Method of measuring NEQ as a quality control metric for digital mammography.

PURPOSE: Current quality control protocols for digital mammography rely on subjective assessments of image quality or simple measures that are not comparable between vendor platforms. The noise-equivalent quanta (NEQ) can be expressed in units of image quanta (fluence) for the spatial frequency range of interest, enabling comparisons between systems and x-ray spectra. The purpose of this work is to explore use of a simple phantom to measure the components of the noise-equivalent quanta of digital mammography systems for use in routine quality control. METHODS: A simple phantom is imaged on six mammography systems from different vendors. The phantom contains uniform regions for measurement of noise power spectrum (NPS), slanted edges for measurement of modulation transfer function (MTF), and objects of various thicknesses for measurement of contrast. Images were acquired at a range of dose levels on each system to examine how measurements scale with dose, and multiple images were taken at a single dose point to examine measurement reproducibility. RESULTS: The phantom and measurement methods show good reproducibility, with average coefficient of variation values of less than or equal to 15% on all systems evaluated. Measured MTF and NPS values are comparable to other published results when the increase in scattered radiation generated by placing the phantom on the breast support is accounted for. CONCLUSIONS: Measurement of the parameters required to calculate NEQ from a single image of a simple phantom is practical, and shows promise as a method of evaluating image quality for routine quality control of digital mammography systems.

Comparative performance of modern digital mammography systems in a large breast screening program.

PURPOSE: To compare physical measures pertaining to image quality among digital mammography systems utilized in a large breast screening program. To examine qualitatively differences in these measures and differences in clinical cancer detection rates between CR and DR among sites within that program. METHODS: As part of the routine quality assurance program for screening, field measurements are made of several variables considered to correlate with the diagnostic quality of medical images including: modulation transfer function, noise equivalent quanta, d' (an index of lesion detectability) and air kerma to allow estimation of mean glandular dose. In addition, images of the mammography accreditation phantom are evaluated. RESULTS: It was found that overall there were marked differences between the performance measures of DR and CR mammography systems. In particular, the modulation transfer functions obtained with the DR systems were found to be higher, even for larger detector element sizes. Similarly, the noise equivalent quanta, d', and the phantom scores were higher, while the failure rates associated with low signal-to-noise ratio and high dose were lower with DR. These results were consistent with previous findings in the authors' program that the breast cancer detection rates at sites employing CR technology were, on average, 30.6% lower than those that used DR mammography. CONCLUSIONS: While the clinical study was not large enough to allow a statistically powered system-by-system assessment of cancer detection accuracy, the physical measures expressing spatial resolution, and signal-to-noise ratio are consistent with the published finding that sites employing CR systems had lower cancer detection rates than those using DR systems for screening mammography.

Optimization of exposure parameters in full field digital mammography.

Optimization of exposure parameters (target, filter, and kVp) in digital mammography necessitates maximization of the image signal-to-noise ratio (SNR), while simultaneously minimizing patient dose. The goal of this study is to compare, for each of the major commercially available full field digital mammography (FFDM) systems, the impact of the selection of technique factors on image SNR and radiation dose for a range of breast thickness and tissue types. This phantom study is an update of a previous investigation and includes measurements on recent versions of two of the FFDM systems discussed in that article, as well as on three FFDM systems not available at that time. The five commercial FFDM systems tested, the Senographe 2000D from GE Healthcare, the Mammomat Novation DR from Siemens, the Selenia from Hologic, the Fischer Senoscan, and Fuji's 5000MA used with a Lorad M-IV mammography unit, are located at five different university test sites. Performance was assessed using all available x-ray target and filter combinations and nine different phantom types (three compressed thicknesses and three tissue composition types). Each phantom type was also imaged using the automatic exposure control (AEC) of each system to identify the exposure parameters used under automated image acquisition. The figure of merit (FOM) used to compare technique factors is the ratio of the square of the image SNR to the mean glandular dose. The results show that, for a given target/filter combination, in general FOM is a slowly changing function of kVp, with stronger dependence on the choice of target/filter combination. In all cases the FOM was a decreasing function of kVp at the top of the available range of kVp settings, indicating that higher tube voltages would produce no further performance improvement. For a given phantom type, the exposure parameter set resulting in the highest FOM value was system specific, depending on both the set of available target/filter combinations, and on the receptor type. In most cases, the AECs of the FFDM systems successfully identified exposure parameters resulting in FOM values near the maximum ones, however, there were several examples where AEC performance could be improved.

Resolution at oblique incidence angles of a flat panel imager for breast tomosynthesis.

Oblique incidence of x rays on an imaging detector causes blurring that reduces spatial resolution. For simple projection imaging this effect is small and often ignored. However, for breast tomosynthesis, the incidence angle can be larger (>20 degrees), leading to increased blur for some of the projections. The modulation transfer function (MTF) is measured for a typical phosphor-coupled flat-panel detector versus angular incidence of the x-ray beam for two x-ray spectra: 26 kV Mo/Mo and 40 kV Rh/Al. At an incidence angle of 40 degrees the MTF at 5 mm(-1) falls by 35% and 40% for each spectrum, respectively (and 65%/80% at 8 mm(-1)). Increasing the detector absorber thickness to achieve improved quantum efficiency will cause the blurring effect due to beam obliquity to become greater. The impact of this blur is likely to cause misregistration and increased relative noise in tomosynthesis reconstructed images.

Lag and ghosting in a clinical flat-panel selenium digital mammography system.

