Breast density quantification in dual-energy mammography using virtual anthropomorphic phantoms.

PURPOSE: Breast density is a significant risk factor for breast cancer and can impact the sensitivity of screening mammography. Area-based breast density measurements may not provide an accurate representation of the tissue distribution, therefore volumetric breast density (VBD) measurements are preferred. Dual-energy mammography enables volumetric measurements without additional assumptions about breast shape. In this work we evaluated the performance of a dual-energy decomposition technique for determining VBD by applying it to virtual anthropomorphic phantoms. METHODS: The dual-energy decomposition formalism was used to quantify VBD on simulated dual-energy images of anthropomorphic virtual phantoms with known tissue distributions. We simulated 150 phantoms with volumes ranging from 50 to 709 mL and VBD ranging from 15% to 60%. Using these results, we validated a correction for the presence of skin and assessed the method's intrinsic bias and variability. As a proof of concept, the method was applied to 14 sets of clinical dual-energy images, and the resulting breast densities were compared to magnetic resonance imaging (MRI) measurements. RESULTS: Virtual phantom VBD measurements exhibited a strong correlation (Pearson's r > 0.95 $r > 0.95$ ) with nominal values. The proposed skin correction eliminated the variability due to breast size and reduced the bias in VBD to a constant value of -2%. Disagreement between clinical VBD measurements using MRI and dual-energy mammography was under 10%, and the difference in the distributions was statistically non-significant. VBD measurements in both modalities had a moderate correlation (Spearman's ρ $\rho \ $ = 0.68). CONCLUSIONS: Our results in virtual phantoms indicate that the material decomposition method can produce accurate VBD measurements if the presence of a third material (skin) is considered. The results from our proof of concept showed agreement between MRI and dual-energy mammography VBD. Assessment of VBD using dual-energy images could provide complementary information in dual-energy mammography and tomosynthesis examinations.

Accuracy and Precision of Iodine Quantification in Subtracted Micro-Computed Tomography: Effect of Reconstruction and Noise Removal Algorithms.

PURPOSE: To evaluate the effect of reconstruction and noise removal algorithms on the accuracy and precision of iodine concentration (CI) quantified with subtracted micro-computed tomography (micro-CT). PROCEDURES: Two reconstruction algorithms were evaluated: a filtered backprojection (FBP) algorithm and a simultaneous iterative reconstruction technique (SIRT) algorithm. A 3D bilateral filter (BF) was used for noise removal. A phantom study evaluated and compared the image quality, and the accuracy and precision of CI in four scenarios: filtered FBP, filtered SIRT, non-filtered FBP, and non-filtered SIRT. In vivo experiments were performed in an animal model of chemically-induced mammary cancer. RESULTS: Linear relationships between the measured and nominal CI values were found for all the scenarios in the phantom study (R2 > 0.95). SIRT significantly improved the accuracy and precision of CI compared to FBP, as given by their lower bias (adj. p-value = 0.0308) and repeatability coefficient (adj. p-value < 0.0001). Noise removal enabled a significant decrease in bias in filtered SIRT images only; non-significant differences were found for the repeatability coefficient. The phantom and in vivo studies showed that CI is a reproducible imaging parameter for all the scenarios (Pearson r > 0.99, p-value < 0.001). The contrast-to-noise ratio showed non-significant differences among the evaluated scenarios in the phantom study, while a significant improvement was found in the in vivo study when SIRT and BF algorithms were used. CONCLUSIONS: SIRT and BF algorithms improved the accuracy and precision of CI compared to FBP and non-filtered images, which encourages their use in subtracted micro-CT imaging.

Out-of-field mean photon energy and dose from 6 MV and 6 MV FFF beams measured with TLD-300 and TLD-100 dosimeters.

