effect produced smaller variations on the evaluated quantities.

TH-SAM-201B-01: Technique Optimization in Digital Mammography

Historically optimization of screen‐film mammography has been constrained by the narrow latitude of film but that limitation is removed for new digital receptor‐based imaging systems which exhibit a high detection efficiency and wide dynamic range thus requiring new approaches for optimization of technical factors impacting image quality and dose. In this presentation we will review the impact of various technical parameters in digital mammography and methods employed for the assessment of optimal technique. Learning Objectives: 1. Understand the factors that impact image quality and dose in digital mammography 2. Learn methods to implement or verify technique factors for digital mammography systems.

Mammography radiation dose: initial results from Serbia based on mean glandular dose assessment for phantoms and patients

The primary objective of this study is to investigate the actual mammography dose levels in Serbia and establish a baseline dose database for the future screening programme. The mean glandular dose (MGD) was assessed for standard size breast substituted by 45 mm polymethyl methacrylate (PMMA) phantom and imaged under typical clinical conditions at 30 screen-film mammography facilities. Average MGD was (1.9 +/- 1.0) mGy, with a range of 0.12-5.2 mGy. These results were used for the calculation of the initial diagnostic reference levels in mammography in Serbia, which was set to 2.1 mGy for a standard breast. At some facilities, high doses were observed and the assessed MGD was supplemented by a patient dose survey. MGD was measured for 53 women having a diagnostic mammography in cranio-caudal (CC) and mediolateral oblique (MLO) projections at the largest mammography facilities in Serbia. The parameters recorded were: age, compressed breast thickness, tube potential (in kV), tube loading (in mAs) and the MLO projection angle. The average MGD per image was 2.8 mGy for the CC projection and 4.3 mGy for the MLO projection. Dose to breast was compared with dose for PMMA phantoms of various sizes, assessed at the same facilities. The results have indicated that phantom dose values can assist in setting optimisation activities in mammography. Both phantom and patient dose values indicated unnecessary high doses in facilities with an extremely high mammography workload. For these facilities, urgent dose-reduction measures and follow-up actions were recommended.

Evaluation of depth dose and glandular dose for digital mammography

Abstract The purpose of this study is to evaluate the depth dose and mean glandular dose for the latest digital mammography. Depth doses were measured using GR-200F thin-film TLDs comprising LiF:Mg,Cu,P over three kinds of composition of mammographic phantom (glandular/fat: 30/70; 50/50; 70/30) under automatic exposure control by a digital mammographic unit (Novation DR, Siemens). Mean glandular doses were derived from entrance surface doses which were measured according to the Mammography Quality Control Manual of American College of Radiology. Two types of mean glandular dose calculation system were used and compared in this study. The depth dose could be established with thin-film TLDs and fitted by the model considered the primary and scatter radiation. The 50% depth dose falls at a depth of between 0.62 and 1.71 cm, which can represent the beam quality of X-ray spectra. The MGD calculated by Dance's method is 9–21% higher than that by Wu's method. Therefore, the difference should be considered by the Taiwan's regulation for Novation DR digital mammographic units.

Comparison of Acquisition Parameters and Breast Dose in Digital Mammography and Screen-Film Mammography in the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial

The purpose of our study was to compare the technical performance of full-field digital mammography (FFDM) and screen-film mammography. The American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial enrolled 49,528 women to compare FFDM and screen-film mammography for screening. For quality assurance purposes, technical parameters including breast compression force, compressed breast thickness, mean glandular dose, and the number of additional views needed for complete breast coverage were recorded and analyzed for both FFDM and screen-film mammography on approximately 10% of study subjects at each site. Technical data were compiled on 5,102 study subjects at 33 sites. Clean data were obtained for 4,366 (88%) of those cases. Mean compression force was 10.7 dN for screen-film mammography and 10.1 dN for FFDM (5.5% difference, p < 0.001). Mean compressed breast thickness was 5.3 cm for screen-film mammography and 5.4 cm for FFDM (1.7% difference, p < 0.001). Mean glandular dose per view averaged 2.37 mGy for screen-film mammography and 1.86 mGy for FFDM, 22% lower for digital than screen-film mammography, with sizeable variations among digital manufacturers. Twelve percent of screen-film mammography cases required more than the normal four views, whereas 21% of FFDM cases required more than the four normal views to cover all breast tissue. When extra views were included, mean glandular dose per subject was 4.15 mGy for FFDM and 4.98 mGy for screen-film mammography, 17% lower for FFDM than screen-film mammography. Our results show that differences between screen-film mammography and FFDM in compression force and indicated compressed breast thickness were small. On average, FFDM had 22% lower mean glandular dose than screen-film mammography per acquired view, with sizeable variations in average FFDM doses by manufacturer.