We present measurements of lag and ghosting in a FDA-approved digital mammography system that uses a dielectric/selenium based detector structure. Lag is the carryover of signal from a previous image, whereas ghosting is the reduction of sensitivity caused by previous exposure history of the detector. Data from six selenium units were acquired. For the type of selenium detector tested, and under typical clinical usage conditions, the lag was as high as 0.15% of source signal and the ghosting could be as high as 15%. The amount of lag and ghosting varied from unit to unit. Results were compared with data acquired on a phosphor-based full-field digital mammography system. Modifications in the technology of the selenium detectors appear to have resulted in a marked decrease in both lag and ghosting effects in more recent systems.

Quality control for digital mammography in the ACRIN DMIST trial: part I.

The Digital Mammography Imaging Screening Trial, conducted by the American College of Radiology Imaging Network, is a clinical trial designed to compare the accuracy of full-field digital mammography (FFDM) versus screen-film mammography in a screening population. Five FFDM systems from four manufacturers (Fischer, Fuji, General Electric, and Lorad) were employed in the study at 35 clinical sites. A core physics team devised and implemented tests to evaluate these systems. A detailed description of physics and quality control tests is presented, including estimates of: mean glandular dose, modulation transfer function (MTF), 2D noise power spectra, and signal-to-noise ratio (SNR). The mean glandular doses for the standard breast ranged from 0.79 to 2.98 mGy, with 1.62 mGy being the average across all units and machine types. For the five systems evaluated, the MTF dropped to 50% at markedly different percentages (22% to 87%) of the Nyquist limit, indicating that factors other than detector element (del) size have an important effect on spatial resolution. Noise power spectra and SNR were measured; however, we found that it was difficult to standardize and compare these between units. For each machine type, the performance as measured by the tests was very consistent, and no predictive benefit was seen for many of the tests during the 2-year period of the trial. It was found that, after verification of proper operation during acceptance testing, if systems failed they generally did so suddenly rather than through gradual deterioration of performance. Because of the relatively short duration of this study further, investigation of the long-term failure characteristics of these systems is advisable.

Quality control for digital mammography: part II. Recommendations from the ACRIN DMIST trial.

The Digital Mammography Imaging Screening Trial (DMIST), conducted under the auspices of the American College of Radiology Imaging Network (ACRIN), is a clinical trial designed to compare the accuracy of digital versus screen-film mammography in a screening population [E. Pisano et al., ACRIN 6652-Digital vs. Screen-Film Mammography, ACRIN (2001)]. Part I of this work described the Quality Control program developed to ensure consistency and optimal operation of the digital equipment. For many of the tests, there were no failures during the 24 months imaging was performed in DMIST. When systems failed, they generally did so suddenly rather than through gradual deterioration of performance. In this part, the utility and effectiveness of those tests are considered. This suggests that after verification of proper operation, routine extensive testing would be of minimal value. A recommended set of tests is presented including additional and improved tests, which we believe meet the intent and spirit of the Mammography Quality Standards Act regulations to ensure that full-field digital mammography systems are functioning correctly, and consistently producing mammograms of excellent image quality.

Effect of scatter and an antiscatter grid on the performance of a slot-scanning digital mammography system.

The use of a grid increases perceptibility of low contrast objects in mammography. Slot-scan mammography provides a more dose efficient reduction of the scattered radiation reaching the detector than obtained with an antiscatter grid in screen-film or flat-panel digital mammography. In this paper, the potential of using a grid in a slot-scan system to provide a further reduction of scattered radiation is investigated. The components of the digital signal: primary radiation, off-focus radiation, scattered radiation, and optical fluorescence glare in a CsI(Tl) detector were quantified. Based on these measurements, the primary and scatter transmission factors (Tp, Ts), scatter-to-primary ratio (SPR), signal-difference-to-noise ratio (SDNR), and the SDNR improvement factor (K(SDNR)) were obtained. Our results showed that the SPR ranged from 0.05 to 0.19 for breast thicknesses between 2 and 8 cm, respectively. The values of K(SDNR) ranged from 0.85 to 0.94. Because the slot-scanning system has an inherently low SPR, the increase in dose required when the grid is used outweighs the benefit of the small increase in SDNR. It is possible that greater benefit could be achieved by using a grid with a higher Tp, such as obtained using air-core technology.

Development of contrast digital mammography.

Development of breast tumors is often accompanied by angiogenesis--the formation of new blood vessels. It is possible to image the effects of this process by tracking the uptake and washout of contrast agents in the vicinity of a lesion. In this article, a method for carrying out contrast subtraction mammography on a full-field digital mammography unit is described. Spectral measurements and modeling were performed to optimize the choice of x-ray target, kilovoltage and x-ray beam filtration for contrast digital mammography (CDM) on an available digital mammography system. Phantom studies were carried out to determine the sensitivity of CDM to iodine. Detection of iodine area densities of 0.3 mg/cm2 is possible for a circular object with a radius of 1.3 mm, which allows detection of uptake levels in the breast typically seen with cancer and some benign breast conditions. It was found that with a molybdenum anode x-ray tube, copper filtration could be used to effectively shape the x-ray spectrum to maximize the proportion of x rays with energies above the k edge of iodine. Simple logarithmic subtraction was found to be adequate in suppressing background signals dependent on the x-ray beam intensity and background thickness of the breast. The total x-ray dose from the procedure ranges between 1 and 3 mGy, similar to that from a conventional single view film mammogram. A clinical pilot study is currently being carried out to evaluate this technique.