PURPOSE: To measure the out-of-field mean photon energy and dose imparted by the secondary radiation field generated by 6 MV and 6 MV FFF beams using TLD-300 and TLD-100 dosimeters and to use the technique to quantify the contributions from the different sources that generate out-of-field radiation. METHODS: The mean photon energy and the dose were measured using the TLD-300 glow curve properties and the TLD-100 response, respectively. The TLD-300 glow curve shape was energy-calibrated with gamma rays from 99m Tc, 18 F, 137 Cs, and 60 Co sources, and its energy dependence was quantified by a parameter obtained from the curve deconvolution. The TLD-100 signal was calibrated in absorbed dose-to-water inside the primary field. Dosimeters were placed on the linac head, and on the surface and at 4.5 cm depth in PMMA at 1-15 cm lateral distances from a 10 × 10 cm2 field edge at the isocenter plane. Three configurations of dosimeters around the linac were defined to identify and quantify the contributions from the different sources of out-of-field radiation. RESULTS: Typical energies of head leakage were about 500 keV for both beams. The mean energy of collimator-scattered radiation was equal to or larger than 1250 keV and, for phantom-scattered radiation, mean photon energies were 400 keV for the 6 MV and 300 keV for the 6 MV FFF beam. Relative uncertainties to determine mean photon energy were better than 15% for energies below 700 keV, and 40% above 1000 keV. The technique lost its sensitivity to the incident photon energy above 1250 keV. On the phantom surface and at 1-15 cm from the field edge, 80%-90% of out-of-field dose came from scattering in the secondary collimator. At 4.5 cm deep in the phantom and 1-5 cm from the field edge, 50%-60% of the out-of-field dose originated in the phantom. At the points of measurement, the head leakage imparted less than 0.1% of the dose at the isocenter. The 6 MV FFF beam imparted 8-36% less out-of-field dose than the 6 MV beam. These energy results are consistent with general Monte Carlo simulation predictions and show excellent agreement with simulations for a similar linac. The measured out-of-field doses showed good agreement with independent evaluations. CONCLUSIONS: The out-of-field mean photon energy and dose imparted by the secondary radiation field were quantified by the applied TLD-300/TLD-100 method. The main sources of out-of-field dose were identified and quantified using three configurations of dosimeters around the linac. This technique could be of value to validate Monte Carlo simulations where the linac head design, configuration, or material composition are unavailable.

Quantitative Imaging Parameters of Contrast-Enhanced Micro-Computed Tomography Correlate with Angiogenesis and Necrosis in a Subcutaneous C6 Glioma Model.

The aim of this work was to systematically obtain quantitative imaging parameters with static and dynamic contrast-enhanced (CE) X-ray imaging techniques and to evaluate their correlation with histological biomarkers of angiogenesis in a subcutaneous C6 glioma model. Enhancement (E), iodine concentration (CI), and relative blood volume (rBV) were quantified from single- and dual-energy (SE and DE, respectively) micro-computed tomography (micro-CT) images, while rBV and volume transfer constant (Ktrans) were quantified from dynamic contrast-enhanced (DCE) planar images. CI and rBV allowed a better discernment of tumor regions from muscle than E in SE and DE images, while no significant differences were found for rBV and Ktrans in DCE images. An agreement was found in rBV for muscle quantified with the different imaging protocols, and in CI and E quantified with SE and DE protocols. Significant strong correlations (Pearson r > 0.7, p < 0.05) were found between a set of imaging parameters in SE images and histological biomarkers: E and CI in tumor periphery were associated with microvessel density (MVD) and necrosis, E and CI in the complete tumor with MVD, and rBV in the tumor periphery with MVD. In conclusion, quantitative imaging parameters obtained in SE micro-CT images could be used to characterize angiogenesis and necrosis in the subcutaneous C6 glioma model.

Medical physics graduate education in Mexico and its relation to the advances in radiation oncology.

