A comparison of the accuracy of film-screen mammography, full-field digital mammography, and digital breast tomosynthesis.

AIM: To measure the change in diagnostic accuracy of conventional film-screen mammography and full-field digital mammography (FFDM) with the addition of digital breast tomosynthesis (DBT) in women recalled for assessment following routine screening. MATERIALS AND METHODS: Ethics approval for the study was granted. Women recalled for assessment following routine screening with screen-film mammography were invited to participate. Participants underwent bilateral, two-view FFDM and two-view DBT. Readers scored each lesion separately for probability of malignancy on screen-film mammography, FFDM, and then DBT. The scores were compared with the presence or absence of malignancy based on the final histopathology outcome. RESULTS: Seven hundred and thirty-eight women participated (93.2% recruitment rate). Following assessment 204 (26.8%) were diagnosed as malignant (147 invasive and 57 in-situ tumours), 286 (37.68%) as benign, and 269 (35.4%) as normal. The diagnostic accuracy was evaluated by using receiving operating characteristic (ROC) and measurement of area under the curve (AUC). The AUC values demonstrated a significant (p = 0.0001) improvement in the diagnostic accuracy with the addition of DBT combined with FFDM and film-screen mammography (AUC = 0.9671) when compared to FFDM plus film-screen mammography (AUC = 0.8949) and film-screen mammography alone (AUC = 0.7882). The effect was significantly greater for soft-tissue lesions [AUC was 0.9905 with the addition of DBT and AUC was 0.9201 for FFDM with film-screen mammography combined (p = 0.0001)] compared to microcalcification [with the addition of DBT (AUC = 0.7920) and for FFDM with film-screen mammography combined (AUC = 0.7843; p = 0.3182)]. CONCLUSION: The addition of DBT increases the accuracy of mammography compared to FFDM and film-screen mammography combined and film-screen mammography alone in the assessment of screen-detected soft-tissue mammographic abnormalities.

Evaluation of a software package for automated quality assessment of contrast detail images--comparison with subjective visual assessment.

Contrast detail analysis is commonly used to assess image quality (IQ) associated with diagnostic imaging systems. Applications include routine assessment of equipment performance and optimization studies. Most frequently, the evaluation of contrast detail images involves human observers visually detecting the threshold contrast detail combinations in the image. However, the subjective nature of human perception and the variations in the decision threshold pose limits to the minimum image quality variations detectable with reliability. Objective methods of assessment of image quality such as automated scoring have the potential to overcome the above limitations. A software package (CDRAD analyser) developed for automated scoring of images produced with the CDRAD test object was evaluated. Its performance to assess absolute and relative IQ was compared with that of an average observer. Results show that the software does not mimic the absolute performance of the average observer. The software proved more sensitive and was able to detect smaller low-contrast variations. The observer's performance was superior to the software's in the detection of smaller details. Both scoring methods showed frequent agreement in the detection of image quality variations resulting from changes in kVp and KERMA(detector), which indicates the potential to use the software CDRAD analyser for assessment of relative IQ.

Chest radiography: a comparison of image quality and effective dose using four digital systems.

Image quality (IQ) and effective dose for chest radiography was compared for four digital imaging systems that used three different detector technologies: a-Si/TFT flat-panel detector (FPD), scanning-slot/charge-coupled device (CCD) and photostimuable phosphor (PSP). On each system a phantom was exposed at 125 kV(p) for automatic exposure control (AEC) and 2, 4 and 8 Gy receptor dose using identical geometrical conditions. All images were scored as softcopy images by three observers. The effective dose was calculated for each exposure condition. For AEC, superior IQ was observed for the GE FPD compared with all the other systems, which showed similar IQ performance. For all systems the entrance surface dose associated with AEC was within the European recommendations but variations in the effective dose were observed between the four systems. For identical receptor dose levels superior IQ was observed with the FPDs. Thorascan was noted for its low effective dose and Agfa CR was associated with the highest effective dose. FPD systems showed a better overall performance, followed by the CCD and PSP systems.

The reduction in radiation dose for intra-oral radiographs by the use of thin K-edge filters.

