Factors affecting increasing radiation dose for mammography in North Carolina from 1997 through 2001: an analysis of Food and Drug Administration annual surveys

Factors affecting decreasing radiation dose for mammography in North Carolina after 2002: an analysis of Food and Drug Administration annual surveys

RATIONALE AND OBJECTIVES

We sought to determine which factors affected the decrease in average glandular dose recorded at the annual U.S. Food and Drug Administration Mammography Quality Standards Act inspections of mammography equipment in North Carolina from 2002 through 2005.

MATERIALS AND METHODS

Average glandular dose, half-value layer, kVp, equipment age, processing speed, and system speed for every mammography unit in the state were collected by Food and Drug Administration-trained state inspectors. A mixed-effect model was used to evaluate the changes of glandular dose over time and to identify the factors associated with these changes.

RESULTS

There was a statistically significant decrease in average glandular dose in North Carolina since 2002. Factors that were statistically significantly associated with this effect were changes in kVp, equipment age, processing speed, and system speed.

CONCLUSION

Average glandular dose for mammography has decreased in North Carolina after 2002. This change is probably at least partially due to the cumulative effect of direct intervention by mammography consultants and statewide educational seminars on mammography quality control.

Technique factors and their relationship to radiation dose in pendant geometry breast CT

The use of breast computed tomography (CT) as an alternative to mammography in some patients is being studied at several institutions. However, the radiation dosimetry issues associated with breast CT are markedly different than in the case of mammography. In this study, the spectral properties of an operational breast CT scanner were characterized both by physical measurement and computer modeling of the kVp-dependent spectra, from 40 to 110 kVp (Be window W anode with 0.30 mm added Cu filtration). Previously reported conversion factors, normalized glandular dose for CT-DgN(ct), derived from Monte Carlo methods, were used in concert with the output spectra of the breast scanner to compute the mean glandular dose to the breast based upon different combinations of x-ray technique factors (kVp and mAs). The mean glandular dose (MGD) was measured as a function of the compressed breast thickness (2-8 cm) and three different breast compositions (0%, 50%, and 100% glandular fractions) in four clinical mammography systems in our institution. The average MGD from these four systems was used to compute the technique factors for breast CT systems that would match the two-view mammographic dose levels. For a 14 cm diameter breast (equivalent to a 5 cm thick compressed breast in mammography), air kerma levels at the breast CT scanner's isocenter (468 mm from the source) of 4.4, 6.4, and 9.0 mGy were found to deliver equivalent mammography doses for 0%, 50%, and 100% glandular breasts (respectively) at 80 kVp. At 80 kVp (where air kerma was 11.3 mGy/100 mAs at the isocenter), 57 mAs (integrated over the entire scan) was required to match the mammography dose for a 14 cm 50% glandular breast. At 50 kVp, 360 mAs is required to match mammographic dose levels. Tables are provided for both air kerma at the isocenter and mAs for 0%, 50%, and 100% glandular breasts. Other issues that impact breast CT technique factors are also discussed.

Global quality control perspective for the physical and technical aspects of screen-film mammography--image quality and radiation dose

The systematic monitoring of image quality and radiation dose is an ultimate solution to ensuring the continuously high quality of mammography examination. At present several protocols exist around the world, and different test objects are used for quality control (QC) of the physical and technical aspects of screen-film mammography. This situation may lead to differences in radiation image quality and dose reported. This article reviews the global QC perspective for the physical and technical aspects of screen-film mammography with regard to image quality and radiation dose. It points out issues that must be resolved in terms of radiation dose and that also affect the comparison.

Are phantoms useful for predicting the potential of dose reduction in full-field digital mammography?

A phantom study was performed in full-field digital mammography to investigate the opportunity and the magnitude of a possible dose reduction that would leave the image quality above the accepted thresholds associated with some classical phantoms. This preliminary work is intended to lay the groundwork for a future clinical study on the impact of dose reduction on clinical results. Three different mammography phantoms (ACR RMI 156, CIRS 11A and CDMAM 3.4) were imaged by a full-field digital mammography unit (GE Senographe 2000D) at different dose levels. Images were rated by three observers with softcopy reading and scoring methods specific to each phantom. Different types of data analysis were applied to the ACR (American College of Radiology) and the other two phantoms, respectively. With reference to the minimum acceptance score in screen/film accreditation programmes, the ACR phantom showed that about 45% dose reduction could be applied, while keeping the phantom scores above that threshold. A relative comparison was done for CIRS and CDMAM, for which no threshold is defined. CIRS scoring remained close to the reference level down to 40% dose reduction, the inter- and intra-observer variability being the main source of uncertainty. Contrast-detail curves provided by CDMAM overlapped down to 50% dose reduction, at least for object contrast values ranging between 30% and 3%. This multi-phantom study shows the potential of further reducing the dose in full-field digital mammography beyond the current values. A common dose reduction factor around 50% seems acceptable for all phantoms. However, caution is required before extrapolating the results for clinical use, given the limitations of these widely used phantoms, mainly related to their limited dynamic range and uniform background.