AIM: To evaluate the state of graduate education in medical physics and progress in radiation oncology (RO) equipment in Mexico since 2000, when conferring degrees from two master's-degree programs in Medical Physics began. BACKGROUND: Medical physics is a Health Profession and there are international recommendations for education, training, and certification. Both programs follow these education guidelines. The most common clinical occupation of graduates is in RO services. Techniques in Mexican RO include traditional and high-precision procedures. METHODS: Academic and occupational information about the programs and their graduates were obtained from official websites. Graduates were invited to respond to a survey that requested information about their present job. We obtained data on RO equipment and human resources from public databases and estimated staffing requirements of medical physicists (MPs). RESULTS: Medical physics programs have graduated a total of 225 MPs. Half of them work in a clinical environment and, of these, about 90 work in RO services. MPs with M.Sc. degrees constitute 36% of the current MP workforce in RO, estimated to be 250 individuals. Survey responses pointed out the main merits and limitations of the programs. The number of MPs in RO has increased fivefold and the number of linacs sixfold in 15 years. The present number of MPs is insufficient, according to published guidelines. CONCLUSION: All MPs in RO services with advanced modalities must be trained following international recommendations for graduate education and post-graduation clinical training. Education and health institutions must find incentives to create more graduate programs and clinical residencies.

Improvement of early detection of breast cancer through collaborative multi-country efforts: Medical physics component.

PURPOSE: The International Atomic Energy Agency (IAEA) through a Coordinated Research Project on "Enhancing Capacity for Early Detection and Diagnosis of Breast Cancer through Imaging", brought together a group of mammography radiologists, medical physicists and radiographers; to investigate current practices and improve procedures for the early detection of breast cancer by strengthening both the clinical and medical physics components. This paper addresses the medical physics component. METHODS: The countries that participated in the CRP were Bosnia and Herzegovina, Costa Rica, Egypt, India, Kenya, the Frmr. Yug. Rep. of Macedonia, Mexico, Nigeria, Pakistan, Philippines, Slovenia, Turkey, Uganda, United Kingdom and Zambia. Ten institutions participated using IAEA quality control protocols in 9 digital and 3 analogue mammography equipment. A spreadsheet for data collection was generated and distributed. Evaluation of image quality was done using TOR MAX and DMAM2 Gold phantoms. RESULTS: QC results for analogue equipment showed satisfactory results. QC tests performed on digital systems showed that improvements needed to be implemented, especially in thickness accuracy, signal difference to noise ratio (SDNR) values for achievable levels, uniformity and modulation transfer function (MTF). Mean glandular dose (MGD) was below international recommended levels for patient radiation protection. Evaluation of image quality by phantoms also indicated the need for improvement. CONCLUSIONS: Common activities facilitated improvement in mammography practice, including training of medical physicists in QC programs and infrastructure was improved and strengthened; networking among medical physicists and radiologists took place and was maintained over time. IAEA QC protocols provided a uniformed approach to QC measurements.

Clinical study of contrast-enhanced digital mammography and the evaluation of blood and lymphatic microvessel density.

OBJECTIVE: To correlate image parameters in contrast-enhanced digital mammography (CEDM) with blood and lymphatic microvessel density (MVD). METHODS: 18 Breast Imaging-Reporting and Data System (BI-RADS)-4 to BI-RADS-5 patients were subjected to CEDM. Craniocaudal views were acquired, two views (low and high energy) before iodine contrast medium (CM) injection and four views (high energy) 1-5 min afterwards. Processing included registration and two subtraction modalities, traditional single-energy temporal (high-energy) and "dual-energy temporal with a matrix", proposed to improve lesion conspicuity. Images were calibrated into iodine thickness, and iodine uptake, contrast, time-intensity and time-contrast kinetic curves were quantified. Image indicators were compared with MVD evaluated by anti-CD105 and anti-podoplanin (D2-40) immunohistochemistry. RESULTS: 11 lesions were cancerous and 7 were benign. CEDM subtraction strongly increased conspicuity of lesions enhanced by iodine uptake. A strong correlation was observed between lymphatic vessels and blood vessels; all benign lesions had <30 blood microvessels per field, and all cancers had more than this value. MVD showed no correlation with iodine uptake, nor with contrast. The most frequent curve was early uptake followed by plateau for uptake and contrast in benign and malignant lesions. The positive-predictive value of uptake dynamics was 73% and that of contrast was 64%. CONCLUSION: CEDM increased lesion visibility and showed additional features compared with conventional mammography. Lack of correlation between image parameters and MVD is probably due to tumour tissue heterogeneity, mammography projective nature and/or dependence of extracellular iodine irrigation on tissue composition. ADVANCES IN KNOWLEDGE: Quantitative analysis of CEDM images was performed. Image parameters and MVD showed no correlation. Probably, this is indication of the complex dependence of CM perfusion on tumour microenvironment.