Comparison of Acquisition Parameters and Breast Dose in Digital Mammography and Screen-Film Mammography in the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial

Comparison of Acquisition Parameters and Breast Dose in Digital Mammography and Screen-Film Mammography in the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial

The relationship between compression force, image quality and radiation dose in mammography

Background. Mammography aims to obtain mammograms of best possible image quality with least possible radiation dose.1 Theoretically, an increase in breast compression gives a reduction in thickness, without changing the density, resulting in improved image quality and reduced radiation dose. &#x0D; Aim. This study aims to investigate the relationship between compression force, phantom thickness, image quality and radiation dose. The existence of a compression point beyond which increased compression gives a change in density rather than thickness is also considered.&#x0D; Method. Image quality is assessed with a contrast-detail phantom within Superflab phantom on a computed radiography (CR) mammography unit using automatic exposure control (AEC). Image quality is determined by visual inspection and image quality figure (IQF) scoring. The effect of compression and lesion depth on image quality is determined. Entrance and exit doses are calculated. The relationship between entrance dose, compression and thickness is investigated, as is the existence of a compression point beyond which a change in phantom density occurs. The average glandular dose (AGD) is calculated from the scanning average level (SAL) and logarithmic mean (LgM) according to Koen et al,2 and compared to the allowable limit. &#x0D; Results. The geometry effect was not observed. An improvement in image quality with increased compression was found. Entrance dose did decrease with increased compression. This trend was not observed with exit dose as AEC was used and exit dose was calculated from SAL values. The “change-in-density” point of compression was determined. Both LgM and SAL could be used successfully for AGD calculation.

Comparison of the NIST and PTB Air-Kerma Standards for Low-Energy X-Rays.

A comparison has been made of the air-kerma standards for low-energy x rays at the National Institute of Standards and Technology (NIST) and the Physikalisch-Technische Bundesanstalt (PTB). The comparison involved a series of measurements at the PTB and the NIST using the air-kerma standards and two NIST reference-class transfer ionization chamber standards. Results are presented for the reference radiation beam qualities in the range from 25 kV to 50 kV for low energy x rays, including the techniques used for mammography dose traceability. The tungsten generated reference radiation qualities, between 25 kV and 50 kV used for this comparison, are new to NIST; therefore this comparison will serve as the preliminary comparison for NIST and a verification of the primary standard correction factors. The mammography comparison will repeat two previously unpublished comparisons between PTB and NIST. The results show the standards to be in reasonable agreement within the standard uncertainty of the comparison of about 0.4 %.

Evaluation of subject contrast and normalized average glandular dose by semi-analytical models

In this work, two semi-analytical models are described to evaluate the subject contrast of nodules and the normalized average glandular dose in mammography. Both models were used to study the influence of some parameters, such as breast characteristics (thickness and composition) and incident spectra (kVp and target-filter combination) on the subject contrast of a nodule and on the normalized average glandular dose. From the subject contrast results, detection limits of nodules were also determined. Our results are in good agreement with those reported by other authors, who had used Monte Carlo simulation, showing the robustness of our semi-analytical method.

Overview of patient dosimetry in diagnostic radiology in the USA for the past

This review covers the role of medical physics in addressing issues directly related to patient dosimetry in radiography, fluoroscopy, mammography, and CT. The sections on radiography and fluoroscopy radiation doses review the changes that have occurred during the last 50 to 60 years. A number of technological improvements have contributed to both a significant reduction in patient and staff radiation doses and improvements to the image quality during this period of time. There has been a transition from film-screen radiography with hand dip film processing to electronic digital imaging utilizing CR and DR. Similarly, fluoroscopy has progressed by directly viewing image intensifiers in darkened rooms to modern flat panel image receptor systems utilizing pulsed radiation, automated variable filtration, and digitally processed images. Mammography is one of the most highly optimized imaging procedures performed, because it is a repetitive screening procedure that results in annual radiation exposure. Mammography is also the only imaging procedure in the United States in which the radiation dose is regulated by the federal government. Consequently, many medical physicists have studied the dosimetry associated with screen-film and digital mammography. In this review, a brief history of mammography dose assessment by medical physicists is discussed. CT was introduced into clinical practice in the early 1970s, and has grown into one of the most important modalities available for diagnostic imaging. CT dose quantities and measurement techniques are described, and values of radiation dose for different types of scanner are presented. Organ and effective doses to adult patients are surveyed from the earliest single slice scanners, to the latest versions that include up to two x-ray tubes and can incorporate as many as 256 detector channels. An overview is provided of doses received by pediatric patients undergoing CT examinations, as well as methods, and results, of studies performed to assess the radiation absorbed by the conceptus of pregnant patients.

Breast cancer diagnosis and digital radiography : update and perspectives

To learn about the advantages and disadvantages of digital mammography. To understand the impact of detector technology on image quality and dose. To learn about new mammographic imaging techniques based on digital detector technology. Digital mammography is superior to film-screen mammography in younger women with dense breasts. Reducing the parenchymal dose in digital mammography too far will impair the detection of microcalcifications. Significant variations exist in image processing between vendors with poor interoperability. Digital breast tomosynthesis is a promising new technique addressing the problem of superposition in mammography. Full-field digital mammography is now a well-established technique. Several different commercial digital mammography systems are available, which differ in detector technology, resolution and detector size. Digital mammography is superior to screen-film mammography in younger women with dense breasts due to its ability to selectively optimize contrast in areas of dense parenchyma. In addition, digital images ideally lend itself to tailored postprocessing and computer analysis. Easier retrieval and communication of digital images and integration of computer-aided diagnosis techniques into soft-copy reading substantially improve the work-flow. New digital mammographic imaging techniques are currently under investigation including contrast-enhanced mammography and digital tomosynthesis.