The aim of this investigation was to reduce the radiation dose to patients undergoing intra-oral dental radiography by using thin K-edge filters in addition to the existing aluminum filter. The subject was a head phantom (a human skull embedded in tissue-equivalent material), which was exposed to X rays over a range of tube voltages (50-90 kVp) for each of the four filter systems. These were 2.7 mm aluminium alone (the existing total filtration) or with added 0.1 mm erbium, 0.1 mm yttrium or 0.05 mm niobium. The radiation dose was measured at four selected sites along the primary beam. These were the entrance skin dose, the exit skin dose and intra-orally both in front and behind the dental film packet. The exposure times and radiation doses required to produce an equivalent density (degree of blackening) on a radiograph of an upper molar tooth were determined. Within the usual diagnostic range of 60-80 kV the use of the thin K-edge filter resulted in a doubling of the exposure time (owing to the additional attenuation of the added filters). However, the skin dose and the total dose imparted to the patient were significantly reduced.

Erbium filtration for dose reduction in dental radiography.

Previous work has suggested that rare-earth filtration of diagnostic X rays is an effective means of dose reduction in radiology. Erbium (atomic number 68) is particularly promising in this respect. The effects on the X-ray beam and surface dose of the addition of 0.1 mm of erbium foil to the conventional filtration of a GE1000 dental X-ray set were investigated. Filtration by 0.1 mm of erbium produced a beam of narrower spectrum, greater penetration but lower intensity than that filtered conventionally by aluminium alone. The overall dose reduction achieved in dental radiography was greater than 30% between 65 and 85 kVp with a maximum dose reduction of 42% at 65 kVp. The question of the cost-effectiveness of erbium filtration as a radiation protection measure is also addressed.

The effect of thin K-edge filters on radiation dose in dental radiography.

The use of thin K-edge filters has been found to reduce considerably the radiation dose in intra-oral radiography. The aim of this study was to investigate the effect of filtration on the skin entrance dose and several sites (representing organs or areas of interest within the head) along the central beam axis, at other points within the primary beam and at two points just outside the primary beam. The subject was a sliced head phantom (a human skull embedded in tissue-equivalent material) which was exposed to X rays from a conventional dental X-ray unit in the range of tube voltage 55-85 kVp for each of four filter systems. These were 2.7 mm of aluminium alone (the existing total filtration) or with an added 0.1 mm erbium, 0.1 mm yttrium or 0.05 mm niobium metal foils. Measurements of radiation dose were made using thermoluminescent dosemeters (TLD rods) and were adjusted to simulate the exposure resulting from a typical dental radiograph of a maxillary molar. The results suggest that the use of thin K-edge filters significantly reduces the entrance skin dose and to a certain extent reduces the total dose imparted to the head. However, the dose to the ipsilateral orbit at higher tube voltages may be increased.

Threshold contrast detail detectability curves for fluoroscopy and digital acquisition using modern image intensifier systems.

Threshold contrast detail detectability (TCDD) test objects are a commonly used tool to assess image quality of imaging systems. FAXIL (The Facility for the Assessment of X-ray imaging, Leeds) produced updated standard TCDD curves, for fluoroscopy systems in good adjustment, in 1992. Fluoroscopy curves can be corrected to account for the effect of image intensifier input air kerma rate and field size. This paper presents updated TCDD curves for fluoroscopy and new curves for digital acquisition. The results for digital acquisition suggest that the TCDD curves should not be corrected for input air kerma, as the quantum noise is not dominant and system noise is significant. These curves will prove useful for accepting new equipment, to give an indication of the expected image quality for a new image intensifier system.

The effect of thin K-edge filters on the image quality of D- and E-speed dental film.

The use of K-edge filters and fast speed dental (non-screen) film have been separately shown to reduce the radiation dose imparted during dental radiography. The effect of these on image quality has been unclear. This study objectively examines the effect on image quality of eight film/filter systems: E- and D-speed film and four filter systems (the existing aluminium filter used alone or with erbium, niobium or yttrium). The components of the image quality parameters assessed were contrast, resolution, the minimum perceptible contrast (noise) and the square wave response function. No clinically significant difference in image quality was observed. This was confirmed by subjective assessment of images of an anatomical phantom. It is concluded that the use of faster speed film in addition to K-edge beam filtration has no major effect on the clinical image.

Mobile X-ray generators: a review.

Mobile X-ray generators vary widely in design, cost and radiographic performance and the new designs of recent years have led to the introduction of jargon. Such terms as 'capacitator discharge' and 'modicum frequency' can give rise to confusion regarding operating technique. This review classifies the mobiles into three distinct categories. Simple rules are presented to enable an operator to transfer exposure factors from one category to another, and an analysis of the relative merits of each category is provided. Part 1 provides a description of the categories available, a broad explanation of the principles involved and discusses the radiographic use. Throughout the text certain terms are given in italics when first used in that particular description and Part 2 gives full explanations of these terms in the context of Part 1.