Use of an orthovoltage X-ray treatment unit as a radiation research system in a small-animal cancer model.

BACKGROUND: We explore the use of a clinical orthovoltage X-ray treatment unit as a small-animal radiation therapy system in a tumoral model of cervical cancer. METHODS: Nude mice were subcutaneously inoculated with 5 x 106 HeLa cells in both lower limbs. When tumor volume approximated 200 mm3 treatment was initiated. Animals received four 2 mg/kg intraperitoneal cycles (1/week) of cisplatin and/or 6.25 mg/kg of gemcitabine, concomitant with radiotherapy. Tumors were exposed to 2.5 Gy/day nominal surface doses (20 days) of 150 kV X-rays. Lead collimators with circular apertures (0.5 to 1.5 cm diameter) were manufactured and mounted on the applicator cone to restrict the X-ray beam onto tumors. X-ray penetration and conformality were evaluated by measuring dose at the surface and behind the tumor lobe by using HS GafChromic film. Relative changes in tumor volume (RTV) and a clonogenic assay were used to evaluate the therapeutic response of the tumor, and relative weight loss was used to assess toxicity of the treatments. RESULTS: No measurable dose was delivered outside of the collimator apertures. The analysis suggests that dose inhomogeneities in the tumor reach up to +/- 11.5% around the mean tumor dose value, which was estimated as 2.2 Gy/day. Evaluation of the RTV showed a significant reduction of the tumor volume as consequence of the chemoradiotherapy treatment; results also show that toxicity was well tolerated by the animals. CONCLUSION: Results and procedures described in the present work have shown the usefulness and convenience of the orthovoltage X-ray system for animal model radiotherapy protocols.

Spatial dose distributions in solid tumors from 186Re transported by liposomes using HS radiochromic media.

PURPOSE: A procedure for the measurement of spatial dose rate distribution of beta particles emitted by 186Re-liposomes in tumoral tissue, using HS GafChromic films, is presented. METHODS: HNSCC xenografts were intratumorally injected with 3.7 or 11.1 MBq of 186Re-liposomes, and planar gamma camera images were acquired to determine the liposome retention in the tumor. After imaging, rats were sacrificed and tumors were excised and processed in slices; HS film sections were placed between slices and the tumor lobe was reassembled. Tumors and films were kept in the dark at 4 degrees C for 18 h. After irradiation, films were removed and response was read using a transmission scanner. Films were analyzed to determine two-dimensional spatial dose rate distributions and cumulative dose volume histograms. Dose rate distributions were quantified using a 60Co calibration curve, the 186Re physical half-life, and a perturbation factor that takes into account the effect of the film protective layer. RESULTS: Dose rate distributions are highly heterogeneous with maximal dose rates about 0.4 Gy h(-1) in tumors injected with 3.7 MBq and 1.3 Gy h(-1) in tumors injected with 11.1 MBq. Dose volume histograms showed dose distributed in more than 95% and 80% of the tumor when injected with the lower and the higher activity, respectively. CONCLUSION: The described procedures and techniques have shown the potential and utility of HS GafChromic film for determination of dose rate distributions in solid tumors injected intratumorally with 186Re-liposomes. The film's structure and the liposomes' biodistribution must be taken into account to obtain quantitative dose measurements.

La calidad de los servicios de radiología en cinco países latinoamericanos / The quality of radiology services in five Latin American countries

OBJETIVO: Determinar la correlación entre ciertos indicadores de calidad para los servicios de imaginología y la certeza en la interpretación de los exámenes radiológicos para cuatro quejas frecuentes: las masas de la mama, el malestar del aparato digestivo, el dolor de espalda y los síntomas de la tuberculosis. MÉTODOS: Se evaluaron veintiséis servicios de radiología en Argentina, Bolivia, Colombia, Cuba y México. Se evaluaron los equipos de mamografía y de radiografía/fluoroscopia convencional usados en los servicios seleccionados utilizando protocolos comunes, hojas de especificaciones técnicas, instrumen-tos de prueba, maniquíes y sistemas de dosimetría calibrados. Los estudios se realizaron en establecimientos de complejidad media. Se obtuvo el consentimiento informado de todos los pacientes estudiados, y se garantizó la confidencialidad de los resultados. Se evaluaron y documentaron los siguientes parámetros: el tipo de establecimiento (público o privado); la población cubierta; el número de pacientes y exámenes; los equipos radiológicos, los de procesamiento de imágenes y los suministros; la educación y la capacitación del personal profesional y técnico; los programas de la garantía de la calidad y del mantenimiento preventivo, y la adherencia a las normas de seguridad radiológica. Se determinaron el funcionamiento de los equipos de rayos X, los receptores de la imagen y las procesadoras; las condiciones del cuarto oscuro y de la visualización de las imágenes; las dosis recibidas por los pacientes y la calidad de la imagen, usando parámetros uniformados en todos los casos. Los paneles independientes de radiólogos, reconocidos como expertos por la sociedad radiológica local, evaluaron la calidad de las imágenes clínicas obtenidas y realizaron una interpretación radiológica para cada paciente usando las mismas películas e historia clínica a disposición de los médicos especialistas en imaginología de la institución. El acuerdo entre...

OBJECTIVE: To determine the correlation between certain quality indicators for imaging services and the accurate interpretation of radiological exams for four frequent complaints: breast lumps, gastrointestinal discomfort, back pain, and symptoms of tuberculosis. METHODS: Twenty-six radiology services in Argentina, Bolivia, Colombia, Cuba, and Mexico were assessed. The mammography and conventional radiographic/fluoroscopic equipment used in selected services were evaluated utilizing common protocols, data sheets, testing instruments, phantoms, and calibrated dosimetry systems. The studies were performed in medium-complexity facilities. Informed consent was obtained from all patients studied, and the confidentiality of results was guaranteed. The following parameters were documented: type of facility (public vs. private); population covered; patient workload; radiological and image-processing equipment and supplies; education and training of professional and technical staff; quality assurance and preventive maintenance programs, and adherence to radiation safety standards. The performance of x-ray units, image receptors and processors; darkroom and image viewing conditions; patient doses and image quality, were determined using standardized parameters in all cases. Independent panels of radiologists, recognized as experts by the local radiological society, assessed the quality of the clinical images obtained and performed a radiological interpretation for each patient using the same films and clinical history available to the institution's imaging physicians. The agreement between the panel of expert's reports and those of local radiologists was taken as an indicator of the radiological diagnostic accuracy. RESULTS: Analyses were carried out of 366 mammograms, 343 radiological procedures for gastrointestinal complaints, 319 X-rays of the spinal column, and 157 chest radiographs. The agreement between the radiological interpretation of...

Phenomenological study of the ionisation density-dependence of TLD-100 peak 5a.

Horowitz and collaborators have reported evidence on the structure of TLD-100 peak 5. A satellite peak, called 5a, has been singled out as arising from localised electron-hole recombination in a trap/luminescent centre, its emission mechanism would be geminate recombination and, therefore, its population would depend on incident radiation ionisation density. We report a phenomenological study of peak 4, 5a and 5 strengths for glow curves previously measured at UNAM for gammas, electrons and low-energy ions. The deconvolution procedure has followed strict rules to assure that the glow curve, where the presence of peak 5a is not visually noticeable, is decomposed in a consistent fashion, maintaining fixed widths and relative temperature difference between all the peaks. We find no improvement in the quality of the fit after inclusion of peak 5a. The relative contribution of peak 5a with respect to peak 5 does not seem to correlate with the radiation linear energy transfer.

Absorbed dose and transmission factor in blocked fields for radiotherapy treatments with 6 MV X-ray.

Absorbed dose and transmission factors were determined for 6 MV X-ray fields applied in four conventional external radiation treatments where protection blocks are used to shield organs at risk. Studied treatments are: head and neck (cancer of the larynx), breast (breast cancer), brain (brain tumours) and pelvis (cervix-uterine cancer). Experimental determinations were made using ionization chambers and thermoluminescent dosimeters, at different locations in phantoms, for blocked and unblocked fields. Calculated absorbed doses, using the treatment planning system and Clarkson method, were compared to those measured. Measured transmission factor values ranged from 5% to 18%. It was found that the planning treatment system may underestimate the absorbed dose under the blocks, up to 35%.

Ionisation density dependence of the optically stimulated luminescence dose-response of AL2O3:C to low-energy charged particles.

The optically stimulated luminescence (OSL) response of Al2O3:C to high doses of gamma or beta irradiation can be used to predict the response of this material to charged particles as a function of particle fluence, particle energy and/or linear energy transfer (LET). In particular, it is predicted that track interaction effects at high particle fluences should result in linear-sublinear growth of the OSL signal. Similar considerations also predict a dependence of the fluence at which sublinearity starts upon the energy of the particles. In this work the OSL response of Al2O3:C to low-energy charged particles was investigated using protons (1, 2 and 4 MeV), carbon ions (13 MeV) and oxygen ions (10 MeV). The sublinear growth predicted above was qualitatively confirmed, but the energy dependence prediction was not. Furthermore, the efficiency of OSL production in the material after charged particle irradiation, compared to that obtained for gamma irradiation, is determined from the dose-response curves by fitting to a simple saturating exponential function. The efficiency values so obtained using this method are compared with those obtained from a conventional single-point measurement in the linear portion of the curve and found to be in good agreement. In general, the efficiency decreases as the LET of the particle increases. The present data are compared with published data obtained using high-energy charged particles and the results show that the efficiency is not a unique function of LET.

Absorbed dose and transmission factor in blocked fields for radiotherapy treatments with 6 MV X-ray

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Absorbed dose and transmission factors were determinedfor 6 MV X-ray fields applied in four conventionalexternal radiation treatments where protectionblocks are used to shield organs at risk. Studiedtreatments are: head and neck (cancer of the larynx),breast (breast cancer), brain (brain tumours) andpelvis (cervix-uterine cancer). Experimental determinationswere made using ionization chambers andthermoluminescent dosimeters, at different locationsin phantoms, for blocked and unblocked fields.Calculated absorbed doses, using the treatmentplanning system and Clarkson method, were comparedto those measured. Measured transmissionfactor values ranged from 5% to 18%. It was foundthat the planning treatment system may underestimatethe absorbed dose under the blocks, up to 35%

[The quality of radiology services in five Latin American countries]. / La calidad de los servicios de radiología en cinco países latinoamericanos.

OBJECTIVE: To determine the correlation between certain quality indicators for imaging services and the accurate interpretation of radiological exams for four frequent complaints: breast lumps, gastrointestinal discomfort, back pain, and symptoms of tuberculosis. METHODS: Twenty-six radiology services in Argentina, Bolivia, Colombia, Cuba, and Mexico were assessed. The mammography and conventional radiographic/fluoroscopic equipment used in selected services were evaluated utilizing common protocols, data sheets, testing instruments, phantoms, and calibrated dosimetry systems. The studies were performed in medium-complexity facilities. Informed consent was obtained from all patients studied, and the confidentiality of results was guaranteed. The following parameters were documented: type of facility (public vs. private); population covered; patient workload; radiological and image-processing equipment and supplies; education and training of professional and technical staff; quality assurance and preventive maintenance programs, and adherence to radiation safety standards. The performance of x-ray units, image receptors and processors; darkroom and image viewing conditions; patient doses and image quality, were determined using standardized parameters in all cases. Independent panels of radiologists, recognized as experts by the local radiological society, assessed the quality of the clinical images obtained and performed a radiological interpretation for each patient using the same films and clinical history available to the institution's imaging physicians. The agreement between the panel of expert's reports and those of local radiologists was taken as an indicator of the radiological diagnostic accuracy. RESULTS: Analyses were carried out of 366 mammograms, 343 radiological procedures for gastrointestinal complaints, 319 X-rays of the spinal column, and 157 chest radiographs. The agreement between the radiological interpretation of the panel of experts and of the local physician ranged from 70% to 100%, except in the case of spinal column films in Cuba (57.8%) and of mammograms in Mexico (33.3%), which the panel of experts found to be among those having the poorest quality. There was a significant positive correlation between the accuracy of the radiological interpretation and the quality of the radiological images. Image quality showed a positive correlation with the technicians' level of education and training. Studies performed in services that had automatic film processors and that complied with the indicators established for screen-film contact yielded better images and a higher proportion of studies with concordant results. More than 50% of the viewboxes did not satisfy the quality criteria for luminance and homogeneity. CONCLUSIONS: A good quality image is critical to achieving an accurate diagnosis. Emphasis should be placed on the continuing education of radiology technicians and on the acquisition and maintenance of adequate equipment and accessories, especially viewboxes, intensifying screens, and automatic film processors, given the impact they have on image quality.

PSF, LSF and S/P in mammography: GEANT4 validation.

The main goal of this study was to validate the predictions of GEANT4, a Monte Carlo code originally developed for high-energy physics, for low-energy (10-40 keV) photon transmission and scattering through matter similar to biological tissue. We compared GEANT4 calculations with existing phantom data relevant for the mammographic imaging technique. This work showed that scattered-to-primary ratio data can be simulated using GEANT4 with a deviation smaller than 5%. At the same time, we encountered a limitation in the small-angle region description by the code, which is important for point- and line-spread function calculations. The comparison with forward angle data showed that the GEANT4 models, known as "G4 Low Energy" and "G4 Penelope", describe the measurements for X-ray beams typically used in mammography better than 10% for angles above 10 degrees, and that "G4 Low Energy" is preferable to "G4 Penelope ". The results confirm the possible use of GEANT4 for the optimization of applications based on low-energy photon transmission and scattering.

Evaluation of equipment performance, patient dose, imaging quality, and diagnostic coincidence in five Mexico City mammography services.

BACKGROUND: Regulations concerning the use of x-rays in medical diagnoses were published in Mexico in 1997. In this work, we evaluate technical aspects of mammography services in the Mexico City area and radiation dose and coincidence between the radiological interpretation by the institution radiologist and by a panel of experts. METHODS: Following methodology proposed by the American College of Radiology and the European Community among others, we have evaluated the performance of six mammography systems in Mexico City public and private services. The studied services carry out approximately one half of the mammography studies in the capital's metropolitan area. RESULTS: The systems comply with 53-82% of a total of 31 applied quality control tests and measurements, which include the mammography unit, x-ray generation, collimation, automatic exposure control, compression devices, grid and image receptor, film processing, darkroom, viewboxes, dose, film rejection, and image quality. The elements that most frequently fail are film processing, darkroom, and light boxes; average ACR phantom score is 11.2 (9.5, 12.0); mean average glandular dose measured with the phantom is 1.00 (0.71-1.15) mGy, and measured in patients is 1.75 (0.3, 4.9) mGy; coincidence between radiologic reports (BI-RADS) by the institution radiologist and a panel of experts is obtained in 35% of studied cases. CONCLUSIONS: Statistical analysis of results indicated that the level of equipment performance is correlated with image quality, image quality estimated by the panel of radiologists is correlated with phantom score, and coincidence in clinical mammography reports is not correlated with equipment performance and appears to depend on the radiologist's experience.